What’s worrying you? Anxiety and its causes.

By Mike DuBose with Dr. Surb Guram, MD

 

Occasionally feeling worried, stressed, and fearful is a part of human life. Some stress can even be healthy because it can push us to accomplish important things we might otherwise delay. However, for some individuals, anxiety becomes a serious problem, negatively impacting their social lives, work, and relationships.

Nearly 44 million Americans have some type of anxiety disorder, making it one of the most common mental health issues in the country. Sadly, nearly 70% of sufferers do not seek treatment, according to the Anxiety and Depression Association of America, and untreated anxiety disorders have the potential to cause mental and physical harm. For example, anxiety is correlated with heart disease, as reported in the October 2017 Harvard Heart Letter: “People with anxiety disorders have inappropriate ups and downs that can cause high blood pressure and heart rhythm disturbances.”

Anxiety is a natural reaction to stressors such major deadlines, relationship and family problems, life changes, or scary situations. These triggers activate the body’s “fight or flight” response, causing reactions (like rapid heartbeat and hyperawareness) that helped our ancestors survive danger. Individuals with anxiety disorders, however, experience this stress response excessively and unnecessarily. Columbia, SC-based psychiatrist Joshua Fowler, MD said, “What I generally explain to patients and parents about anxiety is that it presents as uncontrollable worry. This can manifest in a number of ways depending on the individual and their age.”

Anxiety disorders often coincide with depression: Hara Estroff Marano noted in a Psychology Today article that “half of those with chronic anxiety also have clinically significant symptoms of depression.” (For more about depression and how it relates to anxiety, read our published article “Understanding Depression: The Road to Darkness” at www.mikedubose.com/depressioncauses.)

As with depression, the exact causes of anxiety disorders are unknown, and triggers vary by individual. Risk factors include experiencing a buildup of smaller stressful situations, having a certain personality type, being subjected to a traumatic event, and exhibiting other mental health disorders.

Through research, scientists have identified several other likely causes:

Family history: Anxiety disorders can run in families, indicating that genetics and environmental factors (i.e., how a person is raised) play a major role. For specific phobias (including agoraphobia and social anxiety disorder) and separation anxiety, a person’s history and environment are particularly relevant. Negative experiences, especially those endured as a small child, are a major influence behind related fears later in life; they teach the brain to become oversensitive to perceived dangers.

Brain chemistry: In some anxious people, the “circuits” in the brain are arranged atypically, leading to abnormal stress responses. The amygdala, the part of the brain that decides what is worthy of worry and alerts the body, is thought to be particularly relevant to anxiety disorders.

Medical illness: If you are having difficulties with anxiety and do not have a family history (a sibling, parent, or possibly a grandparent with mental issues) or a traumatic event in your past that could explain it, it may be the first sign of a medical illness. According to the Mayo Clinic and other health professionals, the following have all been linked to anxiety:

• Heart disease
• Diabetes
• Hyperthyroidism (overactive thyroid)
• Meniere’s syndrome (an inner ear disorder)
• Respiratory disorders (including COPD and asthma)
• Drug abuse
• Withdrawal from alcohol, benzodiazepines, illegal drugs, or other medications
• Chronic pain
• Irritable bowel syndrome
• Rare tumors that generate certain “fight-or-flight” chemicals
• Hormonal issues stemming from menopause, postpartum depression, premenstrual syndrome, or Cushing’s syndrome

Medications: Prescription drugs that are linked to anxiety include: albuterol; salmeterol; theophylline; blood pressure medicines; codeine; oral contraceptives and other hormones; amphetamine-based drugs like Adderall, Ritalin, Strattera, Benzedrine, and Dexedrine; cortisone; prednisone; dexamethasone; thyroid products like Levoxyl; the antiepileptic drug phenytoin; levodopa (for Parkinson’s disease); quinidine, a drug used to prevent irregular heartbeat; and some antidepressants, including Wellbutrin, Effexor, and Prozac. Over-the-counter medications that contain caffeine (such as Anacin, Empirin, Excedrin, NoDoz, and some cough medicines) and decongestants such as phenylephrine (including Sudafed PE) can also promote anxiety.

Food and drink: Consuming alcohol, refined sugars, caffeine, plants from the nightshade family, salt, and packaged, fast, aged, cured, fermented, or cultured foods can also promote anxiety.

In addition, some aspects of our modern lifestyle, although not medical causes of anxiety, can certainly exacerbate it:

Social media: Looking at images shared by others on social media outlets like Pinterest or Facebook, some people worry that they’re failing in comparison. Young individuals seem to be most susceptible: a study published in the Journal of Affective Disorders in 2017 found that “more social media use was linked to greater odds of having an anxiety disorder.”

Excessive smartphone use: Many people now keep their smartphones nearby all day, every day, subjecting themselves to a ceaseless barrage of communications. In fact, participants in a recent British study checked their phones an average of 85 times per day—about 5 times per waking hour! These distractions make it harder for workers to focus on their jobs, which can raise stress levels, and also cause anxiety when individuals are separated from their phones.

Negative TV news: Humans naturally have a negativity bias, which causes them to pay more attention to threats and dangers. Originally, this was a survival mechanism, but now, it can make them disproportionately focused on sad and alarming news, which affects their emotions.

Sedentary behavior: A recent review of nine studies published in the journal BMC Public Health said the studies showed “moderate evidence” that increased sedentary behavior is associated with higher anxiety risk. The reviewers suggested that poor metabolic health, disrupted sleep patterns, and social withdrawal—all results of a sedentary lifestyle—could be at least partly to blame.

Insufficient sleep: Exhaustion makes people overly sensitive to common stressors, making them more anxious. Harvard University reported on a major study of 10,000 adults where “people with insomnia were 20 times more likely to develop panic disorder.” A possible explanation for the link between lack of sleep and anxiety was raised in a recent study published in the Journal of Behavior Therapy and Experimental Psychiatry.

Stressful jobs: Too often, today’s workers are expected to clock long hours, produce beyond their limits, and compete with their peers. Their supervisors’ unrealistic expectations make them stressed and angry, but they’re too worried about losing their jobs to speak up. These feelings are elevated when employees feel like they can’t give input. As Joni Johnston, Psy.D., explained in a Psychology Today article, “In particular, jobs with high demands (such as workload, time pressure, and role conflict) and low control (with low autonomy and authority) and rewards (money, esteem, career opportunities) increase stress and, hence, risk for psychiatric ill health.” Ironically, stressed-out employees’ performances suffer due to their fear and worry: in a Monster.com study of almost 7,000 workers, 61% said had been physically ill due to workplace stress, and roughly half had missed work due to the effects of their anxiety-producing jobs!

The American Psychiatric Association focuses on six main types under the general category of anxiety disorders. They include:

Generalized anxiety disorder, where constant, persistent worry and fear interferes with an individual’s normal daily life. Even simple, routine tasks like household maintenance can be the focus of the anxiety. The worry that the person with generalized anxiety disorder (GAD) feels about these tasks is greatly magnified in terms of how important or difficult they truly are.

In addition to intense worrying, generalized anxiety disorder sufferers often endure physical symptoms as well, including:

? Difficulty sleeping (trouble falling asleep or staying asleep)
? Restlessness or feeling “on edge”
? Fatigue
? Chest palpitations
? Inability to concentrate
? Procrastination
? Difficulty making decisions
? Irritability and impatience
? Headaches
? Nausea
? Diarrhea
? Muscle tension or soreness
? Sweatiness
? Having an unrealistic outlook about problems or events (always thinking of the worst-case scenario)
? Trembling or shaking

These symptoms take place over the course of at least six months (or longer), although intensity may vary. Anxiety can present itself at any age, but people with GAD usually begin showing symptoms sometime between childhood and middle age (Anxiety.org says that the average is 31 years old). Women are about twice as likely to have GAD than men. Generalized anxiety disorder often coexists with other anxiety disorders, obsessive-compulsive disorder, depression, and/or alcohol or other drug addiction. According to the American Psychiatric Association, GAD is one of the most common anxiety disorders.

Panic disorder is marked by sudden, unpredictable episodes of terror that strike its sufferers. These instances of extreme terror or anxiety are so physically and mentally overwhelming that some individuals think they are having a heart attack! According to the APA, panic attacks may feature the following:

? Palpitations, pounding heart, or rapid heart rate
? Fear of losing control
? Feeling as if you are dying
? Sweating
? Trembling or shaking
? Shortness of breath or smothering sensations
? Chest pain
? Dizziness, light-headedness, or fainting
? Feeling like you are choking
? Numbness or tingling
? Chills or hot flashes
? Nausea or abdominal pains
? Feeling detached

Fortunately, panic attacks usually last ten minutes or less (rarely, they may last up to an hour). To be diagnosed with panic disorder, an individual must undergo recurrent panic attacks. Although they are usually unpredictable, sometimes a certain event or situation (say, going to the doctor) can trigger attacks. Panic disorder typically surfaces in the early twenties, and sufferers may also experience other mental disorders like post-traumatic stress disorder (PTSD). People with panic disorder often become anxious about when they will have their next attack, leading them to avoid situations, activities, or objects that they believe are triggers.

Phobia is a persistent, intense, excessive avoidance of an event, item, or situation that is not inherently harmful. Simply being afraid of something does not mean you have a phobia; for the disorder to be present, you must be absolutely terrified to the point of irrationality (although you will likely understand that the fear is not rational). According to Anxiety.org, some of the most common phobias deal with flying, the unknown or unfamiliar, spiders, snakes, heights, animals, thunder and lightning, small places, and public speaking.

Phobias can often be traced back to an event where the person was harmed, experienced trauma such as domestic or sexual assault, saw someone else injured, or heard a story about someone else being endangered by a specific situation or object. Children are impressionable, and the fears they learn can last throughout life. Having a panic attack in a certain situation can also lay the groundwork for a phobia of that situation. Likewise, phobias may cause panic attacks. The APA estimates that, in any given year, up to 9 percent of Americans have a phobia!

Agoraphobia is defined by the American Psychological Association as “the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms.” This disorder makes it particularly difficult to function normally, because it is linked to avoiding necessary activities like being in open spaces, crowds, or enclosed areas or taking public transportation. Some severe agoraphobes become distraught at the prospect of leaving their homes or community at all!

Social anxiety disorder is a distinctive phobia that “includes a range of feelings, such as stage fright, a fear of intimacy, and a fear of humiliation,” according to Medical News Today. Sufferers avoid situations where they have the potential to be judged, rejected, or embarrassed in front of others; for example, many are afraid of public speaking. Social anxiety disorder can cause isolation and reduce quality of life. The illness often develops during puberty, and negative childhood or teenage experiences like bullying, sexual abuse, trauma, or family problems can all be triggers. The Anxiety and Depression Association of America estimates that 15 million adults have some form of social anxiety disorder!

Separation anxiety disorder occurs when someone has extreme anxiety or fear of being separated from a person or place that gives him or her stability. The following are some symptoms of separation anxiety:

? Recurrent, significant distress (sometimes including physical symptoms like headaches or vomiting) when separation from home or loved ones occurs or is anticipated
? Worry about possible harm or death befalling loved ones
? Persistent and excessive worry that something bad will lead to separation from people you care about (like a plane crash or being kidnapped)
? Reluctance or refusal to go to school or elsewhere
? Being overly fearful about being alone or without loved ones at home or in other settings
? Inability to sleep when away from home or without being near a loved one
? Recurring separation-themed nightmares

Although many of these symptoms are most common in children, separation anxiety disorder can occur in people of all ages, as long as the feeling is beyond what is normal for the person’s age and lasts for an extended period (four weeks for children and six months in adults). It often occurs alongside depression, excessive worry, and/or panic disorder. Being apart from the person or place that is the focus of the separation anxiety can prompt panic attacks in some sufferers.

The bottom line: Anxiety disorders are fairly common within the American population. Fortunately, they are highly treatable. Regardless of your age or circumstances, it’s never too late to take a new road of happiness with less worry, fear, and anxiety!

An extended version of this article is available at www.mikedubose.com/anxietycauses.

Read about treatments for anxiety disorders in the next segment of this two-part series, “How to Deal with Anxiety.”

 

About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at [email protected].

Mike DuBose, a former licensed counselor, received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, and personal articles, as well as health articles written with Dr. Surb Guram, MD.

Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.

Katie Beck serves as Director of Communications for the DuBose Family of Companies. She graduated from the USC School of Journalism and Honors College.

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