tag:theconversation.com,2011:/fr/topics/panic-disorder-3626/articlesPanic disorder – The Conversation2020-03-06T15:26:50Ztag:theconversation.com,2011:article/1331662020-03-06T15:26:50Z2020-03-06T15:26:50ZCoronavirus: how to stop the anxiety spiralling out of control<figure><img src="https://images.theconversation.com/files/319074/original/file-20200306-118956-1r3nfw3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Don't let fear ruin your life.</span> <span class="attribution"><a class="source" href="https://www.cambridge.org/core/journals/psychological-medicine/article/global-prevalence-of-anxiety-disorders-a-systematic-review-and-metaregression/484845CE01E709EE4FB6554AA78E612F">TeamDAF</a></span></figcaption></figure><p>As <a href="https://theconversation.com/the-hunt-for-a-coronavirus-cure-is-showing-how-science-can-change-for-the-better-132130">the coronavirus</a> proliferates on a global scale, worry and panic <a href="https://www.nbcnews.com/better/lifestyle/coronavirus-fears-have-emptied-supermarket-shelves-are-you-panic-buying-ncna1148536">is on the rise</a>. And it is no wonder when we are constantly being told how to <a href="https://theconversation.com/yes-washing-our-hands-really-can-help-curb-the-spread-of-coronavirus-132915">best protect ourselves</a> from being infected. But how do you stay safe in this climate and simultaneously make sure that the fear doesn’t take over your life, developing into obsessive compulsive disorder or panic?</p>
<p>Fear is a normal, necessary evolutionary response to threat – ultimately designed to keep us safe. Whether the threat is emotional, social or physical, this response is dependent on a <a href="https://www.sciencedirect.com/science/article/pii/S0166223696100692">complex interaction</a> between our primitive “animal brain” (the limbic system) and our sophisticated cognitive brain (the neo-cortex). These work busily in concert to assess and respond to threats to survival. </p>
<p>Once a threat has been identified, a <a href="https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response">“fight or flight” response</a> can be triggered. This is the body’s biological response to fear and involves flooding us with adrenaline in a bid to ensure that we are able to escape or defeat any threat, such as a dangerous animal attacking. The response produces a range of intense physical symptoms – palpitations, perspiration, dizziness and difficulty breathing – which are designed to make us run faster and fight harder. </p>
<p>However, this system can be prone to glitches, sometimes responding disproportionately to threats that aren’t actually that serious or imminent. Worrying about health conditions such as heart attacks, stroke and even COVID-19 (the disease caused by the coronavirus) can therefore also trigger a fight-or-flight response.</p>
<p>That’s despite the fact that there is no role for a primitive biological response to COVID-19 – no running or fighting is necessary. Instead, it is our high-level, cognitive neocortex that is required here, a rational and measured approach to infectious disease, without the messy complications of panic. </p>
<p>Sadly, this is easier said than done. Once the fear has kicked in, it can be hard to stop it. </p>
<h2>Vulnerable groups</h2>
<p>It is highly unlikely that a viral outbreak, even at pandemic levels, will trigger mental health problems in people who don’t already have them or are in the process of developing them. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925038/">Research shows</a> that most mental health problems start between early adolescence and the mid-20s, with <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/development-of-anxiety-disorders-in-childhood-an-integrative-review/78CA4C983719D652402CA1F5A0E259DD">complex factors being involved</a>. Around 10% of the global population experience clinical levels of anxiety at any one time, although some estimates are higher. </p>
<p>People who are chronically and physically unwell – the ones who are the most vulnerable to the coronavirus – are at particular risk of spiralling anxiety. This should not be ignored. Their concern is warranted and is vital in motivating them to take up precautionary measures. But it is important that these individuals have the support they need in dealing with their emotions.</p>
<p>People with health anxiety, preoccupied with health-related information or physical symptoms, are also at risk of worsening mental health as the virus spreads. So are individuals who are prone to frequent or increased “checking”, such as constantly making sure that the oven is off or that the front door is locked. Those at the extreme end of the scale when it comes to such behaviour may be displaying signs of <a href="https://theconversation.com/brain-scans-reveal-why-it-is-so-difficult-to-recover-from-ocd-and-hint-at-ways-forward-74092">obsessive compulsive disorder</a>.</p>
<p>People who have a lot of background anxiety, and are not easily reassured, may also benefit from assessment and support in the shadow of the coronavirus outbreak. This may include people with <a href="https://theconversation.com/explainer-what-is-an-anxiety-disorder-8206">generalised anxiety disorder or panic disorder</a>, which have strong physiological features.</p>
<h2>Ways to manage the stress</h2>
<p>If you find yourself excessively worrying about the coronavirus, this doesn’t necessarily mean that you have a psychological disorder. But high levels of emotional distress, whatever the source, should be appropriately and compassionately attended to, particularly if it is interfering with normal day to day activities.</p>
<p>At times of stress and anxiety, we are often prone to using strategies that are designed to help but <a href="https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/importance-of-behaviour-in-the-maintenance-of-anxiety-and-panic-a-cognitive-account/B3BAA0EFEF179C99BBCA5F983B05A534">prove counter-productive</a>. For example, you may Google symptoms to try to calm yourself down, even though it is unlikely to ever make you feel better. When our strategies for de-stressing instead increase our anxiety, it is time to take a step back and ask if there is anything more helpful we can do.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Stop checking.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-asian-chinese-student-woman-1631236618">TeamDAF</a></span>
</figcaption>
</figure>
<p>There are actually ways to dampen down the physical and emotional symptoms associated with anxiety. One is to stop checking. For example, avoid looking for signs of illness. You are likely to find unfamiliar physical sensations that are harmless but make you feel anxious. Normal physical changes and sensations pass in time, so if you feel your chest tighten, shift your focus onto pleasurable activities and adopt “watchful waiting” in the meantime.</p>
<p>In the case of COVID-19, checking may also include constant monitoring of news updates and social media feeds, which significantly increases anxiety – only serving to reassure us momentarily, if at all. So if you are feeling anxious, consider tuning off automatic notifications and updates on COVID-19. </p>
<p>Instead, do less frequent checks of reliable, impartial sources of information updates on COVID-19. This might include national health websites rather than alarmist news or social media feeds that exacerbate worry unnecessarily. Information can be reassuring if it is rooted in facts. It is often the <a href="https://www.sciencedirect.com/science/article/pii/S0005796707000952">intolerance of uncertainty</a> that perpetuates anxiety rather than fear of illness itself. </p>
<p>At times of stress and anxiety, hyperventilation and shallow breathing is common. Purposeful, regular breathing can therefore <a href="https://link.springer.com/article/10.1007/s10484-015-9279-8">work to reset</a> the fight or flight response and prevent the onset of panic and the unpleasant physical symptoms associated with anxiety. This is also true for exercise, which can help reduce the excess adrenaline build-up associated with anxiety. It can also give much needed perspective. </p>
<p>Perhaps most importantly, don’t isolate yourself. Personal relationships are crucial in maintaining perspective, elevating mood and allowing distraction away from concerns that trouble us. Even in imposed isolation, it is important to combat loneliness and keep talking – for example, via video chats. </p>
<p>We are globally united in living with a very real yet uncertain health threat. Vigilance and precautionary measures are essential. But psychological distress and widespread panic does not have to be part of this experience. Continuing normal daily activities, maintaining perspective and reducing unnecessary stress is key to psychological survival. In other words, where possible, keep calm and carry on. </p>
<p>If you continue to feel anxious or distressed despite trying these techniques, do talk to your GP or refer to a psychologist for evidence-based treatment such as cognitive behavioural therapy.</p><img src="https://counter.theconversation.com/content/133166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jo Daniels does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Stop constant checking and stay social.Jo Daniels, Senior Lecturer of Psychology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/820492017-09-01T00:20:27Z2017-09-01T00:20:27ZBack-to-school anxiety? Here are seven simple solutions<figure><img src="https://images.theconversation.com/files/184077/original/file-20170830-22218-16eshd2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Understanding the source of child anxiety is important. Some fears may be easily soothed; others, such as fears of bullying, may require adult intervention.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>As school starts up again this week, many children will return with excitement, happy to be reunited with teachers and friends. </p>
<p>Others will experience anxiety about this change in routine and the challenges offered by the school day. Sometimes this anxiety might become intense, or persist longer than is healthy.</p>
<p>The good news is that most young people adapt well and their anxiety reduces to normal levels within the first month of school. As a former teacher, and an educational psychologist, I can offer parents a few suggestions to help this adaptation happen faster.</p>
<h2>1. Understand the anxious brain</h2>
<p>From birth to age 11 or 12, children’s brains grow dramatically and <a href="http://developingchild.harvard.edu/science/key-concepts/brain-architecture/">neuronal connections are made rapidly</a>. This allows them to learn from many sources and amass important knowledge and skills (think about learning to talk, read, write and socialize). After that, the focus of brain development turns to <a href="http://onlinelibrary.wiley.com/doi/10.1196/annals.1308.001/full">consolidating and integrating learning</a> while they gain a fuller understanding of the world and how they fit into it.</p>
<p>Whatever stage they are in, children and adolescents are reaching out to explore the world around them, embracing new experiences and facing challenge and change. These new experiences carry with them uncertainty, which has the potential to provoke anxiety.</p>
<p>In its purest form, anxiety is adaptive and helpful. It alerts us to potential risks in the environment around us, helping to ensure that we look before we leap. It keeps us close to those who will protect us. Unfortunately, the brain’s alarm system can become over activated and trigger anxiety in unnecessary circumstances, or evoke excessive anxiety that keeps us from doing things in normal daily life.</p>
<h2>2. Get a good night’s sleep</h2>
<p>Excitement and anxiety can affect sleep. Getting a good night’s sleep is important in helping us cope with stress. Some children get so worked up that they cannot sleep the night before school, or they wake up early. </p>
<p>In the evening, acknowledge your kids’ excitement about school, then try some warm milk (which releases tryptophan to help with sleep). Tuck them into bed to read a familiar story that might even be a little boring. Soft lighting and gentle music can also help. Melatonin is a natural substance that makes them feel sleepy, which can be used for a few nights if needed (consult a pharmacist). Bedtime routines are helpful. And electronics with screens should be shut off <a href="https://sleepfoundation.org/sleep-topics/how-blue-light-affects-kids-sleep">90 minutes before sleep</a>.</p>
<h2>3. Talk about morning anxiety</h2>
<p>Anxiety can present as tummy aches and tears, as well as irritability and avoidance of going to school. It is important to talk with your child about their worries and fears. But do not give in and let them stay home unless there is a really good reason. Staying at home will only reinforce their anxiety and make it worse in the end.</p>
<h2>4. Help kids transition</h2>
<p>It is normal for young children to experience some separation anxiety, especially if they have not previously had the chance to attend daycare or day camps. In this case, you might need to accompany them to the door of the school or classroom to help them transition to the teacher. </p>
<p>Sometimes, it helps to have another child with them. Your child can meet with their friend before school or even travel to school together, an approach that works well with older children and youth.</p>
<h2>5. Figure out the worries</h2>
<p>Ask your child what they are worried about. Once you have found out the cause or trigger for the anxiety, you can take steps to respond. Work together with your child to develop a plan that will help them be successful. </p>
<p>Sometimes problems will require adult intervention. The last thing you want to do is send your child off to school when they have real worries about being bullied or physically hurt by peers who have threatened them. Similarly, some youth can feel threatened by certain teachers or school staff who may not be respectful or sensitive to their needs. Of course, the anxieties may be exaggerated or unfounded but real problems should never be dismissed.</p>
<h2>6. Deal with your own anxiety</h2>
<p><a href="https://link.springer.com/article/10.1023%2FA%3A1005260311313?LI=true">Parental anxiety can affect children</a>. It helps if you talk to your partner or trusted friends about your anxiety. Is this your first child starting school? Try to connect with a more seasoned parent who can help make your journey easier.</p>
<h2>7. Know when to consult a specialist</h2>
<p>There are some types of anxiety that are more severe and require specialized support and treatment. It is important not to let these run on for too long without intervention, as these types of anxiety tend to persist if they are not treated. Anxiety also tends to run in families. </p>
<p>Generalized Anxiety Disorder is characterized by frequent worrying about many topics and situations (including worrying about family members, peers and schoolwork) that provokes an impairing anxiety response. Separation Anxiety Disorder is characterized by marked anxiety at separation from significant adults. </p>
<p>Social Anxiety Disorder is characterized by significant and impairing anxiety and self-consciousness in social situations, which can make it hard to talk or eat in groups. Panic Disorder (rare before age 13) is characterized by an unexpected adrenaline pulse that provokes a strong physiological anxiety response, which can make it difficult to stay in enclosed or public spaces.</p>
<p>Though it is common to experience some anxiety during the first month, most children will make a successful transition. If anxiety continues beyond that, you might need to consult with a specialist such as a child psychologist or pediatrician. An excellent resource that is useful for both transitional anxiety and clinical levels of anxiety is the book <a href="http://barronseduc.com/1438004834.html"><em>Keys to Parenting Your Anxious Child</em></a>.</p>
<p>Help your children to prepare, then you can enjoy the first weeks back at school just as much as your children do!</p><img src="https://counter.theconversation.com/content/82049/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Lee Zwiers consults with the CanLearn Society in Calgary, Alberta, a non-profit society that supports people with attention and learning problems, as well as autism. He has a small independent consulting company that supports and trains psychologists and mental health professionals.</span></em></p>As the first days of school approach rapidly, an educational psychologist offers strategies for combating anxiety in children and teens.Michael Lee Zwiers, Assistant Professor Educational Psychology, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/570572016-05-15T19:47:50Z2016-05-15T19:47:50ZFear of death underlies most of our phobias<figure><img src="https://images.theconversation.com/files/120926/original/image-20160503-19512-x821j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some people focus their fear of death on smaller and more manageable threats.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/pimthida/5418964298/in/photolist-9fRBhW-5zeB54-6otJia-9eyFvf-63Kkd4-4wgp5g-5JyLGJ-63jHR-49L188-5jhvWc-6EAERh-dVGK3L-cyob43-oPD7kt-pjQTT-pyDRL-6PsDnM-x11QJ6-5pCwdV-8A8Mku-24CpzJ-wGs6a3-5RhNyi-4n81L5-dUpKDY-3PxNn-aRN7fT-5oYpoD-4BZZhD-saYoQz-dudTZ5-9WdKwK-b8ALTR-4pSDhX-edWwLF-opWGzz-2KNNJZ-iMzU6e-mbDwqv-iMzXfk-4vZzNp-4ai2Sq-7pAyAs-qBLqtr-6L3ZrL-nF9nvU-AiLRb-9C55VB-iMzXFF-iMACCE">Pimthida/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><em>This is the first in our <a href="https://theconversation.com/au/topics/coping-with-mortality">Coping with Mortality</a> series, which looks at fear of death across the ages and how to cope with the dying process. Read the next article on helping children process death <a href="https://theconversation.com/adults-can-help-children-cope-with-death-by-understanding-how-they-process-it-58057">here</a>.</em></p>
<hr>
<p>Awareness of our mortality is part of being human. As author and existential philosopher <a href="https://mafhom.files.wordpress.com/2012/11/staring-at-the-sun-yalom.pdf">Irvin Yalom said</a>, we are “forever shadowed by the knowledge that we will grow, blossom and, inevitably, diminish and die”. </p>
<p>There is growing <a href="http://psycnet.apa.org/books/13748/001">research exploring</a> the overwhelming anxiety that the inevitability of death, and our uncertainty about when it will occur, has the power to create. A social psychological theory, called <a href="http://web.missouri.edu/%7Esegerti/capstone/Arndt.pdf">terror management theory (TMT)</a>, is one way to understand how this anxiety influences our behaviour and sense of self. </p>
<h2>Coping mechanisms</h2>
<p>According to this theory, we manage our fear of death by creating a sense of permanence and meaning in life. We focus on personal achievements and accomplishments of loved ones; we take endless photos to create enduring memories; and we may attend church and believe in an afterlife. </p>
<p>These behaviours bolster our self-esteem and can help us feel empowered against death. For some, however, periods of stress or threats
to their health, or that of loved ones, <a href="https://books.google.com.au/books/about/The_Psychology_of_Death.html?id=dMfC9N2BoDAC">may result in ineffective and pathological</a>
coping mechanisms.</p>
<p>These people might <a href="http://www.tandfonline.com/doi/abs/10.1080/08873267.2012.732155">focus their real fear of death</a> on smaller and more manageable threats, such as spiders or germs. Such phobias may appear safer and more controllable than the ultimate fear of death.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/120924/original/image-20160503-19538-qdw0yz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/120924/original/image-20160503-19538-qdw0yz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/120924/original/image-20160503-19538-qdw0yz.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/120924/original/image-20160503-19538-qdw0yz.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/120924/original/image-20160503-19538-qdw0yz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/120924/original/image-20160503-19538-qdw0yz.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/120924/original/image-20160503-19538-qdw0yz.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We might take endless photographs to create a sense of permanence.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1442507210693-938e0e77fef2?ixlib=rb-0.3.5&q=80&fm=jpg&crop=entropy&s=cfd25c0a66804cec5e2d5b6eee7af581">Annie Spratt/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>This makes sense because when we <a href="http://www.sciencedirect.com/science/article/pii/S0272735814001354">look closely at the symptoms</a> of several anxiety-related disorders, death themes feature prominently. </p>
<p>When children experience separation anxiety disorder, it is <a href="http://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596">often connected to excessive fear</a> of losing major attachment figures – such as parents or other family members – to harm or tragedy from car accidents, disasters or significant illness.</p>
<p>Compulsive checkers repeatedly check power points, stoves and locks in an <a href="https://www.australianacademicpress.com.au/books/details/125/DIRT_Danger_Ideation_Reduction_Therapy_for_Obsessive_Compulsive_Checkers_A_Comprehensive_Guide_to_Treatment">attempt to prevent harm</a> or death. <a href="https://www.researchgate.net/publication/280142510_Menzies_R_G_Menzies_R_E_Iverach_L_2015_The_role_of_death_fears_in_Obsessive_Compulsive_Disorder_Australian_Clinical_Psychologist_1_6-11">Compulsive hand washers often fear</a> contracting chronic and life-threatening diseases.</p>
<p>People with panic disorder frequently visit the doctor <a href="http://www.jpsychores.com/article/S0022-3999(97)00135-9/abstract">because they’re afraid</a> of dying from a heart attack. Meanwhile, those with somatic symptom disorders, including those formerly identified as hypochondriacs, frequently request medical tests and body scans to identify serious illness. </p>
<p>Finally, specific phobias are characterised by excessive fears of heights, spiders, snakes and blood – all of which are associated with death. Phobic responses to seeing a spider, for instance, typically involve jumping, screaming and shaking. Some <a href="http://psp.sagepub.com/content/early/2007/06/01/0146167207303018.short">researchers argue</a> these extreme responses could actually represent rational reactions to more significant threats, such as seeing a person with a weapon.</p>
<h2>Priming death</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/120929/original/image-20160503-19521-br2obh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/120929/original/image-20160503-19521-br2obh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/120929/original/image-20160503-19521-br2obh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/120929/original/image-20160503-19521-br2obh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/120929/original/image-20160503-19521-br2obh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/120929/original/image-20160503-19521-br2obh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/120929/original/image-20160503-19521-br2obh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Compulsive hand washers used more paper towels when primed with death.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>More evidence for the TMT hypothesis comes from studies showing that death anxiety is capable of increasing anxious and phobic responding.</p>
<p>These studies use a popular “<a href="http://psr.sagepub.com/content/14/2/155.abstract">mortality salience induction</a>” technique to prime death anxiety in people with other anxiety disorders. The technique involves <a href="http://psr.sagepub.com/content/14/2/155.abstract">participants writing down</a> the emotions that the thought of their own death arouses, as well as detailing what they think will happen as they die and once they are dead. </p>
<p>Spider phobics primed like this had <a href="https://arizona.pure.elsevier.com/en/publications/terror-mismanagement-evidence-that-mortality-salience-exacerbates">increased reactions</a> to spiders, such as avoiding looking at spider-related images, when compared to spider phobics not primed with death. And compulsive hand washers spent more time washing their hands and used more paper towels when primed with death.</p>
<p>Likewise, <a href="http://www.tandfonline.com/doi/full/10.1080/02699931.2015.1065794#.VyFiVEIqv8s">those with social phobias took longer</a> to join social interactions. After they had been reminded of death, they also viewed happy and angry faces as more socially threatening – as <a href="http://www.ncbi.nlm.nih.gov/pubmed/17884328">these faces indicate judgement</a> – than neutral, seemingly innocuous faces. </p>
<h2>Is fear of death normal?</h2>
<p>Given that we are all going to die at some point, death anxiety is a normal part of the human experience. For many of us, thinking about death can evoke fears of separation, loss, pain, suffering and anxiety about leaving those we love behind. </p>
<p>According to terror management theory, this fear has the power to motivate a life well lived. It stimulates us to cherish those we love, create enduring memories, pursue our hopes and dreams and achieve our potential. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/120437/original/image-20160428-30953-vsm8kq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/120437/original/image-20160428-30953-vsm8kq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/120437/original/image-20160428-30953-vsm8kq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/120437/original/image-20160428-30953-vsm8kq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/120437/original/image-20160428-30953-vsm8kq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/120437/original/image-20160428-30953-vsm8kq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/120437/original/image-20160428-30953-vsm8kq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Death anxiety is a normal part of human experience.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/bSYRuzEaT5k">Neil Thomas/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Death anxiety becomes abnormal when it forms the basis of pathological thoughts and behaviours that interfere with normal living. Many obsessive-compulsive hand washers and checkers <a href="http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:42972">spend significant amounts of time</a> each day in ritualistic behaviours designed to reduce the threat of dirt, germs, fire, home invasion or threats to themselves and loved ones. </p>
<p>Similarly, those with phobias may go to extreme lengths to avoid what they fear and react with extreme distress when confronted with it. When these thoughts and behaviours lead to impaired functioning, anxiety is no longer considered “normal”.</p>
<p>Treatments, such as cognitive behaviour therapy, for a range of disorders may need to incorporate new strategies that directly address death anxiety. Without such innovation, the spectre of death may tragically haunt the anxious across their lifespan, until it is too late.</p><img src="https://counter.theconversation.com/content/57057/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We manage our fear of death by creating a sense of permanence and meaning in life. But for some people, death anxiety results in pathological coping mechanisms, such as being afraid of spiders.Lisa Iverach, Honorary Associate at Department of Psychology, Macquarie University and Research Fellow, University of SydneyRachel E. Menzies, PhD candidate, Clinical Psychology, University of SydneyRoss Menzies, Associate Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/417602015-07-20T20:11:49Z2015-07-20T20:11:49ZBorderline personality disorder is a hurtful label for real suffering – time we changed it<figure><img src="https://images.theconversation.com/files/87079/original/image-20150702-27109-dfurlv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A diagnostic label such as borderline personality disorder, with its stigma and propensity to invalidate the person’s suffering, clearly has many negative impacts.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/belljar/72332573/in/photostream/">madamepsychosis/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p><em>Trigger warning: the following article has a graphic description of self-harm.</em></p>
<p>Standing in the cold, dark bathroom, she hacked into her wrist with a razor blade and quietly stared at the blood that flowed from the cut. She told herself she was a bad person and deserved the pain. </p>
<p>A part of her felt reassured by the sight of the blood – it showed she was alive – since she felt so dead and empty inside. As she stared at her image in the bathroom mirror, she thought, “I have no idea who that person is staring back at me.”</p>
<p>Such deliberate self-harm is very common in people diagnosed with borderline personality disorder. It takes many forms, including intentional overdoses of tablets with excessive alcohol, risky sexual behaviour, as well as physical self-punishment.</p>
<p>Other symptoms of the disorder include identity disturbances, feeling “dead” inside, rage responses or difficulty regulating emotional reactions to situations, mood swings, constant anxiety and panic, poor self-esteem, memory blanks, dissociation (“out of body” or feeling “unreal”) experiences, problems with concentration, feeling invalid, and fear of being abandoned. </p>
<h2>A bad cycle</h2>
<p>Between 2% to 10% of the population have some degree of borderline personality disorder, which puts them at high risk of suicide. While it’s poorly understood, we know that it predominantly impacts women. </p>
<p>There’s no medication that specifically treats borderline personality disorder, and it’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/16990170">associated with a great deal of stigma</a> among both health-care professionals and the general community. Research shows people seeking treatment for self-inflicted harm, including taking medication overdoses, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23882440">are often seen as “difficult”</a>, a “nuisance” or <a href="http://www.biomedcentral.com/1471-244X/15/2">just indulging in “bad behaviour”</a>. </p>
<p>Rage or diffuse anger is another symptom of borderline personality disorder that’s poorly tolerated by family and health professionals. If the person with the condition repeats self-harming behaviour, frustration among family, friends and health professionals increases and may lead to decreased care. </p>
<p>Since people with the disorder crave reassurance that they are worthy, valid and deserving of care, this rejection sets up a dangerous spiral of increasingly harmful behaviour that’s intended to attract care.</p>
<h2>Origins in trauma</h2>
<p>About <a href="http://www.ncbi.nlm.nih.gov/pubmed/2929750">80% of people with borderline personality disorder</a> have a history of trauma. They may block out recollections of early life trauma, but the impact of their emotional, physical or sexual abuse as a young person is profound and present for many years afterwards. </p>
<p>More specifically, people who were sexually abused as children <a href="http://psycnet.apa.org/psycinfo/1986-14683-001">often feel</a> – wrongly – that they did something wrong, that they are to blame for being abused and that they’re bad people. At a deep level, they believe they deserve punishment; their self-harm acts out this belief. </p>
<p>The rage of people with borderline personality disorder, which often occurs in response to apparently small issues, may actually be totally justified – a delayed expression of anger with the perpetrator of their abuse. And their memory blanks and out-of-body responses to stress may be attempts to repress recollections of abuse and to escape from trauma. </p>
<p>Not all traumas stem from physical or sexual abuse. Emotional neglect or deprivation can also be difficult for people to identify and define. They can, nonetheless, leave a mark for years to come. About <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61422-5/abstract">10% to 20% of people who have borderline personality disorder</a> have no known history of childhood trauma.</p>
<h2>Difficult diagnosis</h2>
<p>The biology of this poorly understood condition <a href="http://www.ncbi.nlm.nih.gov/pubmed/24965581">includes the hypothesis</a> that abused or neglected children produce high levels of stress hormones (cortisol) and remain on “high alert” – watching and waiting for the next abusive episode. These stress hormones impact brain circuits and centres that determine anger or emotional control and higher learning. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/87070/original/image-20150702-27154-nfleu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/87070/original/image-20150702-27154-nfleu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/87070/original/image-20150702-27154-nfleu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/87070/original/image-20150702-27154-nfleu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/87070/original/image-20150702-27154-nfleu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/87070/original/image-20150702-27154-nfleu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/87070/original/image-20150702-27154-nfleu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Deliberate self-harm is very common in people diagnosed with borderline personality disorder.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/future_crazy_cat_lady/2384024631/">Rachel Collins/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Women with this condition can also have <a href="http://www.ncbi.nlm.nih.gov/pubmed/24965581">cortisol-induced cyclical reproductive changes</a>, leading to menstrual cycle-related depression, obesity, diabetes, high blood pressure, increased facial hair, infertility and ovarian cysts. All these long-lasting mental and physical symptoms appear to have their origins in a history of early life trauma with biological brain changes. </p>
<p>There are effective psychological treatments, such as <a href="http://www.ncbi.nlm.nih.gov/pubmed/10598211">dialectical behavioural therapy</a>, for borderline personality disorder but health professionals have to recognise and explain the condition before appropriate care can be provided. </p>
<p>And many health professionals find it difficult to recognise the condition because different symptoms come and go over time. An overall view of the person’s life is needed to correctly make the diagnosis. </p>
<h2>Ill-fitting name</h2>
<p>As a diagnostic term, borderline personality disorder not only fails to capture any of the underlying issues and mechanisms involved in producing its symptoms, it also denigrates. In contrast, major depressive disorder describes a serious condition with the key feature of depressed mood explicit in the diagnostic term.</p>
<p>The word “borderline” was <a href="http://www.bpddemystified.com/references/">used in the 1930s by psychoanalysts</a> to describe patients whose symptoms were on the border between psychosis and neurosis. But today the most common interpretation of the word is that <a href="http://www.ncbi.nlm.nih.gov/pubmed/25536098">the condition “borders” on being a real illness</a>. </p>
<p>In effect, there’s an invalidation of the illness in its name. This mirrors – as well as possibly enhancing – the feeling of invalidation the person with the condition already suffers. </p>
<p>And all this is not helped by the next word either. To suggest there’s something about someone’s personality that’s disordered – especially as personality is, collectively, the intimate and unique qualities that describe a person – is a devastating blow. And it cuts further into the already diminished self-esteem that people with this condition have.</p>
<h2>Why it matters</h2>
<p>Diagnostic labels carry a great deal of weight. They describe symptoms, attempt to answer the question of “what is wrong” and lead to a treatment plan. A diagnostic label such as borderline personality disorder with its stigma and propensity to invalidate the person’s suffering clearly has many negative impacts.</p>
<p>A name that captures the origins of the condition, such as complex trauma disorder, could shift the focus from seeing the person as “behaving badly” or not having a “real” illness, to recognising them as a survivor of trauma or abuse. Such a change could improve outcomes for them and their families.</p>
<p>Of course, what’s also urgently needed is clinical research that creates better understanding of the condition, and the development of tailored, effective treatments. But ultimately, prevention of early life trauma would make the biggest difference to the development and expression of this disorder. </p>
<p>In the meantime, changing the label borderline personality disorder to something more sympathetic, even if just informally, may start shifting negative attitudes to people with the condition.</p>
<hr>
<p><em>For help-seeking information about self-harm, contact Lifeline (24 hours) on 13 11 14; Kids Helpline (24 hours) on 1800 55 1800; MensLine Australia (24 hours) on 1300 78 99 78; SANE Helpline on 1800 18 SANE (7263), or visit www.reachout.com</em></p><img src="https://counter.theconversation.com/content/41760/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jayashri Kulkarni receives funding from the National Health and Medical Research Council of Australia and educational plus clinical trial grants from pharmaceutical companies that manufacture psychotropic medications. </span></em></p>Diagnostic labels usually describe symptoms, attempt to answer the question of what is wrong, and lead to a treatment plan. But “borderline personality disorder” fails on all three counts.Jayashri Kulkarni, Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/428352015-06-15T04:04:54Z2015-06-15T04:04:54ZSeven new genes linked to anxiety disorders<figure><img src="https://images.theconversation.com/files/84407/original/image-20150609-10747-bcbx77.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drug-based therapies for anxiety disorders work on roughly half of those affected and treated.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Researchers have linked seven new genes to anxiety disorders such as obsessive compulsive disorder, panic disorder and social anxiety disorder. </p>
<p>These gene links mean that new drug treatments could be created to target these gene products specifically in the treatment of anxiety disorders. It gives hope to thousands of people who currently have no treatment plan. </p>
<p>Treatments for anxiety disorders involve both drug-free and <a href="http://www.nimh.nih.gov/health/publications/anxiety-disorders/index">drug-based therapies</a>. The most effective treatment strategies are a combination of the two, differing in application from patient to patient. </p>
<p>To treat these conditions using drug-based therapies, drugs have been designed to target specific genes which produce proteins associated with the progression of disorders. Because these disorders are so complex, gene discovery is difficult. </p>
<p>Currently, there are only two core pathways that are associated with drug-based therapies: the dopaminergic and the serotonergic pathways. Dopamine changes have been linked to movement, motivation, reward-response and addiction. Serotonin in the brain has been linked to mood, social behaviour, memory and cognitive function.</p>
<p>Drug-based therapies work on roughly half of those affected and treated, leaving a large number of people <a href="http://www.appi.org/Book/Subscription/JournalSubscription/id-1336/Clinical_Manual_of_Anxiety_Disorders">without tangible assistance</a>. The current treatments for anxiety disorders are not as effective as hoped. A better understanding of why and how these disorders exist is essential for better treatment strategies.</p>
<h2>Looking at novel gene targets</h2>
<p>Our <a href="https://www.researchgate.net/publication/265476243_THE_IDENTIFICATION_OF_NOVEL_SUSCEPTIBILITY_GENES_INVOLVED_IN_ANXIETY_DISORDERS">research</a> uncovered several new genes that could potentially play roles in how anxiety disorders develop and progress. We used an interdisciplinary approach on both animals and people to uncover these genes.</p>
<p>To help us identify the candidate genes, we focused on the striatum section of the brain in which the synaptic plasticity pathway was chosen. In neuroscience, synaptic plasticity refers to the ability of synapses (connections in the brain) to strengthen or weaken over time in response to a stimulus. The striatum helps co-ordinate motivation with body movement. It can be as simple as fine-motor function or as complex as behavioural inhibition depending on social interaction. </p>
<p>The result was that we identified seven new genes as <a href="https://www.researchgate.net/publication/265476243_THE_IDENTIFICATION_OF_NOVEL_SUSCEPTIBILITY_GENES_INVOLVED_IN_ANXIETY_DISORDERS">possible candidates for further study</a>. Six of these genes have never been implicated in anxiety disorders before. </p>
<p>To date, global research has identified a number of risk factors for anxiety disorders. These can be grouped into two categories: genetic factors and environmental factors. Genetic factors relate to differences in one’s genetic code that either protect or put you at risk for developing anxiety disorders. Environmental factors include childhood trauma and substance abuse.</p>
<p>To further complicate things, these categories tend to interact with one another.
Scientists believe the interaction is what results in a plethora of differences among patients even when they have the same disorder. For example, two people may have severe obsessive compulsive disorder and be on the same treatment schedule. Due to the differences in their genetic make-up and lifestyles, they could respond differently to treatment.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/84409/original/image-20150609-10747-18vzvsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84409/original/image-20150609-10747-18vzvsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84409/original/image-20150609-10747-18vzvsi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84409/original/image-20150609-10747-18vzvsi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84409/original/image-20150609-10747-18vzvsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84409/original/image-20150609-10747-18vzvsi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84409/original/image-20150609-10747-18vzvsi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drug-based therapies only work for half of the people suffering from anxiety disorders.</span>
<span class="attribution"><span class="source">shutterstock</span></span>
</figcaption>
</figure>
<p>Some of these candidates also appear to interact with environmental stressors. <a href="http://www.sciencedirect.com/science/article/pii/S002239561300263X">Trauma</a> experienced during early developmental years has been thought to be a risk factor for anxiety disorders for a number of years now. It is believed to be a key factor in the variation seen among different patients. </p>
<p>Although this theory is difficult to investigate and depict, it was possible using the strict and specific conditions that we did. The finding provides a precedent for future work to try and better understand how the environment interacts with genetics to manifest in disease.</p>
<p>Anxiety disorders such as obsessive compulsive disorder, panic disorder and social anxiety disorder are among the most severe and debilitating conditions. They currently affect up to [350 million people worldwide](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13).</p>
<p>Despite this disease burden, they have not achieved the visibility, attention or funding they <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001178">comparatively deserve</a>. For example, the <a href="http://report.nih.gov/categorical_spending.aspx">US</a> allocated (in millions) $3920 to cover all brain disorders research for the 2015 financial year. HIV, with an incidence rate well below anxiety disorder – let alone brain disorders in general – received $3000 (in millions).</p>
<p>Myths, fear and stigma are the persistent barriers in the understanding of mental illness. It also hampers <a href="http://wfmh.com/wp-content/uploads/2013/11/WFMH_GIAS_UnderstandingGeneralizedAnxiety.pdf">public awareness</a>. As a result, as history has shown, those who suffer from mental health illnesses have been ostracised in communities, treated with prejudice and considered second-class citizens.</p>
<h2>The way forward</h2>
<p>By uncovering these new candidates genes – involved not only in risk, but environmental interplay – there is new hope for better and improved treatment strategies.</p>
<p>But whether it is by realising new drug targets, a better understanding at a molecular level or how one’s environment influences disease, a small – yet promising – arsenal of candidates could shed a little more light on a rather dimly lit road.</p><img src="https://counter.theconversation.com/content/42835/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathaniel McGregor receives funding from the National Research Foundation (NRF). He is affiliated with the MRC Unit on Anxiety and Stress Disorders.</span></em></p>There is hope that new drugs can be created to treat anxiety disorders after seven new genes were linked to these diseases.Dr Nathaniel McGregor, Postsdoctoral Researcher, Department of Psychiatry and Department of Genetics, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/82062012-08-23T04:32:22Z2012-08-23T04:32:22ZExplainer: what is an anxiety disorder?<figure><img src="https://images.theconversation.com/files/14417/original/hftx4dww-1345437043.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Excessive anxiety causes serious distress and problems in important areas of life.</span> <span class="attribution"><span class="source">Thomas/Flickr</span></span></figcaption></figure><p>Most of us are intimately familiar with anxiety. We experience it as we walk towards the room to where our job interview is held, when we stand up to give a speech at our best friend’s wedding, or when we find ourselves in conversation with someone we want to impress. </p>
<p>Anxiety is experienced physically as butterflies in the stomach, facial flushing, or trembling hands. It may affect your behaviour – for instance, when you find yourself looking at everything in the room except the person you want to communicate with. You may also recognise the voice of anxiety in your thoughts, when you say things to yourself such as “this is impossible”, “I can’t do this”, or “she/he will think I’m stupid, I won’t be able to think of anything to say”.</p>
<p>Anxiety can be uncomfortable, but it’s also an important motivator. A level of anxiety is important for performance, and it assists us by focusing our attention on the things that we need to achieve. When preparing for an examination or to compete in a sport, anxiety motivates us to study or to practise. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/14420/original/htkqqk6w-1345438146.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/14420/original/htkqqk6w-1345438146.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/14420/original/htkqqk6w-1345438146.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/14420/original/htkqqk6w-1345438146.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/14420/original/htkqqk6w-1345438146.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/14420/original/htkqqk6w-1345438146.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/14420/original/htkqqk6w-1345438146.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We’re all familiar with situations that cause anxiety.</span>
<span class="attribution"><span class="source">Lee Haywood</span></span>
</figcaption>
</figure>
<p>In 1908, <a href="http://onlinelibrary.wiley.com/doi/10.1002/cne.920180503/abstract">researchers</a> described the relationship between arousal and performance as an inverted “U” – where both too little arousal and too much arousal are detrimental to performance. But anxiety may not always have a detrimental effect on performance. Research suggests that people experiencing significant anxiety may do as well as those less anxious much of the time, although it takes a lot of effort to achieve the same outcome. This may help to explain why anxiety is so exhausting.</p>
<h2>Different types of anxiety disorders</h2>
<p>Generalised anxiety disorder (GAD) refers to chronic, persistent worry that is seen as excessive compared to the level of danger or threat involved. Many people worry when they know that their job is under threat because of organisational restructuring, but a person with GAD may worry about their job security, their own or their children’s safety, or their financial situation, without being able to identify any reason for their worry.</p>
<p>Panic disorder is characterised by fear of having an unexpected panic attack that may cause people to avoid places where panic attacks have occurred in the past. A panic attack is a sudden, intense feeling of fear and discomfort associated with physical sensations such as sweating, trembling, numbness, nausea and a racing heart that seems to come from nowhere. These symptoms are severe and frightening, and many people experiencing a panic attack think they’re having a heart attack or dying.</p>
<p>Social anxiety disorder occurs in social or performance situations where a person fears they will be evaluated. These fears, and associated difficulties with communication coupled with feelings of inferiority, create problems for people achieving their potential in educational and work settings, and in developing supportive social relationships.</p>
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<span class="attribution"><span class="source">Chris Scott</span></span>
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<p>Obsessive-compulsive disorder (OCD) is a condition where people experience intrusive and distressing thoughts and images that they often respond to with ritualised behaviours aimed at reducing distress. A person with OCD may have recurrent thoughts about illness and contamination from contact with other people through minor occurrences, such as shaking hands or bumping into someone in a crowd. These events create intense anxiety relieved by compulsive washing of their hands, body, clothing, or cleaning their home. Apart from the severe distress that those with OCD experience, compulsive behaviours are very time consuming.</p>
<p>Post-traumatic stress disorder (PTSD) occurs after a traumatic experience such as experiencing or witnessing an assault or serious injury. For some people, the experience is vividly and repeatedly “relived”. People with PTSD generally avoid places, people, and topics that remind them of the trauma. They often experience a sense of emotional numbing and feel detached from their close friends and family.</p>
<p>While there are important differences between these conditions, what they have in common is the experience of excessive anxiety that causes serious distress and problems in important areas of life, including work, study, and relationships. </p>
<p>Many factors influence whether a particular person will experience an anxiety disorder. These include genetics, personality traits, exposure to trauma and current stressors, such as problems with work, family or relationships.</p>
<h2>Prevalence and treatment</h2>
<p>According to the 2007 <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0">National Survey of Mental Health and Wellbeing</a> (NSMHW), about 20% of Australians will experience the symptoms of a diagnosable mental illness, most commonly an anxiety disorder (14.4%), in any 12-month period. </p>
<p>Anxiety disorders affect women more than men, and in the NSMHW almost 18% of women compared to 11% of men reported an anxiety disorder in the past 12 months. Over a lifetime, as many as 25% of people will experience an anxiety disorder. </p>
<p>Although anxiety disorders are both common and distressing, many people with anxiety disorders don’t seek professional help and may live with these distressing and impairing conditions for decades. But the good news is that anxiety disorders are treatable. Medication can provide some relief from the symptoms of anxiety. There is also a great deal of evidence to suggest that cognitive behaviour therapy (a psychological approach that targets the physical, behavioural and cognitive aspects of anxiety) is very effective in treating anxiety disorders. </p>
<p>If you are experiencing anxiety that’s holding you back, causing you distress and affecting your relationships then take the first step towards putting it behind you. Like all bullies, anxiety feeds on avoidance and melts away when you stand up and say “no more”.</p>
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<p class="fine-print"><em><span>Lynne Harris has received funding from the ARC. She is currently employed by the Australian College of Applied Psychology and is an honorary associate of the University of Sydney. She also practices as a clinical psychologist.</span></em></p>Most of us are intimately familiar with anxiety. We experience it as we walk towards the room to where our job interview is held, when we stand up to give a speech at our best friend’s wedding, or when…Lynne Harris, Associate Professor of Psychological Sciences, School of Psychological Sciences, Australian College of Applied Psychology and Honorary Assoc Prof with the Faculty of Health Sciences, University of SydneyLicensed as Creative Commons – attribution, no derivatives.