Anxiety: The Chameleon

by Dr Gordon Wong, Specialist in Psychiatry

MBBS (HK), MRCPsych, FHKCPsych, FHKAM (Psychiatry), MSocSc (Couns)(South Australia), DCPsyc RCP&S (Irel), DFM (HKCFP), Dip Med (CUHK), PGDipClinDerm (QMUL)

Anxiety is a normal response that arises when we are faced with actual or perceived physical threats, or psychological threats. An optimal amount of stress helps with increasing attention, arousal and performance. However, when stress level cross a certain threshold, our performance becomes impaired. This is called the Yerkes-Dodson Law.

When anxiety interferes with daily life, then we call it an anxiety disorder. Anxiety disorders commonly manifest as anxiety feelings, palpitation, tremor, shortness of breath, limb numbness, dry mouth, sweating and dizziness. There are several types of anxiety disorders, such as generalised anxiety disorder, panic disorder, social anxiety disorder and specific phobias. Let's discuss them one by one.

General anxiety disorder is when a person has “free floating anxiety”, meaning the person is anxious most of the day without a specific reason or cause. The person is often tense, tired and nervous, and may have insomnia and muscle aches. Generalised anxiety disorder often co-occur with depression.

Panic disorder is an episodic type of anxiety that arises in response to specific triggers, such as certain bodily sensations or certain environments. For example claustrophobia is the fear of enclosed space, while agoraphobia is the fear of open spaces. In a panic attack, anxiety rises to a high level very rapidly with minutes or even seconds. The high level of anxiety makes the person feel very nervous, with palpitation, tremor, shortness of breath, limb numbness, and dizziness. The person may also feel out of control, and feel the need to escape from the situation as well. The anxiety typically lasts for about 20 minutes then subsides spontaneously. It is quite a frightening experience.

Social anxiety disorder manifests itself as a high level of anxiety in situations involving social interactions. This is due to an intense fear of being judged or appraised negatively by others. Talking to people, making eye contact, dating or even using public restrooms can be very difficult for people with social anxiety disorder, which creates much impairment in daily life.

Specific phobia is a disproportionate fear or anxiety towards an object (such as a butterfly) that normally do not induce fear or anxiety in other people. It arises because of a learning process called conditioning. The brain pairs up an object with an obnoxious stimulus that happens to have occurred around the same time, hence the person becomes scared of the object.

Treatment methods involve medication and psychotherapy (talking therapy). For medication treatment, specific serotonin reuptake inhibitors (such as paroxetine) are useful in treating anxiety in the longer term. The person needs to take it for a week or two before noticing an effect. Benzodiazepines such as diazepam (Valium) or alprazolam (Xanax) also help with anxiety, with a faster onset time of hours or even minutes. However, the disadvantage is that benzodiazepines merely suppresses the anxiety, so it comes back when the medication effect wanes. In addition, benzodiazepines have the potential to be addictive when used long term.

Psychotherapies that are useful in anxiety disorders include cognitice behavioural therapy, mindfulness and acceptance and commitment therapy. Hypnotherapy also works by facilitating relaxation. Graded exposure (gradually increasing the level of contact with the feared object) or flooding (maximal contact with the fear object) are also psychological treatments used in the treatment of specific phobias.

Anxiety disorders are very common and can hugely affect daily life. Consult a professional for advice if you find yourself or people around you having symptoms of anxiety.