by Edward Bruce Bynum, Ph.D., A.B.P.P.
Director of Behavioral Medicine
From time to time everyone experiences that nervousness and apprehension that we call anxiety. Sometimes it’s very brief but occasionally it lasts longer and we feel uncomfortable. This kind of anxiety usually occurs after a crisis, be it an interpersonal or familial crisis. Anxiety also occurs before an uncomfortable situation such as test anxiety, a new relationship and intimacy, or even an examination. Anxiety often occurs during an acute period of stress. This can be around a tragic circumstance. It can also be in the case of an argument with someone else. Anxiety is generally a warning to ourselves that there is some danger, or some perceived danger, to our situation. There are some positive aspects to anxiety however. That warning to be on alert when it is appropriate is a good one. Most often anxiety is a very transient experience.
When anxiety lasts for more than a few weeks, it is perhaps more of a serious concern. Too much anxiety can lead to decreased concentration and increased irritability. It can lead to sleep onset delay problems, a not very satisfying or non-restorative sleep, even interrupted sleep or one of several forms of insomnia. In some situations it has been known to effect and create stressful dreams which then affect our body, energy level and moods. Prolonged anxiety can exacerbate mild to strong rumination or worry or preoccupation with things. Anxiety can cause increased concern about medical or physical health issues. It can also lead to an exaggeration of usually mild or vague social or family concerns. In some cases anxiety can lead to depressed appetite and weight loss or even an excess weight gain through increased eating in an attempt modulate one’s mood. In a certain percent of cases, anxiety can lead to serious depression. This will include loss of motivation, lethargy and other signs associated with significant depression. Anxiety has been well known to lead to the avoidance of certain situations, be they interpersonal or social in nature. Isolation can result from extensive anxiety. This withdrawal is apparent to others and to one’s self.
The causes or origins of anxiety that are persistent are many. Periodically it is a largely medical condition. Thyroid difficulties, be they hyperthyroidism or hypo-thyroidism, are two of the more well known medical reasons. However acute stress reactions to actual events can also lead to persistent anxiety, even after the initial frightening episode. Dysfunctional coping styles also exacerbate anxiety. The well know fight-flight response will sometimes be exaggerated and extended far beyond its appropriate expression. Muscle tension with diminished or few recreational expressions may lead to persistent anxiety.
Many of you are well aware that in high school, or at other times when there was a great deal of pressure and anxiety, sports and athletics or other physical activities were an outlet for this anxiety. Becoming involved in serious academic work along with continued stress without that traditional athletic expression of dynamic muscle tension release can lead to increased anxiety and emotional tension. This is rather common on college campuses. Ongoing psychological conflicts with one’s self or others can lead to prolonged instances of anxiety. Here the dynamics of anger and resentment, sometimes shame, and even trauma and other unexpressed powerful emotions are at work. In some individuals there is a pervasive, what we call “free floating anxiety” associated with one’s personality style. You may have heard in this context of the type A personality. In some cases poor diet and lack of regulated life patterns that are crucial can lead to prolonged anxiety. Certain situations where there is an excessive use of medications or drugs such as caffeine or nicotine or alcohol or the mixture of these can lead to persistent and pervasive anxiety.
It is of course important to know what to do under these circumstances. The first and easiest thing to do is to talk with others, including friends and other relationships about this. This is to decrease one’s anxiety and sense of isolation. Also it is extremely helpful to regulate one’s diet, get moderate exercise, and a good amount of healthy sleep. Mini relaxations during the day are also extremely helpful in bringing down pervasive and unwanted anxiety. The use of meditation, prayer, and sitting quietly are exceedingly helpful in modulating most normal anxiety.
There are certain circumstances however in which anxiety, be it pervasive and persistent or sometimes extremely acute, warrant a consultation with a professional. Here are twelve such occasions.
1.) When anxiety interrupts your concentration for a week or more.
2.) When sleep and appetite are disturbed for more than a week.
3.) When physical illness or somatic preoccupations significantly decreases work, study, or social and interpersonal and family functions.
4.) When you are aware of an increasing isolation from others, increased irritability, and a sense of depression.
5.) When your mood seems to swing from one extreme to the other. This is not necessarily an indication of a psychiatric condition, but it is a situation that warrants a brief consultation.
6.) When you have noticed an increasing fear of going outside, of traveling, or other phenomena such as this arise. In some cases this is a beginning episode of agoraphobia.
7.) It is extremely important when episodes of “unreality” occur to seek an outside consultation. This is referred to as depersonalization or derealization experience.
8.) When a prolonged depression of over a month or so arises which one cannot seem to shake, this is an opportunity and a time to seek an outside consultation.
9.) When there is obsessive preoccupation with ideas or behaviors which are difficult to get rid of or dismiss.
10.) When an anxiety or panic attack occurs at least two or three times. It is not unusual to have an anxiety attack or panic attack once. This is not an indication of a psychiatric disorder.
11.) When bulimia and/or anorexia or other eating disorder behaviors dawn.
12.) When persistent and/or recurrent thoughts of suicide or homicide occur with strong emotional force. Fleeting self-destructive images occur to many people. It is when they are strong, occur within a specific plan or are unsettling that you must consult someone else.
When any of the above seem to occur and can be identified, a simple phone call to the University Health Services or other counseling agency is warranted. At that point one would talk with a mental health professional who may consult with you or refer you directly to a physician or a therapist for a more appropriate exploration of the situation.
American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC.
Menninger, K. 1963. The Vital Balance: The Life Process in Mental Health and Illness. New York: Viking Press.
Shapiro, D. 1965. Neurotic Styles. New York: Basic Books, Inc.
The information provided in this column is for educational/information purposes only. The intention is not to provide medical advice or replace the services of a trained healthcare professional. Please take specific issues or medical concern to your healthcare provider.
For more information please visit us at our website at www.umass.edu/uhs/mentalhealth.