Writer’s Guide to Mental Health: Anxiety Disorders
Different Types of Anxiety Disorders:
Last post was a broad overview of anxiety as a whole. Now we are going to dive deeper into individual anxiety disorders and what they would look like in your characters.
Agoraphobia: Literally “fear of the marketplace,” agoraphobia is ‘anxiety about or avoidance of places or situations from which escape might be difficult or in which help might be unavailable’ (Videbeck p. 233). This is more than just being a ‘shut-in.’ Many people with debilitating medical conditions can be homebound. The agoraphobe could physically leave the house or be alone, but the overwhelming anxiety is either too much to handle or makes life incredibly difficult. They have trouble shopping, making it to meetings, spending time with friends or family, etc. They may avoid travelling in vehicles. And often, they know their responses to the anxiety are extreme. The agoraphobe often feels trapped in their homes.
So how does agoraphobia develop? It can start with a panic attack at the grocery store with an overwhelming sense of doom and fear of death. The person may end up in the ER only to be told there is nothing wrong with them. They go back to the store a week later and have a panic attack in the parking lot as they think about what happened last time. So they turn around and go home. Then it happens going to work. Then in the car going to the park. Then walking to the mailbox. A person avoids these triggers one-by-one until they just don’t leave the house anymore.
Panic Disorder: ‘is characterized by recurrent, unexpected panic attacks that cause constant concern. A panic attack is the sudden onset of intense apprehension, fearfulness, or terror associated with feelings of impending doom’ (Videbeck p. 233).
Last post we discussed what a panic attack looked like and I have other posts on this subject as well. Visit my website at rwhague.com for more information.
After the first panic attack, the person is left waiting on the next. Soon the anxiety itself is being fueled by anxiety regarding panic attacks. As more panic attacks happen, the more the anxiety increases. The person often feels as if they are going crazy. All they can think about is the next one coming. Every sensation might feel like a threat—even hunger, thirst, tiredness can be interpreted as anxiety coming on.
Specific Phobias: These are things such as claustrophobia (fear of tight spaces), arachnophobia (fear of spiders), etc. Anxiety responses are extreme and can lead to avoidance. This seems as if it would be fine—just don’t go into closets. But when the tight space is an elevator or a car, life can be hampered. Most adults recognize their fear as unreasonable.
Social Phobia: ‘characterized by anxiety provoked by certain types of social or performance situation, which often leads to avoidance behavior’ (Videbeck p. 233). This can lead to isolation or interference in work or habits. The person recognizes their anxiety is unreasonable.
Obsessive Compulsive Disorder (OCD): ‘involves obsession (thoughts, impulses, images) that cause marked anxiety and/or compulsions (repetitive behaviors or mental acts) that attempt to neutralize anxiety’ (Videbeck p. 233). The person experiencing these obsessive and compulsive thoughts and actions do not want them. They are intrusive, recurrent, and persistent. Any attempt to get the thoughts to go away are ineffective. The individual recognizes that these obsessions and compulsions are excessive and unreasonable.
OCD is probably one of the most misunderstood disorders. Keep in mind there are two parts: the anxiety trigger (obsession) and the attempt at solution (compulsion). So fear of germs or contamination can lead to compulsive cleaning—but this is only one type of OCD. Obsession with the number 3 may require things to be done in 3s. Open the door three times before going through it, brush three times before moving on to next section of hair, etc. Here is a good video that helps explain this disorder: https://www.youtube.com/watch?v=DhlRgwdDc-E
People with OCD are also fully aware of these irrational obsessions and compulsions. They do not want them and feel powerless to their mind’s whims.
Generalized Anxiety Disorder: is ‘characterized by 6 months of persistent and excessive worry (Videbeck p. 233). A person might be anxious through a stressful time of life, but usually these parts of life do not last for more than a few days to a few months. If after 6 months, the person continues to have uncontrollable worrying that impairs social or occupational functioning, they may have GAD.
Once again, the person knows their feelings are irrational. They do not want to be this way. But like a panic disorder, the anxiety often provokes more anxiety. The heart palpitations, tremors, tightness in the chest become intrusive—and when the symptoms abate the fear of their return remains prominent in the sufferer’s mind. This is often accompanied by sleep disturbances and insomnia.
Acute Stress Disorder: ‘development of anxiety, dissociation, and other symptoms within one month of exposure to an extremely traumatic stressor; lasts from 2 days to 4 weeks’ (Videbeck p. 233).
Post Traumatic Stress Disorder: ‘characterized by the reexperiencing of an extremely traumatic event, avoidance of stimuli associated with the event, numbing of responsiveness, and persistent increased arousal; it begins within 3 months to years after the event and may last a few months or years (Videbeck p. 233).
It is important to note that not all suffers of PTSD are the victims. Often, they can be the perpetrators. For example, a soldier who shot a non-combatant accidentally might find themselves struggling with what they did. Usually after a traumatic event, a person has suffered a change in their view of the world. If something evil was done to them, their previously naïve self has endured something beyond their imagination. If they previously viewed themselves a good person, but they committed a travesty, this is a change in their fundamental view of themselves.
Often times, the mind will play the event over and over again as it tries to rectify their previous perceptions to form a more accurate view of the world and themselves. The mind is trying to protect the body by re-living the event and trying to solve it, but this is very distressing for the person to live through again and again.
Symptoms of PTSD include: intense fear, helplessness or horror; reexperiencing (intrusive recollections or dreams, flashbacks, physical and psychological distress over reminders of the event); avoidance of memory-provoking stimuli and numbing of general responsiveness (avoidance of thoughts, feelings, conversations, people, places, amnesia, diminished interest or participation in life events, feeling detached or estranged from others, restricted affect, sense of foreboding); increased arousal (sleep disturbance, irritability or angry outburst, difficulty concentrating, hypervigilance, exaggerated startle response); significant distress or impairment.
Not all flashbacks are obvious to those not experiencing it. The person may ‘zone out’ for a moment or two. Often triggers are very subtle and those around them will not know why the flashback occurred. This is important to keep in mind in regard to children or individuals ho are not fully able to articulate the trigger or even the event that lead to the initial trauma.
And with all of these things, depression is often a common compounding problem that arises. Being anxious all the time uses up a lot of energy and often the body and mind just crash into a depressive state from being keyed up all the time. It is rare to find anxiety without some level of depression present.
Next post will be an over-view of different treatments of anxiety. Keep in mind, none of this is to be taken as medical advice. It is just a writer’s guide for character development.