HOW MUCH WORRYING IS TOO MUCH?
While some amount of anxiety is normal and even necessary (especially during the holidays) experiencing too much — as with any emotion — can become unmanageable and start to interfere with our day-to-day lives. This list runs through the most telltale signs that one's everyday worrying has advanced to a potential disorder like generalized anxiety disorder (GAD), the environmental risk factors that may be contributing to anxiety, as well as steps to take if you or someone you care about is exhibiting these signs.
"Anxiety in adults usually manifests in their affect, behavior, and cognition," says George T. Lynn, a counselor with more than 30 years' experience treating patients' neuropsychological issues. In terms of affect, or disposition, anxious people tend to feel perpetually tense or "keyed up" out of proportion to the ordinary concerns triggering those feelings. To be considered a sign of GAD, this worrying must be difficult to control and occur on most days for at least six months.
LACK OF FOCUS
Whether preoccupied with worries for the future or regrets from the past, sufferers of mood- or anxiety-related disorders will often have difficulty concentrating on the present. One study showed almost 90 percent of adults with GAD reported this symptom. This is because extreme anxiety triggers our fight-or-flight response, which may be useful for life-threatening situations, but can be paralyzing when confronting less serious concerns.
This mental lack of focus can manifest as physical restlessness, or having an uncomfortable urge to move, especially in children and teens. One double-blind study by John Hopkins University School of Medicine of 128 children diagnosed with anxiety disorders found that 74 percent reported restlessness as a primary symptom, more than any other.
The second-most common somatic (physical) symptom for children with GAD in the John Hopkins University School of Medicine study was stomach aches, experienced by 70 percent of participants. Counselor George T. Lynn says the same can apply for adults with anxiety, when the "butterflies" we all feel from time to time become distressingly commonplace. This psychosomatic nausea can become especially severe in high-stress situations, as in one of his patients, a high school football player who felt the need to vomit every game before taking the field.
OTHER PHYSICAL PROBLEMS
Other common somatic symptoms experienced by children with GAD include blushing (51 percent), heart palpitations (48 percent), muscle tension (45 percent), and sweating (45 percent). The same goes for adults, who may also experience worsening headaches or migrainesas a result of their anxiety, especially when facing stressful situations where they need to perform.
Children are more prone to experience separation anxiety than adults, becoming clingy and fearful when forced to be away from their caregivers. When this fear occurs excessively in children older than six years of age for longer than four weeks, it may warrant a diagnosis of separation anxiety disorder. This behavior can also be symptomatic of other disorders, counselor George T. Lynn says. "Little kids with bipolar disorder have very pronounced separation anxiety."
"In terms of behavior," Lynn explains, "what I notice most often is things aren't getting done that need to be done — or certain things are getting done way too thoroughly and others aren't done at all." As well as difficulty concentrating, this results from what's called anxious anticipation, when one starts avoiding tasks others may judge as simple, out of fear they'll trigger anxiety.
AVOIDING SOCIAL SITUATIONS
One of the most common things anxious people avoid is social interaction, often to the point that it constitutes its own disorder. "Super anxious people can often be confused for someone autistic," counselor George T. Lynn says. "Autism is about being overwhelmed by the world, and that's also what people feel when they're anxious." Prolonged social isolation can turn into a vicious cycle amplifying anxiety and has been linked to worse health and longevity in general.
While others may perceive them as aloof, people with social anxiety disorder and shyness often have low self-esteem. One 2004 study found levels of self-criticism were significantly higherfor subjects with social phobia, even when controlling for other factors like neuroticism, history of substance use, and current emotional distress.
The perpetual dread GAD sufferers feel may come out as irritability toward others or temper tantrums in children. One 2014 study comparing symptoms of anxiety between self-reported worriers with and without GAD found those with the disorder reported experiencing more than twice as much irritability as those without.
Panic attacks can occur unexpectedly without a clear cause and are characterized by an inability to think, feelings of suffocation and extreme dread, and physical symptoms like sweating, shaking, and shortness of breath. While an estimated 22 percent of Americans will suffer a panic attack at some point, only 3 percentexperience them frequently enough to meet the criteria for panic disorder.
SMOKING, DRINKING, AND DRUG USE
One review of 21 studies involving 163,366 subjects, found panic disorder was positively associated with smoking and drinking, though whether those habits contribute to panic attacks or are simply coping strategies is less clear. Anxiety appears to make one more susceptible to problems with drug use, as those who suffer from an anxiety disorder are two to three times more likely to develop an addiction than those who don't.
POOR EATING HABITS
Perpetual stomach aches due to anxiety can get in the way of appetite. Conversely, eating can become another problematic coping strategy. "They'll eat either too much or too little," counselor George T. Lynn says. "Anxious people eat to soothe their anxious feelings." Unfortunately, unhealthy eating may compound anxiety, as diets rich in whole grains, vegetables, nuts, fish, and unprocessed meats have been linked to lower risk of developing a disorder.
Being in a near-constant state of fight-or-flight response naturally takes its toll on one's energy levels, leading tosleep problems like fatigue. This sluggishness may be chronic or strictly follow an anxiety attack. However, fatigue may overlap more often — even to thepoint of confusion — with depression, which isn't unrelated to anxiety either.
"In anxiety, they can't get to sleep," counselor George T. Lynn says. One study found trouble staying asleep (sleep-maintenance insomnia), followed by trouble falling asleep in the first place (sleep-onset insomnia), are the most common reported problemsfor GAD patients. Having an insomniac phase in childhood to mid-adolescence can increase your likelihood of developing anxiety or depression later in life, too.
Extreme anxiety or excessive behavioral avoidance concerning specific things can constitute a phobia. These irrational fears, which can range from specific phobias of animals or objects to situational fears of open spaces or crowds, affect an estimated 12.5 percentof Americans at some point in their lives.
PROBLEMS AT HOME
Asked about environmental risk factors that can cause or contribute to anxiety, the first thing counselor George T. Lynn mentions is family uproar. "If parents are fighting all the time, kids tend to be very anxious." Perhaps not coincidentally, prevalence of GAD in adults is positively associated with being divorced or widowed and more generally with stressful life events in either childhood or adulthood.
"Money and not being able to pay the bills is a huge thing that causes anxiety in adults," counselor George T. Lynn says. "Anything that pushes worry about the future or regret about the past is going to trigger anxiety, and money is a common thing that puts adults into that zone." In the same vein, both panic disorder and GAD are associated with having fewer economic resources.
EXCESSIVE TECH USE
Counselor George T. Lynn cites frequent use of social media or video games as another contributing factor for anxiety, particularly in children and adolescents. This is consistent with a growing body of research linking interactive screen media use to anxiety-related symptoms like increased arousal, poor sleep, and diminished ability to focus or manage one's emotions.
Counselor George T. Lynn compares the "keyed up" state of people with anxiety to the jittery feeling one gets after drinking coffee, so it makes sense that caffeine intake has been found to worsen feelings of anxiety for many, especially in those diagnosed with a related disorder.
WHEN TO GET HELP
"Anxiety is a condition you'll see in just about any psychiatric diagnosis you can imagine," Lynn says. "The more severe, the more anxiety." Excessive anxiety is nothing to take lightly, no matter its source. Don't ignore any of these worrying symptoms or risk factors if they start to interfere with you or a loved one's daily lives. Seek professional help or call the Panic Attack Hotline or National Suicide Prevention Lifeline.