This year (2023) Mental Health Awareness Week starts on Monday 15 May. The theme is anxiety. To kick off the conversation around the topic, we at MQ want to chat about the difference between anxiety and an anxiety disorder.
Is it anxiety or an anxiety disorder?
No matter who you are, how mentally healthy you’ve been or what struggles you’ve had, we’re all aware of what it feels like to be anxious. A first date, a job interview, for some perhaps public speaking; certain experiences we put our bodies through will result in us feeling nervous or anxious. Even certain physical surroundings will provoke a natural anxious response, like perhaps watching a horror movie or going on a ghost train or being in an escape room.
This nervousness causes our bodies to go on alert. Our amygdala (a part of the brain) send signals of potential danger to our nervous system and in turn to our vital organs (heart, lungs, digestive system and others). That perceived danger could be emotional, physical, present or even in the past. It is a natural evolutionary response. This is “feeling anxious”.
When someone is diagnosed with a Generalised Anxiety Disorder, it is more than occasionally feeling a bit anxious, they feel anxious for a long time and worry about lots of different things. There are different types of anxiety disorders, and although they do vary some symptoms are similar: usually feelings of overwhelming anxiety disproportionate to the situation we find ourselves in that interferes with day to day life.
The key difference between anxiety and an anxiety disorder is the severity and persistence of the symptoms. If you’re about to meet someone for a first date, it’s probably appropriate to feel a little nervous. It’s a nerve-wracking experience for most. But if you have a continuous or overwhelming anxious response to situation, person, place, experience or thing you’re either not aware of or an experience from the past not yet dealt with, this could be diagnosed as an anxiety disorder.
While it is common to feel anxious at times, people with anxiety disorders experience intense and persistent anxiety that interferes with their ability to function in daily life.
There are very real physical symptoms that can be disturbed and anxiety-provoking in themselves. Anxiety attacks may present themselves with an elevated heartrate, difficulty breathing, pins and needles, disorganised speech patterns or quickening speech, disorganised or racing thoughts that are hard to slow down, physical aches or pains, trouble sleeping, nightmares, tingling skin, headaches, nausea, and trembling. These symptoms, feelings and thoughts can lead to avoidance of situations or activities that trigger anxiety.
However avoidance of situations, places, people or experiences that cause anxiety responses can exacerbate the feelings of anxiety and the symptoms too.
If you’re concerned about your levels of anxiety there are some questions you can ask yourself to see whether this is anxiety or anxiety disorder – although we’d like to emphasise the importance of proper medical diagnosis from a trained medical professional:
Does your anxiety affect your day to day routine? Does it change your behaviours? Does it affect your choices in an adverse way? This might be a disorder.
Very simply put, language while clunky is useful when we break it down. A disorder is when our lives, thoughts, feelings are inhibiting or distressing; they are not useful, helpful or productive. They inhibit our lives, rather than expand our experience in a positive way.
In this particular time, when we are coming out of a pandemic world, many of us naturally feel a lot of anxiety. Due to lockdowns and working from home amongst other changes, our day to day lives changed dramatically. The experiences we’ve all had of our worlds shrinking has heightened our sensitivity to all sorts of situations, naturally meaning we are feeling more nervousness. The boundaries between what is proportionate and what is not are also shifting and perhaps are harder to see clearly.
For yourself and for others, be compassionate and patient. Seek help if you need.
There is some school of thought that perhaps anxiety disorder might be linked to a ‘stuck’ nervous system state. This is linked to the polyvagal theory. This theory suggests our nervous systems can exist in different states – broadly speaking there are three:
Dorsal vagal – shutdown. Some people see this as a freeze response like stage fright for example.
Sympathetic vagal – agitated, anxious or nervous state. This might be seen as a flight or fight response.
Ventral vagal – safe, secure, connected. This is where our nervous system can calm itself
This latest thinking around whether these nervous system responses to perceived threats, whether real or imagined, present or in the past, emotional or physical, might get “stuck” in our bodies. If we go along with this idea, our nervous system could be primed to repeat that response or to remain in that response.
So could anxiety disorder be when our nervous system gets stuck in an agitated, anxious, nervous state otherwise known as fight or flight (or sympathetic vagal state in the polyvagal theory)? Could depression be when our nervous system gets ‘stuck’ in dorsal vagal? And could recovery be moving our nervous systems towards ventral vagal more consciously? More research is needed.
As with all mental health conditions, anxiety disorders are treatable with a combination of therapy, medication, and lifestyle choices. And new research is being done all the time to improve understanding and treatment of anxiety disorders. Getting a proper diagnosis is key, so if you’re concerned about your levels of anxiety do make an appointment to see a trained medical professional.
There are many healthy and unhealthy coping mechanisms we can use to manage our anxiety level. This month in the run up to and during Mental Health Awareness Week, we will explore anxiety disorders, personal stories about experiences of anxiety disorder, advice on how to manage anxiety and much more.
MQ has spent 10 years supporting research into anxiety disorders and other mental health conditions. Find out more here
Many thanks to MQ Researcher Professor Colette Hirsch from Kings College London for her help in reviewing this article before publication. Read more about her development of a new evidence-based intervention for anxiety and depression.