Managing panic and anxiety disorders
Anxiety disorders are a common yet misunderstood mental health issue. Here’s how to identify the signs and how to get help.
By Joanne Lillie
“I have been anxious my whole life, but my anxiety really got out of control in the last three or four years. I had to resign from my job as a teacher; at one stage I could not pick up the phone, drive, or face people. Going out was out of the question. My anxiety levels were so high I would just shiver with fear,” says Elaine (36) from Johannesburg. Elaine has generalised anxiety disorder in addition to a particularly challenging type of major treatment-resistant depression. “I had very little motivation, drive or self-esteem, my anxiety had a devastating effect on my quality of life.”
Depression runs in her family, and stress is her main anxiety trigger. “I am someone who works well under pressure, and it has taken me many years to work out where the fine line between productive pressure and an anxiety trigger is,” she says.
Elaine now sees a limited number of students at home for extra lessons. “I am not completely myself yet, I am not functioning at my best, but medication is keeping me stable and I am gaining control of my anxiety and depression.”
Like Elaine, people who suffer from generalised anxiety disorder (GAD) experience an exaggerated sort of tension and extreme worry without an obvious cause. People with GAD often seem unable to relax or fall asleep and may also experience lightheadedness, shortness of breath, nausea, trembling, muscle tension, headaches, irritability, or sweating.
Everyone feels anxiety at some stage as a normal reaction to threatening, dangerous, uncertain, or important situations. Some anxiety can even enhance your function, motivation, and productivity; such as those people, like Elaine, who work well under pressure. But, when you have severe anxiety, which is excessive, chronic, and interferes with your ability to function during a normal day’s activities, your may have generalised anxiety disorder. (Generalised anxiety is different from phobia because it is not triggered by a specific object or situation.)
Symptoms of GAD
- Excessive anxiety and worry for a large portion of the day
- Difficulty controlling worry
- Restlessness or feeling on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
Another type of anxiety disorder, and probably the most common kind, is panic disorder. Brief episodes of intense fear which are accompanied by physical symptoms such as heart palpitations, dizziness, nausea, tingling, feeling out of breath and chest pains characterise panic disorder. These ‘panic attacks’ are believed to occur when the brain’s normal mechanism for reacting to a threat – the so-called fight or flight response – becomes faulty. Most people with panic disorder also feel anxious about the possibility of having another attacks and avoid situations in which they believe these attacks could happen, this can start to impact their lives quite dramatically.
Panic disorder affects one out of every 75 people and usually starts during the teen years or in early adulthood.
Initial panic attacks may happen in ordinary situations or when you’re under a lot of pressure, or feeling stressed from an overload of work, for example, or from the loss of a family member or close friend. The attacks may also follow surgery, a serious accident, illness or childbirth. Too much caffeine or the use of cocaine or other stimulant drugs can also trigger panic attacks. Nevertheless, panic attacks usually take a person by complete surprise. This unpredictability is one of the reasons they are so confusing and devastating; many people seek help at an emergency unit.
Panic attack symptoms
A panic attack is a sudden and strong feeling of overwhelming fear and apprehension…
During a panic attack, some or all of the following symptoms occur:
- A sense of being overwhelmed by fright and terror, with accompanying physical distress for between four and six minutes
- Racing or pounding heartbeat
- Chest pains
- Difficulty breathing
- Tingling or numbness in the hands
- Flushes or chills
- Sense of unreality
- Fear of losing control, going ‘crazy’, or doing something embarrassing
- Fear of dying
Strategies for coping with panic
Remember that although your feelings and symptoms may be very frightening, they are not dangerous or harmful. What you are experiencing is only an exaggeration of your body’s normal reaction to stress.
Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become. Do not add to your panic by thinking about what might happen. If you find yourself asking “What if?” tell yourself “So what!”
Remain focused on the present. Notice what is really happening to you as opposed to what you think might happen. Label your fear level from zero to ten and watch it fluctuate. Notice that it does not stay at a very high level for more than a few seconds
When you find yourself thinking about the fear, change your ‘what if’ thinking. Focus on and carry out a simple and manageable task such as counting backwards from 100 in three’s or snapping a rubber band on your wrist.
Notice that when you stop adding frightening thoughts to your fear, it begins to fade. When the fear comes, expect and accept it. Wait and give it time to pass without running away from it.
Panic and anxiety self-test
If you think you may have a panic or anxiety disorder take this self-rating questionnaire and discuss the findings with your mental health expert.
Anxiety self-rating scale
This scale is designed for your personal use; there are no right or wrong answers. Usually your first response is the best.
For each item decide if it NEVER applies to you (mark 0); SOMETIMES applies to you (mark 1); HALF THE TIME applies to you (mark 2); FREQUENTLY applies to you (mark 3); or ALWAYS applies to you (mark 4).
When you are finished add up your totals in all 5 columns to get your TOTAL SCORE. Make sure you base your answers on how you actually behave in your daily life, not on how you would like to be.
1. I feel tense, nervous, restless, or agitated 0 1 2 3 4
2. I feel afraid for no apparent reason 0 1 2 3 4
3. I worry about bad things that might happen to me or those I care about 0 1 2 3 4
4. I have difficulty falling asleep, staying asleep or waking up early 0 1 2 3 4
5. I have difficulty eating too much, too little or digesting my food 0 1 2 3 4
6. I wish I knew a way to make myself more relaxed 0 1 2 3 4
7. I have difficulty with my concentration, memory or thinking 0 1 2 3 4
8. I would say I am anxious much of the time 0 1 2 3 4
9. From time to time I have experienced a racing heartbeat, cold hands or feet, dry mouth, sweating, tight muscles, difficulty breathing, numbness, frequent urination, or hot/cold flashes 0 1 2 3 4
10. I wish I could be as relaxed with myself as others seem to be 0 1 2 3 4
SCORING: Total the number of points in each of the columns. Add all columns together to get your TOTAL SCORE
0 to 8 points = MINIMAL ANXIETY
8 to 16 points = MILD ANXIETY
17 to 24 points = MODERATE ANXIETY
25 to 32 points = HIGH ANXIETY (Warning Level)
33 to 40 points = EXTREME ANXIETY (Warning Level)
For more information, support, telephone counseling, or referral to a doctor, psychiatrist or clinic in your area, please contact the South African Depression and Anxiety Group on 0800 21 22 23 or 0800 70 80 90 seven days a week, from 8am to 8pm.
Just came across this blog – well, a while ago, but only really reading it now. Fantastic writing. Can really connect to this.
A while ago hubby watched a movie one night when he couldn’t sleep. Me – I was of course so far in zzz land that I don’t think I knew that he was even up that night. The next morning, he told me of a movie that he watched and how much he enjoyed it and that he thinks I should watch it.
And so last night I did.
And it was wonderful.
It’s a story written by Mitch Albom of “Tuesdays with Morrie” fame. And it tells the true of story of Mitch’s experience of visiting his Rabbi who asked me to prepare a eulogy for him. At the time of the request, the Rabbi was 82 – he eventually died at age 90 and in the intervening years Mitch Albom used to visit his Rabbi regularly to prepare a eulogy based on who the man was, not just the man…
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Training your heart and feelings
I am still busy reading Emotional Gravity by Angela de Souza. It really is an excellent book and I would highly recommend it (and I am not even half way, yet). And yesterday, I was reading about how if you have a leaning toward a negative emotion, how you need to focus on the opposite positive emotion and to start training yourself to feel, believe and think in that opposite emotion. So, that you can start to have positive feelings, and positive thoughts – and lead a positive life. As Joyce Meyers says,
“You can’t live a positive life thinking negative thoughts.”
Now, I battle with anxiety and fear. For whatever reasons, I do. And I understand all the reasons, and I know how and why I came to be at this point, but none of this has miraculously relieved me of the anxiety and fear that I feel. That is where I feel this book is coming in handy – it is the realisation that I have to control my thoughts, and train my emotions – as if I am training to run a marathon. I cannot give into the anxiety and fear any longer. I need to acknowledge why I battle with this, forgive those that need to be forgiven and now train my mind and feelings.
So, the opposite of anxiety is:
Assurance, calmness, composure, contentment, ease, happiness, nonchalance, peace, tranquillity
So, I need to focus on feeling calm, composed, content, happy, peace and tranquil.
Easier said than done when living with so much financial stress, and working in a very stressful environment and battling family politics, etc, etc, etc…
But, this I can do. Take a deep breath, and allow the calm and peace to flow over you and allow yourself to believe and have faith.
This I can do. I can learn to not have this anxiety that has plagued me virtually my whole life. It is not going to be easy, because I am constantly aware of this anxiety that sits in the corner like a naughty child, just ready to come out and take over.
13 I can do all this through him who gives me strength.
I need to let go of the “What ifs”? You know… the “what if’s”?
- What if I die tomorrow and there is no-one to look after Baby Girl and Hubby?
- What if I lose my appetite and never eat again?
- What if I have a panic attack? Another one? Again?
- What if I don’t love my hubby as much as what I think I do?
- What if he doesn’t love me?
- What if I get sick?
- What if I can’t work?
- What if we battle financially all our lives?
And people want to know why I battle with anxiety. Yes, seriously. It is these negative thoughts that haunt my dreams and my mind. Things that I cannot control. Things I shouldn’t even try to control. Dr Phil always says, if you’re going to play the “What If” game, you need to play it through to the end. So, well, here goes:
- What if I die tomorrow and there is no-one to look after Baby Girl and Hubby? Well, while of course they will mourn and life will be hard, they will move on. Life goes on. That is the sad reality of death. And all I can do is pray that a woman will come into Baby Girl’s life that will mentor her and look after her and give her guidance and advice and pray for her when she’s feeling scared and lonely. I can never control my own death, but I can look after my health and pray that someone will fulfil that role for me for Baby Girl – IF this should ever happen. And as for my hubby – well, it kills me to say this, but I would want him to meet someone. I don’t want him growing old alone. But, it would have to be someone who will love him and his past with me and respect that I am his first love. And someone who will adore Baby Girl. See – I’m not even sick and there is no need for me to even worry about this, but already I am making plans. The point is, that even though this fear may happen, in the long run, Baby Girl and Hubby will be just fine.
- What if I lose my appetite and never eat again? This is a long and ongoing fear of mine. From years of abuse regarding my weight, I’ve developed a sensitivity to not eating that has seen my grow in size and become rather, uh, large… What if I don’t feel like eating now? Am I going to die? NO – I’ll probably eat later when I’ve calmed down enough to swallow. Its nothing to fear really, but for me it is such a big fear. But, no-one just stops eating unless they are sick. Even people who lose their appetite under huge strain, eventually do start eating again. Even anorexics start to eat – sadly, though too late, but they do try. People have this innate need to survive. So, really, a what if I should never bother to fear. And if I can make peace with this fear, I can lose some weight and start being healthy again.
- What if I have a panic attack? Another one? Again? Seriously, I have been through this more times I can count and I always, ALWAYS come out fine. A bit shaken, a bit nervy, but fine. And if I get my mind right, I can move on from these panic attacks without allowing it to affect me too much. Once again, nothing to fear, nothing to worry about. I have to learn to take the fear out of these panic attacks, because while I still fear panic attacks, it will always have a hold over me. Not fearing panic attacks, frees one to just go on and enjoy what you’re doing. If there is nothing to fear, then I’d probably wouldn’t have another panic attack. But fearing them makes them all too real. And frightening and that fear that holds so much power over me is what brings on these panic attacks in the first place. For me. For you, it may be different. But for me, I know this to be true.
- What if I don’t love my hubby as much as what I think I do? Well, I can’t control what may happen tomorrow. But, for now, I can control how we manage our relationship. And what I feel for him now. And I know that now I love him with all my heart. And I know that underneath all the fear and anxiety, he is the only one for me. So, why fear something in the future that may or may not happen? Who knows – I pretty much fear anything and everything. My point is I only have now to worry about – how I manage my relationship NOW. How I react and love my husband NOW. What type of family life I create NOW. All of this will dictate and pave the path for the future, but I can’t control that outcome – I can only control now. And now? I love him with my whole heart and if I nurture that and maintain that, then this fear will never be realised.
- What if he doesn’t love me? I know how important I am to him. I see all the little things he does for me. How he puts up with my anxiety. How he has stuck with me through all the financial heartache we have experienced, through the lack of support and a baby who cried solidly for the first year of her life.
- What if I get sick? Well, what if I do? We’re on a good medical aid, with some amazing doctors, so what if I do get sick. Or, what if, just for a change, I focus on the fact that I am healthy now. And perhaps I should focus on losing weight and getting fit because then if I do get sick, my body is fighting fit.
- What if I can’t work? Well, hubby and I have already been through so many financial issues that this is almost a no-brainer. Yes, we need both salaries to survive, but we have made it through some really tight financial messes already, I have no doubt that we will find a way to make this work.
- What if we battle financially all our lives? Well, we’ve been battling the last seven years and we’ve been doing okay. In fact, we’re going to send our one and only to a private Christian school, because we both feel that it is just the right school for her.
So, all I have proven is that there is nothing to fear in any of my fears. At all. The trick now is to learn to live all this out. So, that in truth, my life is not governed by fear, but rather by the freedom to enjoy life.
The Anxious Mama