Anxiety Self Test

Introduction

Anxiety disorders cause higher-than-normal feelings of stress and worry. While everyone gets anxious at times, some people feel anxiety all the time. This heart-pounding, constant stress is known as an anxiety disorder. According to the American Psychiatric Association, an estimated 30 percent of adults have had an anxiety disorder at some point in time in their lives.¹ Anxiety Disorders are highly treatable, however only about 37 percent of those suffering receive treatment.

Anxiety disorders make it difficult for a person to go about their daily life. They may not be able to go to work or school, and may have difficulty maintaining relationships with friends and family. Similar to the effects of a chronic medical illness such as asthma, diabetes, or arthritis, anxiety can also negatively impact physical health.²
Recovery from anxiety is possible with the correct supports and therapies.

Rates of Anxiety Disorders

According to the Anxiety and Depression Association of America, an estimated 40 million people, 18 percent of the population, in the United States have anxiety in any given year.³ It is also possible that a person can have more than one type of anxiety at the same time. Women are more likely than men to experience anxiety.²

Doctors have named several types of these types of disorders.¹ These include:

Generalized Anxiety Disorders: An estimated 2 percent of the population has a generalized anxiety disorder.

Panic Disorder: An estimated 2 to 3 percent of Americans have a panic disorder.

Phobia-Related Disorders: An estimated 7 to 9 percent of the population has a specific phobia disorder.

Social-Anxiety Disorder: An estimated 7 percent of the population has a social anxiety disorder.

Agoraphobia: An estimated 2 percent of people in the United States have agoraphobia.

Separation Anxiety: An estimated 1 to 2 percent of the population has separation anxiety.

Types of Anxiety Disorders

Generalized Anxiety Disorder

Generalized anxiety disorder is a condition where a person has stress and worry on more days than not. A person must experience significant stress almost every day for about six months for a doctor to consider generalized anxiety disorder.⁴

Symptoms for generalized anxiety disorder include:

Feeling on-edge most days of the week
Feeling tired all the time or getting tired very easily
Experiencing significant muscle tension
Problems sleeping, such as falling or staying asleep
Feelings of worry that they cannot shake
Problems concentrating

People with generalized anxiety disorder often have mental symptoms (like worrying and feeling stressed) as well as physical symptoms. Physical symptoms can include stomach upset, problems sleeping, and headaches.

An estimated 7.7 percent of women and 4.6 percent of men who have generalized anxiety disorder will experience the condition over the course of their lifetime, according to the American Academy of Family Physicians. People who are most likely to have generalized anxiety disorder include women, those who are unmarried, people in poor health, and those in lower income levels. On average, people present with generalized anxiety disorder at age 30.

Video: Generalized Anxiety

Panic Disorder

Panic disorder is a condition that causes a person to have panic attacks. These are periods of intense fear and anxiety that may even make a person feel like they are dying.⁴ Sometimes, a person knows why they had a panic attack (because of a trigger) while other times a person just has a panic attack for what seems like no reason.

Symptoms of a panic attack include:

Feelings of loss of breath or choking
Uncontrollable shaking
Having a sense of impending doom, like they are about to die
Having a sense of being out of control
A pounding heartbeat, like a person’s heart is beating out of their chest

Panic attacks usually last about 10 minutes and rarely last past 30 minutes.

According to the American Psychiatric Association, most people with a panic disorder start having symptoms between the ages of 22 and 23 years old.¹ Sometimes, a person may have a panic disorder if they have other medical conditions, such as depression or post-traumatic stress disorder (PTSD).

Panic attacks can make a person fear when they will have a panic attack again. Sometimes, a person with panic disorder starts to fear they will have a panic attack again so much that they stop going outside and avoid other people.

Phobia Disorders

There are several different disorders that fall into this category. Phobias are things a person is very afraid of which impact a person’s ability to function within their daily life.

Symptoms of phobia disorders include:

Fear of an object or person that is not as scary as the person thinks
Constant avoidance of social situations because of anxieties and fears
Intense and immediate anxiety upon encountering the person or thing that triggers anxiety

Some examples of phobias include:

Animals, such as dogs or snakes
Blood
Driving
Flying

Going to the doctor/dentist
Leaving home
Heights

In addition to these phobias, people can have other fears. More commonly known phobias include:

Social Anxiety

When a person has an intense fear of social situations where more than a few people are around. They may have problems in work or school environments and be afraid of normal activities, such as eating in front of people, public speaking, or meeting new people.¹

Agoraphobia

People with agoraphobia are afraid of certain situations that involve being outside or in enclosed spaces with people. Examples include using the bus or subway, standing in line with people, or being outside of their home alone. Sometimes, people with severe agoraphobia will not even go outdoors.

These are just some of the examples of phobias a person can have. A lot of times, people feel like the phobias control their life and keep them from everyday activities.

Separation Anxiety Disorder

While a lot of people think separation anxiety just affects children (like a child who does not want to leave their mother), however, adults can have it too.⁴ People who have separation anxiety are afraid of being separated from another person, such as a parent or partner. They can experience extreme fear about being separated. Sometimes, they may even have nightmares or feel sick to their stomach when they are away from the other person.

Selective Mutism

Selective mutism is a very rare condition.⁴ People with severe anxiety, especially young children, can have selective mutism. This means they have the ability to speak but does not. Those with selective mutism can appear to be very shy and clingy in public situations. Many times, a person with selective mutism has other anxiety disorders too.

Other Forms of Anxiety

There is disagreement about whether other conditions like post-traumatic stress disorder and obsessive-compulsive disorder are anxiety disorders. Some classify them as their own separate conditions.⁶ However, each of these and a lot of other mental health disorders have anxiety as one of the symptoms. Treatment can help a person cope with these and other mental illnesses.

Risk Factors for Anxiety

Some of the risk factors associated with anxiety includes a history of:

Being shy as a child
Mental illness, or anxiety disorder in close relatives, like a parent or sibling
Other mental illnesses, such as post-traumatic stress disorder, depression, or obsessive compulsive disorder
Some health conditions, like thyroid and heart rhythm disorders

There are several reasons why a person may have anxiety. They can all come together to make a person feel anxious or worried in some situations. Examples of additional risk factors include:

Hormonal changes

Teenage years and young adulthood is a time when hormones fluctuate a lot due to menstrual cycles or other age-related changes.

Genetic predisposition

Some people may be biologically predisposed to have anxiety based on their family history.

History of traumatic events

Sometimes, a person has a history of trauma that makes them fear other traumatic events. Examples include being in a military battle, experiencing a sexual assault, or having a history of physical or mental abuse.

Diagnosing Anxiety

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is the manual that doctors use to diagnose mental health conditions. When doctors use the same set of criteria to diagnose illnesses, they are more consistent in their diagnoses and treatments.

If a doctor thinks that a person may have generalized anxiety disorder, they will use the DSM-V criteria to diagnose the condition. There is no physical test, like a blood test or X-ray, that a doctor can use as diagnosis. Instead, a doctor must listen to a person’s symptoms and try to rule out other potential medical conditions before they make a diagnosis.

The criteria listed in the DSM-V for generalized anxiety disorder are:

Symptomatic for at least six months (feelings of anxiety and worry)

Difficulty controlling worries or feeling anxious – not moving past the feelings

At least three of the following six symptoms are present most days of the week: restlessness, easily tired, difficulty concentrating, irritability, muscle tension, or insomnia. If a doctor is diagnosing a child, they only need to have one symptom.

The anxiety and worry is severely affecting the ability to go about their daily life

Symptoms are not related to another medical condition or the effects of substance abuse. Doctors may try to rule out medical conditions such as an overactive thyroid or substance abuse.

Symptoms are not due to another mental health disorder, such as obsessive-compulsive disorder, an eating disorder, or a serious mental illness, such as schizophrenia.

Doctors often use “scales” to try and measure how much a person’s anxiety affects them. These scales are basically quizzes or forms that ask questions about daily life. A doctor may ask a person to rate how often they have certain thoughts or behaviors, such as “feeling nervous” or “worrying too much.” A doctor will tally up these answers to determine the severity of the condition.

Video: A Cancer of the Mind

Traditional Treatments for Anxiety Disorders

Treating anxiety disorders requires a combination of coping treatments and professional medical help. However, a lot of people who have anxiety disorders do not seek medical treatment – which can make them suffer needlessly. An estimated one-third of people with these conditions never seek treatment. ³

Professional Therapy

A lot of people with anxiety benefit from professional therapy. This treatment involves meeting one-on-one with a therapist, psychiatrist, or psychologist. Those with anxiety may not recognize some of their symptoms.⁵ They may also not recognize some of the parts of their lifestyle that are making their anxiety worse (like smoking or drinking too much caffeine). Through guidance, it’s possible to understand anxiety and how to deal with it.

Individuals should participate in psychotherapy sessions for at least eight weeks before they can decide if therapy is working well for them or not.⁵ This gives a therapist sufficient time to try to target areas a person struggling with can improve upon.

Cognitive-Behavioral Therapy (CBT)

Another common approach is cognitive-behavioral therapy or CBT.⁴ This is a therapy approach that helps patients recognize that their thinking is not helpful.

A lot of times, people with anxiety have a higher-than-normal reaction to people or things that do not cause extreme worry for others. CBT helps a person recognize that while they do feel anxiety about a certain person or place, the feeling is not rational.

After learning how to recognize triggers, a therapist teaches how to better deal with anxiety. Examples include anxiety-relieving techniques like deep breathing, meditation, or guided imagery, where you think of a pleasant place or thing to replace anxious thoughts.

Exposure Therapy

Another therapy approach for treatment is exposure therapy. This involves working with a therapist to confront fears in a safe environment. Sometimes, this requires imagining the object or person and practicing being around them without being fearful. Other times, this may involve seeing something (such as a spider) and learning how to handle the feelings that arise from being near one.

Exposure therapy is not for everyone but it is a common approach for dealing with phobias.

Mindfulness-Based Stress Reduction

Mindfulness-based stress reduction practices can help a person who is struggling with anxiety.⁵ This treatment involves teaching how to focus on the present and recognize when anxiety is coming on. Practicing mindfulness usually includes meditation to reduce stress and teach the body how to relax.

Another important part of mindfulness is to accept and acknowledge the anxiety without judgement. ⁵ When a person accepts that these feelings are part of life, it’s possible to find ways to deal with it.

Medications to Treat Anxiety

Doctors can prescribe medications for treatment, but they often are not the only treatment suggested. A lot of the time, doctors prescribe anti-anxiety medications for a short period until tools are learned to better handle the condition. Hopefully, after some time medication can be reduced or removed. Examples of these medications include:

Antidepressants

Antidepressants are medications that doctors prescribe to treat depression, but they may also treat anxiety.⁴ There are several different types of antidepressants. These include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants. Each of these can help to reduce depression, but they may take some time to work.

In a literature review of the medications that work best to treat anxiety, researchers found that the medication fluoxetine (Prozac) was one of the most effective in treating anxiety.⁷ An estimated 60 percent of people with anxiety who took Prozac stopped having anxiety symptoms.

Benzodiazepines

Benzodiazepines are medications doctors prescribe to relieve anxiety. They also prescribe them to treat seizures and insomnia. Some examples of benzodiazepines include Ativan, Xanax, and Valium. Many medications have side effects and some benzodiazepines can be addictive. That is why doctors don’t want to prescribe them for any longer than necessary.

Beta Blockers

Beta blockers are medications that doctors usually prescribe to people with heart problems. Examples of these include metoprolol, atenolol, or propranolol. These medicines keep the heart rate from getting too high and can prevent shaking. This can also help reduce anxiety levels.

Buspirone

Buspirone, also known as Buspar, is a medicine that doctors can prescribe to treat chronic anxiety.

Second-Line Medications

These are all first-line medications for treatment. This means that doctors will prescribe one of these medication classes first to treat anxiety. If they are not effective, a doctor may prescribe other medications called second-line therapies.

Examples of second-line therapies include:

Pregabalin (Lyrica):

This is a medication commonly prescribed for those who have nerve pain, fibromyalgia, or diabetes. According to the American Academy of Family Physicians, Lyrica is more effective than a placebo for treating anxiety.⁵ If a person cannot take benzodiazepines, a doctor may consider prescribing Lyrica instead.

Quetiapine (Seroquel):

This is a medication prescribed to promote sleep. However, some doctors have found that it can also reduce anxiety.

A Note on Medications

Taking medications and participating in therapy has been shown to be one of the most effective ways to treat anxiety. According to the American Academy of Family Physicians, treating anxiety with medications and therapy can reduce relapse rates for anxiety, even two years after beginning therapy.⁵

Sometimes, a person has to try several different medications before finding an effective treatment. Anti-depressants work for some people and not for others, just like benzodiazepines do not work for everyone.

Medications should be taken under a doctor’s supervision and closely monitored to maintain safety. Patients should not stop taking a medication all at once because this can have harmful side effects. Many times, phyisicans will recommend slowly cutting back on dosages until medications can be safely stopped with limited withdrawal symptoms.

Complementary Therapies for Anxiety

More treatment centers are offering and recommending complementary therapies alongside traditional treatments. Some complementary therapies that may be used to treat anxiety include:

Acupuncture

This involves a licensed practitioner placing tiny needles along pathways in the body designed to promote energy flow and promote better health.

Aromatherapy

Aromatherapy is smelling or applying certain highly concentrated oils called essential oils to the body. Examples of common essential oils include lavender, chamomile, rose, and more. Studies have found these oils may help to relieve anxiety and reduce pain in some people.

Massage

Massage involves applying soothing pressure to the muscles of the body. This is a stress-relieving practice that may also potentially help to relieve anxiety.

Music Therapy

Music therapy involves listening to or playing soothing music that can help a person refrain from thinking anxious thoughts. Music can also empower a person, helping them feel more confident.

The following are some of the supplements or natural health products people have used to help reduce anxiety:

5-hydroxytryptophan
Inositol
Kava
Lavender oil

Passionflower
St. John’s wort
Valerian
Vitamin B complex

While most of these do not usually have a lot of side effects, others can interfere with other medications. For example, St. John’s wort is a natural plant, but acts on the same serotonin receptors as a lot of anti-depressants. Taking both can produce too much serotonin in the body. This can result in a medical emergency called serotonin syndrome. St. John’s wort is also know to decrease the effectiveness of hormonal birth controls, like birth control pills.

Consult a doctor if you are considering herbs or supplements as part of your treatment program. Doctors can explain possible side effects or if the supplement is safe to take with other medications or health problems.

Preventative and Lifestyle Treatments

There are lifestyle steps a person can take to reduce anxiety. Sometimes, this involves avoiding certain behaviors and foods that can lead to anxiety. Examples include avoiding caffeine, which can cause an increase in heart rate and increased feelings of stress. Taking cough and cold medications, called decongestants, may also cause increased experiences of anxiety.

Other lifestyle treatments that can help treat anxiety include:

Exercise

Regular exercise can help relieve anxiety. Exercise releases dopamine, increasing feelings of relaxation while reducing stress. Low impact exercises like tai chi and yoga have also been shown to help decrease feelings of worry. ⁷

Meditation

Meditation is an activity where a person breathes deeply and focuses their thoughts. People who meditate report feeling greater sensations of calm and anxiety relief.

Connecting with Other People

Reaching out to supportive family and friends can help alleviate feelings of anxiety. Joining a support group for people who struggle with anxiety is also an option. If a support group does not meet nearby, online support groups are also available. Examples of online support groups include DailyStrength.org and The Tribe Wellness Community.

Sleeping Well

Anxiety can worsen after loss of sleep. Getting seven to nine hours of sleep a night can help those with anxiety feel more energetic and rested for the day. Some of the ways to promote better sleep include sleeping in a dark, cool room, refraining from looking at phones, televisions, or the internet at least one hour before bed. It’s also recommended to refrain from exercising, eating, or drinking anything with caffeine for at least two hours before bed for a good nights rest.

Nutrition

Fueling the body regularly with balanced, nutritional meals can also help address anxiety. Hunger and dehydration have been shown to decrease mood and increase feelings of stress. Complex carbohydrates like oatmeal or whole grain breads are recommended along with lots of fruits, vegetables, and fish high in omega-3 fatty acids.

These are just some of the ways to reduce anxiety at home.

Anxiety in Adolescents and Young People

Many studies suggest that anxiety can begin early in life, particularly in young adulthood.⁸ According to an article in the Journal of Clinical Child & Adolescent Psychology, anxiety is the most common mental health disorder facing children and adolescents. The journal reports that an estimated 8 percent of adolescents will experience these disorders that impair abilities to function at school and make friends.

It is crucial to provide treatment early, especially in youth since these conditions at a young age can cause greater health problems down the road. Having anxiety as a child can cause problems such as:

Development of substance use disorder
Development of additional mental health disorders, such as depression
Reduced educational achievement

Researchers who published the article in the Journal of Clinical Child & Adolescent Psychology studied all the available research on treating anxiety in young people. They found several treatment methods that were very effective in helping young people who are struggling. Examples of these treatments included:

Cognitive-behavioral therapy techniques with parent participation
Cognitive-behavioral therapy techniques with medications
Modeling behaviors, where parents, counselors, and even friends demonstrated ways to handle anxiety

The researchers also found treatments they found to be at least “moderately” effective in treating anxiety in young people. These included relaxation techniques and assertiveness training. Assertiveness training is when a therapist teaches someone how to share their thoughts and opinions without extreme fear of embarrassment. Relaxation techniques include a step-by-step process of paying attention to the way the body feels, and slowly releasing tension.

Health Effects of Anxiety

Anxiety can affect physical and mental well being. Medical conditions that can get worse or appear include:

Asthma

Asthma is a condition that affects a person’s ability to breathe well. Having an asthma attack makes a person feel anxious. Sometimes, a person gets even more anxious because they are worried they will have another asthma attack.

Irritable Bowel Syndrome

This is a medical condition that causes a person to experience symptoms such as diarrhea, bloating, gas, and constipation. Having IBS symptoms can make anxiety even worse because individuals are afraid that their symptoms will get worse in public.

Chronic Pain

Anxiety can worsen chronic pain, such as back pain, rheumatoid arthritis, migraine headaches, and fibromyalgia.

Heart Disease

The stress that comes from anxiety can worsen the demands on a person’s heart and potentially worsen heart problems. Fear of having heart problems, such as a heart attack, can also fill a person with significant stress and worry.

When to Seek Help with Anxiety

Sometimes, it is difficult to tell the difference between everyday anxiety and anxiety that requires professional help. Here are some key differences:

Everyday Stress: Worrying about paying a bill on time, a breakup, or getting a certain job.

Anxiety Disorder: Anxiety about a job prohibits applying to the job at all.

Everyday Stress: Worrying about not knowing a lot of people at a party.

Anxiety Disorder: Being so worried about being in front of people and forgo being in public to avoid possible embarrassment.

Everyday Stress: Fear of an object or animal that could be harmful – such as a snake or bear.

Anxiety Disorder: Fear of a person or place that does not pose a danger to most people – such as flying in a plane.

Everyday Stress: Feeling nervous before a big presentation or test.

Anxiety Disorder: Having a panic attack about a big presentation or test, or living in fear of a public panic attack.

If you or someone you know exhibits some of these signs, they should speak to a doctor about the possibility of treatment:

Not make decisions because of anxiety
Not wanting to go out in public or travel because of anxiety
Fear of sharing opinions because of worry and embarrassment
Exhaustion due to constant stress
Feeling alone because of anxiety
Panic attacks because of anxiety
Anxiety has lasted at least six months
Constantly seeking assurance or support because fear of decision making

Why are we treating mental health concerns any differently than an autoimmune problem, [for] which we would immediately seek help if we suspected a problem? Keep the bar low. Seek another viewpoint–there’s absolutely no harm in it.

Dr.Tracy Dennis-Tiwary

It is true that some people have anxiety from time to time. However, anxiety should not be a normal part of a person’s life. You should not have to constantly suffer from anxiety. There are many therapies and medications that can help a person overcome anxiety. With time and treatment, many people experience an improvement in their symptoms. This allows you to live life without fear of another panic attack or worry that the condition will affect physical health in the long-term.

Those struggling with anxiety should see a physician for recommendations for medications, therapy, or at-home treatments. Physical symptoms (rapid heart rate, sweating, etc.) may be due to anxiety and not necessarily an underlying medical condition. Many people seek help for physical conditions, only to find out that anxiety is causing a lot of the symptoms.

If anxiety is interfering with your ability to make it through the day, treatment is recommended. Seeking help is the first step towards overcoming constant feelings of worry and stress.

Resources

Anxiety Disorders. National Institute of Mental Health, “U.S. Department of Health and Human Services”,www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
What Are Anxiety Disorders? American Psychiatric Association, https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders.
Understand the Facts. Anxiety and Depression Association of America, ADAA, adaa.org/understanding-anxiety.
Baldwin David, Woods Robert, Lawson Richard, Taylor David. Efficacy of drug treatments for generalized anxiety disorder: systematic review and meta-analysis BMJ 2011; 342 :d1199.
Anxiety Disorders.Womenshealth.gov, 30 Jan. 2019, www.womenshealth.gov/mental-health/mental-health-conditions/anxiety-disorders.
Schlossberg, Mallory. Signs It’s Time to Get Help for Your Anxiety. Redbook, Redbook, 10 Nov. 2017, www.redbookmag.com/body/mental-health/g13445934/help-for-anxiety/.
Anxiety Disorders and Anxiety Attacks. HelpGuide.org, 18 Sept. 2019, www.helpguide.org/articles/anxiety/anxiety-disorders-and-anxiety-attacks.htm.
Charmaine K. Higa-McMillan, Sarah E. Francis, Leslie Rith-Najarian & Bruce F. Chorpita (2016)Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety. Journal of Clinical Child Adolescent Psychology,45(2)91-113,DOI:10.1080/15374416.2015.1046177
Locke, Amy, et al. “Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults.” American Family Physician, 1 May 2015, www.aafp.org/afp/2015/0501/p617.html.

Anxiety Self Test:

Are You More Than Stressed?