During my time as a high school counselor, I worked with hundreds of students in a wide-range of capacities. For some, I was simply another adult on campus. But for others, I provided much-needed social and emotional support.
One of the most prevalent challenges I witnessed for the high schoolers was anxiety. Even the most well-adjusted teens seemed susceptible to anxiety from time to time. Although I no longer work directly in schools, I continue to see the effects of anxiety on children, adolescents, and adults. Anxiety is one of the more common conditions I diagnose. In fact, the Institute of Mental Health estimates that 31.1% of U.S. adults experience an anxiety disorder during their lifetimes and 31.9% of U.S. adolescents ages 13-18 had an anxiety disorder at some time.
Treating anxiety is highly dependent upon an accurate diagnosis. Today I want to examine what anxiety is and the difference between “normal” anxiety and clinically significant anxiety. Then we can consider treatment options for anxiety.
What is Anxiety?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), which is the gold standard for diagnosis anxiety,
“Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances.”
The two key words in this definition are “fear” and “anxiety.” The DSM-V characterizes them as:
Fear: “emotional response to real or perceived imminent threat”
Anxiety: “anticipation of future threat”
So, when considering anxiety, it is important to note whether the mental state is in relation to an actual event or an anticipated event.
These disorders can manifest in many different ways, depending on the level of fear and anxiety. Some of the more commonly diagnosed anxiety disorders include (definitions from DSM-V):
- Separation Anxiety Disorder: fear or anxiety concerning separation from those to whom one is attached
- Specific Phobia: fear or anxiety about a specific object or situation (i.e., flying, public speaking)
- Social Anxiety Disorder: fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others
- Panic Disorder: recurrent, unexpected panic attacks
While these are some of the more commonly diagnosed types of anxiety disorder, they are usually very specific and mainly refer to one situation or fear.
Generalized Anxiety Disorder
For many individuals who experience anxiety, they experience these overwhelming feelings in multiple settings and under many different conditions. In fact, the majority of anxiety disorders are often comorbid with each other, meaning a person experiences multiple anxiety disorders at once. For these individuals, an alternative diagnosis may be Generalized Anxiety Disorder.
According to the DSM-V, “the essential feature of generalized anxiety disorder is excessive anxiety and worry (apprehensive expectations) about a number of events and activities.”
When considering a diagnosis of generalized anxiety, I always ask myself two important questions:
1. Does the anxiety present in multiple settings?
2. Does the anxiety inhibit the person’s functioning in those settings?
If the answer to both questions is “yes,” then it is likely the individual indeed experiences underlying anxiety consistent with generalized anxiety disorder. If the answer to either question is “no,” then it is more likely the individual experiences a more specific type of anxiety disorder.
Anxiety disorders can be very difficult to diagnose accurately. After all, most of us experience some level of anxiety throughout our lives, but that does not necessarily mean it is a diagnosable condition.
When considering a diagnosis of an anxiety disorder, I always want to evaluate the individual for other conditions that often mimic anxiety symptoms or, more importantly, cause anxiety symptoms. Some of these include:
- Attention-Deficit/Hyperactivity Disorder
- Specific Learning Disorders (dyslexia, dysgraphia, dyscalculia)
- Obsessive-Compulsive Disorder
- Depressive Disorders
- Anxiety due to medication
Confirming or ruling out these (and any other) conditions can help diagnose anxiety more reliably. And diagnosing reliably is an important step to treatment.
Treatment for Anxiety
So, once we have identified the source and type of anxiety disorder, the next step is treating it. For the most part, there are three options: mediation, therapy, lifestyle changes.
Many individuals who experience clinical anxiety are prescribed medication for their symptoms. I am always a “medication is a last resort” type of person, but for many, medication is a life-changing tool.
When considering medication, it is important to understand the pros and cons, including side effects. Also, individuals often respond differently to different types of medication. It can sometimes take trial and error to find the right medication.
There are many types of therapy to help with anxiety. The most common is Cognitive Behavioral Therapy (CBT). The goal of CBT is to change the way one thinks about his or her situation, which will ultimately change his or her behaviors.
Other forms of therapy include Dialectical Behavior Therapy (DBT) and Eye Movement Desensitization and Reprocessing (EMDR), but of which are widely popular in treating anxiety and depression. Once again, however, individuals respond differently to different therapies, so finding the right type (and therapist) is important.
Anxiety is typically a response to environmental factors. One way to manage anxiety is to adapt to or change those factors. Many activities have been proven effective at mitigating anxiety, including exercise, outdoor time, and interaction with animals.
Perhaps most important to reducing anxiety is sleep. When we do not get enough sleep, we are not rested. And when we are not rested, we are susceptible to emotional responses that may trigger elevated anxiety. Getting sleep is important but not always easy. Consulting a sleep specialist may be helpful in these instances.
While anxiety can be a crippling emotional challenge, we are fortunate to live in a time when anxiety is widely recognized and understood. There are more supports for individuals diagnosed with anxiety than ever before, including virtual counseling that make therapy accessible for many. If you or your child experiences any symptoms of anxiety, make sure to seek professional consultation. Identifying the source of your challenges is the first step to overcoming them.