By: Pallavi Vathiar. Practicing Clinical Nutritionist, Mumbai.
An estimated 264 million people worldwide have an anxiety disorder (1).
Coronavirus (Covid-19) is impacting all our lives, and we know that the usual advice might not quite apply. Some ideas for looking after yourself may feel unrealistic right now. And some treatment and support options will be harder to access, or may be unavailable for a while. But we hope that you can still find information here that helps you understand what you’re going through, and find a path forward.
The term “anxiety disorder” refers to specific psychiatric disorders that involve extreme fear or worry.
Anxiety Disorder Includes
Generalized Anxiety Disorder (GAD)
People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work. GAD is the only anxiety disorder that is still common in people aged 50 years or more (2).
A review found that the rate of generalized anxiety disorder was significantly higher (odds ratio 3.3 (95% confidence interval 2.0 to 5.5)) in those who had been involved in civilian trauma (such as a dam collapse or toxic chemical spill). Reviews have linked the disorder with bullying (or peer victimization) (3) and an increase in the number of life events (4).
Panic Disorder and Panic Attacks
Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation. During a panic attack, people may experience: Heart palpitations, Sweating, Sensations of shortness of breath or choking, Feelings of being out of control (2).
A recent large, international, controlled study found that brief cognitive behavior therapy (six to eight hours of therapy, supplemented with hand held computers or manuals) relieved panic attacks for most patients and was as effective as longer treatments (5).
Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.
People with a phobia may have:
- An irrational or excessive worry about encountering the feared object or situation.
- Take active steps to avoid the feared object or situation.
- Experience immediate intense anxiety upon encountering the feared object or situation.
- Endure unavoidable objects and situations with intense anxiety (2).
In the treatment literature, children with natural environment phobias have been shown to have poorer treatment response than children with animal phobias (6).
There are several types of phobias and phobia-related disorders (2):
- Specific Phobias: People who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. For examples of specific phobias include the fear of: Flying, Heights, Particular animal or insect, Blood, etc.
- Social Anxiety Disorder: They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. Social anxiety disorder can occur in places such as workplace or the school environment. Family studies of individuals with social anxiety disorder show a higher incidence of the disorder than that found in the general population (7).
- Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or being in a crowd
- Being outside of the home alone
People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. A study found that, the driving and public transportation group patients showed a higher incidence of co-morbid agoraphobia than the other groups. Additionally, for panic disorder patients with co-morbid agoraphobia, the at-home group had a higher frequency of fear of dying compared to the patients in the outside-of-home group and felt more severe distress elicited by their FPA (First Panic Attack) (8).
Separation Anxiety Disorder (SAD)
Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder.
People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs (2).
SAD was a strong (78.6%) risk factor for the development of mental disorders during young adulthood. The major vulnerabilities were for panic disorder and depression (9).
Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums (2).
Obsessive Compulsive Disorder (OCD) and post traumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time as depression.
Obsessive Compulsive Disorder (OCD)
People with OCD experiences obsessions and compulsions. Obsessions are intrusive and unwanted thoughts, images, or urge that cause distress or anxiety.
Compulsions are behaviors that the person feels compelled to perform in order to ease their distress or anxiety or suppress the thoughts. Some of these behaviors are visible actions while others are mental behaviors.
Common obsessions include concerns about contamination, cleanliness, aggressive impulses, or the need for symmetry.
Common compulsions include checking, washing/cleaning, and arranging. There isn’t always a logical connection between obsessions and compulsions (10).
Kamath et al. examined suicidal behavior in 100 consecutive Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV OCD patients; 59% had ‘worst ever’ (lifetime) suicidal ideation and 28% had current suicidal ideation. History of suicidal attempt was reported in 27% of the subjects. Major depression, unmarried status and hopelessness were the major risk factors for suicidal behavior (11).
Post Traumatic Stress Disorder (PTSD)
is a serious potentially debilitating condition that can occur in people who have experienced or witnessed a natural disaster, serious accident, terrorist incident, sudden death of a loved one, war, violent personal assault such as rape, or other life-threatening events. people with PTSD continue to be severely depressed and anxious for months or even years following the event. Trauma survivors who have PTSD may have trouble with their close family relationships or friendships. Their symptoms can cause problems with trust, closeness, communication, and problem solving, which may affect the way the survivor acts with others. In turn, the way a loved one responds to him or her affects the trauma survivor (12).
Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although the risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include:
- Temperamental traits of shyness or behavioral inhibition in childhood
- Exposure to stressful and negative life or environmental events in early childhood or adulthood
- A history of anxiety or other mental illnesses in biological relatives
- Some physical health conditions, such as thyroid problems or heart arrhythmia, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms; a physical health examination is helpful in the evaluation of a possible anxiety disorder (2).
Anxiety Management Strategies
There are a range of strategies you can try to manage your anxiety. What works is different for everyone, and it can take time to find the strategies that work best for you. But remember, if your anxiety is proving difficult to manage seek support from a professional.
- Slow Breathing: Count to three as you breathe in slowly – then count to three as you breathe out slowly.
- Progressive Muscle Relaxation: Close your eyes and slowly tense and then relax each of your muscle groups from your toes to your head. Hold the tension for three seconds and then release quickly.
- Stay In The Present Moment: Try to bring yourself back to where you are. Practicing meditation can help.
- Healthy Lifestyle: Keeping active, eating well, going out into nature, spending time with family and friends, reducing stress and do the activities you enjoy.
- Take Small Acts Of Bravery: Try approaching something that makes you anxious – even in a small way, you’ll be able to cope with it.
- Challenge Your Self Talk: Try to think of different interpretations to a situation that’s making you anxious, rather than jumping to the worst-case scenario.
- Plan Worry Time: Even 10 minutes each evening to write them down or go over them in your head can help stop your worries from taking over at other times.
- Get To Know Your Anxiety: Keep a diary of when it’s at it’s best – and worst and proactively manage your anxiety.
- Learn From Others: Talking with others who also experience anxiety – or are going through something similar – can help you feel less alone.
- Be Kind To Yourself: Remember that you are not your anxiety. You are not weak. You are not inferior. You have a mental health condition. It’s called anxiety (13).