The Nature of Anxiety

A question that many of us often ask ourselves is, "Do I suffer from an anxiety disorder?" This is a very difficult question for us to answer, and it is also very difficult for any professional to answer, for that matter. This article will be a guide that instructs an individual on how anxiety exists and how to identify when one should seek treatment for anxiety. Any competent mental health professional would tell you that any mental health condition exists on a continuum. What is a continuum? Here is a graphic representation of a continuum (my apologies but this website does not allow upload of graphics, you will have to research this on your own):

What this continuum represents is the complete possible range of degrees of intensity of the mental condition. Persons with very mild anxiety conditions will be found more on the left side of the continuum, and this would include people who suffer from no anxiety at all. Persons with increasingly severe anxious conditions will fall father on the right side of the continuum. The arrows on either end represent the belief that anxiety, or any other mental condition, can continue on into infinity in terms of increasing severity, when speaking of the right side of the continuum; or, anxiety can continue on into infinity in decreasing severity, when speaking of the left side of the continuum. Personally, I believe a person can only be so anxious or so non-anxious, so I would argue against the idea of mental conditions continuing into infinity, but that is a topic to address at a different time.

What a professional is trying to do when speaking with a client is determine where on the continuum the client falls. Not all professionals are aware that they are trying to do this, but it is in fact what they are trying to do. The general belief among professionals is that there is a certain "cutoff" point where they believe that individuals that fall to the right side of the cutoff point are individuals who are in need of help, while individuals who fall to the left of the cutoff point are individuals who are not in need of help.

So, a professional is asking the client questions and administering standardized measurement tools to try to determine where on the continuum the client lies and what level of help the client needs. As stated before, professionals are not necessarily aware that this is what they are doing, but in fact, they are trying to determine if the condition is severe enough to warrant treatment, and if so, what kinds of treatment may be appropriate. Personally, I have never heard of anyone being refused treatment, but I have heard of professionals saying that a person does not suffer from a condition and that the person will be just fine. The real problem with the cutoff point is that nobody knows where it should be. Should the cutoff be farther to the left so that it includes many people who have struggles with anxiety, but not necessarily severe anxiety? Should it be all the way to the left so that everyone who wants to can receive treatment? Or, should the cutoff point remain where it is on the graphic, so that only the most severe and profound cases are treated, thus excluding those who are nonetheless hampered by the condition, but not enough so to warrant treatment? The real truth of the whole matter is that nobody knows where the cutoff point should be, or how to place people properly on the continuum in order to determine what kind of treatment might be appropriate. Placing people on the continuum properly is a very difficult task and requires excellent professional judgment and a high level of personal skill in managing anxiety. It is a talent to be mastered, just like anything else. Some are better at this than others, and often times, mistakes are made by even the best of professionals.

In the following paragraphs, I will demonstrate how I personally view anxiety management. My personal view is that those affected by anxiety conditions fall into three different ranges: mild, moderate, and severe.

Those in the Mild Anxiety Level range are persons who can interact and perform the daily tasks their society requires with little interference from anxiety. They may experience some anxious symptoms such as sweatiness of palms, slight shaking, and perhaps some anxious thinking. But, they know how to manage these symptoms, and can get back on their feet without much outside support. People in this range can hold down a job, have mostly successful interpersonal relationships, and feel happy and confident most of the time.

Those in the Moderate Anxiety Level range can have some difficulty with anxiety. They may experience more severe episodes of anxiety. Some nights these persons may lose sleep because of anxious worry; they may spend several hours fretting with anxiety, and also might find themselves significantly impaired in routine situations. Holding down a job may at times prove difficult. Persons in this range may not have many successful interpersonal relationships and are often too afraid to take risks and reach out to other people. But, even though anxiety can cause significant difficulties at times, these people are able to carry out basic functions required by society, although it can be somewhat miserable.

Finally, those in the Severe Anxiety Level rangeare in almost a constant crisis state. People in this range experience significant anxiety on almost a constant basis and have little, if any, idea of how to manage it; many have given up hope of a better life altogether and have resigned themselves to a miserable existence. Persons in this category experience severe symptoms often throughout the day; they may pace around at home filled with worry for hours on end; leaving home at all may be a terrifying thought. Routine tasks like signing one's name on a check in front of a cashier or asking a clerk for help are horrifying thoughts for this individual. Persons in this category will often be found to be co-morbid (co-morbid means that a person suffers from two or more mental-health impairing conditions at the same time). For example, many who suffer from severe anxiety also suffer from alcoholism or drug addiction. Often, persons in this category are barely hanging on to life by a thread and may have given up on life completely, and may possibly be contemplating suicide.

The previous three paragraphs are meant to give the reader a basic understanding of how I believe anxiety exists. Persons do not fall neatly into any one category, and the experiences of individuals in the different ranges are different based upon the condition with which they are afflicted (e.g. severe social anxiety has different symptoms and effects than severe obsessive-compulsive disorder).

As noted before, professionals are trying to discern how severe one's condition is in order to determine what treatment is appropriate. The first problem is that in regard to most conditions, and I imagine often times with anxiety too, professionals only treat those falling in the Severe range, and push those in the less severe ranges out the door, citing the fact that there are "others who are worse off." However, a good counselor is willing to help anyone who desires it, be it someone who wants to progress from the Severe range to the Moderate range, or someone who wants to progress from the Moderate range to the Mild range. The next problem for professionals is determining roughly how severe a person's condition is. They will ask questions and provide a standardized measurement tool of some sort (typically they give the client a questionnaire), and based upon that and professional judgment, the professional makes recommendations. In my personal experience, when I first sought medication for anxiety, I was labeled as having an "average" anxiety level, yet I knew that anxiety impacted my life in ways that were holding me back from the life I wanted to live. I had to provide the doctor with personal experiences that do not affect the typical person in order to convince him that medication would be beneficial for me. My personal opinion is that it takes several weeks, if not a couple months, to fully assess exactly how severely one's life is affected by anxiety. However, another issue that arises is that there are not enough professionals available to serve all those with anxiety struggles (this is the case for almost every other mental health disorder as well). In other words, the supply is not great enough to meet the demand, which explains why it costs $100 or more an hour to see any professional (counselor, psychiatrist, doctor, or therapist).

The final problem that arises is how to tell the difference between persons in different ranges. For example, imagine a client who is significantly impacted by anxiety, but is not quite severe enough for professionals ro proscribe some sort of treatment.

How is a professional supposed to be able to read the anxiety level of the client as being in the Moderate range as opposed to the Severe range? Practically, it does not make much of a difference because either way, the person needs help. But, in the real world, this would mean that certain people who are really in the Severe range may be subject to a professional mistakenly placing them in the Moderate range, and as a result, that person may not receive the help they need from the system. In a layperson's experience, this could mean that medication may not be recommended or other treatment may be withheld because the professional believes the anxiety condition to be less severe than it actually is.

This article is very dense, but I am attempting to communicate how I believe the analysis of anxiety works. The bottom line to take away from this article is that professionals are doing their best to help people improve their lives, but professionals make mistakes too. The important thing to remember is that you are the expert on yourself. If something is causing difficulties but a professional insists that no problem exists, clients have every right to fire the professional they are seeing! Many more professionals exist, and if one is blocking progress rather than enhancing it, the road--blocking professional must be removed. This can be difficult because sometimes one can run into several unhelpful professionals in a row, making it seem as though no one cares or is able to treat the condition affecting one's life. However, in every profession there are helpful people and unhelpful people, and it is simply a matter of time until a person finds the right professional to help. Just remember one of the golden rules of mental health: you are the expert on yourself; follow your gut. If your anxiety level is bothering you, go out there and find the help you need because someone is out there who will help you!

Dan Stelter

Anxiety Support Network Site Administrator and Lead Author
www.anxietysupportnetwork.com
Copyright ©2008.
All rights reserved.
The article and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright 
holder's express written permission.  However, this article may be downloaded, printed, or e-mailed for individual use.  
For permission to redistribute this article please contact the author at:  danstelter@gmail.com