Living with Anxiety

What is Clinical Anxiety?
Clinical anxiety in its various forms boils down to the overwhelming, persistent, and disruptive form of the 'fight or flight' mechanism in the brain. The climax of this disorder is normally an anxiety attack (also called a panic attack). Depending upon the type of anxiety you may have, anxiety attacks may or may not be able to be detected before the onset. One of the most frustrating aspects of this disorder is the inability to express to others what is wrong before diagnosis in most cases. Although there is no immediate danger, the brain is telling the rest of the body that something is very wrong and in some cases, death is imminent. Clinical anxiety is closely related to post-traumatic stress syndrome which is marked in cases of war veterans and disaster survivors.

Physical symptoms can include (although combinations vary) feeling as if you cannot breathe, heart palpitations, chest pain or tightness, shaking, dizziness, severe headaches, feeling you may pass out, nausea and vomiting, fear you're losing control or crazy beyond help, hot and cold flashes, extreme fatigue, and insomnia.

Emotional symptoms can include (although it varies by person) paranoia, dread, restlessness, avoidance, hypersensitivity to surroundings, irritability, confusion, behavioral problems (especially in children and adolescents), consistent nervousness or jumpiness, feelings of insecurity and being overly self-conscious, abnormal fear of imminent death, and a strong desire to escape or run away from a situation (which could be represented by the need to move house or even country).

Types of Anxiety
The main types of anxiety include generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), panic disorder, phobias (to an unrealistic or exaggerated level), separation anxiety, and social anxiety. Many people have more than one type of anxiety disorder, and these can co-exist with depressive disorders. The descriptions of each type are extremely general and, if you feel one of these apply to you, I suggest further study and talking with your doctor.

GAD manifests as a consistent worry or fear which interfere with daily activities. This can be in the form of 'premonitions' that something bad will happen. These fears are not only for oneself, but also about surrounding areas, friends, family, times of day, and many others. Other forms of GAD can include a nervousness or paranoia that never stops although there may be no obvious reason for this fear. Physical symptoms are normally headaches, stomach problems, and fatigue.

OCD is characterized by repeated actions which may seem impossible to stop or control. This can also be shown as a need to do something repetitively to insure it is done correctly due to a fear its not. Reoccurring fears or obsessions about a possible danger (such as the gas being left on, the car not being locked, etc) lead some sufferers of OCD to stop what they are doing and go to check on the possible threat or worry about this constantly when they are not able to do so.

Panic disorder shows itself by repeated and unexpected panic attacks. These do not have a trigger, cannot be detected before onset and can last 15 to 30 minutes. This disorder can also have agoraphobia, or a fear of crowded or confined spaces. In pre-diagnosis vernacular, this can be called - but is not - a nervous breakdown.

Phobias are an unrealistic or exaggerated fear level which can trigger from a specific object, activity, or situation which does not present clear and present danger. The level of fear in this respect is not simply a fear and avoidance, but a fear of all things related. An example of common fear would be a fear of bears, which leads someone to be more careful when hiking, whereas someone with a phobia disorder will avoid all places bears may exist, become nervous of bears in photos or on the television, and perhaps be fearful of plush bear toys and avoid all of these at all costs.

Separation anxiety is a normal part of child development and consists of crying and distress when a child (or pet) is separated from its family or home. This becomes a disorder when it persists beyond a healthy age or disrupts daily activities and routines.

Social anxiety, or social phobia, is a debilitating fear of negative judgement from others or public humiliation. This can be seen as extreme shyness, or in more severe cases, sealing oneself off from anything outside familiar or comfortable environments. Performance anxiety (stage fright) is a common social phobia.

Types of Depression
I feel this should be touched upon because of the nature of treatment which is needed when both an anxiety and a depressive disorder are diagnosed.
The main types of depression include major depression, atypical depression, dysthymia, bipolar disorder (also known as manic depression), seasonal affective disorder (SAD), and postpartum depression. There is no single cause of depression and all are characterized by avoiding the support and comfort of others. Suicidal thoughts are a warning flag and should be treated by a doctor because depression does not make you a lost cause; depression is treatable.

It should also be said that gender and age plays a part in depression and anxiety as well. Teenagers show symptoms of hostility, lack of temper control, headaches, and stomachaches. Women are twice as likely as men to have depression which includes premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, perimenopausal depression, and are also more likely to suffer from seasonal affective disorder. Men are less likely to acknowledge their feelings but one who suffers from depression can become secluded in their work or hobbies. Older and elderly adults can be more prone to depression depending upon their circumstances but this is not a normal part of aging, and symptoms could go unnoticed because complaints normally take the form of physical ailments instead of emotional.

Major depression is marked with a persistent feeling of sadness or hopelessness with an inability to enjoy things which were once a pleasure. These symptoms are constant and will interfere with a productive and fulfilling life. If left untreated, a major depressive 'episode' can lost for six months or more. Some can experience major depression once in their lifetime, but for most it is a reoccurring problem.

Atypical depression is a subtype of major depression and has a specific symptom pattern including temporary mood lifts in response to positive events. The response does not last once the enjoyment has run its course, and other symptoms include weight gain, significant increase in appetite, excessive sleeping, a feeling of heaviness in arms or legs, and sensitivity to rejection.

Dysthymia, also known as dysthymic disorder, is a 'low-grade' depression which lasts for at least two years. This is less severe than major depression, but chronic symptoms can impair one who suffers from it. This is marked with mild to moderate feelings of depression, although it is common to feel 'normal' for short periods. Those who suffer from dysthymia can also suffer from major depression which is known as 'double depression'.

Bipolar disorder shows itself with moods which cycle, going between deep depression and hopelessness to episodes of high mania which is characterized by hyperactivity, rapid speech, and impulsive behavior. It is unique in that it gives the feeling of power and happiness but is rapidly followed up by suffering which is unbearable with thoughts of suicide.

SAD normally occurs in the autumn or winter when sunlight is limited, but goes away once the seasons change. It is more common in areas where daylight is limited during these seasons, and also in younger people.

Postpartum depression, is related to - but not the same as - the 'baby blues'. It is common for many women who have given birth to feel some form of depression, but postpartum depression lasts longer than the 'baby blues', is thought to be triggered by hormonal changes, and can show itself around the first six months after childbirth.

Similar Conditions
Conditions which have similar symptoms but are unrelated to anxiety include adrenal disorders, asthma, diabetes, epilepsy, some heart conditions, hypoglycemia, migraines, sleep disorders, thyroid disorders, and others.

Because of the wide variety of similarities between anxiety and these disorders listed above, it is important that you are diagnosed correctly. Ask your doctor any questions you may have, research your symptoms, and never be afraid to get a second opinion if you're unsure. Being misdiagnosed can lead to months if not years of frustration, and if you have anxiety it can cause this to become worse with fears of health and uncertainty about medications you've been prescribed. You owe it to yourself to be open-minded to what doctors say, but mindful of your symptoms and anything you take for a diagnosis.

Keep a medical journal and write down a brief description of how you feel that day along with medications you are taking. This can be of infinite help to a doctor who is working with you.

Triggers & Webs
Depending upon the type of anxiety you may have, which may not neatly fall into one category, you could have what is called a 'trigger' or several of them. This would be something that causes you to have a panic attack; for me it was the fear of loss and the inability to control things around me (surgery, childbirth, domestic violence, etc). There are two ways to deal with triggers not including medication: desensitization through therapy and avoidance. How you choose to deal with your triggers should come from talks with your closest friends, relatives, and a doctor or therapist who specializes in panic and anxiety disorders. Avoidance is normally the wrong answer because it can lead to depression and heightened phobias. Desensitization is a long process, but when it is successful you gain a great deal from the experience including confidence in all areas of life.

You can also have more than one type of anxiety. For example, you can have panic attacks which are triggered by an obvious source, and other attacks which are not linked to anything. This example is particularly debilitating because it can easily lead to a social phobia and feelings of lost control. Without a thorough understanding of what you're affected by and how it can change and 'web' into other types of anxiety, this can also lead to depression.

The 'webs' of anxiety and depression are characterized by disorders which change through the years; separate but related, anxiety is not always a static thing. The triggers can change, and even once you've mastered your triggers, you can still be affected by anxiety in ways which are not obvious to you, or said more clearly, without a trigger. Because of this possibility, keeping a journal which has even a brief description of your daily feelings and medicinal results will be helpful in keeping your diagnosis up to date with any needed changes in therapy or medication caught faster. Never wait until things are unbearable to discuss your situation with your doctor.

If you suffer from both an anxiety and depressive disorder, be aware of any medication combinations which are offered. Specifically ask about drug interactions, and see if there are better alternatives.

The Good News
If anxiety is left untreated, the compounded fear which is triggered by the brain along with the fear of having the attack or confronting the fear is debilitating. Despite this, the greatest aspect about almost all forms of anxiety is that it is easily treatable and once you understand the cause you don't fear the symptoms and attacks as much. With understanding comes acceptance and through that you can heal with the help from a program from your doctor and support from those closest to you.

As I have gotten older and drastic life changes have come and gone (attempted college again, my mother died, divorce, moving to Europe), fighting against anxiety has slowly turned into living with anxiety. These are the steps that I have taken to get where I am today.

A Late Diagnoses
There were signs that I had anxiety when I was younger, but they went undiagnosed despite my visits to therapists and councilors. When I was 13 I suddenly developed a sort of sickness that left me with an extreme headache (on par with, but not the same as, a migraine), inability to hold anything in my stomach, trouble breathing and a claw that wrapped around my chest and felt like it was squeezing the life out of me. That lasted for three agonizing days. After this my life has been a stream of anxiety-related incidents which cost me my confidence, severed most social relationships, and left me lost. I went on a three-month trip to Western Australia which was amazing and fun, but as the return trip neared I started to fall apart. The headaches, lack of sleep and vomiting returned, so by the time I was back in the United States no one knew what to do with me; crying, shaking, unable to breathe, problems identifying common things and being caught in the grip of whatever was taking over my mind completely blinded me until I went to see a doctor and asked (begged) for help.

Control & Release
You should become intimately aware of where your line of allowable stress is. Not everyone is wired the same, so not everyone can endure the same amount of stress. This is where the comparisons will hurt you; never compare yourself to anyone else. Statements such as, "I don't understand why he/she can handle this, but I cannot. I should be able to," should be thrown out immediately even if you do not have clinical anxiety. Do not take on self-defeating concepts or mind-sets.

There are tests on the Internet which can tell you what your stress number is or take one from your local doctor or clinic that offers them. Do this every 3 months and keep a simple journal of your feelings (unless you like to detail everything out like I do, but it's not a requirement).

The trick with stress and anxiety is weighing your options. This is the most unfair part about anxiety in my opinion because, as the saying goes, it feels like you can't win for losing. If, for example, you're having money problems and want to take a second job, you have to see if your stress level is low enough and your support strong enough to take on more. If you don't, you're left with stress about what isn't being paid. In this example, you should focus on what you can handle, contact the companies and see what help they offer (if any) to get you through this time, then decide if that second job is right for you. Always try to focus on what you can do and have done. This is not always something which is optimistic; it can be frustrating to realize that you have limits on what you can accomplish at the moment, but letting go of what you cannot fix this moment is necessary. Quick fixes are almost always self-defeating. In the example above, a quick fix would be getting a credit card, taking out a personal loan or a loan from a friend. These will only lead to more problems down the road.

You should be humane and reasonable in your expectations of yourself. Do not push yourself to the breaking point or expect more from yourself than you can handle at this moment. Stress levels change, and with it your expectations should as well. Allowing yourself to release, or let go, of things you cannot change at this moment does not mean you do not care, but it may help you put the reality of things into perspective so when you are able, and not before, you will deal with things.

Treatment: Body & Soul
Although many people, including myself, take some form of medication in order to combat our anxiety, you may not need to. Most importantly, regardless of if you do or not, you should be able to function and feel normal. If you feel you're having problems with lack of medication or the medication you've been given, you owe it to yourself to be firm with your doctor. Do follow the doctor's advise with medication (some meds have a 14 day to month-long adjustment time), but if you have any problems with your medication (unable to think clearly, lack of motivation, meds seemingly ineffective) you should discuss them as soon as possible. Do not allow yourself to become impaired and unable to fulfil your daily routine. This should never happen. Losing a job or dropping out of college due to problems with your medication will only compound the situation.

There are other treatments which do not include medication, but can be just as effective, and are used in tandem with meds. Two examples of this include therapy dogs and psychiatric service dogs (PSDs). There is a distinct difference between these two in that therapy dogs are not trained to do tasks which fall under the realm of service dogs.

PSDs are trained to handle a number of situations including answering the door, providing support during severe spells of vertigo or panic, barking in case of emergency, opening doors to find outside assistance, retrieving medication and a drink to take a pill, calling emergency assistance in case of an unresponsive owner, alert the owner to risks, bracing between owner and unknown people (without any aggression), assistance to leave an area, tactile stimulation to release mental overload, provide a focus in public situations and at work, environmental assessment, vigilance in public situations (ATM for example), and even turning on lights for the owner in case they are fearful of an intruder. Also, PSDs are allowed to go into places where pets are not so that they are a constant companion and help to their owner.

Therapy dogs are normally dogs trained to go into public places with permission (nursing homes, hospitals, etc) in order to be a well-mannered individual who gives comfort to residents and patients. Therapy dogs can also be highly-trained pets which do not have the ability to be accepted in public places, but are a great asset and comfort to their owners.

Natural remedies are becoming increasingly popular. Some of these which are being researched and marketed include passionflower, valerian, kava, chamomile, as well as an assortment of vitamins. Before taking any natural remedy, especially if you are on any medications, you should discuss them with your doctor or therapist. If you are interested in natural or alternative remedies, you might find a doctor who is both familiar with conventional medication as well as natural alternatives.

There are also other types of treatment and therapies which include massage therapy, breathing work, meditation, aromatherapy, and countless others.
Finding the right combination for you is paramount.

Stability is Key
Having stability doesn't mean that you lead a boring life or become a hermit. Stability includes having a constant and comforting source for housing, food, sleep and companionship. If one of these often changes drastically it can lead to an increase of panic attacks as well as triggers changing, or perhaps panic attacks not having a trigger at all. Streamline your life as much as possible (this can take years to do, but its worth it) and keep things simple so that the level of stress and anxiety decreases.

When it comes to stability, don't be afraid to ask for help. This can be from government organizations, your healthcare provider, as well as friends and family. There are many national and international organizations who can help point you in the right direction for assistance for many things - financial and otherwise.
Avoid being a guinea pig. New medications - prescription or alternative - which have not been tested can cause you more harm than good. New therapies or counseling by well-meaning psych students can also create havoc with your diagnosis and peace of mind. When in doubt, question, and if you don't receive answers that suit your quandary, move on. Having an open mind about your treatment does not mean that you are ready, especially in your initial diagnoses, to be tested on.

Moving Forward
Since I have always been a fan of Dune, and more than willing to be a bit ironic about 'serious subjects' as long as it is constructive; more than once I have said the Bene Gesserit litany against fear and found myself smiling through the storms. After all, anxiety isn't who or what you are, it is just a part of living which you can do without hiding, fighting, embarrassment or shame. Celebrate your strengths for weathering the storms and be a "desert creature."