Anxiety is a normal reaction to fears or danger. While it can be uncomfortable at times, it's something we all encounter. However, anxiety can start to cause a lot of problems if it comes up often, comes up when you aren’t in danger, or is hard to manage. Anxiety disorders are among the most common mental illnesses, but many people learn how to manage anxiety and live well.
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If anxiety is just part of being human, how can it also be an illness? The difference is in what causes the anxiety to occur and the extent that it impacts your quality of life. Feeling anxious before you write an exam may not feel good, but it’s manageable and you feel better when the test is over. Normal anxiety is:
A response to a specific situation or event
Proportional to the situation of event—a minor issue causes a little bit of worry while a larger problem might cause a lot of anxiety
Realistic—worries or fears are a response to something that could happen
Time-limited—anxiety starts to fade away as the situation or event is resolved or passes
Problematic anxiety is much stronger, lasts longer, and is harder to control than normal anxiety. It can be a real barrier in people's lives and prevent them from pursuing their usual activities. When people experience anxiety disorder, anxiety:
Feels like it comes up for no reason or comes up when you aren't in danger
Is much stronger than you'd expect—for example, you feel a lot of anxiety over a very small issue
Is unrealistic—your worries or fears focus on situations or outcomes that are unlikely to ever come true (or involve many hypothetical situations)
Is a lasting pattern—the same things or situations bring up a lot of anxiety every time, or you feel anxious most the time
Anxiety disorders are a group of mental illnesses that have similar symptoms around problem anxiety, though the cause of anxiety may be different.
Separation anxiety disorder
Separation anxiety is anxiety around separation from a parent, caregiver, or other important loved one. People may worry about losing their loved one (such as in an accident or illness) or worry that an illness or accident will cause separation. These fears are excessive and cause a lot of distress—some people have a hard time leaving their home without their loved one. Separation anxiety disorder is most common in children, but it can also affect adults. It can be very disruptive because it prevents people from going to work or school, meeting others, spending time with friends, travelling alone, and other important activities.1
With selective mutism, people can't speak or communicate in some situations. It's common for children with selective mutism to speak around their immediate family members but not at school. Many people with selective mutism also experience a lot of anxiety. People with this illness have normal language abilities, they just can't communicate in certain situations. Selective mutism is often most noticeable when children start school and have to manage more social interactions. While many children seem to outgrow selective mutism, they may continue to experience anxiety problems like social anxiety disorder into adulthood.2,3
Generalized anxiety disorder
People with generalized anxiety disorder or GAD worry or feel anxious most days. They worry about different parts of daily life, such as their home, work, family, health, finances, and the future. Triggers for anxiety can change from day to day. These worries are extreme or unrealistic and hard to control. Many people with GAD say it's almost impossible to stop their anxiety and that they can't remember the last time they felt relaxed. GAD can cause a lot of physical signs of anxiety, like muscle tension, headaches, stomach problems, and sleep problems.4
Specific phobia is a fear of a specific object or situation, like dogs, heights, or needles. With specific phobias, the fear comes up in all encounters with the feared object or situation. Some people do everything they can to avoid the object or situation while others can get through an encounter but feel very anxious. People may experience a lot of anxiety, even panic attacks, when they expect to encounter an object or situation.
It's natural to feel uncomfortable or nervous at times. If you've had a bad experience with a dog, for example, you might feel nervous around other dogs. However, the fears in specific phobia don't match the situation and can stop people from living their lives. A nervous flyer might feel uncomfortable getting on a plane, but they still fly when it's needed. Someone with a specific phobia around flying may not be able to make it to the airport, even when flying is required.5
Social anxiety disorder
Social anxiety disorder is fear around social situations. Common feared social situations in social anxiety disorder include social interactions (like talking with others), situations where others watch you (like eating in a group), or situations where you have to perform in front of others (such as talking to an audience). People with social anxiety disorder worry that others will judge them or think poorly of them. As in specific phobia, the feared situation causes anxiety most times it comes up and people may have a lot of anxiety when they know a particular social situation is coming up.
Social anxiety disorder can be very disruptive. It can be hard for people to share their skills at school or work, build relationships, and work towards their goals. While it's normal to feel shy around new people or feel nervous about performing in front of others, people without social anxiety disorder can get through the uncomfortable feelings. Someone with social anxiety disorder might pass up a job or goal to avoid a particular social situation.6
People with panic disorder experience unexpected panic attacks. Panic attacks are sudden and intense feelings of fear or danger along with symptoms like a pounding heart, sweating, shaking, chest pain, nausea, dizziness, and numbness. Some people say they feel like they're dying or "going crazy." Panic attacks peak within a few minutes and then slowly fade away. People who experience panic disorder say that panic attacks feel like they come out of nowhere. They may have a lot of worries around future panic attacks and may avoid activities or situations they think might cause a panic attack. Some may even avoid activities that trigger sensations that are present during a panic attack, like exercising or drinking coffee (increased heart rate). Panic attack symptoms can look like heart problems or other serious health problems, so some people who experience panic attacks have a lot of fears around their health. Like most mental illnesses, the severity of panic disorder can vary a lot. Some people may only experience a panic attack once in a while, while others may experience panic attacks every day.7
Agoraphobia used to be considered a part of panic disorder, but it's now considered a separate illness. Agoraphobia is the fear of panic or similar symptoms in a public space you can't easily escape. The anxiety experienced in agoraphobia may be related to actual or anticipated situations. Some people experience agoraphobia as embarrassment, like falling in front of everyone on the bus. As a result, people with agoraphobia experience a lot of anxiety in places like airplanes or public transportation, malls or theatres, parking lots or other open spaces, or crowds. People may experience anxiety every time they leave home, and some can't leave their home at all.8
Two illnesses used to be classified as anxiety disorders, but they are now considered to be their own categories.
Obsessive-compulsive disorder or OCD is made up of obsessions and compulsions. Obsessions are unwanted and intrusive thoughts or images that cause a lot of anxiety. Compulsions are behaviours or mental acts designed to temporarily reduce the likelihood of a particular feared consequence (like repeating a specific phrase or washing hands more than once for a certain amount of time). For example, someone who has a lot of obsessions around getting sick might feel like they have to clean their home a specific way until it feels "right."9 Anxiety is still a key part of OCD, and when you seek help for anxiety, your mental health care provider may also ask questions about OCD.
Post-traumatic stress disorder or PTSD comes up when people experience, witness, or are exposed to traumatic events like accidents, abuse, or a serious injury. People with PTSD experience a lot of anxiety around reminders of the event and around flashbacks, dreams, or other memories of the event. Many people with PTSD feel on edge most of the time, like they have to watch to make sure everything is safe.10 As with OCD, your mental health care provider may ask you about traumatic experiences in your life or other questions about PTSD when you seek help for anxiety.
If you think that you have an anxiety disorder, it's a good idea to talk to your family doctor or nurse practitioner. They can recommend treatment or connect you with specialized services.
Your exact treatment will depend on the specific illness, but in general, anxiety disorders may be treated with a combination of psychotherapy, medications, and self-help. In many cases, psychotherapy is recommended as the first treatment, with medications recommended if psychotherapy doesn't work on its own. Self-management includes little things you do every day to take care of yourself, like eating well, staying active, getting enough sleep, and watching your use of alcohol and other drugs. These strategies can have a big impact on your well-being.
In addition to talking to your family doctor, check out the resources below for more information about anxiety disorders:
Visit www.anxietycanada.com for anxiety resources for children, youth, and adults. Learn more about anxiety, use My Anxiety Plan to help manage anxiety, download the MindShift app, and find local mental health professionals and services across Canada.
BC Partners for Mental Health and Substance Use Information
Visit www.heretohelp.bc.ca for info sheets, tips and personal stories to help you understand anxiety disorders. You can also take self-tests to check in on your anxiety, mental health, and well-being.
Call 811 or visit www.healthlinkbc.ca to access free, non-emergency health information for anyone in your family, including mental health information. Through 811, you can also speak to a registered nurse about symptoms you're worried about or talk with a pharmacist about medication questions.
Crisis lines aren't only for people in crisis. You can call for information on local services or if you just need someone to talk to. If you are in distress, call 310-6789 (no area code) 24 hours a day to connect to a BC crisis line, without a wait or busy signal. The crisis lines linked in through 310-6789 have received advanced training in mental health issues and services by members of the BC Partners for Mental Health and Substance Use Information.
About the author
The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.