CHAPTER
1

Just the Jitters?

In This Chapter

• The symptoms of anxiety
• Discover when normal anxiety crosses the line
• Conduct your own anxiety self-assessment
• Learn who is vulnerable to anxiety disorders
• Physical problems that cause anxiety

“Well, Miss Gordon, how are you today?” he [my psychiatrist] asked. I was shocked to hear myself burst into a monologue of almost feverish intensity.

“What’s new, Dr. Allen, is that I can’t walk the streets of the city I love alone. Unless I’m stoned on pills or with someone. I can’t do it. I can’t function without Valium. I’m growing too dependent on something other than myself to function. I’m growing too dependent on pills. Why? Tell me why!”

He interrupted. “But I’ve told you many times, Miss Gordon, they are not addictive. They can’t hurt you.” And he crossed his legs and sat back in his chair to hear my response.

Barbara Gordon was a talented, award-winning American filmmaker—with an anxiety disorder. She was prescribed Valium and visited a psychiatrist once a week for more than 10 years with no noticeable improvement. Barbara Gordon documented her life with an anxiety disorder in the best-selling book I’m Dancing as Fast as I Can, describing in detail her struggle with her anxiety disorder, the Valium addiction she developed when she sought help, and her ultimate recovery. There are at least two takeaway messages from this book:

• People from all walks of life develop debilitating anxiety.
• We are ultimately responsible for taking the necessary steps for our own recovery.

In this chapter, we talk about what anxiety is and what it’s not, when it helps and when it hurts, what’s normal and what isn’t, and what other illnesses can masquerade as an anxiety disorder.

What Is Anxiety?

If someone asked you to define anxiety in 25 words or less, could you do it? Probably, because the odds are you’ve experienced it. Perhaps you’d say “worrying too much” or “feeling uptight.” Perhaps you’d describe flip-flopping in your stomach or tightness in your chest. Anxiety involves all these and more; in fact, it can show up in many ways: physically, emotionally, cognitively, and/or behaviorally.

MYTH BUSTER

“Anxiety is a sign of weakness.” Wrong! Big, strong, macho guys get anxiety disorders, too. Famous men known or strongly suspected to have suffered from an anxiety disorder include Abraham Lincoln, actor James Garner, football star Earl Campbell, and even Winston Churchill.

Physical Symptoms: From Butterflies to Insomnia

Ever had to give a speech without preparation? How about swerved at the last moment to avoid hitting someone with your car? Then you probably know firsthand the physical signs of anxiety:

• Nausea or indigestion (“butterflies” in the stomach)
• Sweating, especially sweaty palms, forehead, or underarms
• Shortness of breath
• Racing pulse or a feeling like your heart is pounding
• Trouble swallowing or feelings of choking
• Dizziness or headache
• Chills or hot flashes
• Muscle tension
• Skin changes (“goose bumps”)
• Trembling or shaking
• Difficulty sleeping

ANXIETY ATTACK

Starting to feel nervous in a situation? Breathe. Concentrate for a few minutes or even a few seconds on taking slow, deep, regular breaths. When some of us begin to get anxious, we start breathing quickly and shallowly, which sets up a whole chain reaction in our bodies that can cause more anxiety.

Emotional Symptoms: Fear

Fear is the main feeling associated with anxiety. And when it starts, it can snowball (especially for those of us with panic disorder). First we’re anxious in a certain situation; then we become anxious about being anxious—and afraid that next time we’re confronted with that situation, we’ll get anxious again.

Other emotions associated with anxiety include feelings of nervousness, irritability, and the sense that something bad is about to happen. Molehills seem like mountains, and it is harder to control our tempers. Or perhaps we feel as if we’re outside ourselves watching what’s happening rather than being involved. In fact, sometimes our feelings can be numbed or blunted; it may be hard to recognize any emotion.

Cognitive Symptoms: Thoughts

Cognition is just another word for “thinking.” Being anxious can affect the kind of thoughts we have, and it can certainly affect our concentration!

For difficult tasks, we need a certain level of arousal or alertness in order to focus properly. Both too little and too much arousal can interfere with difficult tasks. For example, it is hard to solve complicated math problems in our heads if woken up suddenly from deep sleep. On the other hand, if we are extremely anxious while taking questions from an audience, it can be very difficult to “think on our feet” and remember what we actually (usually) know. Two psychologists, Robert Yerkes and John Dodson, described this relationship in the early 1900s, as illustrated in the following figure.

In addition, what we think can affect how we feel, and unhelpful ways of thinking are common in anxiety disorders. Some common unhelpful ways of thinking that contribute to anxiety include the following:

• Thinking about fearful situations over and over without resolving anything
• Focusing too much on tiny details, not seeing the big picture
• Overestimating the real danger of everyday activities or situations
• Doubting our ability to cope
• Worrying that any physical symptom is either the beginning of an anxiety attack or a sign of a life-threatening illness
• Overestimating the likelihood of a negative outcome
• Thinking excessively about the possibility of failure or of drawing negative attention

STRESS RELIEF

When speaking or performing in public, some people get so anxious about making a mistake that their anxiety gets out of control. Some therapists who specialize in anxiety disorders actually suggest that performers intentionally make a small error at the beginning of their performance so that they can let go of the internal pressure to be perfect, and relax.

Behavioral Symptoms: Either Take Charge or Run Away!

The last aspect of anxiety involves our response to our fear. Because anxiety feels threatening, it’s no surprise that, in response to it, we either fight or “fly” away. Common behavioral responses include the following:

• Avoiding situations that have made us anxious in the past
• Freezing up
• Avoiding situations that we are afraid might make us anxious
• Refusing to try new things
• Procrastinating–putting things off for later
• Using drugs or alcohol to try to cope

Donny Osmond: A Familiar Face with Anxiety

Here’s another real-life example of a celebrity who has met anxiety up close and personally. Singer/performer Donny Osmond learned to cover up his anxiety for years until it got so out of control he could no longer hide it.

Osmond reported the emotional signs of anxiety, which centered on his escalating fear of performing onstage: “There are times I remember before I walked on stage, where if I had the choice of walking on stage or dying, I would have chosen death.”

He has described some of his anxiety-related thoughts, including the pressure to be perfect and the fear of scrutiny: “I knew at least somebody in that audience was looking at me all the time.”

He eventually ended up having a full-blown panic attack, with all the physical and behavioral symptoms that accompany them. “I remember shaking in bed, and I just, I couldn’t get out of bed. Something was wrong and my wife took me to the hospital.”

Through psychotherapy, Osmond eventually learned to cope with his social anxiety disorder.

ON THE CUTTING EDGE

Some people apparently need more anxiety. Recent research has shown that some people don’t feel much anxiety even in dangerous or life-threatening situations. These people tend to take extreme risks and are more likely to die in thrill-seeking activities. Apparently, a certain amount of anxiety keeps us on our toes when we need to pay extra attention and proceed with caution.

Cautious, Nervous, or Dealing with a Disorder?

If you look at all the different anxiety symptoms, you might think we all suffer from anxiety—and you’d be right! There’s nothing wrong with a little anxiety. In fact, we need some in order to survive.

For a physical comparison, think about the sensation of pain. No one likes to hurt, but people who are born without an ability to feel it are at chronic risk of serious injuries and tend to die earlier; there has been at least one case of a toddler who could not feel pain who walked into a pretty bonfire on purpose and stayed there. And if pain didn’t accompany a heart attack, we wouldn’t seek the medical attention we need to survive. So pain isn’t much fun, but we often need it. In a way, the same is true for anxiety.

For example, suppose you need to cross a busy street, but cars are rushing by in both directions. A little jolt of anxiety will motivate you to be extra vigilant and cautious and wait until you can cross safely. If you weren’t worried at all, you might just walk out into traffic and get hit by a car.

In addition, people who don’t become anxious in normally anxiety-causing situations may have difficulty learning from mistakes. They may be even more likely than the rest of us to make the same mistakes over and over.

Although not everyone with a chronic anxiety deficit is a criminal, it is true that some criminals have a low ability to become anxious. That may explain, in part, people who make the same mistakes time and time again, even if they are punished for making them. It may also help explain how the presence of anxiety can be an important signal tweaking our conscience, telling us that we are acting, behaving, or thinking in a way that conflicts with a deeply held value or belief.

As discussed previously, normal anxiety can be good for you; it can give your conscience a necessary tug or inspire you to prepare just a little bit harder. There is a continuum of anxiety, and we want to be somewhere in the middle range. So how much anxiety is too much? There are a few ways of telling.

Context and Continuum

First, most people with diagnosable anxiety disorders experience feelings of anxiety, fear, or terror in situations that don’t justify it. Either it’s a situation (context) in which most of us wouldn’t feel particularly anxious (such as driving a car), or the level of anxiety is much greater than the circumstances warrant. For example, most of us might feel a little bit uneasy entering a grocery store we’ve had a bad experience in, but the person who associates panic attacks with a particular store may avoid it no matter the personal or relationship costs.

Of course, the continuum of normal anxiety depends upon the situation, how most people experience it, and your unique personal makeup. So if your palms are sweaty when you stand in line for that new thrill ride at the amusement park, join the crowd! Got a few butterflies in your stomach going in for that important job interview? Perfectly normal. But if you’re so terrified of the thrill ride that you refuse to even enter the amusement park, that’s not how most people would react. It would be pretty extreme. And if your anxiety gets so out of control that you blow off the interview, or get there and freeze up, unable to answer questions, then it’s a problem.

Here’s a true story: a colleague of Joni’s interviewed at several graduate schools before selecting one. During the interview process, one university conducted group interviews so the staff could see how well potential students handled themselves. In front of the group, this intelligent, articulate woman began to respond to a question, stopped, blushed, and completely froze up. She was unable to answer or even function at all. Although all the candidates had high test scores, high grade point averages, and excellent credentials, this woman’s anxiety ended up getting her rejected as a candidate.

ANXIETY ATTACK

Getting back on the horse that threw you can be good advice. When people are frightened by a certain situation, they may start avoiding that situation and others like it. The best thing to do is face the situation again as soon as you can by any means possible—with a friend’s support, in gradual steps, and so on.

States and Traits

Anxiety can be divided into either state anxiety or trait anxiety. State anxiety refers to your level of anxiety in a particular situation. Maybe you stay cool during job interviews, but you’re terrified of spiders. You’re not anxious all the time, just in certain situations.

Trait anxiety refers to our tendency to respond to a wide variety of situations with either too much or not enough anxiety. Those who take big risks tend to have low levels of trait anxiety—even when a higher level might be helpful or appropriate. But people with high levels of trait anxiety tend to be much more anxious in general, even in situations that most of us don’t think of as particularly stressful.

Although certain types of state anxiety can be very unpleasant and can impact your life significantly, high levels of trait anxiety tend to be the most crippling.

MYTH BUSTER

Some people believe that religious faith will overcome anxiety. You might feel that if you’re just a devout enough Christian, Jew, Buddhist, Wiccan, Muslim—whatever—you can overcome anxiety. But anxiety disorders are just as real as other medical illnesses. Rather than try to overcome a broken leg (or severe anxiety) through faith alone, why not just bless the doctor who helps you heal?

How Bad Is It?

One way to look at how much your anxiety affects you is by how much it keeps you from dealing with everyday life. Let’s look at three different people with anxiety about the same issue. Betty, Bob, and Brittany are all anxious about heights. But they deal with their fears differently.

Betty works on the twenty-sixth floor of a building. Every time she rides up or down the elevator, she closes her eyes and concentrates on her breathing to keep from getting overly nervous. She has a corner office with a great view, but she keeps the blinds pulled because the view scares her. When she and her husband went to Paris and he went up the Eiffel Tower, she decided to stay on the ground and take photos. When she flies on business, she requests a seat as close to the middle of the row as possible. If she sits by the window, she closes the shade and reads a book for distraction.

Bob works in a city on one side of a major river. It’s a dead-end job, and he could do better if he was willing to get a job in the city on the other side of the river, but he just can’t bring himself to drive across that suspension bridge every day. Once when a job assignment involved giving a presentation on the other side, Bob called in sick. His bosses weren’t happy, and the guy who covered for him got the next promotion. Bob met a great woman at a party once. They went out a few times, but she lived across the river. When she found out Bob wasn’t willing to drive across the bridge to see her, she called him a “wuss” and dumped him. Bob is sometimes afraid she was right—maybe he is a wuss. His self-esteem is pretty shot, and he hasn’t dated anyone in a while.

Brittany is terrified of heights—any heights. When her family went to the Grand Canyon when she was a child, she curled up in a ball on the floor of the family car. Everyone in her family teased her about her fears. She won’t get in an elevator, and escalators scare her even more. She has to pay a neighbor’s son to come change her light bulbs because she can’t stand on a stepladder. Brittany’s husband left her years ago; one of the reasons was that he was tired of his life being so affected by his wife’s fears. Brittany’s grown daughter lives in Hawaii and is getting increasingly angry with her because she won’t fly out to see her new grandchild. But Brittany has never been on a plane—the mere thought makes her shake all over. She walks out of the movie theater if a scene unexpectedly shows a view from a great height or if someone is shown climbing a mountain, driving over a high bridge, or parachuting. She has trouble getting to sleep and often has nightmares about falling. She knows her fears have taken over her life, but she doesn’t know what to do about it.

Three people, one fear, and three different outcomes. Betty is anxious about heights, yes, but it doesn’t have a huge impact on her life. She has developed coping strategies that work for her. The anxiety does not keep her from doing what she wants or needs to do. Brittany clearly has a full-blown anxiety disorder. Her anxiety is impacting her life negatively in a variety of ways. Bob’s anxiety is also affecting his life negatively, but it’s more subtle. He qualifies as having an anxiety disorder, too, but it’s not as severe as Brittany’s.

Does any of this mean that Betty is smarter, stronger, or somehow better than Brittany or Bob? Absolutely not! Though Betty may enjoy life more without her anxiety about heights, Betty is doing fairly well. Bob and Brittany need some help in dealing with their anxiety; with treatment, they could both end up doing the things that today seem impossible.

ANXIETY ATTACK

Anxiety makes it hard to look on the bright side. To prepare in advance for anxiety-provoking situations, psychologist Daniel Wegner suggests writing down a list of happy memories, tough times you’ve conquered, or things you’re looking forward to. It might be helpful to keep such a list in your pocket to review when you get stressed.

Assess Yourself: How Much Is Too Much?

Although different anxiety disorders have their own clusters of symptoms (which we discuss in upcoming chapters), some general signs suggest that your anxiety is severe enough that it’s time to take some action. To determine whether your anxiety has crossed the line, ask yourself the following questions—and be honest!

• Does your anxiety cause you to avoid specific places, events, objects, or situations?
• Are these places, events, objects, or situations that other people don’t seem to be afraid of or consider relatively harmless?
• Does your anxiety interfere with your ability to work?
• Does your anxiety cause problems in your relationships with other people—or prevent you from having relationships at all?
• Does your anxiety keep you from taking care of your responsibilities around the home?
• Does your anxiety cause you discomfort or distress on a regular basis?
• Do things seem to be getting worse over time?
• Have friends, family members, or employers expressed concern over your anxiety or its effect on your life?
• Do you sometimes feel that your thoughts are out of control?
• Do you frequently feel irritable?
• Do other people tell you that you always look stressed out?
• Do you feel like your mind often just goes blank?
• Do you often have trouble falling or staying asleep?
• Do you worry about the same things over and over?

In general, the more questions to which you answered “yes,” the more likely it is that you have an anxiety disorder.

However, this is just an informal screening. We culled symptoms from several different anxiety disorders, so even the most anxious person is unlikely to answer “yes” to each and every question. A person suffering from generalized anxiety disorder, for example, may not identify with the person who avoids social situations out of embarrassment—and may be completely unable to relate to someone who avoids crowds because of fear of panicking and having difficulty getting out. Yet all of these individuals have anxiety disorders.

Of course, the bottom line, as we said at the beginning of this chapter, is your own experience. If your anxiety is causing you significant pain or is limiting your life, then it’s a problem for you. Whether or not you meet the clinical criteria for an anxiety disorder, what matters is that your life gets better—and easier. And it can!

Primary Anxiety or Something Else?

So you’ve looked at the self-assessment questions in this chapter, and you may be sure you have an anxiety disorder. However, it is important to note that a number of other conditions can cause anxiety (secondary anxiety) and be mistaken for run-of-the-mill (primary) anxiety disorders. It’s important to rule out these other conditions first.

For instance, several different types of heart conditions can cause symptoms of anxiety; sometimes a heart attack and a panic attack can be hard to tell apart. Another heart condition, paroxysmal supraventricular tachycardia (PSVT), is characterized by sudden attacks of palpitations, chest pain, shortness of breath, anxiety, and dizziness—similar to panic attacks.

Certain diseases of the lungs can also cause anxiety symptoms. It’s terrifying to not have enough oxygen; our bodies need it!

How healthy are your eating habits? If you have a poor diet or difficulty absorbing some critical vitamins or minerals, you could end up with symptoms of anxiety; in particular, low levels of thiamine, pyroxidine, and folate have all been associated with anxiety, as has iron-deficiency anemia. So take your vitamins if your doctor says you need them!

Many illicit drugs can cause anxiety, the most notorious of them being stimulants like speed, cocaine, or meth. But another anxiety-inducing intoxicant is perfectly legal: caffeine. Although many of us can drink coffee with relatively few side effects, some of us are very sensitive to caffeine, and a little coffee or tea, even an over-the-counter pain reliever with caffeine, can cause substantial anxiety. The worst part is that these sensitive people may not connect the anxiety with the soda or the chocolate bar they had earlier.

STRESS RELIEF

Want to reduce your anxiety? Cut out (or at least cut down on) the coffee. Excessive caffeine can make you anxious and jittery. If you suffer from anxiety or panic attacks, even small amounts of caffeine can exacerbate it. How much is too much? It depends. If you have trouble falling asleep, if you find it hard to concentrate during the day, or if you drink more than 5 cups of coffee a day, you may be getting too much caffeine.

Other psychiatric disorders can sometimes look like anxiety disorders. Individuals with attention-deficit hyperactivity disorder, or ADHD, can display leg/foot movements, hand tapping, and other physical signs that may be mistaken for anxiety. Poor concentration—common in anxiety—is also common in depression. In addition, some people with anxiety disorders may have other disorders (depression or substance use disorders) that make diagnosis more complicated. Is the substance use an attempt to self-medicate anxiety? Did depression come before the anxiety, or is a person depressed because of persistent anxiety?

If anxiety is making you miserable, get a thorough medical checkup to be sure an underlying physical illness isn’t causing it. Start with your primary health-care provider, and go from there.

What’s the Difference?

What if you’re free of any other medical problem, and you’ve already been diagnosed with an anxiety disorder? But your cousin has an anxiety disorder, and her symptoms are completely different from yours! Why?

Each anxiety disorder shares something in common with the others, but each one is different. These disorders may have partly different origins and often have different treatments, as we discuss in the following chapters.

The key things to remember with any anxiety disorder are you are not alone and there is hope. Other people suffer from the same disorder you do; other people have gotten better. You can feel much better!

Having anxiety is nothing to be ashamed of; in fact, the main reason we focused on celebrity experiences of anxiety in this chapter is to show you (and perhaps your doubting or judgmental friends or family) that anxiety is not something anyone wants to have; that no one is immune; and that richer, more famous, better-looking, and smarter people than we have been down the same road.

In the next chapter, we take a look at the different anxiety disorders—and you can find the path you need to take to emotional freedom.

The Least You Need to Know

• There are four components of anxiety: physical, emotional, cognitive, and behavioral.
• The best way to determine whether your anxiety is truly a problem is by how much it affects your work, school, social, or personal life.
• Many medical conditions can cause anxiety; a physical checkup is always a good idea before deciding that you have an anxiety disorder.
• Each anxiety disorder has its own set of symptoms; your disorder may not look much like someone else’s.