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.