What if ___________ happens?
I can’t cope with this.
I’ll never be able to handle ___________.
This is too much for me. I’m going to fail.
I have to be in control.
I might as well give up now. This isn’t going to work, no matter how hard I try.
Everyone is going to laugh at me.
I must be going crazy!
Again, people can have these thoughts and not have an anxiety disorder. To understand the distinction, let’s take a look at the difference between “everyday” anxiety and a diagnosable anxiety disorder.
“Everyday” Anxiety vs. Anxiety Disorders
It can be a fine line to distinguish between “everyday” anxiety and a diagnosable condition. Often the distinction hinges on whether people describe symptoms of anxiety that interfere with their quality of life, are pervasive, and negatively impact their performance (whether that’s in one area of life or across all situations).
For example, if your partner has a big presentation coming up at work soon and has been working extremely hard to pull it together, he might be feeling anxious. Symptoms of that anxiety might include having trouble sleeping, being irritable and impatient, and having worry thoughts about what might go wrong. This could be “everyday” anxiety, or it could be a sign of an anxiety disorder, depending on how long the symptoms have been going on, the severity of the symptoms, and whether they resolve after he gives the presentation. If his symptoms do go away afterward, he was probably experiencing “everyday” anxiety in response to a stressful situation. If he still struggles with his symptoms afterward and also feels anxious about other life situations, it might be a sign of an anxiety disorder.
Aaron Beck, an eminent psychiatrist and early developer of cognitive therapy, describes people with anxiety disorders as having a “hypersensitive alarm system” (Beck and Emery 2005, 31). In his view, they are so sensitive to any stimuli that might indicate imminent danger that they constantly warn themselves about potential danger. Unfortunately, almost any stimulus can trip the alarm, and as a result, they are in a constant state of anxiety.
It’s estimated that over forty-three million Americans have an anxiety disorder (Kessler et al. 2005), or almost one in five adults. So whether or not your partner has been diagnosed with an anxiety disorder, he’s far from alone: many others have similar difficulties with anxiety. The good news is that anxiety disorders are among the most treatable mental health conditions. The possibly not-so-good news is that many people choose not to consult a mental health professional about their symptoms and suffer needlessly as a result.
In the following sections, I’ll describe the major anxiety disorders. If your partner has been diagnosed with an anxiety disorder, the discussion of that disorder may give you more insight into what your partner is experiencing. If your partner doesn’t have a diagnosis, please understand that this information shouldn’t be used to attempt to diagnose your partner; only a trained mental health professional can do that. Nevertheless, even if your partner hasn’t been diagnosed or doesn’t qualify for an official diagnosis of an anxiety disorder, this discussion—and this book—will still be relevant and helpful.
Types of Anxiety Disorders
The American Psychiatric Association (2000) has identified six types of anxiety disorders:
Generalized anxiety disorder
Obsessive-compulsive disorder
Panic disorder
Post-traumatic stress disorder
Social phobia or social anxiety disorder
Specific phobias
Each of these disorders is diagnosed by trained mental health professionals using criteria outlined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (2000). As you’ll learn, there are overlaps in the criteria for these disorders, but also characteristics that make each condition distinct. In addition, it isn’t uncommon for people to be diagnosed with multiple anxiety disorders or to have another mental disorder along with an anxiety disorder. (Having two or more diagnosable mental or physical health conditions is referred to as comorbidity.)
In addition to describing each of the six anxiety disorders in the following sections, I’ve also provided brief real-life examples.
Generalized Anxiety Disorder
Linda is a forty-seven-year-old proprietor of a small business. She feels like she’s constantly worrying about everything: Is her business making enough money? Will she and her partner, Bill, be able to pay for their daughter’s college tuition? Is her fatigue just because of working too much, or does she have some mysterious disease? What if her taxes are audited? What will she and Bill do if their house suddenly needs a major repair? Despite knowing that many of her fears are unfounded, Linda struggles to control her thoughts and relax. Bill does his best to relieve her worries, reassuring her that everything is fine and nothing bad will happen, but it seems like no matter what he says, it’s never enough.
Linda is a typical example of someone who might be diagnosed with generalized anxiety disorder (GAD). People who have GAD tend to go through life chronically worried, even though there’s little or no basis for their concern. People with GAD anticipate disaster and worry excessively about things that probably will never happen. Concerns about money, illness, relationships, or work problems dominate their thoughts. For some, the thought of just getting through the day can be overwhelming. People with GAD usually realize that their concerns are excessive, but they still struggle to let go of their worry thoughts. In addition, people with GAD often have a comorbid disorder, such as another anxiety disorder, depression, an eating disorder, or substance abuse.
People with mild GAD can usually hold down jobs, take care of their daily responsibilities for the most part, and have typical social relationships. Those with more severe GAD may have trouble with everyday tasks. Avoiding specific activities or situations, such as riding an elevator or driving, isn’t a symptom of GAD; rather, these are specific phobias, which I’ll describe shortly.
GAD usually develops gradually. It can appear at any point in a person’s life but is most commonly diagnosed between childhood and middle age. Genetics may play a role in whether a person has a predisposition toward developing GAD, and women are twice as likely as men to be diagnosed with GAD (Robins and Regier 1991).
Obsessive-Compulsive Disorder
Emily is a thirty-six-year-old mother of two small children. She finds herself having the urgent need to wash her hands many, many times a day, especially after playing with her kids outside, going out in public with them, or doing something that seems dirty to her. If she’s able to wash her hands exactly twenty-eight times, she feels better…until the next time she encounters something that might have germs on it. Her hands are chapped and often bleed from the excessive washing, but she feels unable to reduce the number of times she washes. Her partner, Sarah, has expressed concern about Emily’s need to wash her hands constantly but hasn’t been able to persuade Emily to stop.
Emily’s urgent, uncontrollable need to wash her hands excessively is a result of her struggle with obsessive-compulsive disorder (OCD). People with OCD have obsessions: distressing, recurring thoughts that compel them to perform rituals (compulsions) in order to relieve their distress. Unfortunately, these rituals usually end up controlling the person, making things worse instead of better. Performing the rituals isn’t pleasurable, but those with OCD often feel as if they have no other option for relieving the anxiety associated with their obsessions.
It’s common for people to joke that they have OCD because they’re rigid about how they do certain things, such as following a set routine in the morning because they fear that if they don’t, they’ll forget to do something or be late for work. The difference between a ritual that isn’t obsessive and one that’s driven by OCD is that people with OCD become extremely upset and are often unable to function if they can’t perform the ritual. Rituals overtake their lives, whereas thos
e who don’t have OCD can adapt and go on with their day even if their routines are disturbed.
Contamination fears and compulsive hand washing are just one example of how OCD manifests. Other common examples are a person who is obsessed about safety and, as a result, locks, relocks, and checks all the doors and windows in the house over and over again before going to sleep at night or repeatedly checks things that might pose a danger, such as whether the stove is turned off or the iron unplugged. Some people with OCD get relief from their obsessions by touching things, particularly in a certain sequence, or by mentally counting objects or numbers repeatedly. Other common symptoms of OCD are a need for symmetry or order, difficulty throwing things away, and hoarding.
OCD can become a severe problem that prevents people from being able to function in a work environment or live safely at home. People with OCD commonly have comorbid disorders, such as other anxiety disorders, an eating disorder, or depression. They may also take excessive measures to avoid triggering situations or use alcohol or drugs in an effort to calm their anxiety. The prevalence of OCD is nearly equal in women and men (Robins and Regier 1991).
Panic Disorder
Mike is a twenty-seven-year-old graduate student preparing to take his comprehensive exams. Understandably, he’s having some anxiety, since whether or not he passes determines whether he will graduate. But one night something weird happened: As he sat down to study, he suddenly felt light-headed, started to sweat profusely, had chest pain, and couldn’t breathe. This episode lasted about ten minutes, and Mike thought he was going crazy, having a heart attack, or both. His partner, Michelle, didn’t know what to do or how to help him, but Mike insisted she not call for help. When the episode was over, Michelle took Mike to the urgent care clinic, and the tests they ran came back negative for physical issues. Now Mike is worried that it will happen again, not just because it was really scary, but also because of how embarrassing it would be if it happened at school or in public and others witnessed it.
Mike had a panic attack when sitting down to study for his exam. Panic attacks occur without warning and are characterized by sudden feelings of terror accompanied by a racing heart, excessive sweating, weakness, and feeling faint or dizzy. Other symptoms include numbness or tingling in the hands, feeling flushed or chilled, chest pain, feeling nauseated, and having the sensation of being unable to breathe. As a result of these symptoms, people who are having a panic attack often believe they are having a heart attack, losing their mind, or about to die. The reality is that, despite how panic attacks mimic heart attack symptoms, they aren’t fatal (though an extreme reaction to a panic attack may sometimes lead to serious injury or possibly even death). Panic attacks can happen at any time, even when people are asleep. They usually peak within ten minutes and subside naturally, but some symptoms can linger much longer.
A key symptom of panic disorder is the fear that a panic attack will occur again. Many people who have a single panic attack never have another one, but others develop panic disorder and have panic attacks repeatedly. The tendency to develop panic disorder appears to be hereditary. Panic disorder is diagnosed twice as often in women as in men (Robins and Regier 1991).
People who develop panic disorder often become restricted in their daily lives because of their fear of having a panic attack. This can develop into agoraphobia, a fear of being in situations where escape would be difficult. If a panic attack occurs in a specific place, people may develop a specific phobia related to that place and become restricted in what they can do because of the specific phobia. For example, a panic attack in an elevator that leads to a specific phobia about elevators could restrict where a person might live, work, visit friends and family, or access services. Some people with panic disorder can only go out in public if they have a trusted person with them, which also severely limits their quality of life.
Post-Traumatic Stress Disorder
George is a twenty-one-year-old man who has served two tours of duty in war zones. Since returning from his second deployment, he’s been having difficulty settling in at home and reestablishing a normal life with his girlfriend, Kristy. He’s having trouble sleeping, and when he does manage to sleep, he often has distressing dreams about combat and seeing people die. When he’s awake, he’s easily startled by loud noises or by Kristy “surprising” him when he didn’t know she was in the room. Sometimes he has flashbacks, which make him feel as if he is back in combat, seeing, hearing, and smelling everything just as it was when he was deployed. Kristy gets frightened when this happens because it’s as if George loses touch with reality. In addition, George often has angry outbursts and feels the need to be vigilant about keeping himself safe, even though he knows he isn’t in a war zone any longer.
George has post-traumatic stress disorder (PTSD). Although the media has given a lot of coverage to veterans who are suffering from PTSD as a result of military experience, PTSD can develop from any traumatic event, including being raped, mugged, or assaulted; being kidnapped or abused; being in a car accident or plane crash; experiencing a bombing or fire; or living through a natural disaster, such as an earthquake, flood, or tornado. The triggering event may have happened to the person, to a loved one, or in the person’s presence, such as witnessing someone else being harmed.
Common symptoms that indicate PTSD are the inability to feel a range of emotions, distancing from others, being easily startled, avoiding situations that could trigger memories, being hypervigilant, having trouble sleeping, being aggressive or irritable, having trouble with intimacy, and sometimes being violent toward others. Anniversaries of the triggering event are often very difficult. PTSD symptoms may be more severe when the event was purposely perpetuated by another person, such as in a rape, mugging, or kidnapping (National Institute of Mental Health [NIMH] 2009).
People with PTSD often relive their experience, both while awake and while asleep. The waking memories are called flashbacks, and the person may not realize that the flashback isn’t reality. Flashbacks can be triggered by ordinary stimuli, such as a door slamming or a car horn honking. During a flashback, images, sounds, smells, and feelings from the triggering event can all be present. When sleeping, the person may have disturbing nightmares about the event.
In order to be diagnosed with PTSD, the symptoms must be present for at least four weeks. Not every person who experiences a traumatic event will develop PTSD, and research indicates that women are twice as likely to develop PTSD as men (Breslau 2002). The duration of PTSD varies from person to person. Some people recover quickly, whereas for others it becomes a chronic condition. As with the other anxiety disorders, PTSD often isn’t the only psychiatric condition a person has. Depression, substance abuse, and other anxiety disorders often also afflict those with PTSD.
Social Phobia or Social Anxiety Disorder
Jane is a fifty-three-year-old executive assistant at a large corporation. She’s held her position for over twenty years but frequently worries that she’ll be fired. Despite having consistently positive job performance reviews throughout her career, Jane cringes when her boss or coworkers say anything about her work, even if their comments aren’t critical. In addition, she struggles to make small talk with her colleagues, preferring to work alone in the safety of her office with the door closed. She rarely accepts invitations to lunch or to socialize outside of work out of fear that her coworkers will discover “the real Jane”—one who isn’t worthy of being liked. Jane is convinced that if she were to lose her job, she would never be hired elsewhere. Jane’s husband, Elliot, has been listening to Jane’s worries about her job performance for the twenty-five years he’s known her. At this point, he mostly tunes her out when she starts worrying out loud because he’s learned that nothing he says or does helps her feel better.
Jane’s concerns about her job performance are an example of the struggles those with social phobia experience. This disorder is diagnosed when a person experiences such intense and overwhelming anxiety and self-consciousness
in the presence of others that it interferes with relationships. Those who have social phobia live with constant fear of being observed and judged by others or doing something embarrassing. This fear is so pervasive that some people with social phobia worry about encounters with others for days or weeks ahead of time. This can prevent them from being successful at school and work and in creating and maintaining relationships.
Social phobia may be limited to certain situations, such as talking or eating in front of others, or it may be broader in scope, where any activity involving people other than a small, trusted circle causes paralyzing anxiety. Here are some situations that those with social phobia commonly fear:
Public speaking or performing
Making small talk
Participating in group discussions
Asking questions while in a group
Being introduced to new people
Meeting or talking with strangers
Being assertive
Being watched while doing something, such as eating or writing
Attending social gatherings
Using the telephone
Using public restrooms
Interacting with “important” people, such as supervisors, people in authority, or people with high social standing or power
Being evaluated indirectly, such as when taking a test
People with social phobia usually recognize that their fears about scrutiny from others are overblown but feel powerless to change their thoughts. Social phobia is different from shyness in that people with social phobia don’t experience relief once the dreaded situation is in progress, whereas people who are simply shy often feel better once they’re in the situation because they’re able to get comfortable and warm up to it. People with social phobia, on the other hand, continue to feel intense anxiety when in the situation and will obsess over the interaction long after it is over, analyzing their performance and what others might have thought about them.
Loving Someone with Anxiety Page 2
