Anxiety Disorder

Edited by Giuseppe Calcagno
Doctor specialising in Clinical Psychology

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Anxiety is a defence mechanism, closely linked to our self-preservation instinct, and manifests itself as intense emotional tension. You know that feeling of sudden sweating, palpitations, heart beating wildly and sometimes a slight tremor in the hands? Here, this picture, unfortunately increasingly common in recent years, is the calling card of anxiety. In a functional context, anxiety helps us to anticipate dangers and keeps us in a state of alertness that is useful in facing daily challenges. However, when this 'danger light' remains on non-stop and disproportionately, anxiety becomes pathological. It is like living with a constantly activated alarm, which ends up exhausting our resources and limiting our capabilities. Symptoms can involve body, mind and behaviour. It thus goes far beyond simple heart palpitations: we are talking about exaggerated worries, constant tension, a sense of imminent threat and difficulty in carrying out even the simplest everyday activities with serenity. Those suffering from pathological anxiety usually show a continuous and disproportionate preoccupation with everyday life events. Think of someone who feels terrified at the idea of receiving a phone call, or of being late for work or school. This hypervigilance turns into a kind of negative 'premonition': as if every small obstacle could become a catastrophe.

This inevitably leads to difficulties in managing one's autonomy. Some people often rely on family and friends, while others, unfortunately, prefer to isolate themselves because they are convinced they cannot cope with the outside world. And it is precisely the latter choice that often worsens the perception of anxiety, triggering a vicious circle.On a somatic level, anxiety can involve the neurovegetative system with symptoms that many of you may have already experienced at least once in your life:

• Sweating (particularly on the palms of the hands)
• Frequent palpitations and shortness of breath
• Dry mouth
• Sense of 'knot in the throat' or 'heavy head'
• Hot flushes, nausea, diarrhoea (in those who are more sensitive)
• Muscle tension, often concentrated on head, neck and back

On the psychological side, we find frequent sleep disturbances, cognitive difficulties (such as a sense of confusion and limited concentration) and a tendency to repeatedly visit the doctor in the belief that there is something physically serious. But if all analyses turn out negative, it is plausible that the root is psychological.

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Anxiety according to the DSM-5

For the uninitiated, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) has recently reclassified some disorders, moving, for example, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) out of the category 'anxiety disorders'. Here are which ones now fall into this area:

1. Separation anxiety disorder
   • Intense fear related to separation from loved ones (manifests in childhood but may continue into adulthood).
2. Selective mutism
   • Difficulties in speaking in specific contexts, with serious consequences in social and working life.
3. Specific phobia
   • Disproportionate fear and anxiety when confronted with certain situations or objects (think phobia of spiders or enclosed spaces).
4. Social anxiety disorder (social phobia)
   • Persistent fear of social interactions where one fears being criticised, humiliated or rejected.
5. Panic disorder
   • Sudden and recurrent panic attacks, with intense anxiety spikes within minutes. People often worry about having more attacks, drastically changing their habits.
6. Agoraphobia
   • Fear or anxiety in situations from which it is difficult to get out or receive help (standing in line, using public transport, being in open or enclosed spaces, crowds). One tends to avoid these circumstances or only experience them with someone one trusts.
7. Generalised Anxiety Disorder (GAD)
   • Continuous and excessive anxiety, difficulty controlling worries in various areas (work, study, relationships) and related physical symptoms (restlessness, fatigability, irritability, sleep disturbances, etc.).

In addition to these are the substance/drug-induced anxiety disorder (caused by intoxication or withdrawal) and the anxiety disorder due to a medical condition.

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Common characteristics and possible risks

Although each disorder has specific peculiarities, they all share an excessive fear, anxiety or avoidance of perceived threats, which may be real or internalised. Always remember that fear is an immediate response to a concrete danger, while anxiety is the anticipation of a future risk. One aspect not to be underestimated concerns the onset of suicidal thoughts, especially in panic disorder, GAD and some forms of specific phobia. This is why it is essential to seek the advice of a specialist: therapeutic tools exist and can really make a difference.

If you see yourself in any of these symptoms or feel that your anxiety has now taken over, do not hesitate to seek support. Talking to a professional, even if only for an initial interview, can help you better understand what you are experiencing and, above all, receive the most appropriate treatment.

Have courage, because recognising that you have a problem is already a step forward. And don't forget: anxiety is indeed a wake-up call, but it can also become an extremely important signal to start a path of change that will restore your peace of mind, don't underestimate it, try to act in time, without procrastinating.

If you need further information or would like a comparison, please do not hesitate to contact us. We are here with you.

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BIBLIOGRAPHY

• By Salvo S., Depression, anxiety, panic attacks: treatment paths, Edizioni Libreria Cortina, Turin, 2002.
• American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders - DSM-5 TR.