What makes an anxiety disorder?

Chris Smith asked Stephen Lawrie what actually makes an anxiety disorder...

Stephen - I'm getting more relaxed as time goes by. So we all feel a bit nervous at times don't we? Such as with exams looming or other relatively common events in life, but the difference between that and an anxiety state is really, in essence, the severity of the anxiety that one feels and how long it goes on for. Most anxiety states, for example, are defined by having anxiety for at least six months.

And then also the fact that the anxiety is in itself distressful and/or disabling. So that's how you distinguish a whole range of different anxiety states from normal anxiety or stress, and then there's a number of different conditions. So generalised anxiety for example is pretty much feeling anxious all the time.

Panic disorder, on the other hand, is having panic attacks, which are relatively discrete episode of anxiety which can be extremely unpleasant. People tend to feel that they are dying or having a heart attack or going to collapse in public.

Then the other types of anxiety are the various phobias. So they affect a very large number of kids - 5 or 10% of kids have a phobia to things like dogs or the dark or spiders. Most of those tend to go away with time but they can persist.

The other thing to say about anxiety is that particularly the phobias are highly responsive to treatment. And a panic disorder and generalised anxiety can also benefit from a number of different treatments.

Chris - What sort of treatment? Do you mean behavioural therapies to help talk people down so they don't go into this? Because my experience of talking to people who had panic and anxiety disorders is that they end up in this vicious cycle where they feel a bit panicky and that makes symptoms like their heart flooding in their chest or they breathe too fast which then makes them feel a bit faint and woozy, and then they think they're having a heart attack so that makes them get even more panicky and it gets worse and worse and worse and they don't know where to turn.

Stephen - Exactly. And you can end up in a Catch-22 situation like that, absolutely. So yes, a variety of cognitive or behavioural strategies can help with anxiety. Very commonly they would include a physical component if you like of encouraging people with relaxation exercises, and the more that you do that,  the better you get at it. And the more you can employ a relet station technique if you catch yourself beginning to feel anxious in that situation and it helps you avoid that kind of Catch-22.

Chris - Sort of talk yourself down and say look, I know this is happening because I am making myself nervous, this is because I'm making more and more adrenaline go around in my bloodstream and it’s making my symptoms worse, so because I know I'm doing this if I know that's happening it's not so scary anymore and you can break the cycle?

Stephen - Right, yes. And if those kind of simple measures don't work then there's a range of other treatments that you can apply including antidepressants which we might be talking about later I understand. So they are actually surprisingly effective for anxiety states that haven't responded to those kind of approaches as well.