Anxiety

Anxiety, or anxiousness, is a state manifested by a feeling of unease, apprehension, and fear that can escalate to panic, along with psychomotor (bodily) tension and inner restlessness, and a sense as if the person might “explode”. It is most often unmotivated and not tied to a specific object or person.

Anxiety is divided into three main types:

• general anxiety

• phobia

• panic disorder

The group of anxiety disorders includes most of the disorders that for decades were known under the name “neuroses”. They usually do not involve the marked disturbances of mental functioning seen in psychoses; the ability to distinguish fantasy from reality, so-called reality testing, is preserved, unlike in psychoses. However, significant difficulties in behavioral patterns and interpersonal relationships may also arise. Anxiety disorders occur with a frequency ranging from 0.05% (obsessive-compulsive disorder – OCD) to 5% (generalized anxiety disorder). Certain features of individual anxiety disorders are actually quite common, and we speak of a disorder when these symptoms represent a significant limitation for the person in their everyday social and occupational functioning. In general, they occur more often in women.

Anxiety occurs in all psychiatric disorders, and it is the primary symptom of anxiety disorders. These are disorders characterized by intense anxiety, which the person seeks to resolve unconsciously in various ways, using different mental mechanisms. The source of anxiety may be an internal unconscious conflict or a situational factor such as a traumatic experience, stress, or loss. If there is a particularly difficult and problematic situation at work or at home, the stress that arises as a reaction to such a situation can spill over into other areas of life and thus create anxiety. Anxiety is the most common emotional disorder, occurring in both young and older people. It is a reaction to a real situation of danger, in which fear arises, followed by an appropriate reaction that becomes less effective the greater the fear. It can develop as a combination of risk factors, including life events, personal characteristics, genetics, and chemical processes in the body. Naturally, anxiety is felt when people are faced with a threat or danger, or when they are under stress. This disorder usually appears during early adolescence or early adulthood.

Symptoms of anxiety:

• easily losing patience

• difficulty concentrating

• expecting the worst possible outcome of a situation

• constantly thinking about the worst possible outcome

• difficulty sleeping

• fear of fear, negative thoughts

• preoccupation with something, or obsessiveness

• anxiety, depressive symptoms

• increased feeling of thirst

• a nervous “stomach”

• passing gas, digestive problems

• frequent urination

• inability to respond to sexual stimulation

• tightness in the chest

• episodes of a pounding heart (palpitations)

• muscle pain

• headache, sweating, tremor,

• disturbance of the menstrual cycle

Anxiety and stress

Anxiety disorders are caused predominantly by psychological factors, although there is evidence of a genetic influence (particularly in OCD) and a neurophysiological basis. Emotional stress can often be an additional factor causing anxiety (feeling threatened, changes in interpersonal relationships). On the other hand, symptoms of anxiety are direct manifestations of arousal of the peripheral autonomic nervous system, arising from frightening unwanted ideas and impulses. If unconscious psychological mechanisms fail to channel anxiety, the person will show a picture resembling general anxiety at the slightest provocation, or anxiety will be experienced as a state in the form of panic attacks.
If psychological defense mechanisms direct anxiety toward certain external objects or situations that symbolize the initial, true cause of anxiety, this allows the anxiety to be displaced and attached to some external symbol such as an elevator, a tunnel, etc., and that situation may then be avoided. In this case we speak of a phobic disorder or phobia.
Fear is an affect or feeling that has a motor and emotional reaction. Neurotic anxiety is similar to fear, but it arises when there is no visible danger, through general worry, a foreboding of danger, or through attachment to a specific situation – a phobia.

Phobia is divided into:

• rational – a reflex response to a possibly dangerous situation.

• irrational.

Anxiety disorders can be divided into:

Generalized anxiety disorder

The main feature of generalized anxiety disorder is chronic anxiety that lasts for days, weeks and months. In adults it centres on themes such as health, money or career. In addition to chronic worry, anxiety disorder involves trembling, muscle tension, insomnia, tension in the abdominal area, dizziness and increased irritability. Patients are constantly worried, they are troubled by even the smallest things and they are extremely uncertain about the future. They feel general tension, anxiety, a tendency to startle at minimal stimuli such as a sudden sound, and discomfort and nervousness when dealing with people. All of this may be accompanied by chronic fatigue, headaches, insomnia and numerous subacute autonomic symptoms. Although anxiety disorder is not entirely disabling, the patient feels chronic discomfort when carrying out daily activities and in interpersonal relationships, and work capacity is reduced by chronic fatigue and difficulties with concentration.
Panic disorder, or anxiety disorder, is among the most painful life experiences. It can recur repeatedly over time and can be extremely limiting for the person. It usually lasts from a few minutes to 1-2 hours, and a panic attack reaches its peak intensity after just a few minutes. The patient feels terror that arises without any visible cause, a threat of imminent death, which temporarily makes rational thinking impossible. During such panic attacks the person often feels they are going to die, especially because of numerous physical symptoms such as "pounding heart", occasional premature heart contractions ("heart skipping a beat") and chest pain described as very sharp or stabbing. Trembling, a visible fine tremor, sweating, stomach unease, general motor weakness, dizziness, nausea and diarrhoea often occur. A "hunger" for air often arises, leading to hyperventilation, which can result in muscle cramps and a tingling sensation around the mouth and in the fingers. After the first attacks, in anxiety disorder the patient begins to fear that such states will recur, and we can say they develop a "fear of fear", or the fear that the anxiety disorder will never stop.
Because of its cardiac manifestations, a panic attack can be mistaken for a myocardial infarction. This is also the reason these patients are often referred for numerous tests, after which usually "nothing is found".

Panic Disorder

People with panic disorder suffer from serious panic attacks without an obvious reason. A panic attack creates the feeling that the person will faint, go mad or have a heart attack and die. Panic disorder manifests as a pounding heart, discomfort or pain in the chest, sweating, trembling, flushing or tingling in parts of the body, a dry mouth and a feeling of choking, fear of dying and losing control, a sense of unreality, etc. Panic disorder often occurs together with agoraphobia – the fear of having a panic attack in places from which it would be difficult to escape, so such places are avoided. The causes lie deep in the subconscious, in repressed memories that seemingly without reason surface.

Phobic Disorder (Phobia)

A phobia is a neurotic disorder characterised by an irrational or excessive fear of objects or situations that are not really dangerous and are not a justified source of anxiety, e.g. fear of riding in a lift, fear of dogs, fear of going out into the street, etc.
The mere thought of the object of the phobia is usually enough to cause anxiety, and as the patient in reality gets closer to the phobic stimulus, the anxiety reaches a level where a panic attack can arise. The patient feels fear even though they are aware that it is irrational. They therefore avoid the situation they fear, which often leads to disability in daily activities and a reduced ability to function normally (they must walk up to high floors, cannot go to work alone on foot along the street, etc.). Agoraphobia (fear of open, public places or crowds) is the most common phobic disorder. The individual's activities are substantially reduced; in extreme cases they cannot leave the house at all and cannot leave the safety of their home. Often, an agoraphobic can go out into the street only if accompanied by a close person, and that person becomes a "compulsory companion".
Specific fears can also develop (e.g. of dogs, insects, enclosed spaces such as lifts – claustrophobia, or heights – acrophobia). If objects are unusual or can easily be avoided, no serious incapacity arises. However, significant functional impairment can occur, e.g. when a fear of aeroplanes develops in a businessman whose job requires frequent flying.