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How do you know when everyday anxiety or stress becomes anxiety disorder?

Posted Nov 17 2008 11:50pm


Lynn Friedmanis a clinical psychologist, psychoanalyst and executive coach in Chevy Chase, Maryland, specializing in workplace and relationship concerns.

She writes for theWashington Business Journaland the Washington Post interactive site and is on the associate faculty atJohns Hopkins University. Those interested in consulting her can reach her at: (301), (article reprinted with permission)


Symptoms of anxiety are more prevalent than the common cold. Who hasn't experienced a knot in the stomach, heart palpitations, sweaty palms, worrying, irritability, difficulty concentrating, muscle tension, a dry mouth, difficulty sleeping or restlessness? Who hasn't felt "wired" or found that they were easily fatigued? These feelings and symptoms are ubiquitous.But, how does one know when these symptoms are an anticipated, reasonable reaction to endless gridlock, long commutes and the pervasive workaholism that is endemic to the greater metropolitan area? Or, how does one know when they are indicative of a more significant problem? Once one has determined that their symptoms warrant evaluation, how does one go about seeking treatment? What sorts of treatment options are available?

Everyday Anxiety

Everyone experiences anxiety. In small amounts it can be useful. That is, it can serve as a warning signal that something isn't quite right. Take a classic example, undoubtedly familiar to anyone who has been a student. You're in college, the term is nearing its end. Finals are on the horizon. You're behind in your reading and you're behind in your studying. Your heart starts to palpitate. You experience feelings of impending doom. You imagine what it would be like to fail your courses. You become worried. And, you are compelled to take action. You hit the books and you study. You pass your finals with flying colors. In this case, your anxiety served a productive, advisory role. In a sense your anxiety was adaptive. It signaled to you that trouble was imminent and it prompted you to take effective action. It helped you to function and to meet the demands of your every day life.

A little bit of anxiety can be motivating. It can help us to go to work when we'd rather play, to clean when we'd rather relax and to carry out the responsibilities of our every day lives. But, how do we know when we have crossed the fine line between everyday anxiety and generalized anxiety disorder?

When Everyday Anxiety becomes "Disorder"

How does one know when anxiety represents a significant difficulty? This is an important question, many people worry that they may be depressed but anxiety is actually a far more prevalent psychological concern. Anxiety, unchecked, can lead to significant health and mental health difficulties.

It is important to know when everyday anxiety crosses the threshold and becomes "anxiety disorder". Anxiety disorder is the most common of psychological concerns. The good news: it is also the most treatable.

We should become concerned when anxiety begins to persistently interfere with our capacity to function effectively in our everyday lives. For example, let's take the head of a start-up who experiences profound apprehension in preparing for a meeting with her board. She attempts to get ready but has difficulty concentrating. She worries about sounding silly or incompetent. As she tries to organize her ideas, she finds that she can not focus. She worries about the outcome of a potentially unsuccessful meeting. In fact, she finds that she is so worried that she is unable to formulate her ideas and do her best work. At night, she reports that her sleep isn't restful.

While this type of experience is fairly common, if it is recurrent, it is evidence of maladaptive anxiety. That is, the anxiety is getting in the way of the individual's ability to function effectively in the workplace.

Similarly, we should become concerned when anxiety interferes with our establishing and maintaining the kinds of personal relationships that we seek. For example, let's take the woman who would like to date and marry but finds rather than enjoying dating -- she worries throughout the entire dating experience. Will he call? Won't he call? What does it mean that he doesn't call? What does it mean that he asks her out at the "last minute"? Will it last? Won't it last? She calls her friends, seeking reassurance. Instead of relaxing and having fun, she finds that she can't enjoy herself. Anxiety that interferes with our ability to have gratifying professional or personal lives warrants evaluation.

Evaluation and Treatment

How does one go about seeking evaluation and treatment and what sorts of treatments are effective? Research has demonstrated that many types of treatment are effective in alleviating anxiety disorders. How one goes about seeking treatment reflects ones personal goals.

Some approaches focus primarily on helping the individual to achieve symptom relief. For example, medication can be helpful in helping the individual to calm down and not be so reactive to the stressors in her life. Like medication, cognitive behavior therapy focuses on alleviating the symptoms. Individuals are taught to manage their symptoms by altering their maladaptive thought patterns.

Psychoanalytic approaches work by helping the individual to deepen their understanding of what is making them so anxious. Individuals are encouraged to talk freely about themselves and their lives with the idea that they may come to understand and overcome their inner conflicts. For example, the woman who is anxious about dating may be very frightened for many reasons. She could be frightened of intimacy. A psychoanalytic therapy will help her to learn more about why she is so frightened of intimacy with the hope that as she deepens her self-understanding, she will become less frightened and more open to entering into a loving relationship. The idea is that if the anxiety can be fully understood and resolved, it is less likely to return.

A family therapy approach, works with all family members in an attempt to resolve conflicts leading to anxiety. Such an approach often leads to improved family relationships. As relationships improve anxiety attenuates.

Research shows that all of these approaches, and combinations of them, can be extremely helpful in treating anxiety disorder. The key is to seek early evaluation with a qualified mental health professional.

Does your anxiety warrant a professional evaluation?
Answer true or false to the following questions and find out.
For at least the last several weeks:
  1. I have been excessively worried. I worry excessively about things.
  2. I have difficulty settling down and working on a project.
  3. I have difficulty concentrating.
  4. Most nights, I have difficulty falling asleep or my sleep is fitful and restless.
  5. My hands are sweaty and damp.
  6. Frequently, I am irritable.
  7. I am fatigued.
  8. My anxiety makes it difficult for me to do my job as well as I should.
  9. My anxiety makes it difficult for me to have the kind of relationships that I seek.
  10. I experience a lot of muscle tension.
If you have any of these symptoms persistently, you should seriously consider a psychological evaluation.

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1. If I want a Committed Relationship, why am I Still single?
2. Anatomy of a Symptom: Why do people sabotage themselves?
3. What is psychoanalysis?

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