Anxiety

Anxiety, an emotion and a disorder.

Anxiety is a natural feeling that everyone experiences at some time, there is no one who is completely anxiety-free. People often get anxious before an important event, such as a final exam, sports final, premiere of a play or a first date. Anxiety is an emotion most of us feel in relation to things that are important to us and it can be very useful; it can get people to work harder, work better or improve concentration. Anxiety also benefits us in dangerous situations. It is anxiety that helps people run away from falling rocks or run from approaching cars.

We all have a built-in anxiety response that has evolved with humanity and helped us survive. The anxiety reaction manifests with a variety of symptoms, both emotional and physical. Common physical symptoms include, for example, accelerated heartbeat, shallow breathing, increased sweating and nausea. The anxiety reaction also affects our thoughts and when we experience symptoms of anxiety, thoughts are often characterised by great concern, irritability and difficulty in staying focused.

Although anxiety is primarily a natural feeling and can be very useful, it can also be a problem. When anxiety is excessive, it often arises or manifests itself in inappropriate situations and ceases to benefit us. Anxiety can become so great that it holds people back, prevents them from doing the things they want to do or causes them to feel extremely bad in situations that cause anxiety. When anxiety starts to have a significant impact on our daily life, an anxiety disorder may be present. A simple example of the difference between anxiety as a natural and even more beneficial feeling and then anxiety in an anxiety disorder would be anxiety for a final exam which causes a person to work hard, achieve better concentration and study hard before an exam but, on the other hand, anxiety for a final exam that becomes so great that a person fails to learn or focus and eventually decides to skip the exam.

You can think of the anxiety reaction like a smoke detector. A smoke detector is very useful and can save our life when there is a fire and it goes off (similar to an anxiety response that triggers in real danger). If the smoke detector goes off continuously and from the smallest trigger, e.g. when we light candles or make popcorn, then it is no longer useful (such as an anxiety reaction triggered in inappropriate situations or in excessive amounts). When the smoke detector behaves in this way, it is time to replace the battery or repair it. The same goes for the anxiety reaction. If people experience severe anxiety, very often experience anxiety or if anxiety holds them back in some way then they should seek the help from a professional.

The objective of an anxiety treatment is thus not to get rid of anxiety completely, but rather we want it to serve its purpose as this natural and useful feeling. The goal is to reduce it when it does not benefit us and learn to deal with it.

Anxiety as a disorder

If anxiety is beginning to have a major impact on your quality of life, e.g. if you skip doing the things you want to do because of anxiety, it is possible that an anxiety disorder is present. An anxiety disorder is really another way of saying that anxiety has become so great and inhibiting that an individual needs assistance to tackle it. There are many types of anxiety disorders, and they all have in common that individuals experience anxiety that holds them back in some situations. Anxiety can also occur with anxiety attacks, when many physical anxiety symptoms occur at the same time. A great deal of people experience anxiety attacks at some point in their life. It is important to know the symptoms of anxiety disorders and anxiety attacks in order to distinguish between anxiety as a natural feeling and anxiety as a problem or an anxiety disorder. This page contains information on some common anxiety disorders; general anxiety disorder, social anxiety and specific phobia as well as information about anxiety attacks. More detailed information on anxiety can be found on the Internet, for example on Kvíðameðferðarstöðin's website: www.kms.is.

Panic attack (anxiety attack)

A panic attack is when people experience a sudden and overwhelming fear without a real danger being present. In panic attacks, people experience very strong physical anxiety symptoms that intensify and peak in minutes. Panic attacks usually pass quickly and most often the symptoms disappear within half an hour. Examples of these physical symptoms include accelerated heartbeat, increased sweating, shivering, feeling like you are suffocating, chest pain, numbness, feeling like you might faint and nausea. This is often followed by thoughts and fears of losing control, losing your mind, having a heart attack or dying. Panic attacks can occur unexpectedly and occur in situations where an individual does not expect them, but they may also occur in situations that usually give the person anxiety.

Panic attacks are not a disorder but they are extremely uncomfortable and can be symptoms of a disorder. Panic attacks can occur in many anxiety disorders, e.g. people with a syringe and needle phobia may have a panic attack in the proximity of syringes and needles. The anxiety disorder called panic anxiety disorder is when people get repeated panic attacks, causing them great distress, and they are constantly worried about getting a second attack. Although panic attacks are often accompanied by the disorders, they can occur to anyone, and anyone can have a panic attack without having an anxiety disorder.

In the vernacular (everyday language), a panic attack is often referred to when people are very worried about something for a long time or feel overwhelmed by worries. Such experiences are certainly uncomfortable, but the emotions and physical reactions associated with a panic attack are much stronger and more overwhelming. It is important to know the symptoms of a panic attack and to know the difference between these two because when people have a panic attack and do not know the symptoms, they can think that they are dying or having a heart attack and even seek medical help because of it. Panic attacks are characterised by frenetic fears, great physical reactions and they peak in minutes.

Some people only have one attack, but others have them every once in a while without them having a major impact on their daily life. When panic attacks are regular, part of a disorder or the main symptoms of the disorder (panic anxiety disorder), the attacks cause great difficulties and distress. When panic attacks start to have a significant impact on life and well-being, people should seek help.

Specific phobia

Specific phobia is a great fright or fear of certain things or phenomena that is not in accordance with that which creates fright or fear. This is called a phobia, but in everyday speech that word is often used for fear that is much milder than an actual phobia. Common examples of specific phobia are phobia against spiders, dogs, wasps, vomiting, elevators, airplanes, storms or being high up. People with a phobia try to avoid these phenomena to the best of their ability or endure through them with great anxiety, fear or distress. As an example, a person with a phobia of wasps may find it difficult to stay outside during the summer, keep all windows closed, avoid going camping or any situation where there might be wasps. Therefore, there is a big difference between being uncomfortable with being close to wasps and having a phobia for them, although the former example is often mistakenly called a phobia.

The symptoms of anxiety that are common in a specific phobia are rapid heartbeat, increased sweating and feeling like you are unable to move. Furthermore, some people experience a panic attack when they see what they fear. In specific phobia, a vicious circle is formed in which an avoidance behaviour (for example, not going out in summer, never getting close to dogs or never going on an elevator) sustains the anxiety and even increases it over time. By avoiding the circumstances or the phenomena, people feel a relief for a short period of time but the worries and fears are still present. If people manage to stay in the situation, they usually realise that there is nothing to fear and the anxiety decreases slowly. Thus, a person with mild anxiety that is somewhat similar to specific phobia, e.g. fear of spiders, can minimise anxiety by being around spiders and getting used to being close to them. People often need help in reducing anxiety, especially if anxiety and fear have become so great that specific phobia is present. The treatment for specific phobia is fairly simple and often only a few sessions with a psychologist are needed to overcome it

Social anxiety

Social anxiety is when people feel great fear or anxiety in social situations. Most often, the anxiety is associated with the concern that others are judging you, that you are badly perceived or that you will say or do something that others think is stupid. Examples of social situations are having a conversation with someone, going to a party, meeting new people, giving a lecture, eating or writing in front of someone or talking to supervisors. It is normal to feel anxious in some social situations and most people, for example, find it stressful to give a lecture or to speak publicly. If we did not have any anxiety related social conditions then we would not care how we are perceived and what other people think. Most of us are social beings and with that comes experiencing anxiety in connection with some social situations.

Those with social anxiety experience greater anxiety in social situations and the anxiety becomes so great that it causes difficulties in daily life or significant distress. Often, social anxiety leads to people completely avoiding social situations or just about enduring through them and experiencing great anxiety and distress during the situation. It can be noticeable when people avoid situations, such as not attending a party or refusing to attend school, but sometimes the behaviour of people with social anxiety can be less noticeable, e.g. when people practise a lot for a lecture or limit eye contact. Some people have social anxiety only in certain situations, such as presentations in front of people, which is called performance anxiety. Social anxiety can have a significant impact on people's lives and decision-making. It can lead to social isolation, prevent people from attending birthdays, parties or events that would be enjoyable without the anxiety and sometimes it can even make people choose an education where there are not many presentations or group work, or make them not accept a promotion if it is followed by increased communications.

Some people with social anxiety drink alcohol or consume drugs to facilitate social interaction and cannot even attend a party without it. A short-term solution in the form of drugs does not fix social anxiety but can lead to even more problems and may even develop into an addiction. Therefore, individuals who experience social anxiety or mild anxiety in this type of situation should monitor their consumption closely and even reduce or stop it until they overcome the social anxiety. Social anxiety can also lead to depression and then it is also important to seek help.

Physical symptoms that are common with social anxiety include blushing, sweating, shivering or stuttering. It is common for these physical symptoms to stimulate even greater anxiety because people often fear that others will notice them and judge them for the symptoms. These concerns are usually unrealistic and the blushing or sweat is not enough for others to notice, and most people would not think much about these physical symptoms if they were to notice them. In social situations, individuals with social anxiety may also experience a great deal of insecurity or an empty mind. People who experience these symptoms and experience difficulties in social situations, whether they are many or few, should not hesitate to seek help.

General anxiety disorder

General anxiety disorder consists of large and repeated various concerns and of concerns of various things. Concerns are negative thoughts that often revolve around the fact that something bad will happen to oneself or close relatives. They can be related to anything like work or school performance, the future, money issues, personal health or the health of others. It is difficult or impossible for a person with a general anxiety disorder to shake off their worries and divert their mind to other things. Often, the worries become more and more exaggerated as they last longer, like a constantly growing snowball rolling down a hill.

People with a general anxiety disorder often experience restlessness and extreme fatigue, as it is difficult for the body to be in chronic anxiety. Muscle tension is very common among people with general anxiety disorder and they often see a doctor for bad muscle inflammation but not for the anxiety itself. Other common symptoms include difficulty concentrating, irritability and dyssomnia. Individuals with general anxiety disorder often find it difficult to fall asleep, often because worries pop up in their mind when they have settled in bed and have time to think.

There is a great deal of uncertainty that comes with in being alive, the uncertainty is in fact inevitable. We can never know for sure what will happen tomorrow, how others will behave or what the future holds. Individuals with general anxiety disorder are believed to have difficulty coping with uncertainty. As a result, they often try to organise just about anything that can be organised and repeatedly check if everything is exactly as it should be. Concerns add to the uncertainty, and the uncertainty adds concerns, creating a vicious circle that is difficult to get out of. When people experience great and onerous concerns, it is important to seek professional help.

Post traumatic stress disorder (PTSD)

A traumatic event is a difficult or burdensome experience that naturally affects people and often takes time to recover from. Traumatic events vary in severity and people’s sensitivity towards them varies. However, some traumatic events are so severe that they would cause vast difficulties for most people. When people experience a serious traumatic event that threatens their life, the life of others, their welfare or the welfare of others, and they experience great fear, horror or powerlessness during the traumatic event, it is common for people to experience symptoms of traumatic stress or even develop post-traumatic stress disorder.

Post-traumatic stress is not necessarily a sign of post-traumatic stress disorder but may be a natural response to a difficult life experience. If symptoms of traumatic stress are still present, disturbing life and causing distress, and more than a month has passed since the traumatic event, it can possibly be due to a post-traumatic stress disorder. Post-traumatic stress disorder is common and it is estimated that about 10% of people will have it at some point in their life.

The symptoms of post-traumatic stress disorder are numerous and must always be diagnosed by a professional. The following are the main categories of symptoms, but professionals look at many factors, such as number of symptoms, for diagnosis and the symptoms are much more than what is listed here.

• Reliving the traumatic event in some way (e.g. memories, flashbacks or dreams)
• Avoiding situations, stimulus, thoughts and other things which remind the individual of the traumatic event
• Negative changes in mindset or deteriorating condition (e.g. guilt, less interest in important activities, difficulty remembering issues related to the traumatic event and difficulties in experiencing positive emotions)
• Altered levels of stimulation and response (e.g. irritability, self-harm, carelessness, easily startled and sleep disorders)

It is important that individuals with post-traumatic stress disorder seek assistance. People that have been traumatised but do not meet the criteria for post-traumatic stress disorder can also benefit greatly from processing their trauma. It can be very difficult to overcome traumatic events and difficulties and distress associated with a traumatic event should not be ignored, even if it occurred a long time ago.

Resources

Health care clinics: When people seek help from professionals, the first point of contact is usually the health care clinic. The first step is to make an appointment with a doctor who can refer you to the appropriate person if the problem cannot be resolved. heilsugaeslan.is

Mental health ward emergency reception: If the situation is acute or severe, do not hesitate to reach out to the mental health ward emergency reception at Landspítali, where people with urgent mental health issues can go without having an appointment. The psychiatric ward emergency reception is located on the 1st floor of the psychiatric building at Hringbraut. The emergency reception is open from 12:00 to 19:00 on weekdays and from 13:00 to 17:00 at weekends and the telephone number is 543 4050. In case of an emergency outside these hours, you can reach out to the emergency department at Landspítali Fossvogur. landspitali.is

Psychologists' private offices. On the psychologist's website, you can search for psychologists who attend to a variety of problems, such as depression. sal.is

Psychiatrists' private offices. A number of psychiatrists conduct medical and conversational therapy for depression in their private clinics.

A more detailed list of resources in Iceland can be found here.