Understanding anxiety disorders

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 because it is a normal life-saving function. However, anxiety becomes disordered when your feelings, thoughts or behaviours meet a specific criterion.

What are anxiety disorders?

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 was published by the World Health Organisation, and the latter by the American Psychiatric Association. 

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 the link to anxiety.

Anxiety shows up in different ways, for example, constant worry or panic that seems to come out of nowhere, fear of social judgement, or even the compulsion to check and recheck things. The medical manuals have names for these, but what matters most is how they feel in your body and your life.

Maybe you notice your heart racing in the supermarket queue, or you find yourself lying awake rehearsing conversations that may never happen. Perhaps you avoid parties, or maybe your anxiety comes in waves that feel like fear of dying. However it looks for you, anxiety is always real, even if it doesn’t fit neatly into a category.

Our biology evolved to use anxiety as a survival signal; its purpose is to mobilise energy when we need to act quickly. But in a world of constant notifications, 24/7 light, and relentless demands, the system fires too often, in ways that no longer match the threats we face.

Here, I will describe the diagnostic criteria for some anxiety disorders, including some aspects of trauma and OCD. This is what your doctor would use to give you a diagnosis; however, if anxiety is affecting your life, you don’t need to wait for a diagnosis to start finding relief. Talking therapies like hypnotherapy can help you reconnect with your body’s natural rhythms. Small changes in daily rhythms, paired with gentle inner work, can begin to shift things.

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 so 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
• fatigued easily and/or experience sleep disturbance
• difficulty concentrating or cannot focus your mind
• 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 get a formal diagnosis, 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. 

Panic disorder

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 their 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 these feelings during your panic attack:

• heart disturbances (palpitations, pounding or racing)
• sweating
• shaking
• 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. 

The DSM distinguishes OCD 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 is 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 recurring. 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, and 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 enquire further if you feel that PTSD is 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.

Anxiety is part of our human biology, but when it takes over your life, it feels overwhelming. Whether you recognise yourself in the descriptions above or your experience feels harder to name, what matters most is that it feels real to you. You don’t need a formal diagnosis to begin making changes.

Understanding your own patterns, restoring balance to your daily rhythms, and working with therapies such as hypnotherapy can help you find steadiness again. Anxiety is a signal from a body doing its best to keep you safe. With the right support, you can learn to work with your body’s signals, asking what you need, rather than battling against them.