3.1 The experience of anxiety
The main types of anxiety and anxiety-related disorders are summarised in Box 2. We will look at diagnosis and diagnostic criteria a little later on, but the information provided here should serve as a useful reference as you read further and engage with the activities in Sections 3.1 and 3.2.
Box 2 Anxiety and anxiety-related disorders
A sudden episode of intense fear and desire to escape; distressing physical symptoms (pounding heart, shortness of breath, sweating, nausea, trembling), can be accompanied by fear of dying, losing control or ‘going crazy’; anxiety peaks in around ten minutes, then subsides; occurs in situations that do not involve ‘real’ danger; leads to overly worrying about additional attacks and temptation to avoid feared situations.
Excessive worry (most days) about everyday events or activities; difficulty controlling worry, difficulty relaxing, sleep disturbances, difficulty concentrating, irritability, procrastination. Worry interferes with everyday life.
Persistent fear of social or performance situations (e.g. dating, public speaking); intense fear of negative evaluation by others; fear of being humiliated or embarrassed; avoidance of feared situations or enduring intense distress.
Intense, persistent and excessive fears of animals, objects or of enclosed spaces.
Fear of having a panic attack in a place where escape may be difficult or help unavailable; avoidance of anxiety-provoking situations (e.g. shopping mall, public transport, etc.).
Obsessive-compulsive disorder (OCD)
Characterised by recurring upsetting thoughts, and attempts to deal with these (e.g. compulsions such as hand-washing, arranging items in a particular order, counting) to temporarily relieve anxiety.
Post-traumatic stress disorder (PTSD)
Anxiety induced after witnessing or being subjected to or experiencing a traumatic event (recent or in the past).
Activity 3 The experience of an anxiety disorder and panic attacks
Watch the video below and consider the questions that follow. You might wish to view the entire recording first and then watch the video again thinking specifically about the questions the second time around, or you can review the questions as you watch the video from the start. Choose whichever approach suits you best.
Transcript: TED Talk: Alison Sommer − Anxiety Disorders and Panic Attacks
I have an anxiety disorder called Obsessive-compulsive disorder or OCD. I have a form of obsessive-compulsive disorder that causes me to become anxious or frightened when something wrong or unexpected happens, like if somebody sits at my seat at the table.
It also causes intrusive thoughts. These are thoughts that come unbidden to my head about things that I've done in the past or things that I might do, things that could happen by chance or because everybody secretly hates me. As you might imagine, these intrusive thoughts are really quite anxiety-producing. And this anxiety can manifest in different physical and emotional responses, one of which is the panic attack, which I'll be talking about more in depth later.
But the thing that made me really hyper-aware of the effects of my OCD, and made me determined to spread awareness about anxiety disorders in general is that my own symptoms were not always this severe. So I want to start at the beginning. As long as I can remember, I've always been sort of an obsessive-minded child. I would take a thing, good or bad, and roll it over in my head over and over.
I was also really shy and awkward. And I know, especially at Carlton, a lot of you are thinking 'Yeah. Me too!' [LAUGHTER] Because you know, there are a lot of shy, awkward people and all of us have our little obsessions.
I don't know if there's a scale for being shy, awkward and obsessive, but I always felt like I was toward the high end of the range. 'Weirdo' and 'freak' were terms I readily accepted as a teenager. And when all the other girls my age were really into the Backstreet Boys − I'm dating myself − I was obsessed with Star Wars. Sort of still am. I got in trouble for coming home late for curfew once as a teenager, and as punishment, my parents took away my Star Wars stuff and I thought that the world had collapsed.
I also had on-again/off-again issues with anxiety and depression. And anxiety and depression really go hand in hand, like two best friends who like to corner a third person and make them feel like shit. [LAUGHTER] So there I was, this anxious, awkward, obsessive, and sometimes depressed girl. And that was life. That was my normal.
When I got a little older and started coming out of my shell, and meeting people with similar interests to me, like the folks here at the sci-fi house at Carleton − Benton House, anyone? Woo. [LAUGHTER] I started actually opening up, and talking to people about my feelings.
And I started to realise that there were other people that were like me, that suffered from anxiety and depression. And suddenly, I went from feeling − instead of feeling like a ‘freak’, I felt like just kind of a normal anxiety depression story with a little obsessive behaviour thrown in for good measure. And that actually felt pretty cool.
So that was my life. I also started to get a little help then. I saw my first psychiatrist, got my first meds, and you know things were going pretty good.
And then I got a really bad concussion while I was playing hockey. Love the sport. Still play it. But it was bad.
That's when things took a nosedive from me feeling like normal, heyit-runs-in-the-family crazy, to scary crazy. That's when the intrusive thoughts started getting louder and louder. This clicker sucks.
[LAUGHTER] And it was bad. It was really, really bad. I was angry all the time. It mostly came out at my husband. But my road rage was also pretty epic.
And while I was being an ass to other people, I was also being an ass to myself. I was not eating. I was down to a size zero, and the thought monkey was saying, you can get skinnier.
And I didn't want to accept that I had a problem. I wanted to feel like I was kicking ass. But I knew deep down that there was something wrong, because I wasn't sleeping and my marriage was going through the shitter. But trying to even think about changing my habits, really thinking about changing any of my habits, would give me massive anxiety. And this anxiety was leading to panic attacks.
Panic attacks are one of the most frightening manifestations of anxiety. I know if you've never had a panic attack, the name sounds kind of lame. We all have those moments of panic, like 'oh, did I leave the oven running', or 'my kid just bolted out in the middle of the street', or maybe more for you, 'I forgot to study for that test'. But none of these are panic attacks.
The Mayo Clinic's website says that a panic attack 'is a sudden episode of intense fear that triggers severe physical reactions when there's no real danger or apparent cause. Panic attacks can be very frightening. When a panic attack occurs, you might think you're losing control, having a heart attack, or even dying.' That's a pretty good definition.
But what does it really feel like? That's what I'm going to try to show you. OK.
So it's a pretty normal day, but maybe a little bit stressful, like in a performance evaluation at work, or packing for a vacation. I'm doing something pretty normal. And I start to feel off. I know something's not quite right.
I'm getting tingly. That tingling numbness creeps up my neck and all over my face and seeps into my head. I feel dizzy, so I sit down. Sometimes I think maybe I just didn't eat enough today, so I grab for some crackers or a candy bar or whatever I have.
My head is feeling fuzzy. And as I'm sitting there, sometimes I think 'oh, my gosh, it’s seizures or a heart attack'. But I know better. I know it's a mounting panic attack when my heart starts beating harder − not faster, really, just hard, like the heartbeat in the background of a horror film.
Now I'm getting scared. I'm thinking, 'No. No, not here. Not now!' Right now, the right medication might help, might bring this crescendo back down and end the panic attack. But sometimes even the right medication doesn't always help.
I feel off. And I want to sit still, but my body just won't listen. So I pace. I lash out.
The tears come now, broken, dry cries. Weak, angry shrieks break through. And my brain is screaming, 'shut up, shut up, shut up'.
Not a real cry. Nothing that could be cathartic can come out. It all gets caught in my throat and in my head.
Oh, it's − I get angry, mad at this feeling, myself, and everything. I pound my head with my fists. I want to bang it against the floor. I want to smash my skull and make it all end.
And sometimes I do. I just hit myself. And I can't hold back.
And it feels like relief, suddenly, that physical pain. And I crave physical pain − cuts, burns, bruises. And then that scares me even more.
And I look up on my shelf of pill bottles and I think, I could take them all. I could end it right now. But I don't. [CRYING] I don't.
Real tears come now. So sad tears. But now I can lay down, and just wait for it to be over.
Eventually, it ends. And it always does end. And I'm still here. And with my sanity coming back, and with my head clearing, I'm grateful to still be here and that it always stops eventually.
This is not an easy thing to live with, knowing that it could happen at any moment, any place, at home, at work, at the tattoo parlour. That's happened. And not a lot of people talk about it, even though a lot of people go through it. When I first posted to my blog about my experiences with panic attacks, I was surprised when people started contacting me from all corners of my life and the internet to tell me about their experiences, and to thank me for speaking out, and told me I was brave.
It got me thinking. You know, these days, everything seems to have an ‘awareness month’ or a ribbon or some picture you can share on Facebook to spread awareness. Well, I've made this sort of my panic attack awareness effort. And now I hope all you know a little bit more about what they really feel like.
As for me, my husband did finally get me to see a doctor. It turns out that my anxiety and obsessive tendencies had basically been given steroids by the concussion and I was diagnosed with severe OCD. And we started the dance of trying to find the right combination of meds and therapy. We're still figuring it out. I still have panic attacks.
But luckily, thanks to some wonderful people and some magical chemicals, they're fewer and further in between. And blogging about it and talking about it is part of my therapy, too. I'm very blessed to have such a wonderful support structure here in my life and to have been given these opportunities to talk openly about my anxiety disorder.
40 million adult Americans, according to the National Institute for Mental Health, have anxiety disorders. That's just over 18% of the population. So chances are you know someone with an anxiety disorder, whether it's a friend, a colleague, or even yourself. Of the 40 million who have anxiety, 15% of them experience the terror of panic attacks. And it's twice as common in women as in men, because we're lucky. [LAUGHTER]
When I'm having a panic attack, the best thing that people can do for me is to just be with me and let me know they're there for me and will do things I ask that I say I need, whether that's to open a window or let me run away from the room or turn out the lights, none of which you can do on an airplane, by the way, turns out. [LAUGHTER] And so if you're there when someone you know is having a panic attack − it's hard to breathe in the middle of attack, much less speak.
So instead of asking them over and over, 'Are you OK? What's wrong? Are you OK? What are you panicking about? What can I do? Are you OK? Are you OK' −– just be there, let them know you support them, and sit with them as they ride out those waves of panic. Because you can't tell a panicking person to calm down. That's like trying to tell someone with a gaping wound to just stop bleeding. [LAUGHTER]
But what you can do is let them know you're there for them. It may make you feel helpless, but your presence is more comforting than you may realise. And then when it's over, then you can ask what you can do for next time, if anything, really.
But one thing we can all do is work together to end the stigma surrounding mental health disorders like anxiety so that everybody who needs help can feel safe in asking for it. You can help by showing respect to people who seek the aid of therapists, psychiatrists and medications. Instead of telling someone to work harder or worry less, tell them that you're there for them, and you understand these things can be a struggle.
If you have anxiety, it's not your fault. Help is available in many forms. I started getting help by working with my primary care physician, but there are also hotlines and websites such as the Anxiety and Depression Association of America at ADAA.org. In short, if you or someone you know has an anxiety disorder, give help, get help, speak out. You're not alone.
In this absorbing talk given in 2013 at Carleton College, a private liberal arts College in Northfield, Minnesota in the USA, Alison Sommer, a graduate of Carleton who was working as an academic technologist at Macalester College at the time, speaks candidly and poignantly about her personal experience with anxiety and panic attacks, sharing her difficult ordeal vividly with the audience on stage.
What form of anxiety does Alison suffer from?
How does her anxiety usually manifest?
How does Alison describe her own temperament, growing up?
What other mental health condition does Alison describe as having experienced, growing up?
Before her sporting injury (her concussion), how did she come to terms with her anxiety?
What, as she describes it, were the consequences of her concussion on her subsequent behaviour?
How does she define a panic attack (according to the Mayo Clinic’s website)?
How is Alison’s anxiety currently being managed?
What useful tip does Alison offer to support people experiencing a panic attack?
She states that she has a form of obsessive-compulsive disorder that causes her to become anxious or frightened when something wrong or unexpected happens. She also suffers from panic attacks, and intrusive ‘anxiety-provoking’ thoughts.
Her anxiety can manifest in different physical and emotional responses, one of which is panic attacks.
She describes herself as being really shy and awkward as a teenager, and obsessive-minded as a child.
She notes ‘on-and-off’ issues with both anxiety and depression (prone to depression), and that she was anxious, awkward, obsessive and sometimes depressed.
Through meeting people with similar interests, opening up and talking to people about her feelings.
Her symptoms were exacerbated by the concussion. They became severe and worsened considerably (she refers to her anxiety and obsessive tendencies metaphorically as ‘basically being given steroids by the concussion’). Intrusive thoughts predominated. She was angry, she was not eating or sleeping and her marriage was adversely affected. Thinking about her situation and changing her habits made things worse, giving her further anxiety, leading to panic attacks. She was diagnosed with severe OCD.
She defines a panic attack as 'a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When a panic attack occurs, you might think you’re losing control, having a heart attack, or even dying.'
Through a combination of medication and therapy, which is still being figured out (she describes this as a ‘dance’ given the difficult nature of finding the right combination that would work best). She still experiences panic attacks, but these are fewer and further in between.
She says the best thing someone can do is to be there and let the person experiencing the panic attack know that they are there for them, and that they will support them, a comforting presence that will help ‘ride out those waves of panic’.