Ministry of Health Vanuatu
October 2019 Mental Health Newsletter
Is Anxiety the same thing as Stress?
Sometimes people use the terms stress and anxiety to explain the same feeling. However, to a mental health expert, the difference is essential, because the management of each condition are different.
Negative stress or distress is the feeling you get when you “lose control of a situation” and do not believe that you have the necessary resources to handle the situation successfully.
Stress is your body’s way of responding to any demand or threat. When you feel threatened, your nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol, which rouse the body for emergency action. Your heart pounds, you feel tense and alarmed and experience many sensations as well as thoughts.
Anxiety can produce feelings of distress too, but it is the excessive worrying about the future and the things you are afraid of coming true.
If someone has a big exam coming up, they may feel the physical symptoms of stress because they want to do well, and this can help them to study. However, if they are too anxious about failing the exam, they will want to avoid studying because it feels too scary for them.
When does Anxiety become a problem?
Everyone gets nervous or anxious from time to time. If we have to make a speech, attend an interview, or deal with a problematic upcoming event, we can all experience stress, fear and worry. However, for some people, anxiety becomes so frequent, or so forceful, that it begins to take over their lives.
Anxiety also comes in many different forms including generalised anxiety, panic attacks, phobias, social anxiety, obsessive-compulsive disorder, hoarding and post-traumatic stress disorder. The distinction between an official diagnosis of anxiety and “normal” levels of worry isn’t always clear. Anxiety can be a complex disorder to diagnose and treat, and a person’s background and personality may also be a significant factor.
The best way to know if anxiety is becoming a problem for you is if you find yourself always worrying about something that may or may not happen in the future. If this worrying is causing you a lot of distress and making it difficult for you to focus on what you need to do in the present moment or enjoy life, then it is becoming an issue.
Anxiety is usually “future” oriented. Even if you are worrying about something that happened in the past, the anxiety is focused on what the consequences will be from this in the future. The most common question a person with anxiety asks themselves is “What if?’ The answer to what if questions for someone with problematic anxiety tends to be the worst case scenario. This is called catastrophizing, and only leads to more stress and worry over time.
What are the Different Anxiety Disorders?
The following are the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) definitions for each anxiety disorder. Please not that these symptoms need to cause significant distress or impairment to daily activities for them to be significant enough to warrant a diagnosis.
Generalised Anxiety Disorder (GAD)
- Excessive anxiety and worry about a wide variety of topics, events or activities.
- Worry occurs more often than not for at least 6 months and is clearly excessive.
- The worry is difficult to control, and may easily shift from one topic to another.
- The anxiety and worry is accompanied by at least one of the following symptoms in children, and at least three in adults:
- Restlessness or edginess
- Tires or fatigues easily
- Impaired concentration or mind going blank
- Irritability which may or may not be observable by others
- Increased muscle aches and soreness
- Difficulty sleeping, including falling to sleep or staying asleep or poor sleep quality
Specific phobias are an intense and irrational fear of specific natural events, mutilation, animals or situations. A specific phobia diagnosis needs to have:
- Unreasonable, excessive fear
- An immediate anxiety response
- Avoidance or extreme distress
- Presence of symptoms regularly for at least six months
The top ten most common specific phobias are:
- Arachnophobia – fear of spiders
- Ophidiophobia – fear of snakes
- Acrophobia – fear of heights
- Agoraphobia – fear of crowds or open spaces
- Cynophobia – fear of dogs
- Astraphobia – fear of thunder and lightning
- Claustrophobia – fear of small spaces
- Mysophobia – fear of germs
- Aerophobia – fear of flying
- Trypophobia – fear of holes
A panic attack needs to have four or more of the following symptoms:
- Palpitations or increased heart rate
- Shaking or trembling
- Shortness of breath or a feeling of not being able to breathe
- A feeling of choking
- Pain or discomfort in the chest
- Nausea or upset stomach
- Feeling dizzy, lightheaded, faint or unsteady
- Feelings of unreality or being detached from oneself
- Fear of losing control or “going crazy”
- Fear of dying
- Numbness or tingling in different parts of the body
- Sudden chills or hot flushes
Panic disorder occurs when after someone has a panic attack, they then begin to worry about having more panic attacks and avoiding situations or places that they worry will trigger another one.
Post-traumatic Stress Disorder (PTSD)
- For a diagnosis of PTSD, the person needs to have been exposed to a situation that involved:
- Actual or threatened serious injury
- Actual or threatened sexual violence
This could be exposure via direct experience, witnessing it happening to someone else, or hearing about it happening to a relative or close friend.
- Presence of at least one persistent intrusive or re-experiencing symptom:
- Nightmares about what happened
- Flashbacks about what happened
- Unwanted upsetting memories
- Emotional distress after exposure to reminders of the traumatic event
- Physical reactivity after exposure to reminders
- Presence of avoidance in at least one way:
- Avoidance of having trauma-related thoughts or feelings
- Avoidance of external places or things that act as reminders of the traumatic event
- Presence of at least two negative changes to beliefs and mood:
- Overly negative thoughts about self, others or the world
- Strong negative feelings, including sadness, anger and guilt
- Exaggerated blame of self or others for the traumatic event
- Decreased interest in engaging in activities that one used to enjoy
- Feeling isolated and cut off from others
- Feeling emotionally numb or unable to experience positive emotions
- Presence of at least two symptoms of hyper-arousal:
- Irritability and aggression
- Risky or destructive behaviour
- Hypervigilance or being “on guard”
- Exaggerated startle response
- Difficulty concentrating
- Difficulty sleeping
- These symptoms must have occurred for at least one month, or it is an acute stress reaction.
Obsessions and Compulsions (OCD)
Obsessions consist of two important elements:
- Recurrent and persistent thoughts, urges, or impulses that are experienced as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
- The individual attempts to ignore or suppress such thoughts, urges or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)
Compulsions have two core features also:
- Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
- The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation, however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
For a diagnosis of OCD, the obsessions and compulsions must be time-consuming and take more than one hour per day or cause significant distress or impairment. Some people with OCD have good insight into their behaviours and why they do it, but struggle to change, and other people may not have any insight into why they do what they do or how they can change it.
Hoarding disorder is characterized by the following symptoms:
- Persistent difficulty in parting with or discarding possessions, regardless of their actual value.
- This difficulty is due to a perceived need to save the items and wanting to avoid the distress associated with discarding them.
- The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (eg. Family members, cleaners, authorities).
- The hoarding makes it difficult to maintain a safe environment for self and others
The person with the hoarding behaviour may have good insight and realise their excessive acquisition of things is a problem, or they may have poor insight and not recognise that their behaviour is unhealthy.
Treatment of Anxiety
There is a variety of treatments available for anxiety. Most psychological treatments of anxiety disorders are supported by research as being effective treatments that can significantly improve functioning and reduce distress.
If you or someone close with you is experiencing one of the above anxiety disorders, it would be wise to discuss this with your health professional and in some cases obtain a referral to a mental health unit.
For more information, support or advice, please contact:
Mind Care Clinic
VILA CENTRAL HOSPITAL
Mental Health Clinic
NORTHERN PROVINCIAL HOSPITAL
Mental Health Clinic
Mental Health Clinic