Anxiety – Is it normal?
Everyone feels anxious at some point throughout their life. Whilst unpleasant, it is a normal, human emotion. This might happen around the time of big life events such as exams, job interviews, medical tests etc. But sometimes anxiety can become not normal. Sometimes anxiety can happen all too often and can impact on our day to day lives. This is when it becomes a mental health problem. We would refer to this as generalised anxiety disorder. Anxiety can also be the main symptom of other problems such a panic disorder, different types of phobias and posttraumatic stress disorder. But let’s focus on generalised anxiety disorder for now. Up to 5% of the UK population suffer with generalised anxiety disorder and it can effect men, women and children but is more common in people between the ages of 35-39.
But what are the symptoms of generalised anxiety disorder?
Most times, we would use the diagnostic and statistical manual, which is on its 5th version (DSM-V), to look at the symptoms of a mental health problem and see if someone meets that criteria. So, in order to explain what the symptoms of anxiety are we will be using the ones set out in the DSM-V.
Generalised anxiety disorder is about an excessive level of worrying; always expecting something to happen.
- It also must happen more than 50% of the time over a period of 6 months. So it needs to be happening more days than it is not.
- It also covers a range of events or topics. Generalised anxiety disorder is not about feeling anxious over a single thing, it is about feeling anxious around multiple events or activities.
- In addition to his, anxiety in this format is very difficult for that person to be able to stop or control.
- It needs to be happening to a level where it is causing distress that impacts on the person’s social life, work life, education or other important areas of life.
- Furthermore, anxiety of this level needs to be associated with at least three of the following symptoms to be classified as generalised anxiety disorder.
- Restlessness or feeling on edge
- Being easily fatigued
- Having difficulty concentrating or your mind regularly going blank
- Being agitated or irritable
- Having muscle tension
- Having problems sleeping.
- Finally, in order for it to be classed as generalised anxiety disorder it needs to not be happening under the influence of alcohol or drugs, be caused by other medical conditions, or be better explained by another mental health problem.
Whilst not in the criteria of the DSM-V it is also very common for people to not only have psychological symptoms but also physical symptoms. Sometimes people may get heart palpitations or feel dizzy.
How do we diagnose it?
One of the ways that we might aid a clinical interview to say that someone is likely to be suffering from generalised anxiety disorder is to complete a tool known as the GAD-7. This is a 7-point questionnaire that screens people for anxiety by looking at the last 2 weeks. Response options include “not at all”, “several days”, “more than half the days” and “nearly every day”.
Over the Last Two Weeks, how often have you been bothered by the following problems?
Not at all
More than half the days
Nearly every day
Feeling nervous, anxious or on edge
Not being able to stop or control worrying
Worrying too much about different things?
Being so restless that it is hard to sit still
Becoming easily annoyed or irritable
Feeling Afraid as if something awful might happen
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Not difficult at all
When all the scores are added we can use this as an indicator as to whether someone might have generalised anxiety disorder and if so, how severe it is.
Moderately Severe Anxiety
What causes generalised anxiety disorder?
There are a number of reasons why people might feel anxious on a long-term basis and there is no single reason that fits everyone. Some reasons that have been suggested are:
- overactivity in areas of the brain involved in emotions and behaviour
- an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
- the genes you inherit from your parents – you’re estimated to be 5 times more likely to develop generalised anxiety disorder if you have a close relative with the condition
- Learned behaviour from those around you
- having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying
- having a painful long-term health condition, such as arthritis
- having a history of drug or alcohol misuse
- But many people develop generalised anxiety disorder for no apparent reason.
The two key therapies for anxiety that have been proven by research and recommended by NICE (National Institute for Health and Care Excellence) guidelines, are to create an individualised approach using person-centred counselling or cognitive behavioural therapy (CBT). In addition to this there may be some benefit in visiting your GP as there are a range of different medications including selective serotonin reuptake inhibitors, betablockers and anxiolytics that may help.