A General Overview

Once in a while we get nervous or tensed which is a regular part of everyday living. Either when faced with a problem at work, before taking an interview or other crucial issues that demand a person's attention without necessarily needing the fight -or- flight reaction. This type of tension is known as anxiety.  Anxiety is a general term for several disorders that cause nervousness, fear, apprehension, and worrying.

When faced with potentially harmful or worrying triggers, feelings of anxiety are not only normal but necessary for survival. These alarms become noticeable in the form of a raised heartbeat, sweating, and increased sensitivity to surroundings. A rush of adrenaline in response to danger causes these reactions. This adrenaline boost is known as the ‘fight-or-flight’ response. It prepares humans to physically confront or flee any threats to safety.

That nervous feeling before an important life event or during a difficult situation is a natural echo of the original ‘fight-or-flight’ reaction. It can still be essential to survival – anxiety about being hit by a motorbike when crossing the street, for example, means that a person will instinctively look both ways to avoid getting hit.

The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.” These disorders affect how we feel, behave and can cause physical symptoms. Mild anxiety is vague and unsettling, while severe anxiety can seriously affect day-to-day living.

According to assistant professor at the College of Medicine University of Lagos, Doctor Erinfolami  Adebayo ‘’anxiety is a form of mental health disorder characterized with intense fear in different situations for a period of time say up to six months’’. However, anxiety disorder is more than just a mild or temporary worry or fear. For instance, a person with an anxiety disorder can get worse over time. This type of emotions can affect the persons school work, relationship and even job performance.

Here some types of anxiety disorder

• Generalized anxiety disorder.
• Obsessive compulsive disorder
• Panic disorder.
• Post-traumatic stress disorder.
• Social anxiety disorder.
• Separation anxiety disorder.

Signs and Symptoms

Generalized anxiety disorder (GAD)

This is when the individual displays excessive anxiety or worry for months and face several anxiety-related symptoms. This is the most common type of anxiety disorder. People with GAD are not always able to identify the cause of their anxiety. Generalized anxiety disorder symptoms include:

• Restlessness or feeling wound-up or on edge
• Being easily fatigued
• Difficulty concentrating or having their minds go blank
• Irritability
• Muscle tension
• Difficulty controlling the worry
• Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)

Obsessive-compulsive disorder (OCD)

This is an anxiety disorder characterized by thoughts or actions that are repetitive, distressing, and intrusive. OCD suffers usually know that their compulsions are unreasonable or irrational, but they serve to alleviate their anxiety. People with OCD may obsessively clean personal items or hands or constantly check locks, stoves, or light switches.

Often, compulsions are performed in a ritualistic, or very specific way.  For example, counting to six each time an article of clothing is removed. OCD occurs in 2-3% of children and adults during their lifetime. OCD can begin early, starting between ages seven and 12. In fact, up to half of all adults with OCD say their symptoms started when they were children. OCD is more common in boys than girls in childhood, but into adulthood, women are affected at a slightly higher rate than men.

Obsessive compulsive disorder symptoms include

• Fear or distress about coming into contact with dirt, germs, sticky substances, or chemicals (e.g., household cleansers), or getting sick, or getting others sick after touching "dirty" or "contaminated" items
• Fear of harming yourself or others through carelessness. For example, "what if I don't wash my clothes properly and there are still germs on it, and my mom gets sick because of me!"

• A need to have items ordered in a certain way. For example, according to colour, size, or facing a certain direction. Children and teens with this type of obsession are either anxious because "it just doesn't feel right" or because of a superstitious belief that something bad will happen.

• Most times, the content of obsessions sounds very odd or makes no sense. For example, a child with OCD might say that he or she needs to arrange all the teddy bears from smallest to biggest or else something bad will happen to mom. Most children and teens are aware that these thoughts are strange; however, do not be surprised if the child doesn't think his or her thoughts are odd. Most younger children have no idea that their obsessions sound unusual to others

• Some children and adolescent feel a strong need for things to be perfect or right. For example, your child might not be able to start her homework until her books are all ordered and perfectly arranged or cannot turn in an assignment until she is certain its perfect. Other kids struggle to tolerate if something isn’t 100% right, focusing on doing the right thing all the time or thinking about every little mistake.

Panic disorder

Panic disorder is diagnosed in people who experience spontaneous seemingly out-of-the-blue panic attacks and are very preoccupied with the fear of a recurring attack. Panic attacks occur unexpectedly, sometimes even when waking up from sleep. Panic disorder usually begins in adulthood (after age 20), but children can also have panic disorder and many children experience panic-like symptoms 

These attacks can lead to shaking, confusion, dizziness, nausea, palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom. Panic attacks tend to occur and escalate rapidly and peak after 10 minutes. However, they may last for hours.

Panic disorder symptoms include:

• Sudden and repeated attacks of intense fear
• Feelings of being out of control during a panic attack
• Intense worries about when the next attack will happen
• Fear or avoidance of places where panic attacks have occurred in the past

Social Anxiety Disorder

The fear of being negatively judged by others in social situations or a fear of public embarrassment is called social anxiety. Such feelings include, stage fright, a fear of intimacy, and a fear of humiliation. This disorder can cause people to avoid public situations and human contact to the point that everyday living is rendered extremely difficult. People with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others.

Social anxiety disorder symptoms include:

• Feeling highly anxious about being with other people and having a hard time talking to them.
• Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others.
• Being very afraid that other people will judge them
• Worrying for days or weeks before an event where other people will be.
• Staying away from places where there are other people
• Having a hard time making friends and keeping friends.
• Blushing, sweating, or trembling around other people.
• Feeling nauseous or sick to the stomach when other people are around

Post- traumatic stress disorder (PTSD)

This type of anxiety results from previous trauma such as military combat, sexual assault, a hostage situation, or a serious accident. PTSD often leads to flashbacks, and the person may make behavioural changes to avoid triggers. A disorder characterised by failure to recover after experiencing or witnessing a terrifying event. More than 1.5 million cases per year in Nigeria alone. The condition may last months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions.

According to the National Centre for PTSD, about 7 or 8 out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men, and genes may make some people more likely to develop PTSD than others

Post -traumatic stress disorder symptoms may include

• Nightmares or flashbacks, avoidance of situations that bring back the trauma.
• Heightened reactivity to stimuli, anxiety or depressed mood.
• Agitation, irritability, hostility, hypervigilance, self-destructive behaviour, or social isolation.
• Flashback, fear, severe anxiety.
• Loss of interest or pleasure in activities, guilt, or loneliness.
• Insomnia or nightmares.
• Emotional detachment or unwanted thoughts.

Separation anxiety disorder

A disorder in which a child becomes excessively anxious when separated from parents. More than 100 thousand cases per year (Nigeria). Children are especially prone to separation anxiety during times of stress.

Separation anxiety differs from normal clinginess. Children with the disorder can't think about anything but the present fear of separation. They may have nightmares or regular physical complaints. They may be reluctant to go to school or other places.

According to the American Psychiatric Association, separation anxiety disorder is an excessive display of fear and distress when faced with situations of separation from the home or from a specific attachment figure. The severity of the symptoms ranges from anticipatory uneasiness to full-blown anxiety about separation.

Symptoms

• Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated
• Persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
• Persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
• Persistent reluctance or refusal to go to school or elsewhere because of fear of separation
• Persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
• Persistent reluctance or refusal to go to sleep without being near a near a major attachment figure or to sleep away from home
• Repeated nightmares involving the theme of separation
• Repeated complaints of physical symptoms (such as headaches, stomach aches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated.

Source: American Psychistric Association, Diagnostic and Statistics Manual of Mental Order.

The cause and diagnosis of anxiety disorder will be the next article.