Anxiety
Anxiety is a symptom that can accompany various mental health issues, ranging from mild to severe. It can encompass general anxiousness, separation anxiety, panic attacks, and persistent severe anxiety. It's crucial not to confuse the term "anxiety" with Generalised Anxiety Disorder (GAD), which only represents a small portion of anxiety experiences. Anxiety usually accompanies other mental health disorders. When anxiety is severe and presents as a distinct standalone disorder, it may be characterised as GAD, which is a narrower concept than anxiety in general.
Difference Between Anxiety and Generalised Anxiety Disorder (GAD)
Anxiety is a term that encompasses a wide range of experiences, both in terms of the quality of the experience and its severity. It is usually not a standalone symptom and typically accompanies other mental health disorders and psychological conditions.
For instance, anxiety is a common symptom among those who have experienced childhood trauma, especially those who may have been subject to the authoritarian parenting style, which could have been punitive, controlling, or even abusive.
Also, individuals who formed an adult attachment style characterised by a high level of attachment anxiety, such as anxious-preoccupied and fearful-avoidant adult attachment styles, tend to experience anxiety in response to ruptures in close relationships.
Anxiety is also a common symptom accompanying personality disorders, especially borderline personality disorder (BPD), where it can be experienced as anxiousness, including nervousness, tenseness, or panic, as well as separation anxiety. The experiences of anxiety, in the case of BPD, are normally associated with issues one experiences in close and romantic relationships.
Similarly, anxiety is often experienced in individuals with higher levels of dependency, where it usually has the quality of separation anxiety and fears of abandonment.
Anxiety is usually an accompanying symptom of various other mental health conditions, such as post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder (C-PTSD), obsessive-compulsive disorder (OCD), and often occurs alongside depression.
Anxiety also occurs with mental health issues and psychological distress that may present itself at subclinical level. This means that the issues an individual is struggling with do not meet the diagnostic criteria threshold of a particular mental health disorder, for instance, they are not severe enough for a diagnosis. Nonetheless, the anxiety one experiences may still be crippling and significantly impact their quality of life.
It is important to remember that the above list of different mental health disorders and psychological issues that may underpin anxiety is by no means exhaustive, and that anxiety is a common symptom of many mental health issues.
What is Generalised Anxiety Disorder (GAD)?
Generalised Anxiety Disorder (GAD) is a prevalent mental health condition characterised by constant worry. It involves ongoing or prolonged states of tension and nervousness without a clear reason or trigger, and may cause increased concern over everyday situations.
It may involve irrational, uncontrollable worry and anxiety about various aspects of life, such as work, health, family, or finances; however, this worry is often not an appropriate reflection of reality. Unlike normal anxiety, which is typically situational and temporary, GAD involves persistent and excessive worry that is disproportionate to the actual circumstances. The irrational fears or worries are often difficult to control or dismiss, even as one recognises that their concerns are excessive or unrealistic.
GAD is often accompanied by physical symptoms like restlessness, fatigue, muscle tension, difficulty concentrating, and sleep disturbances. Some may experience the physical symptoms alone but not the emotional ones. So, a person may have bodily symptoms of a fight or flight response. They may feel nervous in their body, feel agitated and fidgety, and feel like they want to get up and move, however, without a clear reason for it.
While occasional anxiety is a normal part of life, GAD can significantly impact an individual's quality of life and ability to function effectively. If left untreated, GAD can lead to other mental health issues. For instance, self-medication may lead to substance abuse, which could push one into a cycle of social isolation and addiction, further compounding the individual's mental health challenges.
Common Symptoms of GAD
People with GAD often experience a constant state of worry and fear without any specific trigger. Even minor everyday events can provoke intense anxiety. Here are some typical signs of this disorder:
Persistent worry: Individuals with GAD frequently experience a cycle of persistent worrying about multiple aspects of life, including work, health, family, or finances. These worries tend to be hard to control and are often disproportionate to the actual situation.
Physical symptoms: Apart from emotional distress, Generalised Anxiety disorder (GAD) is often characterised by physical symptoms, which may include muscle tension, restlessness or feeling on edge, fatigue, and sleep disturbances such as insomnia.
Cognitive impairments, which may entail trouble concentrating or the mind going blank.
Irritability: A person struggling with GAD may also exhibit irritability or edginess as a result of a constant state of anxiety.
Hyper-vigilance: Someone with GAD may often have an increased awareness for potential threats or dangers in the environment.
It's important to note that everyone experiences anxiety differently. The above symptoms serve as general indications and might vary from person to person.
Childhood Trauma and Generalised Anxiety Disorder (GAD)
Childhood trauma can have a significant impact on mental health, and it is not uncommon for individuals who have experienced traumatic events in their early years to develop anxiety disorders like Generalised Anxiety Disorder (GAD). Traumatic events during formative years can disrupt normal emotional development and coping strategies, making an individual more vulnerable to anxiety disorders.
Research indicates a link between childhood trauma and the development of anxiety (Shafiei et al., 2022; Ölmez et al., 2022), as well as the development of subsequent concurrent physical pain (Kascakova et al., 2020). A similar association between childhood trauma was also found in the case of Social Anxiety Disorder (SAD) (Seedat et al., 2019).
Traumatic childhood experiences can shape how an individual perceives and responds to the world around them. When a child endures abuse, neglect, or other forms of trauma, it can lead to a persistent state of heightened vigilance and fear, even in situations posing no real threat. This can often manifest physically, with the person adopting a posture indicating threat or fear. This constant state of apprehension and worry is also a characteristic of Generalised Anxiety Disorder (GAD).
Furthermore, childhood trauma can impair the development of effective coping mechanisms and emotional regulation. Without these capacities, an individual may struggle to manage stress and anxiety healthily, leading to distress, fear, avoidance, isolation, and constant rumination.
While childhood trauma may increase the risk of developing GAD, not everyone who experiences trauma will go on to develop an anxiety disorder. However, recognising this link is crucial for early intervention and providing appropriate support to those who have experienced trauma, as it can help mitigate the long-term impact on mental health and overall well-being.
Psychotherapy and Anxiety
When considering the psychotherapeutic treatments for anxiety, there is no standardised approach. It's important to note that anxiety as a symptom may be treated differently than Generalised Anxiety Disorder (GAD), as they may have different underlying causes.
This also means that the treatment of anxiety can be done at a symptomatic level by addressing the symptom itself, or by addressing the underlying causes, such as personality impairments, that may underpin the symptom.
For instance, if one presents with dependency and anxiety as a response to interpersonal (relationship) stressors, treatment may focus on the underlying dependency rather than on anxiety as a symptom. Similarly, when treating anxiety that accompanies the diagnosis of borderline personality disorder (BPD) or anxiety that may be an aftermath of childhood trauma, the underlying condition may be the primary focus rather than the anxiety itself.
However, psychotherapy can also focus predominantly on anxiety as a symptom. In such cases, psychotherapy may involve only a brief psychotherapeutic intervention as opposed to psychotherapy that focuses on the underlying internal conflicts, which tends to be longer in duration.
The psychotherapeutic treatment approach will tend to vary significantly depending on whether anxiety is viewed as a symptom or as the root of emotional distress. Irrespective of the perspective, managing anxiety requires an individualised treatment plan, designed in accordance to each individual’s underlying issues and their needs.
Ales Zivkovic, MSc, Psychotherapist
Resources:
Overview - Generalised anxiety disorder in adults — NHS
Generalized Anxiety Disorder: When Worry Gets Out of Control — NIH
References:
Kascakova, N., Furstova, J., Hasto, J., Madarasova Geckova, A., & Tavel, P. (2020). The Unholy Trinity: Childhood Trauma, Adulthood Anxiety, and Long-Term Pain. International journal of environmental research and public health, 17(2), 414. https://doi.org/10.3390/ijerph17020414
Ölmez, S. B., Sarıgedik, E., & Ataoğlu, A. (2022). The relationships between separation anxiety disorder, childhood traumas, and anxiety sensitivity in a sample of medical students. Journal of Affective Disorders Reports, 9, 100367-. https://doi.org/10.1016/j.jadr.2022.100367
Seedat, S., Marx, M., Young, S. Y., & Bruijnen, C. J. W. H. (2019). Social anxiety disorder and childhood trauma in the context of anxiety (behavioural inhibition), impulsivity (behavioural activation) and quality of life. The South African Journal of Psychiatry, 25(1), 1–7. https://doi.org/10.4102/sajpsychiatry.v25i0.1189
Shafiei, M., Rezaei, F., & Sadeghi, M. (2022). The role of childhood traumas, interpersonal problems, and contrast avoidance model in development of the generalized anxiety disorder: A structural equation modeling. Psychological trauma : theory, research, practice and policy, 14(3), 377–385. https://doi.org/10.1037/tra0001117