“Go easy on yourself. Whatever you do today, let it be enough.”
– Unknown ❤️
November 2021, Volume 5
The G.T.Health Letter
~Adding a dose of mental health awareness to our community~
Mental Health Spotlight – Anxiety Disorders
Xtra Scoop of the Week – Anxiety in School
Weekly Testimonial – Too Sick to Leave the House
Mental Health Spotlight – Anxiety Disorders
What is an anxiety disorder?
Anxiety disorders are a collection of functionally-impairing conditions characterized by large excesses of anxiety and fear. It is important to distinguish between these two terms when understanding anxiety disorders: fear is the reaction to a current threat, like a fight-or-flight response, but anxiety is the anticipation of future threats. There is nothing happening to you now, but you’re convinced that something will. Whereas a fear response is associated with heightened arousal (increased heart rate, sweat, blood flow to the limbs), an anxiety response is more like a state of hypervigilance. The muscles tighten in preparation for an attack that might never come. One of the most unnerving things about anxiety and fear responses are their evolutionary origins: tensing for battle and running from danger are behaviors that have kept humans alive for many centuries, and our species would have gone extinct if we did not have these instincts. However, in the modern-day most of the threats we are faced with are not deadly. We used to fend off raging mammoths and big cats and other apex predators, but now we fend off SATs and public speaking presentations with the same instinctual response, which is way more extreme than necessary to deal with an exam. It is for this reason that anxiety disorders are so crippling: their symptoms are an excess of emotions that we already experience in excess, and so can be enough to stop a person from leaving their house, talking to other humans, or even taking care of themselves. The biggest difference between different anxiety disorders is that they each have different root causes. For example, social anxiety disorder involves excessive anxiety targeted at social situations and public spaces, whereas a specific phobia might be targeted at a type of animal or an element (like water or fire). Interestingly, specific phobias are often directed at things that are good to be afraid of: drowning, animals that could harm us like spiders, death, and the unknown are some examples. However, this does not make an anxiety disorder any less harmful to the sufferer.
What are some of the major anxiety disorders?
There is a large handful of diagnoses in the DSM that are classified as anxiety disorders. Some of them are more prevalent in childhood, like separation anxiety disorder (SAD), which is characterized by fear of separation from a major attachment figure, like a parent or caregiver. About 1-2% of American adults are diagnosed with SAD, compared to about 4% of children, and the risk declines with age. Separation anxiety is natural and instinctual. Big life changes, like going away to college or starting preschool, can bring on higher levels of separation anxiety, so to be diagnosed as SAD the anxiety must be developmentally inappropriate; for example, nightmares about separation, refusing to sleep without an attachment figure, refusal to leave the house, and physical reactions like vomiting. The symptoms must also be persistent, for at least 4 weeks in children and 6 months in adults. Another disorder more common in children is selective mutism (SM), which is a specific failure to speak in certain social situations, although speech is possible elsewhere. For example, a child is incapable of speaking in school, but shows no signs of this symptom at home. This disorder is a very rare form of social anxiety, in about 0.3-1% of the population. There are also specific phobias, which are characterized by elevated and inappropriate fear responses to certain stimuli, which are present for at least 6 months and inhibit normal functioning. Rates of specific phobia are higher in the US and Europe (6-9%) than on other continents (2-4%), and symptom severity usually decreases with age. Then there is panic disorder, which is unique because it involves a fear response instead of an anxiety response: panic attacks. The diagnosed individual must experience at least a month of impairment due to panic attacks or fear of panic attacks, such as avoiding stimuli that might trigger an attack. Panic attacks themselves can involve fear of losing control, sweating, fear of dying, and chest pain. Finally, generalized anxiety disorder (GAD) is diagnosed after a period of at least 6 months of excessive worry that is difficult to control and associated with functional impairments like exhaustion, irritability, insomnia, and muscle tension. There is a major sex difference in GAD diagnosis, with females being twice as vulnerable as males.
How can you help someone with an anxiety disorder?
If you know someone with an anxiety disorder, the best thing you can do for them is to educate yourself on how to help, and the second best thing is to treat the disorder like it’s real. There are certain coping strategies that don’t involve spending money on therapy or medication that you can help with, like limiting caffeine intake (don’t bring your friend out for coffee; maybe to a juice bar instead), meditating and practicing mindfulness (offer to take a yoga class with your friend), and exercising (turn those juice dates into walking dates). It is also important not to interfere with your friend’s anxiety: don’t try to make them confront their fears before they are ready (you might cause a major anxiety attack), but don’t help them to avoid the situation at all costs and thus enable and validate those fears. A person with anxiety must work through it at their own pace; being a good friend to them means reading them closely for signs of distress or acceptance, and learning to react to those signs. If I have GAD, and you convince me to come to the mall with you to buy the new Adele record, I might stay up until 2 the night before worrying about how long the check-out line will be and how many people will be staring at me. You might try to distract me from thinking about others, or promise me ice cream once we leave. We find the record easier than you were assuming, and you decide that my relative ease means you can go one step further, and suggest we look at the Wii games. But that section of the store is much more crowded; we get a few feet into the aisle and you can feel me starting to tense up, so you decide that’s enough for one day and we go to checkout. This way, you as a friend have both helped to conquer the fear by taking me to the store in the first place and celebrating the successful purchase of the record, but you’ve also acknowledged my limits and not pushed me too hard for your own benefit.
What kinds of treatments exist for anxiety disorders?
The most common class of medication taken to help reduce symptoms of anxiety is anxiolytics, like Xanax and Valium; they work quickly, but can become addictive, so are given in small doses. Anxiolytics are sedatives, which means they work by slowing brain activity to make the individual more relaxed, thus reducing anxiety symptoms like tension and other physical reactions. Common types of therapy for anxiety are cognitive-behavioral therapy (CBT) and exposure therapy, both of which attempt to get to the bottom of your anxiety by helping you identify and improve your relationship with environmental triggers. Exposure therapy in particular involves the systematic confrontation of the avoided stimulus. For example, I once watched a case study about a woman who was petrified of heights, and specifically elevators. Her sessions would start out as simply as thinking about heights, which would trigger a panic response. When the response arose, she and the therapist would face it head-on, reminding her that fear is natural and she is okay. As she was able to cope more easily with each stimulus, the therapist would take it up a notch: pictures of elevators, a video of a moving elevator. Then, the therapist went with her to the elevator in the building and they began practicing stepping into the elevator with the door open, then letting the door shut, and then eventually (after many weeks, that is) going up a floor. This success was achieved not because the woman stopped being scared of elevators, but because when she got scared, she was able to talk herself through it and not lose control to anxiety.
When I’m standing there –
Fists bracing –
For ‘no reason at all,’ I hope it makes you
Feel big and tall, To tell me I’m being stupid.
When I can’t talk to someone –
Because my throat is dry,
And I feel sick,
Like I can’t
Catch my breath,
Like I’m going to cry
Like I’m hurtling
Towards death – Don’t tell me to
‘Get over myself.’
When I’m crying –
And my knees
And I’m too scared
And every heart
Makes me jump – How can you tell me
I need to ‘grow up’?
When I can’t get on a bus –
Because so many people,
So many eyes,
And my mind is force-feeding
Me so many lies – Don’t tell me I ‘think I’m better
Than everyone else.’
I’m trying my hardest.
Reallly, I am.
Would you tell someone with a broken leg
To just get up and walk?
Would you tell someone with no tongue
To open their mouth and talk?
Would you tell a wingless angel
So tell me why –
When it is my head that’s sick,
A sick you can’t see – Is it any different for anxiety?
Let’s talk about this poem.As I was mentioning before, one of the worst things you can do for someone with anxiety (or someone with any disorder, for that matter) is refuse to validate their suffering. Disorder does not define you, but it does impair you, in exactly the same way as a physical deformity. Just as the poem says, we don’t tell people with paralysis to get up and walk and stop complaining that they can’t; what difference does it make that the impairment is visible or not? American society in particular has the habit of holding people responsible for their own actions; people like to believe that they succeeded because they worked hard, not because they are privileged, and that they failed because of their own shortcomings, not because of systemic oppression.
But this mindset leaves many people ignorant of the fact that there are some things about life that are simply out of our control, and thus makes them blame individuals for things they couldn’t change if they tried. Consider the Equal Pay movement; women are systematically paid less than men in many professions, sometimes by a startling margin. If you start telling me that I’m getting paid less only because I’m not working as hard, I might start believing you, and trying to work harder to compensate. But because the pay gap is largely out of my control, my efforts won’t get me anywhere, and you’ll just increase my own feelings of worthlessness because now I’m convinced I should be able to affect something I physically cannot. It is the same way with disorder; if you invalidate someone’s suffering by telling them it isn’t real or it’s all their problem, they might become too hopeless to try and seek help. You are not a slave to your symptoms; you can improve them and change your lifestyle, but in most cases they will never truly go away, because they are biological as much as they are environmental. And that’s okay.
Xtra Scoop of the Week – Anxiety in School
A lot of pressure is put on children and adolescents to succeed in school. In many countries, your future depends on good grades, and good grades often depend on the ability to participate effectively in class. But many disorders, like ADHD and anxiety, make this impossible. Children with SAD might be chronically absent because they’re afraid to leave their parents when they go to school. Children with selective mutism might be incapable of speaking up in class, and thus not get the help they need with their work (and, worse, might be teased by other children). Generalized anxiety can make people disturbed or irritable, meaning that children might become disruptive in class and even be misdiagnosed with ADHD. This disruptiveness can even come out as aggression: in the same way a cornered cat is more likely to strike, a scared child might have quite a negative response to people confronting her. Anxiety can also produce physical symptoms like stomach problems and racing heart, sending children to the nurse’s office especially in high-stress situations, like exams. I’ve had one such experience like this: in eighth grade, I was sitting for a math test and could not think of any answers. My vision became blurry and my brain seemed to stop working, and the reaction was so intense that I had to sit out in the hall and reschedule the exam.
When I was younger, about five or six, I started becoming afraid of new things. Not just that natural twinge of apprehension when you step off the plane in a new country, when you sit down on a blind date and are faced with a potential partner. Children naturally fear new things; if a child is securely attached to her parents, she will be curious enough to explore the surrounding environment but cautious enough to run back to the security of her mother when the newness is too much. But being my parents’ first child, they were more often than not afraid for me, projecting their own worries about their firstborn getting hurt onto me. When my sister was born colicky and full of tantrums, they became sleepless and frustrated. She would throw a fit leaving the house, getting dressed, picking out shoes.
That’s when the vomiting started. Whenever we left the house, I would worry myself sick – literally. She would scream, and I would throw up, probably I came to associate her fits with my parents’ distress, and their distress with going out, and thus going out became petrifying.
I have three notable memories of such instances:
When I was about six, my great-great aunt passed away. She’d lived a long life and I hadn’t known her very well. I was wearing a sage green dress and sitting in the third row of seats with my cousin. My sister had thrown a tantrum before we left, and her and my parents were still on edge, and I threw up in the car and still had to sit through the funeral.
In the same year, we went to meet our friends at the beach; though it was an objectively happy experience, with a picnic and playtime in the sand, I still threw up before we left the house.
I won a trip to a museum with my second-grade teacher and a friend of my choosing when I was eight or so. I was sick before we left, and I remember crying as well.
These memories are your reminder to feel strong enough to speak up if you too have symptoms of anxiety; people might not always understand or be able to empathize, but your mental health is more important than their ignorance. I was helped by that second-grade teacher, who taught me to be alright with change, and I haven’t vomited out of anxiety since third grade. These days, I do still dread new experiences and will sometimes decline an invitation in fear of it, but I’m learning, and trying to be open about the journey.
That’s all for this week, folks!
Next week’s topic:Prejudice and Stereotyping
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