Anxiety is a normal emotional state or reaction to stress. It is an uncomfortable feeling of fear, apprehension, and concern. Typically, a person experiences anxiety when confronted with an important or unfamiliar event. For example, giving a public speech for the first time. Anxiety is useful in urging the individual to actively prepare for or to cope with the stress. However, when the anxiety becomes overwhelming, the person can become incapacitated and the anxiety becomes a disorder. Anxiety disorders are treatable psychiatric/psychological conditions.
In a stressful and high-paced society such as Singapore, anxiety disorders are common but many continue not to seek treatment and suffer in silence.
Anxiety Disorders include:
- Generalised Anxiety Disorder (GAD)
- Panic Disorder (with or without Agoraphobia)
- Post-traumatic Stress Disorder (PTSD)
- Obsessive Compulsive Disorder (OCD)
- Social Phobia
- Specific Phobia
- Treatment of Anxiety Disorders
Generalised Anxiety Disorder (GAD)
GAD is an anxiety disorder whereby the sufferer complains of free-floating anxiety which is excessive and difficult to control. Patients with GAD will complain of the following symptoms for more than six months:
- Constantly worrying or obsessing about small or large concerns
- Feeling restless, keyed up, or on the edge
- Fatigue and easily getting tired
- Difficulty concentrating or mind “going blank”
- Irritability and feeling frustrated
- Muscle tension or muscle aches
- Trembling, feeling twitchy, or being easily startled
- Trouble sleeping
- Sweating, nausea, or diarrhea
- Difficulty breathing or rapid heartbeat
GAD can happen in children and adults. Children may present with excessive worries about school work or Co-Curricular Activities (CCAs) or they may catastrophize about unlikely events such as tsunamis, accidents, or that a loved one may die.
Panic Disorder affects about one out of eighty people and usually starts in youth or early adulthood. Women are twice as likely to be affected. It is related to genes and can be precipitated by stressful events.
In Panic Disorder, the sufferer will have panic attacks, anticipatory anxiety, and fear of future attacks. Panic attacks typically last for 10 to 30 minutes at which time the anxiety will wax and wane. The symptoms of a panic attack are:
- Increase heart rate
- Trembling or tremors
- Shortness of breath
- Choking Feeling
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- De-realization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or going insane
- Sense of impending death
- numbness or tingling sensations
- Chills or hot flashes
The sufferer may think that he or she is having a heart attack or is going crazy. The consequent anxiety and fear further enforce the panic attack.
In more severe cases, the individual may worry about having attacks in public or in certain situations where they will be embarrassed and cannot get help. Consequently, they may get increasingly homebound and develop Agoraphobia.
Post-Traumatic Stress Disorder (PTSD)
PTSD is an anxiety disorder occurring when one is confronted with a life-threatening event or when there is a real or perceived risk of getting seriously hurt. Commonly in Singapore, people develop PTSD after road traffic accidents. In countries where there are wars, soldiers often suffer from PTSD after their tour of duty. Disasters, natural or man-made can also cause PTSD.
There are three main categories of symptoms for PTSD:
- Re-experiencing the traumatic event
- Avoiding reminders of the trauma
- Increased anxiety and emotional arousal
- recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions
- recurrent nightmares of the event
- reliving the experience including illusions, hallucinations, and dissociative flashbacks
- intense psychological distress at exposure to cues that symbolize the traumatic event
- avoiding thoughts, feelings, or conversations to do with the trauma
- avoiding activities, places, or people that arouse recollections of the trauma
- inability to recall an important aspect of the trauma
- diminished interest or participation in significant activities
- feeling detached or estranged from others
- inability to have loving feelings
- sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
Increased Arousal Symptoms
- difficulty falling or staying asleep
- irritability or outbursts of anger
- difficulty concentrating
- hyper-vigilance and exaggerated startle response
Sufferers can go on to develop depression, other anxiety problems, and substance abuse due to the difficulties they are facing.
OCD is characterized by obsessive thoughts and compulsive behaviours. Obsessive thoughts are experienced by the individual as intrusive and distressing.
Common obsessive thoughts include:
- fear of contamination by germs or dirt
- fear of harming oneself or others
- repetitive sexual or violent thoughts or images
- intrusive thoughts about symmetry and orderliness
- obsessive thoughts of checking things
- repetitive religious thoughts
As a result of the obsessive thoughts, the individual feels that he has to perform a certain act (compulsive behaviours) to undo the obsessions. These include excessive washing and cleaning and/or checking and counting. The compulsions are often performed in a ritualistic manner over a “magical” number of times.
Social Phobia / Social Anxiety
Social Anxiety is also called social phobia. It is not normal shyness. Social anxiety is characterised by persistent fear in social or performance situations where the individual is exposed to public scrutiny. The individual is worried that he may embarrass himself and be humiliated. As a result, the person with social anxiety will go to great lengths to avoid these situations. At the same time, he recognizes that his fears and anxiety are excessive.
In Singapore, social anxiety often presents in young people. They may have difficulties interacting with their peers in polytechnic, junior college, or in the armed forces when enlisted. The problem is made worse if they need to make speeches or presentations in public.
Adults may also seek help as the social anxiety may be hampering them in their daily work.
Phobias are excessive and unreasonable fears of specific objects or situations. As with other anxiety disorders, the individual will avoid these objects or situations. Common phobias involve insects, animals, heights, and flying. Phobias need not be treated if it does not affect one’s life in any way.
Treatment of Anxiety Disorders
Anxiety disorders as a group respond well to antidepressant medications. Short-term use of anxiolytic medications such as benzodiazepines may be warranted. You can read about medications in Anxiety Disorders here.
Cognitive behavioural therapy (CBT) is helpful for many anxiety disorders such as Panic Disorder, OCD, phobias, and GAD. In CBT, the catastrophic thinking of the sufferer is corrected and he or she is slowly and gradually exposed to his or her fears.
Eye-movement Movement Desensitization and Reprocessing (EMDR) is a fairly new technique that has been shown to be effective in addressing psychological trauma and PTSD. Read more about it here.