When it's more than worry... Breakthrough Fall 2004

At the Centre

Anxiety is common, but if it's overwhelming and affecting your everyday life, you may need to seek help
Given the complexity of the modern day world, there will always be things that trouble us, make us sad or leave us feeling anxious. Am I going to miss my bus? Will I get into college? Do I have enough money for next month's rent? The world can be a pretty hectic place sometimes, and stress can play on your nerves and make you question yourself about seemingly trivial matters. These thoughts go through everyone's mind to a greater or lesser degree on a daily basis. Some are just fleeting thoughts, some are serious considerations, and sometimes these feelings are more than just worry.

"It's important to remember that anxiety is normal and is experienced by every living organism, right down to the sea slug," says Dr. Neil Rector, Head of CAMH's Anxiety Disorders Clinic. "It is necessary in humans for survival and adaptation, and it is not in the least harmful or dangerous. Anxiety is typically short-lived, and in some cases moderate levels of anxiety actually enhance performance."

Anxiety refers to excessive worrying that is hard to control, but at what point does it become more than worry? Dr. Rector says that while worry is very natural, something most of us do on a regular basis as demonstrated by research, normal worry can become abnormal worry when symptoms become too persistent, and too severe, causing the person high levels of distress and impairment. "For example," explains Dr. Rector "the intense 'fight or flight' response of a panic attack is normal and adaptive. It occurs when a person is faced with a direct threat to his/her life such as being attacked by a wild animal.

However, if the person experiences intense panic attacks in response to being left home alone, it would be considered excessive relative to the context in which it occurs and is more likely to be a clinical problem."
Anxiety becomes a clinical problem if it leads to significant distress and impairment. "For instance," says Dr. Rector, "if a person has a lot of anxiety around an event such as a test or exam, this short-term test anxiety would not likely be diagnosed as an anxiety disorder. However, if the person had very intense and frequent test anxiety that led to distress prior to exams that affects test performance, then it would likely be diagnosed as an anxiety disorder. The good news here, however, is that the person could then receive very effective treatments for their performance anxiety."

What are some symptoms of an anxiety disorder? "There are many different anxiety disorders and many have varying symptoms, however it can be said that all anxiety disorders can be understood in relation to their specific physical, cognitive, and behavioural features," says Dr. Rector, "the 'fight/flight' response prepares the body for action - to either fight or to flee away from the situation." Features of this response include:

• Physically, symptoms can include heart palpitations or increased heart rate, shallow breathing, trembling or shaking, sweating, dizziness or lightheadedness, muscle tension, shortness of breath, nausea and other symptoms of sympathetic nervous system arousal.
  
• Cognitively, a person's awareness and ability to judge are affected, which may mean having anxious thoughts, anxious predictions, and anxious beliefs. This can be triggered by activities or events that leave a person feeling like they either want to run away or stay and face the challenge (what is called the 'fight/flight' response) or alerts the person to the possible existence of danger which results in an immediate and automatic shift in attention to carefully look at what is scary or feels dangerous. This can range from mild worry to extreme terror.  
•  Behaviourally, those feeling extreme anxiety may act in a certain way but may feel unable to act in other ways as a way of protecting themselves from perceived danger and/or the discomfort created by anxiety. These behaviours include avoidance of feared situations (e.g., driving), avoidance of activities that bring up feelings similar to those experienced when anxious (e.g., exercise), doing things to distract yourself (e.g., talking more during periods of anxiety), and safety behaviours or habits to minimize anxiety and feel 'safer' (e.g., always having a cell phone on hand to call for help).

Given these symptoms, when should a person seek treatment? "We have extremely effective psychological and medical treatments for anxiety disorders," says Dr. Rector. "The starting point is to help a person feel okay about the experience of anxiety, since most of us do not get through a week without experiencing some anxiety. But if the person is experiencing frequent, distressing and impairing levels of anxiety then they should consider receiving help for these problems."

If you feel your anxiety has become persistent and is causing high levels of stress and impairment you should discuss this with your family doctor. But remember, anxiety is a normal part of daily life, and even that sea slug will experience it at some point!

Becky McEwen, Communications Assistant at CAMH, wrote this article with information provided by Dr. Neil Rector, Head of the Anxiety Disorders Clinic. The Anxiety Disorders Clinic is located at CAMH's College Street site and can be reached at (416) 979-6819. Referral is required from family doctor.

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