When it comes to living with anxiety, no two experiences are the same. Anxiety is a complex emotion that manifests itself in various forms and can have profound impacts on one’s life. Developing an understanding of how your anxiety manifests may help to provide insight into your associated emotional and physical experiences, as well as providing guidance for treatment and coping strategies. In this post, we will explore the different types of anxiety disorders, common characteristics of each, the experience of living with significant anxiety, and psychodynamic approaches to treatment. By understanding these facets of mental health, we hope that people who struggle with anxiety can find better ways to take charge of their wellbeing.
Anxiety Disorders and Types of Anxiety
Anxiety disorders can have an overwhelmingly powerful impact on individuals living with them, resulting in changes to their mood, relationships, and behaviors. It is important to understand that anxiety is not just a feeling of worry or fear–the embodied experience and the effect on one’s life can be significant. Many people find that understanding their anxiety as well as the various forms of treatment available for managing or alleviating their discomfort helps them to live better lives. In addition to different therapeutic approaches like psychodynamic therapy, there are certain lifestyle strategies that can serve as useful tools for managing symptoms. By gaining knowledge about the various types of anxiety and exploring their own personal experiences related to their disorder, people can work towards finding the best path for recovery.
Effects of Anxiety on Daily Life
Anxiety can take many forms and present in a variety of ways. Some may experience restlessness and sleeplessness; others notice that tension and irritability are predominant. For others, fear, doubt, apprehension, or obsessive thinking are most pronounced. Physical discomfort is also common, such as muscle tension, sweating, headaches, and nausea. Those who live with anxiety often note the impact it has on their relationships and daily life, e.g. feelings of nervousness or discomfort in social situations can greatly affect self-confidence and cause one to withdraw from social activities they may have previously enjoyed. Mood variability is also common, changing an individual's mental state frequently. Those dealing with heightened anxiety might notice an interference with the ability to concentrate or stay focused. Living with anxiety can be highly distressing, making it important to learn ways to manage with its effects through therapy and coping skills.
What are the Different Anxiety Disorders?
Separation Anxiety Disorder
Central to Separation Anxiety Disorder is excessive fear or anxiety concerning separation from attachment figures, like parents or romantic partners. This fear goes beyond what one would expect given the person’s developmental level. Though more commonly observed in young children, adults can experience it as well. Aside from excessive distress when separated from loved ones, we would also note worry about the wellbeing of loved ones and the need to know their whereabouts or remain in touch with them. The affected individual might also be preoccupied about untoward events befalling themselves, such as getting lost, being kidnapped, or having an accident–the occurrence of which feeling as if it would prevent them from ever reuniting with loved ones. There is a marked reluctance to go out by themselves; we might see resistance to sleeping away from home or going to school among children. In adults, it is more common to feel uncomfortable if faced with the prospect of traveling independently. The anxiety can manifest physically as headaches, abdominal pain, nausea, or vomiting. Though rare in children, adults with Separation Anxiety Disorder may experience heart palpitations, dizziness, and feeling faint.
Experiencing a panic attack can be a frightening and confusing experience. Panic disorder is characterized by unexpected and intense episodes of fear and anxiety that peak very quickly. These are characterized by an abrupt surge of intense fear or discomfort that peaks within minutes. Features of a panic attack can include rapid heart rate, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, or feelings of dizziness. The individual might also feel chills or sensations of heat, or numbing or tingling sensations. Derealization (feelings of unreality, as if seeing events “at a distance; in a dream”) or depersonalization (being separate from oneself), fear of “going crazy,” and fear of dying may also be present. Four or more of these occurring at the same time constitute a panic attack.
Panic Disorder, then, is seen when a person experiences recurring and unexpected panic attacks. That is, there is no obvious cue or trigger that would launch a person into this state of sudden fear. The frequency and severity of panic attacks can vary widely. One might have moderately frequent attacks (one per week) for months, or short bursts of more frequent attacks (daily) separated by weeks or months without any attacks at all. Worries about panic attacks and their consequences usually are focused on the physical symptoms, as individuals often believe they are experiencing a heart attack. Others may feel embarrassment or fear of being judged negatively by others because of the features of panic attacks that can be observed outwardly. People with panic disorder attempt to minimize or avoid panic attacks, which often means rearranging the course of their days and lives, e.g. avoiding physical exertion, restricting usual daily activities, or making sure that help is available at all times in the event of an attack.
Specific phobia is an anxiety disorder characterized by excessive fear of certain objects, situations, places, or activities. It can cause people to experience increased levels of physical arousal and intense discomfort when near the trigger. The feared object or situation almost always provokes immediate anxiety, and is either avoided altogether or endured only with intense fear.
Commonly seen specific phobias encompass fear of animals or aspects of the natural environment (heights, storms, water). The Blood-Injection-Injury phobia relates to needles and invasive medical procedures. Situational phobias can include fear of flying, elevators, and enclosed spaces. This is not an exhaustive list, and many individuals are noted to fear objects from more than one category.
Symptoms typically include an initial feeling of apprehension or dread upon seeing the trigger, then chest pain, shortness of breath, shakiness or trembling along with a strong desire to escape the triggering situation or object. The degree of fear may vary with nearness to the object or situation. Individuals with phobias will actively avoid the feared object, e.g. taking a tunnel instead of a bridge on the commute to work; avoiding entering a dark room for fear of spiders; avoiding accepting a job offer in an area where the feared object is more common. Finally, the fear is out of proportion to the actual danger the object or situation poses. While people with phobia can see their reactions as disproportionate, they tend to overestimate the danger in their feared situations.
Social Anxiety Disorder
Social Anxiety Disorder is a type of anxiety that manifests in an intense fear or discomfort of being negatively judged or scrutinized by others. This can involve circumstances such as having a conversation, meeting unfamiliar people, being observed eating or drinking, or performing in front of others. When exposed to these situations, the affected individual feels as if they will be negatively evaluated, concerned that they will be seen as anxious, weak, stupid, intimidating, or unlikeable. Also present is the fear that the symptoms of their anxiety–blushing, trembling, sweating, stumbling over words–will be noticed and judged as well. Other individuals may fear offending others with their gaze or symptoms.
Those affected may avoid situations in which socializing is expected, leading to a general lack of contact with others. This disorder can cause significant distress and hinder the ability to socialize or engage comfortably with others, leading some to feel socially awkward and isolated. Avoidance can be overt (not going to parties, refusing to go to school), or more subtle (overpreparing the text of a speech, diverting attention to others, limiting eye contact). Those with the disorder may be inadequately assertive, excessively submissive, or (infrequently) highly controlling of the conversation.
Agoraphobia is an intense fear brought on by real or anticipated exposure to a wide variety of situations. These can include marked anxiety when using public transportation, being in open spaces, being in closed spaces, standing in line or being in a crowd, or being outside of the home alone.
People with agoraphobia may experience a deep-seated dread when in these settings, feeling trapped or unable to flee the situation. A common fear is that something terrible might happen, that escape from such situations may be difficult, or that help might not be forthcoming. The fear one feels tends to vary with nearness to the feared situation, and may take the form of a panic attack. Intense anxiety is evoked virtually every time the individual is exposed to the feared situation; thus, those with agoraphobia tend to actively avoid the feared situation. This can involve changing daily routines, like choosing jobs nearby to avoid use of public transportation or ordering food delivery to avoid entering shops or grocery stores. At its most severe, agoraphobia can leave people completely homebound.
Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is known by excessive anxiety and worry about a broad number of events or activities. As with the other anxiety disorders, the intensity, duration, or frequency of the anxiety is out of proportion to the actual likelihood or impact of the anticipated event. Worry can be present about everyday, routine life circumstances, e.g. potential job responsibilities, health and finances, or the wellbeing of family members. The focus of worries may shift from one concern to another, and tend to be more pervasive, pronounced, and distressing than non-clinical anxiety. The greater the range of life circumstances the individual worries about, the more likely they are to experience GAD. Notably, the difficulty to control worry corresponds to physical unease. This can include restlessness or feeling on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, or disturbed sleep. Many with GAD describe feeling that they have felt anxious and nervous their whole lives.
Living with Anxiety: Social Anxiety
A friend describes her experience of living with social anxiety:
I have always experienced anxiety, but I noticed it coming to a peak just before high school. I felt increasingly awkward, and it seemed that there were mounting social pressures.
I think what contributed heavily to my anxiety was being bullied. After being rejected from a circle of friends, it felt like my social world was collapsing. I had to scramble to find my footing. It changed how I felt a lot of the time: I had this new feeling of being uncomfortable around others, like they were always on the verge of discovering something humiliating about me. By the time I was in high school, it grew. Later in grad school, it came again. Whenever I had to start over and make new friends, like after a move, the anxiety would become more pronounced.
I was exceptionally anxious about being judged as socially awkward with others. I was afraid that because I was so uncomfortable in my own skin, that others would see that and somehow know that I was pathetic, weak; a loser. It felt like any “weakness” I showed, that others would jump on me for it. It always felt like my heart would beat out of my chest, and that it was somehow so obvious to other people. I got very good at hiding it, but it was a struggle: I had to be mindful to not get out of breath when talking, striving to appear something close to calm. It made it awful to be around others. Being alone was the only escape from these feelings.
Social interactions were terrifying. I always had this feeling that I’d choke on my words. My palms would get sweaty. Despite my efforts, I’d fidget and then get self-conscious about my fidgeting. I felt alone: I had this sense that something was deeply wrong with me. The shame at feeling this meant that I did not tell anyone I had social anxiety until my 20’s. I was just too embarrassed to name it.
I missed out on things because my anxiety felt too loud, too uncomfortable to go. The isolation hurt my self esteem, which made me even less comfortable around others. I would find any reason not to be where I knew I’d have to talk to other people.
This all came at a cost. It led to feelings of hopelessness and depression because I thought something was wrong with me. I missed out on job opportunities, making new friends. I would miss class because I couldn’t muster the energy it would take to go to. I felt at times I was almost wearing a mask, or living a lie: I tried so hard to be perceived as ok when I was constantly and deeply uncomfortable. My self-esteem took a blow.
Emotionally, I felt such sadness and hopelessness. There was internalized shame, and a great deal of embarrassment. When I finally talked about this in therapy, I got feedback that I presented as “fine,” which was profoundly at odds with how I felt around others. Again came that feeling of living a lie–that others did not really know me. It made it hard to trust my own perceptions if others’ sense of me was so divergent from the gnawing discomfort I embodied.
Avoidance was a constant battle, trying to get myself to do anything social because it was so uncomfortable. Even spending time with my oldest, dearest friend was hard. I wanted so badly to escape the feelings, and the anxiety only left when I was alone. I was even anxious around my family. There was no one I felt comfortable with. It made me sad that I was anxious around my family–I felt that I should be at ease at home. I was guarded, as if I couldn’t show vulnerability with them, or with anyone. I had this barrier between myself and everyone else. As much as I craved having relationships with others, I could not bear to get too close.
My friendships suffered, as I tended to engage less than was necessary. I didn’t feel well known, even among friends. I wasn’t really being authentic–I was just trying desperately to feel comfortable. The worst thing about it was being uncomfortable in my own skin. I hated getting out of the car, walking up to the house, all of the steps leading up to hanging out with friends, going to class, going to a party–anything where there were other people. Having any attention on me was unbearable.
I decided to seek help when a friend of mine shared that she had anxiety. At the time, she had tried medication. Her naming something that I secretly struggled with made me feel less alone. I realized how much my quality of life was being eroded, and that something else was possible for me.
In therapy, I learned coping skills like distress tolerance and diaphragmatic breathing to take the edge off the physical discomfort. Deeper still was having space to talk about my experiences and not feeling like such a freak: my feelings were normalized. I was not met with the judgment I so feared. I learned about the roots of my feelings: there were links to traumatic experiences in my childhood, and I did not have stable figures to rely on. My parents, my family were not affectionate people–I didn’t get comfort from them. I learned that my anxiety made sense in light of what I’d experienced.
Not only is it ok to seek help, it’s important to do. If you’re feeling any shame or embarrassment, it’s more common than you think. Your therapist has heard it all before. Change is possible, and I know it because I’ve been there.
Psychodynamic Treatment for Anxiety
A psychodynamic approach to treating anxiety prioritizes the unconscious and uncovering the past experiences of an individual to gain insight into their current behavior and emotions. Two core features of this approach to therapy can be 1) developing insight and 2) transformation through embodied corrective experiences.
Developing insight about your anxiety:
To develop insight about anxiety, you may start with thinking about what are your early memories of anxiety? What was happening when you had feelings of being unsafe, unsettled, unknown, or not good enough? How did people around you (e.g., family, parents, friends) respond or react to your feelings? All of these experiences build on each other and pave ways for your body’s anxious responding as well as your cognitive frame around being anxious. You may also seek to gain an understanding of how the mind’s experiences of anxiety (e.g., worried thoughts, repeating ideas, negative thoughts, irrational beliefs) are interrelated to the body’s experience of anxiety (e.g., physical sensations of tightness, shortness of breath, racing heartbeat, stomachache, etc.). Insight can also be developed working to uncover beliefs, urges and avoidance techniques that may be present underneath the surface.
However, is insight always enough for change?
Embodied Corrective Experience:
Insight can have a profound effect on how you understand your past and present experiences. However, if it just stays intellectual, it may not affect the deep and long standing patterns, or the visceral and/or neurological webs around anxiety. A psychodynamic approach to anxiety may include working the anxiety out through the relationship with your therapist. For example, if you have social anxiety, you may be supported through thinking out loud about your fears of judgment from your therapist. By experiencing the true feelings in the moment, with another person who is able to attend to those feelings with attunement, empathy, and contextualization of how it fits into your life-long story, you may have an experiential shift that is in your body as much as it is in your brain.
Hope for Change
Within a psychodynamic therapeutic approach, you might explore how unresolved conflicts from the past may be shaping your current experiences with anxiety. The relationship between therapist and patient is of utmost importance and helps form a platform for hope and change. As you begin to understand the relational dynamics that provoke and sustain anxiety, you have increasing choices open to you; new ways of being with others and with yourself. As problematic internal or interpersonal relationships begin to resolve, the symptoms that initially led you to therapy will often resolve as well. If needed, many therapists can instruct their clients in relaxation techniques or lifestyle changes to reduce anxious distress. As the tension abates, more focus can be dedicated to exploring the underlying dynamics that give rise to the anxiety in the first place.
Anxiety is a part of life, and will always exist within us to a degree. When anxiety reaches an unmanageable pitch, there is help. It is important to reach out for professional help if needed so that you can have the best opportunity to cope with feelings of overwhelm in a healthy way. Try to remember that you are not alone in your journey. And, to show yourself kindness so that you can handle whatever life throws at you with confidence, strength, and peace. If you or someone close to you experiences anxiety or distress, please do not hesitate to schedule a consultation for therapy.