General anxiety disorder

Introduction

Most people diagnosed with general anxiety disorder are always surprised at their diagnosis. It is precisely those people who always appear to be calm and collected who may suffer from anxiety.

Nevertheless, more than half of my practice consists of people with general anxiety disorder.

What is general anxiety disorder?

General anxiety disorder is characterised by chronic stress, present for at least six months, however not always accompanied by associated panic attacks, phobias, or obsessions. You simply experience constant stress and/or worry.

To be diagnosed with anxiety disorder, your anxiety and worries must focus on two or more stressful functioning areas (such as finances, relationships, health, work, or school performance) for most days in a six-month period. It is common that when you have a general anxiety disorder, you have a lot of worries and you spend a lot of time focusing and controlling these worries. More than that, the intensity and frequency of the worries are always out of proportion with the possibility that these things will really happen.

Diagnostic criteria of general anxiety disorder according to the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders Edition 5): 

Excessive anxiety and concern (expecting the worst) over several events or activities for at least 6 months.  You may also find it difficult to control your anxiety. The anxiety and concerns are associated with three (or more) of the six symptoms listed below:

• Restlessness or feeling upset or on edge;
• Easily fatigued;
• Problems concentrating or your mind just going blank;
• Irritability;
• Muscle tension;
• Sleep disturbance (difficulty falling asleep, staying asleep, or restless unsatisfactory sleep).

You may find it difficult to relax. You feel restless throughout the day. You may find it difficult to watch a show on television without wanting to jump up to do something else. By the afternoon, you may already be exhausted and feel sleepy. You may start reading a magazine for example, to realise after the first or second paragraph that you have no idea what this article is about.

It might just be anxiety. You feel easily irritated and especially noise may frustrate you endlessly. You may experience muscle tension, especially in your shoulders and neck. You may think it is because you are all day in front of your computer, but it is not. Finally, you may be an insomniac. In short, you are known as a control freak. You are probably only suffering from a general anxiety disorder.

Your anxiety, worries, or even physical symptoms cause a clinically significant problem in your social, occupational, or other important areas of functioning.

How general anxiety disorder works

In our general language, a general anxiety disorder is known as stress. However, strictly psychologically speaking, there is no such a term as stress. This is general anxiety.

It’s usually not your circumstances that cause stress or anxiety, but how you think about them. This thought always begins with: What if…? What if that happens? Or What if I do this or not do that?

As a child, I had a dog. This dog especially hated cats. One day my dog pinned a cat in a corner. What my poor dog did not realise was that this cat was a Siamese cat.

As Bobbel cornered the cat, it started to hiss, arched its back, tensed its muscles, hair rose, and exposed its claws.  Although the cat seemed angry, the cat was, in fact, frightened and in survival mode. 

The next moment the cat stormed Bobbel, hit him on the nose, causing blood to splatter everywhere, and with the minimum effort jumped over the wall.  A wall higher than I ever thought a cat could leap over.

What happened here? In nature, an animal, when in trouble, secretes adrenaline and nor-adrenaline to enable it to fight or flee. Hence the so-called fight-or-flight response. The animal’s heartbeat increases, muscles tighten, and breathing becomes faster and flatter to enable it to fight harder or run faster. When the danger is over, the animal goes to sleep to rebuild its adrenaline levels.

There are certain similarities and differences between us and animals. The similarity is that we share more or less the same central nervous system with animals. When we feel we are in danger, we produce adrenaline and nor-adrenaline, just like the cat to avoid the danger by fighting or running away without necessarily thinking.

If a taxi swerved in front of you, your cerebellum and brain stem (that’s the part of your brain focused on survival), as well as your small brain, also known as your reptile brain, would kick in. You’re not going to use your neocortex (that part of your brain that has to do with logical thinking, language, and logic) during this event. You are not going to think: a) should I swerve? b) should I brake, or c?) Could there be an alternative option? It’s as if your instincts kick in – you do not think – you just act. And nine out of ten times, you have made the right decision.

The similarity between us and animals is that our primitive brain would do the right thing to avoid the accident, almost as if we would go on auto pilot and instinctively just act.

There are, however, also important differences between us and animals. We can’t always respond to the instincts of our primitive brain.

As a human being, we can’t always use our adrenaline like an animal does. We can’t beat up that difficult colleague at work or run away from the receiver of revenue. Thus, that adrenaline remains trapped in our body leading to anxiety. Adrenaline is generated but not used. 

There is also another difference between humans and animals. We might sometimes perceive an experience as a threat because of our irrational perception of it. When we perceive a threat, we use our primitive brain as if there is a real physical threat. Our body receives the message that there is danger and starts secreting adrenaline for the fight or flight response.

Such thinking usually starts with what if? I call anxiety the what if disease. We torture ourselves with questions about possible catastrophic consequences. Most of our fears never happen anyway!  Your primitive brain does not understand that it’s just your imagination. This part is just too primitive, and does not understand language, timespan, or logic. That part thinks what if your thinking is real, actually happening now, and then prepares itself for the response to the perceived thread.

Keeping the symptoms of anxiety as described above in mind, it makes sense that you may become restless, easily exhausted, experiencing concentration problems, irritated, muscular tension, or having difficulty sleeping. Your body is constantly alert and ready for danger, which is only your imagination. No person can relax, concentrate or sleep when the proverbial Bobbel pinches you in a corner. You are often tired because your adrenaline is depleted. Sleep helps you rebuild that adrenaline and you may even struggle to sleep as well. It will, in itself not be of much help with your concentration and memory.

You may also experience the following:

People suffering from general anxiety disorder may experience some of the following:

• A so-called nervous breakdown

It might be a good idea for you to know that there is no such thing as a nervous breakdown. A so-called nervous breakdown might just be a severe anxiety or panic attack.

• Anxiety and panic attacks

Please visit my website jorganharris.co.za. Click on Therapy, and click on Anxiety and Panic attacks for the symptoms and an in-depth discussion.

These attacks do cause you to feel the most terrifying symptoms. During such an attack, it might feel as if:

1. you’re going crazy (though it feels like that);
2. you are getting a heart attack
3. you are getting an asthma attack;
4. you are busy dying;
5. you are busy getting a stroke;
6. you are having a life-threatening disease that doctors can’t detect.

The truth is, that it is just an anxiety or a panic attack.  Not one of these feelings mentioned above will ever happen during such an attack.

• Fear of early dementia, such as Alzheimer’s disease

Since lack of concentration is a well-known symptom of anxiety, the lack of concentration leads to a loss of memory, especially short-term.  If you can’t concentrate, you can’t remember. 

Many people who struggle with anxiety confuse their anxiety with dementia, as they have difficulty remembering. 

However, there is a misconception that Alzheimer’s disease is a memory problem. This is not necessarily true. There are more differences between General anxiety and Alzheimer’s disease. Alzheimer’s disease is characterised by the following:

– apathy – lack of motivation and drive;

-affective dysregulation – especially mood changes, anxiety and depression;

-lack of impulse control – they also become difficult and rigid;

-socially inappropriate actions – they struggle to adhere to social norms;

-abnormal perceptions or thoughts – such as their suspicion in other people’s motives.

• Confusion with ADD (attention deficit disorder) and ADHD (attention deficit hyperactivity disorder)

Anxiety and ADD/ADHD can be confused with each other.  Two classical symptoms of anxiety – restlessness and lack of concentration overlap with the symptoms of ADD/ADHD.  For this reason, the two diagnoses can easily be confused with each other.

There are currents in psychiatry that deny the existence of ADD/ADHD and argue that it is simply anxiety, with good evidence as well.  There are also other currents that argue that there is indeed such a thing as ADD/ADHD, also with good evidence.  I tend to agree with the first point of view, as too many people are misdiagnosed with ADD/DHD while only having anxiety.

• Obsessive Compulsive Disorder (OCD)

Although it is true that there exists something like an OCD personality disorder – most OCD is just the result of anxiety. You may experience one or more of the following:

1. OCD of checking

You may want to check over and over again that your doors are locked or that the kettle is switched off, etc.

2. OCD of washing

You may bath or wash your hands excessively.

3. OCD of counting

You may want to count everything around you, and you may develop an obsession that all your numbers must come down to a certain number.

4. OCD of perfection

Everything must be perfect at all costs. Paintings must hang perfectly. Everything should be perfect in their place. Of course, that fear of failure makes you work so hard to be perfect.

5. OCD of hoarding

You can’t throw away anything. You keep on hoarding stuff you don’t need. 

• Anger

We are not interested in so-called anger management in this practice. Why should you manage your anger if you can just get rid of it? You do not have to handle nor manage it.

One might think the cat in our story was angry. However, that was not the case.  The cat was just ready for possible danger waiting for him. Your anger may just be the result of suppressed anxiety.  Someone once said that your anger is your hidden sadness. We would rather try to work through your subconscious sadness than focus on anger.

People with anxiety are also likely to suppress their anger. It is literally like a large cement block placed over your volcano of anger. This cement block is known as a psychological defence mechanism. The volcano is pushing up and the defence mechanisms are pushing down and this tension between the two is what anxiety looks like.

Another metaphor is that you are like a pressure cooker. Someone angers you and it’s like pressure pumped into the cooker, but you can handle (contain) it. As more pressure builds, you manage and contain it.  Eventually, the cooker becomes pressurised and on edge. 

Then, one day something small might happen and you totally lose it – you literally blow your top and explode. People might then react, saying: it’s just a little thing that happened, why do you overreact so much? Certainly, it wasn’t just this one small incident that caused the cooker to explode, but rather the accumulated pressure that led to its explosion.

• Alcohol abuse and addictions

Alcohol, marijuana, or any drugs do curb anxiety. Alcohol is indeed a fantastic cure for anxiety. Just a pity that it is only a short-term cure with too many side effects.  People with anxiety may tend to ab-use substances. You may not be an alcoholic (now known as someone with an alcohol use disorder), but you may drink too much. Your excessive intake of alcohol may decrease when you overcome your anxiety, not needing as much to calm you down.

Some people become aggressive under the influence of alcohol. Alcohol relaxes your psychological defence mechanisms, which may cause feelings of repressed anger to emerge, hence becoming more aggressive. Cutting back on alcohol consumption isn’t an effective long-term solution. Addressing anger or underlying anxiety should naturally lead to a decrease in alcohol consumption.

• Low self-esteem

Strictly speaking, a psychological concept such as low self-esteem, low self-image, poor self-confidence, or whatever else does not exist.

A so-called low self-esteem is simply the consequence of negative thinking (the so-called irrational thinking) about and of yourself, telling yourself that you are not good enough or a failure.  Brené Brown writes in her book Imperfect: We seem to measure the value of people’s contribution (and sometimes their entire lives) by their level of public recognition.  Thus, worth is measured by fame and fortune.

• Social phobia

I don’t like the term social phobia, and would rather call it social fear. You may simply fear rejection, or fear people’s opinions or what they think of you.

You may also fear the opinions of other people. What are other people thinking of or saying about me? No wonder the French philosopher Jean-Paul Sartre once said: hell is other people (and their opinions). Psychology may add to Sartre’s statement: only if you allow it to be your hell.  You can read more about Jean-Paul’s statement on my website and click on Hell is other people.

You may also fear rejection.  You may, as a reaction, rather reject others or cut them out of your life before they can reject you, and by doing so, you are actually sabotaging yourself.

• Procrastination

People tend to procrastinate when they are afraid to do something for fear that it is too difficult, too much, or the fear of failure.  Therefore, you prefer to postpone a task or do other things rather than the task you should do.

People are not lazy, they rather procrastinate.  The only guarantee never to fail is never to do anything.  If you do nothing, you can’t fail.

• Lack of assertiveness

Please have a look at my article on Assertiveness at jorganharris.co.za.

In short, there are three levels of assertiveness:

• Submissive behaviour;
• Assertive behaviour; and
• Aggressive behaviour

Assertive behaviour means to ask in a friendly but firm manner what you want and to say no to what you do not. Most people suffering from anxiety tend to be submissive and neglect their own needs and wants.  They are either too afraid to hurt other people’s feelings or, on the other hand, too afraid of rejection should they not please others. They just want to be accepted and want people to like them. It might become frustrating from time to time, and they may leap from submissive behaviour right through assertiveness to aggressive behaviour, which leads to more guilt. More about guilt later.

• Control freak

There is also no such thing as a control freak. Control freaks are people who do not feel in control or people who fear that they may lose control. These people may also be so-called manipulators. A so-called manipulator may just be somebody who is afraid to lose control.  Wanting to force people and things to go their way, is just a way to control the anxiety and consequent feelings of not being in control of their own lives.

• Guilt feelings

People suffering from anxiety may also struggle with excessive feelings of guilt. They are unnecessarily hard on themselves for what they are doing wrong, or for what they haven’t done. Guilt, however, is the most useless emotion you can ever experience. It gets you nowhere. Feeling guilty is actually fear – a fear of Karma’s revenge or ending up in the so-called hell for the bad person you are.

• Weight gain

Recent research has also shown that stress and anxiety are the main reasons for weight challenges.

Simply explained: you eat food. Food goes to your stomach. From your stomach, it spreads to all the parts and organs of your body that need it for survival. The excess or unnecessary food you eat goes in one of two directions: it either moves to your digestive system (to be discharged) or it gets absorbed into your body’s fat cells. Why is food being kept in fat cells rather than being excreted?

The primitive brain or the reptile brain is the part of your brain that has one function only: survival. When you’re anxious, it does not know you’re anxious about your boss at work which gives you trouble again. This part interprets anxiety in terms of survival. It thinks e.g. there’s a lion chasing you or there’s starvation. Your primitive brain will cause you to eat more, as well as to store your food in fat cells for energy to fight for survival when it is needed later.

You will be able to lose weight when you overcome your anxiety. When your primitive brain is no longer feeling the need to store food or eat more for energy for survival.

• Sensory overload

People with anxiety may often be oversensitive to any form of sensory perception. They become more easily irritated with sensory overstimulation.  Especially noise or even bright light may irritate them boundlessly.

Possible causes of anxiety

Anxiety is predominantly sharpened by the anticipation of the future, rooted in the possible uncertainties that lie ahead.

Below are a few possible causes of anxiety:

• Trauma

Trauma means what you experience as traumatic for you. You may have experienced a trauma or more in your life. Trauma can be anything from an event where your life was threatened to as little as something that made you feel negative about yourself.

• Your parents

It may be that one or both of your parents suffered from anxiety and that you have formed an image in your mind of the world as a dangerous place based on your parent(s) perception of the world. Perfectionist parents or parents who have high expectations of you may also be a cause of anxiety.

• Your birth order

Eldest children are more likely to develop anxiety than the younger children in the family of origin, as they bear more responsibilities, and more are expected of them than from the younger children.  Firstborns are often seen as trailblazers and are considered the example for the other siblings.

• Daily stress

Stress about money, work, family, expectations of yourself and others, illness, etc. is a major cause of anxiety.

• Other factors

There may be many other factors that can cause anxiety, for instance economic, political and world circumstances.

Psychology does not believe in genetic or biological factors at all.

The possible causes mentioned above were discussed very briefly and your own unique situation will be investigated in depth during consultation.

The bad news is:

that you might think and your reference framework suggests that life should be like this.  That’s how you are and that’s how you’ve been put together. People with general anxiety think they are the craziest of them all, and that is part of their personality, but:

The good news is:

that it is not part of your personality. You are not born as such. Anxiety has no genetic origin. It is simply the result of your way of thinking and your learned thinking. Just because your parents had anxiety and their parents had anxiety, does not mean that you too will have anxiety as it lies in your genes.

You might be conditioned from childhood that the world is a bad place since your primitive brain has been fully developed since childhood, but your neocortex (your thinking brain) has not developed yet. Subsequently simply started to believe that the world is a bad place, despite the evidence of the contrary.

I refer to general anxiety as the sophisticated person’s challenge. You must have an overactive imagination or a high intelligence to think about all these irrational thoughts. A beggar only thinks about survival and does not experience anxiety.

General anxiety, more than depression, is considered to be the disease of our time.  General anxiety is nowadays much more common than even depression.

However, it is also one of the easiest challenges to overcome. It is a general and well-known disorder; hence a lot of research has been done about it. It is a disorder that we understand very well and can easily be solved.

Tips to handle anxiety

We will address all the aspects of your anxiety during therapy. For now, it can help by following these three tips:

• Take a deep breath

Breathing is the essence of relaxation. Breathe in, almost as if you inhale the air into your stomach and abdomen. Your breathing is the one thing you always have absolute control over. You can read more about this in my article on breathing on my website: jorganharris.co.za, click on Inhaling the Spirit.

• Scan your body for tension

Become aware of your forehead, let it feel smooth and relaxed with every easy breath that you breathe out. Then relax your jaw, let your jaw feel loose and relaxed. Become aware of your shoulders and let your shoulders drop and relax. Next become aware of your abdomen, as you allow your stomach to relax deeper and deeper with every easy deep breath that you exhale. You can continue to scan the rest of your body for tension and to relax those parts.

• Change your thinking

There is nothing you have to do or nothing that must happen or not happen. Think of something that is causing you anxiety, and ask yourself:

1. What’s the worst that can happen?
2. If it happens, how bad is that really?
3. What are the chances for it to happen, since 90% of things we worry about, never happen anyway?

Life does not have to be like this

Somebody once said: Relax, you are not in control anyway!

We are not in control in any way.  Why then worry? We are conditioned that the world is a dangerous place and that we should be on guard. We make life difficult for ourselves. Even in the Holy Scriptures, there are many quotes telling us that we do not have to worry about anything. We will not achieve anything by worrying about it.

Therapy

Medication may help you suppress these terrible symptoms of anxiety, but it does not take away your challenges or your fearful thinking. It may help you in the short term. Psychologists however prefer to work with your thinking and perceptions in order to overcome anxiety.

Your challenge lies not in your neocortex (the thinking brain) but in your primitive brain (feeling brain) which doesn’t comprehend language and continues to feel threatened.  Even if you reassure yourself, your primitive brain still experiences stress, preparing for the fight or flight response.

That’s why I am doing alternative therapeutic modalities that address the challenge directly in your cerebellum and brain stem, such as hypnosis, NLP, and BWRT. The neocortex may not understand these therapies, but the cerebellum and brain stem will.