It’s normal to feel worried from time to time. Maybe you’re nervous about taking a test, an upcoming medical procedure, or having to do something new. Concerns about money are another big source of stress for many people. As troubling as it can be, occasional stress is not harmful. In fact, it can actually be helpful, serving as the motivation you need to face challenges.
But too much anxiety isn’t healthy. It could also be a warning sign of an anxiety disorder or another medical condition that needs treatment, according to Christina Lynn, MD, medical director of the Behavior Health Unit at Grand Strand Medical Center in Myrtle Beach, South Carolina. We spoke with Dr. Lynn about anxiety, and she offered some insight on what’s excessive and when it may be a red flag for a serious health issue.
Q: Is it normal to experience bouts of anxiety?
A: Yes, anxiety is a normal response that everyone experiences. It's actually part of what drives people. It helps you to prepare. It helps you to get up in the morning, to get your work done. If we didn't have anxiety, you wouldn't be as motivated to do things. It makes you take that extra step, to dress up a little bit more nicely and make a good first impression. It's a normal response to stressful events and change. We expect people to have anxiety. I would actually be more concerned if someone did not have anxiety when coping with change.
Q: At what point does anxiety start to become a problem?
A: Anxiety becomes a problem when it’s debilitating and taking over your life. When it shifts from being something that motivates you to take an extra step in life to something that keeps you from moving forward. When your anxiety becomes so intrusive that you can't think past it and all that you're doing is worrying. When you wake up in the middle of the night and you're worried about the next day. When you're not leaving your house because you're worried about what's going to happen, what you're going to miss or what you're going to do. Anxiety is a problem when it’s interfering with your life and no longer helping you prepare for it.
Q: Are there different types of anxiety disorders?
A: Yes, there are many different anxiety disorders. Generalized anxiety is probably the most common. People with generalized anxiety get overly anxious about a wide variety of everyday things. There is also social anxiety, which is more of a performance-based anxiety. I see that a lot in high performers, CEOs and other professionals. Panic disorders cause people to have panic attacks. Sometimes these intense episodes of fear have certain triggers and sometimes they don't. Phobia disorders occur when very specific things cause anxiety, such as a fear of heights or spiders. You can also have anxiety about a medical condition you’re facing. For example, if you've had heart attack, your fear of having another heart attack may be so intense that it disrupts your life.
Q: Do anxiety disorders also cause physical symptoms?
A: If you have normal anxiety your heart rate may pick up. You could get a little sweaty and have a bit of an upset stomach. When it starts crossing over into pathological anxiety, you might start having more headaches. You could also develop symptoms that resemble IBS [irritable bowel syndrome], such as diarrhea, nausea and vomiting. The symptoms may become so severe that you're going to the doctor's office because you're literally sick. Your muscles may hurt so much that you struggle to get out of bed and function.
Q: Could symptoms of anxiety signal an underlying medical condition—not a mental health issue?
A: Absolutely. If your blood sugar drops too low, it can cause you to sweat and feel shaky, which may be confused with anxiety. If your thyroid gland is overactive, you can sweat excessively and feel restless and nervous. These symptoms could be mistaken for anxiety. Irregular heartbeats and tachycardia, which is increased heart rate, can also present as an anxiety disorder. Dehydration often looks like anxiety because it increases heart rate and can make you feel lightheaded or dizzy. For women, hormonal imbalances can trigger anxiety as well as mood swings, insomnia and depression. If you're having symptoms of anxiety, please get a medical workup because it could be an actual physical condition that needs treatment. Don't just assume that it's anxiety. Look for the medical cause first.
Q: Are anxiety disorders often dismissed as “just part of life”?
A: Anxiety disorders are very treatable, yet many people aren't receiving treatment. Our society and our culture, we are really behind the times. We don't talk about it a lot. We don't seek out help. That mentality has to change. We have to begin to think of anxiety and depression as actual health problems, like diabetes, heart attacks and strokes, and start treating them as such.
Q: How are anxiety disorders treated?
A: Treatment involves therapy, which can help you identify what's causing your anxiety and learn how to work through it, or a combination of therapy and medication. Together, medication and therapy have often been proven to have the best and most effective response in serious anxiety-based disorders. Treatment however, really depends on the diagnosis, the patient, the patient’s desire and the healthcare provider. As a treating psychiatrist, my preference is to try the least invasive means possible first as we would with any disorder. Let’s figure out what's going on, what's causing the anxiety and see if we can fix that. In addition to therapy, we could ensure that you’re getting enough rest and consider lifestyle and dietary changes, like exercise, reducing caffeine intake and eating a healthy diet to avoid major swings in your blood sugar. If these strategies fail, then yes, let's try medication. An anxiety disorder is a health problem and we approach it the same way that we do many other health problems. People with diabetes may try changing their diet or exercising before starting a medication. It's the same philosophy. Medication does help but it’s not the only solution.
Q: Many medical problems worsen if left unchecked. Is the same true for anxiety?
A: Some anxiety—a more normal course of anxiety, like going off to college, getting married, having kids—will improve over time. These are normal expected anxieties that everyone experiences. Some people are not able to transition through normal anxiety and it begins to change the way that they interact with the world. They start to limit their daily activities and their health and job begin to suffer. This is when it’s important to have early conversations with a physician, family member or seek out a therapist. We need to begin to change the way we view mental health. It is no different than any other chronic medical condition. It improves with treatment. There are times when it is stable and times when it worsens and requires medication or therapeutic adjustments. Overall, if we would begin to recognize and manage mental health as we do any other health condition, we would see significant improvements in quality of life.
Q: Are there ways to ease anxiety before it becomes debilitating?
A: Find someone close to you that you trust and try to identify what's causing your stress. Is it work? Is it family? Is it not feeling organized? Talk about it and try to figure out how to mitigate that stress. Maybe that person is in a similar situation, such as a co-worker that has the same boss. Find out how are they handling it. Exercise is also a wonderful endorphin release. It can help release tension and stress.
Q: When is it time to seek medical help?
A: If you feel like your anxiety is causing you to pull away from friends and family and you're not doing the things that you used to do and enjoy, you really need to start looking for help. If you're not able to find time to relax because you can’t shut off your stress, that's when you need to find a healthcare provider that can intervene and help you.
Q: What is the first step?
A: Anyone struggling with anxiety should first talk to their primary care doctor and just ask, "Am I worrying too much or is this normal?" At that time, they could have a physical, which would help rule out medical conditions that can present as anxiety. It's a good, safe place to begin. Just start the conversation. That's the biggest thing. I really think we're teaching our youth that. The group of people that haven't quite figured it out is probably adults between 30 and 60 years old. This is the population that is struggling right now because they still view anxiety as something they just have to accept—just keep going and keep plugging.
