May is Mental Health Awareness Month, and the UNMC wellness team – Steve Wengel, MD, Sarah Fischer, PhD, and Priya Gearin, MD – will be discussing mental health topics weekly in UNMC Today. Dr. Gearin is an assistant professor in the UNMC Department of Psychiatry and a child psychiatrist with Nebraska Medicine.
Anxiety disorders are the world’s most common type of mental health condition. They often start in childhood or adolescence, affecting 31.9% of people between 13-18 years old.
But how do we know when anxious thoughts and feeling cross over to a disorder?
I often tell patients and families that everyone worries or feels anxious at times, and some worry is healthy because it can help us make choices that promote our well-being. For example, a new driver may worry about getting into a car accident, so they will be more careful to follow traffic laws.
However, when worried thoughts start to become persistent and excessive, they may be crossing over into an anxiety disorder. To be considered a disorder, anxiety symptoms must interfere with an individual’s functioning. Using the same example, if a new driver starts to worry most of the time that an accident will occur, focuses on worst-case scenarios in other situations and begins to avoid getting in a car due to these fears, they may be experiencing an anxiety disorder.
There are different anxiety disorders, such as generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, panic disorder and illness anxiety disorder. Obsessive compulsive disorder is a related condition. Each has its own set of features that are required to make the diagnosis, including number of symptoms and duration of symptoms. Generalized anxiety disorder is the most common anxiety disorder and is diagnosed by the following criteria:
- Excessive anxiety and worry about a number of events or activities that occurs the majority of days for six months or more
- Difficulty controlling worry
- Three or more of the following (only one required in children)
- Restlessness or feeling on edge
- Easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance
- The symptoms cause clinically significant distress or impairment in functioning
- The disturbance is not better explained by another mental health condition, substance use or another medical condition
Anxiety disorders can cause more than mental or emotional distress. Physical manifestations of anxiety may include stomachaches, headaches and muscle tension. In children, school avoidance can be a sign of anxiety.
Part of the therapy for anxiety disorders, along with other mental health conditions such as depression, involves identifying automatic negative thoughts. Automatic negative thoughts are thoughts that pop into our brains without thinking, and they can perpetuate anxiety. For example, if someone gets an email from their boss saying they need to meet, the individual may automatically think, “I am going to get fired.” In reality, there might be several other possibilities, but anxiety often makes the worst-case scenario the “only-case scenario.” Therapy works to identify thought traps, such as catastrophizing, overgeneralizing and all-or-nothing thinking, that can underly these automatic negative thoughts.
If you are concerned about an anxiety disorder in yourself or a loved one, begin by asking your primary care provider to screen you for anxiety, as well as other common causes of anxiety, such as thyroid conditions. Along with psychotherapy, medication can be considered for both children and adults, depending on the severity of the anxiety disorder and goals of the patient and caregivers. Primary care providers can refer to a specialist in psychiatry if needed, especially if co-occurring diagnoses exist.