Do I have anxiety?
There is currently an increasing awareness of mental health, in particular anxiety. As you hear others speak about their experiences of anxiety you might wonder whether you too feel anxious. We all feel anxious at times, it is a normal life saving function. However, anxiety becomes disordered when your feelings, thoughts or behaviours meet a specific criterion.
There are two manuals that define mental health disorders. The International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). The first published by the American Psychiatric Association and the latter the World Health Organisation. I use the DSM for my own understanding, I am not a psychiatrist and do not diagnose people, but I feel it is important for me to understand the specifics of mental health disorders when a client comes to me and asks for help with a diagnosis they received.
The DSM lists 10 different anxiety disorders within the anxiety disorder section. Obsessive compulsive disorders and trauma related disorders have their own sections; however, the DSM places the sections together and acknowledges a link between these and anxiety.
The anxiety disorders listed in the DSM are agoraphobia, separation anxiety, selective mutism, specific phobia, social anxiety, panic disorder, panic attack specifier, generalised anxiety disorder, substance/medication induced anxiety disorder, anxiety disorder due to another medical condition, other specific and unspecified anxiety disorder.
In this article I will describe the diagnostic criteria for some of these anxiety disorders, including some aspects of trauma and OCD. If you feel that you match any of the below, please speak to your GP who may offer you medication which you can choose to take or not. An understanding of what is going on for you might help you alongside some talking therapy to help manage the symptoms.
Generalised anxiety disorder (GAD)
The first symptom of GAD is excessive worry about several different things. You experience more days of worry than not and have done for at least six months. This worry is about different things, and you find it difficult to control the worry.
In addition to the worry, you find yourself with at least three of the following physical symptoms that you associate with the worry you feel:
- Restlessness or on edge.
- You fatigue easily and/or experience sleep disturbance.
- Have difficulty concentrating or cannot focus your mind.
- Feel irritable and/or have tension in your muscles.
The feelings of anxiety or the symptoms it causes create enough distress to stop you functioning as you feel is typical and you cannot put this down to substance use or another medical condition.
Social anxiety disorder
Also known as social phobia, social anxiety disorder causes a noticeable fear or anxiety about social situations in which there is the possibility of scrutiny by others. You fear negative judgement by others because of your actions that may or may not relate to the symptoms of anxiety. The fear is of embarrassment, humiliation, or rejection. To be formally diagnosed the social situations must almost always provoke fear or anxiety and therefore you avoid or endure them.
Whilst you may not feel so, the fear or anxiety is out of proportion to the actual threat and has been present for at least six months. As with GAD the feelings of anxiety or the symptoms it causes create enough distress to stop you functioning as you feel is typical and you cannot put this down to substance use or another medical condition.
Those with a panic disorder diagnosis experience recurrent unexpected panic attacks and go on to experience at least one month of persistent worry about another panic attack or a significant change in your behaviour because of the attacks.
Panic attacks can arise suddenly, from a calm state or progress from an anxious state. A panic attack is an unanticipated surge of intense fear and can last from minutes to up to 45 minutes.
The DSM lists the symptoms of a panic attack as follows, for a formal diagnosis you must have experienced four of the feelings during your panic attack;
- heart disturbances (palpitations, pounding or racing)
- feeling short of breath or like you are suffocating
- tightness in the throat so it feels like you are choking
- chest pain
- nausea or discomfort in the abdomen
- dizziness (lightheaded/faint)
- feeling a change in temperature, hot or cold
- numbness or tingling sensations
- dissociation from oneself or feeling detached from reality
- fear of losing control or that you have gone mad
- fear of dying
Obsessive compulsive disorder (OCD)
The initialism OCD is extensively used colloquially to describe someone who is particularly organised or tidy. This can minimise the true effects of OCD and a loss of awareness of what OCD really is.
OCD is distinguished by the existence of unpleasant and distressing obsessions or compulsions. Obsessions are recurrent and persistent thoughts, images or urges that are intrusive, unwanted and cause noticeable anxiety or distress. To mitigate the anxiety or distress you try to remove it with another thought or action which is the compulsion.
Compulsions are repetitive behaviours or mental acts that you feel compelled to perform in response to your obsession or rules that you have rigidly set. You perform the behaviours or mental acts to reduce anxiety or prevent an event or situation you fear. However, the connection between the behaviours or mental acts and the feared situation is unrealistic.
The obsessions or compulsions you experience take you more than an hour each day or hinder a typical functioning lifestyle.
Body dysmorphic disorder (BDD)
The American Psychiatric Association consider BDD an obsessive-compulsive disorder. You might have BDD if you feel preoccupied with one or more aspects of your physical appearance that you perceive to be a defect or flaw. The perceived defect is not obvious to others.
You either do or have performed repetitive behaviours or mental acts because of your concerns. For example, you might excessively groom, pick your skin, regularly mirror check, or seek reassurance. This fixation affects your life enough to prevent typical functioning and not related to body weight or fat.
Post-traumatic stress disorder (PTSD)
To qualify for post-traumatic stress disorder as per the DSM you must have previously experienced an actual or threatened death, serious injury or sexual violence in at least one of the following ways:
- Direct experience.
- Witnessing an event in person.
- Hearing of a traumatic event that occurred to a close family member or friend. The actual or threatened death must have been violent or accidental.
- Experiencing repeated or extreme exposure to unpleasant details of traumatic events.
After the event you experience recurrent and intrusive memories that you cannot control, including dreams. You might also experience flashbacks in which it feels as though the event is reoccurring. You might feel distress at exposure to things that relate to the event in some way and avoid people, places, objects, or situations that bring back memories of the event. You might also do things yourself to avoid the memories.
You have found a mood change and/or a change in your cognitive functioning because of the event. Such as negative beliefs about yourself and a negative emotional state. Lack of interest in activities, detachment from others, inability to experience positive emotions. You find yourself to be more reactionary since the event, feel irritable and express that with angry outbursts. Your behaviour might be reckless or self-destructive. The feelings or thoughts affect your sleep and you struggle to concentrate.
There are further symptoms of PTSD so please speak to your doctor if you feel that PTSD might be the cause of your problems. As before, the symptoms PTSD causes create enough distress to stop you functioning as you feel is typical and you cannot put this down to substance use or another medical condition.
If you feel that you experience disordered anxiety, seek the advice of your GP. Various talking therapies such as hypnotherapy or CBT help with the symptoms of anxiety and will benefit you whether your GP considers your anxiety disordered or not.