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Anxiety

Introduction

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.

Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam or having a medical test or job interview. During times like these, feeling anxious can be perfectly normal.

However, some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily life.

Anxiety is the main symptom of several conditions, including panic disorder, phobias, post-traumatic stress disorder and social anxiety disorder (social phobia).

However, the information in this section is about a specific condition called generalised anxiety disorder (GAD).

Generalised anxiety disorder (GAD)

GAD is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event.

People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include feeling restless or worried and having trouble concentrating or sleeping.

 

Symptoms of generalised anxiety disorder

Generalised anxiety disorder (GAD) can affect you both physically and mentally.

How severe the symptoms are varies from person to person. Some people have only one or two symptoms, while others have many more.

You should see your GP if anxiety is affecting your daily life or is causing you distress.

Psychological symptoms of GAD

GAD can cause a change in your behaviour and the way you think and feel about things, resulting in symptoms such as:

  • restlessness
  • a sense of dread
  • feeling constantly “on edge”
  • difficulty concentrating
  • irritability

Your symptoms may cause you to withdraw from social contact (seeing your family and friends) to avoid feelings of worry and dread.

You may also find going to work difficult and stressful and may take time off sick. These actions can make you worry even more about yourself and increase your lack of self-esteem.

Physical symptoms of GAD

GAD can also have a number of physical symptoms, including:

  • dizziness
  • tiredness
  • a noticeably strong, fast or irregular heartbeat (palpitations)
  • muscle aches and tension
  • trembling or shaking
  • dry mouth
  • excessive sweating
  • shortness of breath
  • stomach ache
  • feeling sick
  • headache
  • pins and needles
  • difficulty falling or staying asleep (insomnia)

Anxiety triggers

If you are anxious as a result of a specific phobia or because of panic disorder, you will usually know what the cause is. For example, if you have claustrophobia (a fear of enclosed spaces), you know that being confined in a small space will trigger your anxiety.

However, if you have GAD, it may not always be clear what you are feeling anxious about. Not knowing what triggers your anxiety can intensify it and you may start to worry that there will be no solution.

When to see your GP

Although feelings of anxiety at certain times are completely normal, you should see your GP if anxiety is affecting your daily life or is causing you distress.

Your GP will ask you about your symptoms and your worries, fears and emotions to try to find out if you could have GAD.

 

Diagnosing generalised anxiety disorder

See your GP if anxiety is affecting your daily life or is causing you distress.

Generalised anxiety disorder (GAD) can be difficult to diagnose. In some cases, it can also be difficult to distinguish from other mental health conditions, such as depression.

Talking to your GP about anxiety

Your GP may ask you questions about your worries, fears and emotions. They may also ask about your personal life. Tell your GP about all your symptoms – physical and psychological – and explain how long you have had them for.

You may find it difficult to talk about your feelings, emotions and personal life. However, it is important that your GP understands your symptoms and circumstances so that the correct diagnosis can be made.

You are most likely to be diagnosed with GAD if you have had the symptoms for six months or more. Finding it difficult to manage your feelings of anxiety is also an indication that you may have the condition.

To help with the diagnosis, your GP may carry out a physical examination or blood tests to rule out other conditions that may be causing your symptoms, such as anaemia (a deficiency in ironor vitamin B12 and folate) or an overactive thyroid gland (hyperthyroidism).

Do you have GAD?

You may have generalised anxiety disorder if:

  • your worrying significantly affects your daily life, including your job and social life
  • your worries are extremely stressful and upsetting
  • you worry about all sorts of things and have a tendency to think the worst
  • your worrying is uncontrollable
  • you have felt worried nearly every day for at least six months

What causes GAD?

The exact cause of GAD is not fully understood, although it’s likely that a combination of several factors plays a role. Research has suggested these may include:

  • overactivity in areas of the brain involved in emotions and behaviour
  • an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
  • the genes you inherit from your parents – you’re estimated to be five times more likely to develop GAD if you have a close relative with the condition
  • having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying
  • having a painful long-term health condition, such as arthritis
  • having a history of drug or alcohol misuse

However, many people develop GAD for no apparent reason.

Who is affected?

GAD is a common condition estimated to affect about 1 in every 25 people in the UK.

Slightly more women are affected than men, and the condition is more common in people between the ages of 35 and 55.

How GAD is treated

GAD can have a significant effect on your daily life, but several different treatments are available that can help ease your symptoms. These include:

  • psychological therapy
  •  medication – such as a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs)

There are also many things you can do yourself to help reduce your anxiety, such as going on a self-help course, exercising regularly and cutting down on the amount of alcohol and caffeine you drink.

With treatment, many people are able to control their levels of anxiety. However, some treatments may need to be continued for a long time and there may be periods where your symptoms worsen.

 

Social anxiety disorder (social phobia)

Introduction

Social anxiety disorder (social phobia) is a persistent fear about social situations and being around people. It’s one of the most common anxiety disorders.

Much more than just “shyness”, social anxiety disorder causes intense, overwhelming fear over what may just be an everyday activity like shopping or speaking on the phone. People affected by it may fear doing or saying something they think will be humiliating.

Social anxiety disorder disrupts normal life, interfering with social relationships and quality of life, and impairing performance at work or school.

It’s generally more common in women than men and often starts in adolescence, or sometimes as early as childhood.

If you think you may have social anxiety disorder, don’t be afraid to see your GP. It is a recognised condition that can be effectively treated.

What are the signs of social anxiety disorder?

A child with social anxiety disorder may cry a lot, freeze, or have tantrums. They may fear going to school and participating in class and school performances.

Teens and adults with social anxiety disorder may:

  • dread everyday activities such as:
    • meeting strangers
    • talking in groups or starting conversations
    • speaking on the telephone
    • talking to authority figures
    • working
    • eating or drinking with company
    • going shopping
  • have low self-esteem and feel insecure about their relationships
  • fear being criticised
  • avoid eye-to-eye contact
  • misuse drugs or alcohol to try to reduce their anxiety

They may just fear one particular situation, such as speaking on the phone, or all social situations.

Panic attacks

Sometimes, the fear and anxiety of a social situation can build up to a panic attack, a period of usually just a few minutes when the person feels an overwhelming sense of fear, apprehension and anxiety.

There may be physical symptoms too, such as feeling sick, sweating, trembling and having heart palpitations.

These feelings reach a peak and then pass rapidly. They are alarming but cannot cause any physical harm.

Learn how to deal with panic attacks.

Other mental health problems

Many people with social anxiety disorder will also have another mental health problem, such as depression, generalised anxiety disorder, panic disorder and/or post-traumatic stress disorder.

Some people may have a substance or alcohol misuse problem, as they use drugs or alcohol as a way of coping with their anxiety.

We don’t really know what causes social anxiety disorder, but it is likely to involve a combination of factors. Genes may play a role.

Also, the behaviour of parents may have an influence on whether their child will develop social anxiety disorder. According to Anxiety UK, people with the disorder have described their parents as:

  • overprotective
  • not affectionate enough
  • constantly criticising them and worrying they may do something wrong
  • overemphasising the importance of manners and grooming
  • exaggerating the danger of approaching strangers

Getting help

If you think you may have social anxiety disorder, don’t be afraid to see your GP for help.

They’ll make it as easy as possible for you to have a consultation with them. You might be offered an assessment over the phone if you find that easier, or an appointment at a time when the surgery is less crowded or busy, before or after normal hours.

If your anxiety is severe, or you’d like your child to be assessed, your GP may be able to visit you at home.

Getting a diagnosis

Your doctor may ask you some questions from a diagnostic questionnaire, such as the Social Phobia Inventory, Social Phobia Scale or Social Interaction Anxiety Scale. These give a score that indicates your level of anxiety in social situations (there are similar scales designed for use on children).

The sorts of questions your GP might ask you are:

  • do you/does your child tend to avoid social places or activities?
  • do you/does your child get scared about doing things with other people, like talking, eating and going to parties?
  • do you/does your child find it difficult to do things when others are watching?

Your GP will want to rule out other possible causes of your fear, such as generalised anxiety disorder or agoraphobia (a fear of being in situations where escape might be difficult, or where help wouldn’t be available if things go wrong).

Learn more about phobias.

They’ll also want to explore whether you have any other problems that would need to be treated separately, such as depression or a drugs or alcohol problem.

Read about the treatment of depression, treatment of drug misuse andtreatment of alcohol misuse.

Treating social anxiety disorder in adults

Counselling

Generally, it works by helping you identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to change your behaviour and replace unhelpful beliefs with more realistic and balanced ones.

You can be taught new skills that helps you understand how to react more positively to situations that would usually cause you anxiety.

Your therapy sessions may include education about social anxiety, and   feedback to correct distorted views of yourself, and behavioural exercises and experiments.

 

Psychotherapy

If all of the above interventions are not right for you, for whatever reason, you may be offered interpersonal psychotherapy or short-term psychotherapy specifically designed for social anxiety disorder.

Psychotherapy generally involves talking to a trained therapist either one-to-one, in a group, or with your wife, husband or partner. It allows you to look deeper into your problems and worries and deal with troublesome habits and a wide range of mental disorders.

Interpersonal psychotherapy aims to link social anxiety to relationship problem areas and address these. You’ll probably be offered 16-20 sessions over four to five months.

Short-term psychotherapy for social anxiety disorder aims to improve your social skills, among other things, and encourage you to face feared social situations outside therapy sessions. It is normally 25-30 sessions over six to eight months.

Antidepressants

Some people may benefit from trying a type of antidepressant medication, usually an SSRI (selective serotonin reuptake inhibitor), either instead of or in combination with individual CBT.

SSRIs increase the level of a chemical called serotonin in your brain. They can be taken on a long-term basis.

As with all antidepressants, SSRIs can take several weeks to start working. You will usually be started on a low dose, which will gradually be increased as your body adjusts to the medicine.

You will probably be offered escitalopram or sertraline, and should initially see your GP every few weeks to check your progress and see if you are responding well to it.

Common side effects of SSRIs include:

  • nausea (feeling sick)
  • low sex drive
  • blurred vision
  • diarrhoea or constipation
  • dizziness
  • dry mouth
  • loss of appetite
  • sweating
  • feeling agitated
  • insomnia (problems sleeping)

When you and your GP decide that it is appropriate for you to stop taking your SSRI medication, you will gradually be weaned off it by slowly reducing your dose. Only stop taking medication when your GP specifically advises you to.

Treating social anxiety disorder in children

The psychological therapies offered to adults outlined above should also be considered for children aged 15 and older.

Group-based CBT can be offered for children and young people aged seven and older. Group sessions aim to gradually expose affected children to feared or avoided social situations, and train them in social skills. There may be eight to 12 sessions, each 90 minutes long.

For younger children, parent-driven CBT is more appropriate. Parents are trained to use CBT-based materials with their children, such as books designed to treat their child’s anxiety problem.

 

 

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