One of the things I get asked a lot is, "How do I know when _______________ is a problem that I need help with?" The short answer is, "when it interferes with living your life," but sometimes that's not a whole lot of help. With anxiety, there are so many types and so many symptoms that it can be hard to know when it crosses that line. Anxiety can be kind of like depression in that regard, because it can sneak up on you and suck you in without your realizing it's becoming a problem.
First, let me say that in this post when I talk about "anxiety" I'm talking about a general sort of anxiety. Clinically speaking, "anxiety disorders" are a whole category of things that include PTSD, agoraphobia, phobias including social phobia, and panic disorders. Obviously, a lot of these specific conditions have symptoms that are going to overlap with a more generalized form of anxiety.
Everybody experiences anxiety - it's a fact of human life. Anxiety is generally a protective thing - it warns us when something might be unsafe or unhealthy for us. When anxiety is ongoing, though, and severe and NOT related to any realistic danger or situation, it gets in the way of living.
Clinically, we call this "Generalized Anxiety Disorder" (or GAD), and the criteria for diagnosing it are:
- Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities (like work or school performance)
- The person finds it difficult to control the worry
- The worry and anxiety are associated with 3 or more of the following 6 symptoms, with some occurring more days than not
- Restlessness or feeling "keyed up" or "on edge"
- Being easily fatigued
- Difficulty concentrating or or mind "going blank"
- Muscle tension
- Sleep disturbances
The anxiety or worry is not limited to another disorder (in other words, it's not anxiety about being depressed, an eating disorder, or a specific phobia or any other disorder). The anxiety also has to be separate from any anxiety that someone might feel with PTSD (PTSD would be the diagnosis in that case).
The anxiety, worry or physical symptoms cause "clinically significant distress" or impairs the person's ability to function in everyday life.
Finally, the anxiety or worry is not related to a medical condition or the effects of substance use or abuse.
Ok, as you can see, that's quite a list. If you think about it, 6 months is a long time to deal with anxiety on that level - and many people do, and deal with it longer even because they don't want to look foolish seeing their doctor about it. I'm going to tell you - it's not foolish, and it helps.
So you know now how to tell when we clinicians consider anxiety to be a diagnosable problem - does it have to be clinically diagnosable to be causing impairment? NO. If you're feeling severe anxiety that doesn't go away - even if it IS related to another disorder or medical condition, I recommend seeing your doctor. It's tough to live with. A lot of people who are diagnosed with generalized anxiety disorder say that they've felt this way all their lives, and it does tend to run in families.
So what does it feel like? Well, not being able to sleep - get to sleep, stay asleep, get good sleep - leaves you feeling irritated, edgy, exhausted. Irritated more on top of it - some people describe the feeling like "a sinking feeling in the pit of their stomach," "always waiting for the other shoe to fall," "a sense of impending doom," or "like I swallowed a ball of barbed wire that's just sitting there." You can't focus - it may feel like your mind is jumping all over, or that you're "thinking through mud." You may feel like you can't escape your worries, or can't get away from the anxiety. It's NOT comfortable, and it CAN be helped.
So what works? Well...I know some of you aren't going to like to hear this, but there are medications that can help. There are some medications that help short term, but can be addictive - these are probably best used temporarily. There are some antidepressants that help as well. Getting some good therapy can also help - talking over some of the issues and learning good coping skills helps. When I work with clients I use an analogy that seems helpful - the house with the cracked foundation. Medication is like shoring up the house, and therapy helps you go in and fix it so that you can cope better when you stop the medication.
The bottom line is that if anxiety if interfering with your life, there is something you can do - you don't have to suffer. It's not showing weakness and you're not crazy if you go to get help. You're very, very sane in my opinion - it takes strength and courage to get help, and chances are you'll feel better for having done so.
Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.
If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: firstname.lastname@example.org