Anxiety Disorder or Just Anxious?

What is the difference between normal anxiety and anxiety disorder? Learn more, so you can seek solutions and professional help if need be.

Everyone experiences some form of anxiety from time to time. Some even feel anxious all the time. But when does it become a health concern, and how do we know if we are just being overly-worried — or if we are suffering from an anxiety disorder? If you find yourself asking, “Do I have an anxiety disorder?” or “Why do I get anxiety?”, this guide should answer some of your questions.

So what is anxiety? Anxiety is the sensation of worry, nervousness or unease, such as the feeling you get before your final exam or a big presentation at work. You feel some stress, but that “good anxiety” motivates you to prepare ahead. And when whatever has been causing you worry (for example, the final exam or presentation) is over, you stop worrying and don’t carry the anxiety with you.

“Being anxious is a normal reaction to stress. It protects you and puts you on alert to potential dangers,” explains Dr Susan Zachariah, Consultant with the Department of General Psychiatry at the Institute of Mental Health (IMH). But if a person starts to experience physical discomforts such as a very fast heartbeat, giddiness or shortness of breath, and is affected so much that he or she calls in sick or does not turn up for the event causing the worry, then that may be the onset of an anxiety disorder.

“When anxiety debilitates a person’s life in such a way that it interferes with day-to-day functions and relationships, professional help is needed,” advises Dr Zachariah.

Related: Understanding Anxiety

What Anxiety Disorder Feels Like
Anxiety disorders comprise a full spectrum of conditions, of which one of the more incapacitating is a panic attack. Dr Zachariah describes a panic attack as “an unusual physical sensation where you feel like you are going to pass out”. Your stomach becomes uncomfortable, your heart beats fast, you feel short of breath, and your body becomes hot and sweaty, or cold and clammy. The symptoms are intense, but short-lived. They last about 10 minutes each time, and can occur once or twice a day, or every morning when you wake up.

Many people who have experienced a panic attack described it as feeling as though “you are going to die”. A person is diagnosed as suffering from a panic attack when the condition is present for at least a month.

Another condition is generalised anxiety disorder (GAD), characterised by constant worry, fear and concern. Sometimes, you will experience shortness of breath and your heart may beat very fast. The symptoms can last throughout the day. A person is diagnosed with GAD if the condition recurs for six months.

Other conditions classified as anxiety disorders include:

Phobia: a phobia is defined as an extreme or irrational fear of something, such as the fear of heights (acrophobia), fear of insects (entomophobia), fear of open spaces (agoraphobia) and fear of people not of your own kind (xenophobia).

Social phobia: people with this condition feel extremely uncomfortable in social situations, such as making a speech or attending a social gathering, and will go to great lengths to avoid such events. They feel that they are being scrutinised by others.

Post-traumatic stress disorder: this occurs as a result of overwhelming stress from a traumatic event such as a natural disaster, physical or sexual abuse, or seeing a loved one die in an accident.

Obsessive-compulsive disorder (OCD): this is the need to check things or perform certain routines repeatedly. One in 33 people in Singapore may have OCD at some point in their lifetime.

It is possible to have one or more of these conditions at the same time.

Root Causes of Anxiety Disorders

It does seem that genes play a part in anxiety disorders. “When we look at the family patterns of many patients, there is usually a first-degree relative who has an anxiety disorder, or some kind of mood disturbance such as depression,” says Dr Zachariah.

Other reasons include the biological (such as chemical imbalances in the body) or environmental. For example, a child who was stressed around a strict father while growing up may be inclined to feel the same when he is working with a supervisor who behaves like his father.

Seeking Treatment

Luckily, anxiety disorders are treatable. “Our brain can change with new learning and therapy. If diagnosed early and the right treatment is administered, a patient can recover. About 60 to 70 percent of patients get better and are able to lead normal lives,” says Dr Zachariah.

The key is to seek help. If left untreated, anxiety disorders can lead to further complications such as depression. A person should seek professional help when the feeling of anxiety starts to chronically affect their mood, social relationships and work performance.

When to Seek Help

Just Being Anxious:

Anxiety Disorder:

A mother, concerned about her newborn baby’s hygiene, makes sure she washes her hands each time she attends to the child.

A mother, concerned about her newborn baby’s hygiene, makes sure she washes her hands each time she attends to the child... but she cleans them to the point that the hands become sore. She also stocks up on hand soap and her water bills are high. Sometimes she forgets to feed her baby due to the time spent on keeping things clean.

You attend a party alone and feel awkward at first because you don’t know anyone. But you settle in and find a seat, drink or someone to chat with, and your level of alertness reduces.

You feel very uncomfortable when you set foot at a party. You feel that everyone is scrutinising what you wear and say. You clam up, your heart beats fast and you feel dizzy. The symptoms last even after you leave the premises.

You get nervous before a job interview. You experience some mild stomach discomfort or a slightly faster than normal heart rate, but the symptoms do not last. Once the interview is over, you feel relieved — or disappointed — but you are no longer nervous.

Your heart starts to beat very fast, and you feel giddy and short of breath. You are so affected by the symptoms that you decide not to attend the interview.

Most patients are managed in an outpatient setting. “During the first visit, patients usually complain of stress and sleep difficulties,” says Dr Zachariah. They also often reveal other symptoms such as “my heart bounces”, “my heart feels heavy”, or “my throat feels dry”.

During consultation, the psychiatrist will also assess if the patient is suffering from other medical problems such as cardiovascular disease or hyperthyroidism that have similar symptoms to anxiety disorders (racing heartbeat and tremor).

Those diagnosed with anxiety disorder are referred to a psychologist for the management of the disorder. They may be asked to attend therapy sessions, or start on medication, or both.

If well treated, most patients will show signs of improvement within two to three months. If they continue treatment, says Dr Zachariah, they should “get back on their feet again” within a year.

Related: Working Towards Recovery

How to Reduce Anxiety:

Here are some ways to reduce your anxiety levels:
 • Establish good habits:
 o Have a good sleep pattern
 o Limit your alcohol intake
 o Eat a well-balanced diet
 o Drink coffee in moderation
 o Exercise regularly
 • Talk to someone about your feelings of anxiety 
 • Try relaxation techniques such as meditation, yoga or other activities that you enjoy
 • Think positively

This article was first published in the Apr–Mar 17 issue of Imagine. Permission required for reproduction.


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