What is an Anxiety Disorder?
Anxiety is a state of unease, fear, and discomfort in your own skin. It is entirely normal to feel anxious at times; indeed, anxiety is a healthy response in a dangerous or stressful situation. However, some people regularly experience anxiety that is not connected to any external threat, often so frequently that it becomes debilitating and interferes with living. This experience of chronic anxiety is called an anxiety disorder.
There are several different types of anxiety disorders. Some people may feel anxious in certain situations or in response to specific stimuli. Examples include feeling particularly uncomfortable in social situations, a powerful fear of heights, or the experience of sudden, overwhelming anxiety that is known as a panic attack. Others may feel a certain level of anxiety all the time. This is often called generalized anxiety disorder (GAD).
Chronic anxiety in one form or another often has roots in painful or traumatic experiences in childhood (although trauma later in life can also lead to anxiety). Stressful life circumstances such as a difficult job, poverty, conflict in relationships, sexism or racism, genetics, diet and family dynamics can also help cause an anxiety disorder. Some health conditions such as thyroid problems sometimes can trigger ongoing symptoms of anxiety.
Anxiety also often co-occurs with other mental health disorders like depression and addiction.
There is no single cure for an anxiety disorder - letting go of fear and learning to feel more at ease is an ongoing process. A holistic approach to treating anxiety relies on psychological or mind-body techniques, lifestyle changes, and nutrition to help relax your mind and body. This may include psychotherapy, meditation, practicing acceptance and changing your diet. Nutritional supplements can also be helpful.
"Anxiety is a fancy word for fear", says Family Systems therapist Hetty Irmer Barnett, LCSW-C, LICSW. "It's a natural human emotion in response to things that are 'threatening'. It's about biology. We've evolved to respond to fear in a very physiological way, but our minds still need to figure out how to cope with it. How do we tolerate the fact that we're little people in this huge universe who don't have a lot of control?"
What are the symptoms of an anxiety disorder?
People suffering from an anxiety disorder typically experience frequent or ongoing emotional and physical symptoms. Common symptoms of anxiety include:
Feelings of fear and unease
Recurring sense of panic
Physical and emotional tension
Frequently thinking about or dwelling on your fears
Dizziness
Nausea
Deep concern about what others think of you
Rapid heart rate
High blood pressure
Insomnia
Trouble concentrating
Fatigue
Strong social discomfort
Anger and irritability
People with an anxiety disorder may also use drugs, alcohol, overeating or other potentially harmful behaviors to try and cope. There is a significant amount of crossover between anxiety and addiction, people with an anxiety disorder are more likely to become addicted, while people with addiction usually suffer from anxiety. Likewise, for many people, anxiety goes hand-in-hand with depression.
Not everyone who struggles with anxiety experiences all of the symptoms. In addition, symptoms may vary depending on what type of anxiety disorder a person has. Some of the most common types of anxiety disorders include:
Generalized anxiety disorder (GAD)
As the name implies, people with generalized anxiety disorder experience chronic, nonspecific anxiety. That means that they feel stressed, nervous and uneasy much or most of the time, and that their anxiety is not tied to being in any particular situation or circumstance. Their level of anxiety might fluctuate, but it is almost always present to some degree.
Obsessive-compulsive disorder (OCD)
People with OCD struggle with obsessive thinking. They often have powerful, specific fears that they can't get out of their head. These fears are unwanted and unpleasant, and may feel like an ongoing attack on their sense of well-being. Common areas of fear include sickness, sex and harming oneself or others.
In response, people with OCD often turn to specific, compulsive behaviors to make themselves feel better by giving them a sense of control. These behaviors can be external, where they may appear ritualistic, or exist entirely in a person's own mind. Examples include frequently washing hands, counting, and a focus on doing things exactly the right way every time.
Social anxiety
Some people may generally feel fairly okay in their own skin, but notice a sharp uptick of anxiety in social situations, where they tend to feel deeply uncomfortable. This discomfort may extend to even the knowledge of an upcoming social situation - someone with social anxiety might worry for weeks ahead of time about having to attend a friend's party, or give a presentation at work. People who experience social anxiety often avoid social events as a result.
Phobias
A phobia is a specific fear. Someone with a phobia might be terrified of spiders or being in a tall building. However, they may otherwise experience no more anxiety than average. Someone can have one or more phobias.
Panic disorder
Someone with panic disorder experiences frequent panic attacks. A panic attack is a relatively short burst of terror that is so intense the person having it may feel like they are dying. Panic attacks typically last only a few minutes, but are usually completely debilitating during that time.
What are the causes of an anxiety disorder?
The exact causes of anxiety disorders may differ from person to person. However, a number of factors play a role. These include:
Physical
Anxiety is rooted in the brain. The normal, healthy experience of anxiety is part of your body's fight, flight or freeze response - a series of neurological and physiological changes that occur when you are faced with a dangerous or stressful situation. The fight, flight or freeze response involves your brain activating the sympathetic nervous system, which triggers the release of stress hormones like adrenaline and cortisol into your bloodstream.
The fight, flight or freeze response is meant to be short term. Ideally, it should last just long enough for you to get out of the dangerous situation. However, due to trauma or chronic stress, many people's sympathetic nervous systems are continuously activated. Their parasympathetic nervous system, which is supposed to calm the body back down and deactivate the fight, flight or freeze response, doesn't turn on. The result - they walk around constantly on the lookout for danger that isn't there. This can lead to chronic feelings of anxiety.
In addition, the actual structure and operation of the brain may be different in people who struggle with anxiety. Studies have found that the amygdala (the part of the brain that triggers feelings of fear) is actually larger than normal in people who have been diagnosed with an anxiety disorder. The amygdala may also be more active in people who struggle with anxiety. Meanwhile, activity in the prefrontal cortex (the part of the brain responsible for rational thought) actually decreases as the amygdala becomes more active. While this happens for most people, the effect is more pronounced in people with anxiety.
In other words, someone with an anxiety disorder may feel fear much more intensely than normal, and be less equipped to respond to it rationally in the moment.
Gut health also plays a role. Your gut and your brain are intimately connected. Indeed, your gut and spinal cord (which connects your gut to your brain) even contains hundreds of millions of neurons - which are literally brain cells. It is well documented that health conditions that affect your gut tend to negatively impact your mental and emotional health as well. If your gut is irritated, that feeling can quickly spread to your brain.
Likewise, diet can affect anxiety. Certain foods can cause inflammation and irritation in your gut, and have been found to cause feelings of anxiety. These include processed foods, sugar, artificial sweeteners and preservatives and in some cases gluten or dairy. Foods that spike your blood sugar, like sweets and processed carbohydrates, also directly influence your mood and have been linked to anxiety and depression.
Chronic inflammation can also directly affect your brain, resulting in mental health symptoms.
Genetic
Anxiety often runs in families. This means there is likely a genetic component to anxiety disorders. Research has found a number of genetic factors that correlate with anxiety disorders, along with related conditions like depression. However, it is believed that exposure to trauma and difficult life circumstances is often needed to activate these genes.
In other words, just because someone may have a genetic predisposition towards anxiety doesn't mean they will develop an anxiety disorder. For families with a history of anxiety, healing the family dynamics may help prevent anxiety disorders from appearing in future generations.
Emotional
Trauma often plays a major role in the development of an anxiety disorder. Childhood trauma is particularly important - many people who struggle with anxiety experienced a significant amount of trauma during childhood. Likewise, a trauma or series of traumas later in life can also lead to developing chronic anxiety.
Chronic emotional stress is also a factor. This sort of stress might not qualify as trauma, but it adds up over time. People who live in poverty, work high-stress jobs, regularly experience discrimination, sexism or racism, have a tumultuous family life, or lack loving and supportive relationships often struggle with anxiety.
Children who may not have experienced discrete traumas, but grew up in emotionally unsupportive families are also more likely to develop an anxiety disorder.
Environmental
Research indicates that exposure to toxic chemicals like pesticides, air pollutants and heavy metals may be a cause of anxiety. While this is true at any age, toxins have an especially powerful effect on young children. Most brain growth occurs before two years old - exposure to toxins during this time can be devastating and lead to the development of anxiety later in life as well as permanent neurological damage.
How do you treat an anxiety disorder?
There is usually no silver bullet for anxiety. Treatment and healing is an ongoing process. A holistic approach to treating anxiety is multifaceted, and can include psychotherapy, addressing any underlying medical conditions, lifestyle changes, eating differently and supportive healing modalities.
Assessment
Anxiety disorders are typically assessed by a mental health professional. These can include social workers, therapists, counselors, psychiatrists, psychologists and doctors. If you suspect you have an anxiety disorder, it's a good idea to see a mental health professional. They can help you explore your symptoms and history, and work with you over a period of time to come up with a diagnosis. Ideally, this should be an ongoing process.
Lifestyle
Lifestyle changes are usually a major part of treating an anxiety disorder. Key changes often include:
Exercise
Mind-body techniques
Reducing stress
Practicing acceptance
Emotional support
Sleep
Exercise
Exercise is a mood booster. Physical activity releases endorphins, which make you feel good, and lowers your overall stress level. Following a regular exercise schedule can help you to feel less anxious, more relaxed and sleep better, as well as support your overall health.
Mind-body techniques
Mind-body techniques like meditation (or moving meditation like yoga and tai chi) can be very helpful. They won't cure your anxiety right away, but a daily meditation practice has actually been found to produce structural changes in the brain that can help you to feel more calm and less reactive to stress over time. The key is patience, and not having expectations.
Reducing stress
While an anxiety disorder is about more than just stress, stress plays a big part. Regular exposure to highly stressful situations contributes to anxiety, so it can be helpful to consider ways to limit or lower your stress. This could include looking at what in your life may be causing you stress, and figuring out if you can do anything to change that.
Practicing acceptance
An anxiety disorder can feel deeply limiting and frustrating. However, it can be useful to practice self-acceptance in response to anxiety. Rather than trying to force yourself to overcome anxiety, or feeling guilty when you don't, you can also be gentle with yourself and just accept that it is occuring.
Anxiety can be an opportunity to learn more about yourself (mind-body practices can be helpful here). After all, it's okay to have limits. Everyone does. Accepting your limits and working within them can be a great way to respond to anxiety.
Emotional support
People with an anxiety disorder often have a hard time getting the emotional support that everyone needs. It's hard to make friends if you're scared of social situations, for example. However, good social support can really make a difference. It's worth making an effort to spend time with friends or loved ones, join an anxiety support group, or otherwise give yourself a break from being alone with your fears. For people with social anxiety in particular, finding community online can also be an alternative that feels safer and more doable.
You can provide emotional support for yourself.
"A huge piece is not to get anxious about the anxiety", therapist Hetty Irmer Barnett shares. "What we tell ourselves about what we're experiencing is so important. We say, 'I was so stupid to waste my day!' We beat ourselves up all through our lives, yet it doesn't help at all. It activates more stress hormones and perpetuates incapacity. Encourage yourself to be as kind to yourself as you can be".
Sleep
Everything is harder without enough sleep. A good night's sleep helps your body and mind rest, restore and rebuild after the day. People who struggle with anxiety often find that their symptoms are even worse if they don't get enough sleep. It's a good idea to get at least 8 hours, if not more.
Nutrition
Getting the right nutritional support can be very helping for treating anxiety. This means cutting or limiting your intake of anxiety-provoking foods, and eating foods that support your brain and gut health. Nutritional supplements can also be useful.
An integrative, functional medicine or naturopathic physician can help provide specific, personalized guidance on proper nutrition.
Diet
It is recommended that people with an anxiety disorder avoid foods that cause inflammation or major spikes in blood sugar. Foods like this tend to damage your gut and brain health. These include:
Processed foods
Vegetable oils
Sugar, corn syrup and artificial sweeteners
High levels of carbohydrates
Gluten (for some people)
Caffeine and other stimulants
Alcohol
By contrast, eating a healthy, natural diet rich in whole foods can help support your brain, gut and body, and can result in you feeling safer and more calm in your own skin. Foods that can help support your mental health include:
Healthy fats like olive oil, coconut oil, avocado and ghee or grass-fed butter
Leafy greens (and other vegetables)
Fresh fruits
Lean proteins
Beans, lentils, nuts and seeds
Probiotic-rich foods like kefir, kombucha and sauerkraut
It's a good idea to pay attention to how you feel after you eat. If you feel a surge in anxiety after a meal, what you just ate may be contributing to your anxiety. If you feel better after eating, those foods are probably nurturing your body instead.
Supplements
Certain supplements can be useful for dealing with anxiety. Probiotics support your overall gut health, and are always a good idea. Magnesium has a calming effect, while B vitamins promote brain health. Inhaling lavender essential oil or rubbing a drop or two into your wrists or temples can also be very relaxing.
Healing modalities: who should I go see?
Making an appointment with a mental health professional is a great place to start. They can assess you, develop a treatment plan, and provide psychotherapy or counseling. They can also refer you to other health professionals as needed.
If you don't feel comfortable with the first therapist you see, it's okay to try another one. Fit is especially important because the relationship between you and your therapist is the biggest part of what makes therapy effective. Find someone you feel safe talking to.
Seeing a holistic physician is also a good idea. They can rule out whether your symptoms are being caused or influenced by another medical condition (like a thyroid problem or a gut disorder), and help you treat that condition if it is a factor. They can also help with guidance on supplements and diet.
Other health professionals who do bodywork that helps activate your calming parasympathetic nervous system, like massage therapists, acupuncturists and chiropractors, can also help with anxiety. Float therapy or craniosacral therapy can also provide relief
References:
Is Your Gut Making You Depressed or Anxious?
Savvy Psychologist Ellen Hendriksen
The future mental health research might mean targeting the gut!
How meditation cured Dan Harris's panic attacks
Louise Chun
After Dan Harris had a public meltdown, he used meditation and mindfulness to put himself back on track.
Selected Studies:
Genetics of generalized anxiety disorder and related traits
Michael G. Gottschalk, PhD & Katharina Domschke, MD, PhD
Dialouge in Clinical Neuroscience
The Neurobiology of Anxiety Disorders: Brain Imaging, Genetics, and Psycho-neuro-endocrinology
Elizabeth I. Martin PhD, Kerry J Ressler MD PhD, Elisabeth Binder PhD, and Charles B. Nemeroff MD PhD
Psychiatr Clin North Am
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