Anxiety is a normal part of life and mild anxiety can be productive, such as the anxiety experienced prior to taking an exam or when faced with a threat.
This type of anxiety works to increase our level of alertness and cope with the stress of the exam. If we are faced with danger, anxiety will stimulate physiological responses that trigger the ‘fight’ or ‘flight’ response, allowing us to fight the danger or run from it.
When anxiety is irrational or becomes unmanageable it is likely due to an anxiety disorder, of which there are several types.
Anxiety disorders are classified as a mental illness, and comprise of consistent fear and worry which affects most aspects of daily living. Anxiety disorders can lead to depression.
- One quarter of Australians will experience an anxiety condition in their lifetime.
Breakdown: 26.3% of Australians aged 16 to 85 have experienced an anxiety disorder. This is equivalent to 4.96 million people today.
- One in seven Australians is currently experiencing an anxiety condition.
Breakdown: 14.4% of Australians aged 16 to 85 have experienced an anxiety disorder in the last 12 months. This is equivalent to 2.71 million people today.
- One in six Australians is currently experiencing depression or anxiety or both.
Breakdown: 17% of Australians aged 16 to 85 have experienced an anxiety and/or affective disorder in the past 12 months. This is equivalent to 3.2 million people today. Note: the percentage of Australians who have lifetime experience of anxiety and/or an affective disorder is unknown.
- Females are more likely than males to experience depression and anxiety.
One in six females will experience depression in their lifetime compared to one in eight men. One in three females will experience an anxiety condition in their lifetime compared to one in five men.
Breakdown: 17.8% of females aged 16 to 85 will experience an affective disorder in their lifetime compared to 12.2% of men. Thirty two percent of females aged 16 to 85 will experience an anxiety disorder in their lifetime compared to 20.4% of men (ABS 2016).
Anxiety disorders are believed to be caused by combinations of factors, these include:
- The first consideration is the possibility that anxiety is due to a known or unrecognised medical condition. Substance-induced anxiety disorder (over-the-counter medications, herbal medications, substances of abuse) is a diagnosis that often is missed.
- Genetic factors significantly influence risk for many anxiety disorders.
- Environmental factors such as early childhood trauma can also contribute to risk for later anxiety disorders. The debate whether gene or environment is primary in anxiety disorders has evolved to a better understanding of the important role of the interaction between genes and environment.
- Some individuals appear resilient to stress, while others are vulnerable to stress, which precipitates an anxiety disorder (Mayo Clinic 2018).
All anxiety disorders have specific symptoms and essential criteria they must meet to reach diagnosis, but the central features of severe anxiety are:
- Feeling nervous, restless or tense
- Having a sense of impending danger, panic or doom
- Having an increased heart rate
- Breathing rapidly (hyperventilation)
- Sweating
- Trembling
Feeling weak or tired
- Trouble concentrating or thinking about anything other than the present worry
- Having trouble sleeping
- Experiencing gastrointestinal (GI) problems
- Having difficulty controlling worry
- Having the urge to avoid things that trigger anxiety (Mayo Clinic 2018).
Individuals with anxiety disorders may experience some or all of the symptoms mentioned, and different anxiety disorders stipulate a minimum number of symptoms that must be experienced within a given timeframe in order to establish a diagnosis.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) describes anxiety as ‘anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioural disturbances’. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these two states overlap, but they also differ, with fear more often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviours, and anxiety more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviours. Sometimes the level of fear or anxiety is reduced by pervasive avoidance behaviours. Panic attacks feature prominently within the anxiety disorders as a particular type of fear response. Panic attacks are not limited to anxiety disorders but rather can be seen in other mental disorders as well (Psychiatry Online).
The manual identifies the following disorders as anxiety disorders and the anxiety must be to such an extent that it interferes with the individual’s ability to carry out normal activities of daily living, such as attending work or school.
- Separation anxiety disorder
- Selective mutism
- Specific phobia
- Social anxiety disorders (social phobia)
- Panic disorder
- Panic attack specifier
- Agoraphobia
- Generalised Anxiety Disorder (GAD)
- Substance/medication induced anxiety disorder
- Anxiety disorder due to another medical condition
- Other specified anxiety disorder
- Unspecified anxiety disorder (Psychiatry Online).
Anxiety disorders can be distressing and debilitating. They may contribute to loss
of educational and employment opportunities and difficulties in family and social relationships. Recovery is possible with appropriate treatment such as exposure therapy, attention training, and a range of anxiety management techniques that can help you manage your symptoms (Better Health Channel 2017).
Treatment for anxiety disorders may include cognitive therapy, exposure therapy, attention training, counselling, diet and exercise and the use of techniques including relaxation and assertiveness training.
Medication can help to alleviate anxiety symptoms, but is not a long-term solution. SSRI’s are anti-depressants and are currently the most popular anti-depression/anti-anxiety drugs as they have fewer side effects than Monoamine Oxidase Inhibitors (MAOI’s).
Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counsellor, to discover what caused an anxiety disorder and how to deal with its symptoms. Cognitive-behavioural therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioural part helps people change the way they react to anxiety-provoking situations (National Institute of Mental Health 2018; Better Health Channel 2017).
In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person’s preference.
Before treatment begins, a careful diagnostic evaluation must be conducted to determine whether a person’s symptoms are caused by an anxiety disorder or a physical problem.
If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse.
Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control (National Institute of Mental Health 2018; Better Health Channel 2017).
References
Better Health Channel: Victorian Government: Managing and Treating Anxiety: May 2017: Accessed August 2019 betterhealth.vic.gov.au/health/ conditionsandtreatments/ anxiety-treatment-options
Beyond Blue: General Statistics: Accessed August 2019: Sourced from the Australian Bureau of Statistics (ABS) Australian Demographic Statistics, June 2016. beyondblue.org.au/ media/statistics
Mayo Clinic: Anxiety disorders: 4 May 2018. Accessed August 2019 mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
National Institute of Mental Health: Anxiety Disorders: July 2018: Accessed August 2019 nimh.nih.gov/health/topics/ anxiety-disorders/index.shtml
Psychiatry Online: DSM Library: DSM-5 Handbook of Differential Diagnosis: Anxiety Disorders: Accessed August 2019 dsm.psychiatryonline. org/doi/full/10.1176/appi. books.9780890425596.dsm05
The following excerpt is from the ANMF’s Anxiety Disorders Tutorial on the Continuing Professional Education (CPE) website. The complete tutorial is allocated two hours of CPD, the reading of this excerpt will give you 30 minutes of CPD towards ongoing registration requirements. The complete tutorial covers: causes in detail, types of anxiety disorders and phobias in detail, treatment options in detail including medications, suggested readings.
To access the complete tutorial, go to anmf.cliniciansmatrix.com
For further information, contact the education team at education@anmf.org.au
anmf.org.au/cpe
