I’m lucky that I rarely get anxiety attacks, but when I do, they stick with me for hours. Once the panic button gets hit in my mind, it’s nearly impossible to calm down. I have to spend a couple of hours distracting myself with television in order to set things straight again- doing anything is out of the question.
I certainly don’t have panic attacks with enough frequency to be diagnosed with a panic disorder, which is a subset of anxiety, but this week made me incredibly sympathetic to those who do struggle with recurring panic episodes and generalised anxiety disorders. It also made me very curious about how anxiety and panic appear in the brain, and what makes them so physical.
Today, I’m going to explore human anxiety, from its origins in the brain to its effects on the body. How many kinds of anxiety are there, and what do they look like? What’s the evolutionary basis for anxiety? Why do some people develop anxiety but not others, and why does the incidence of anxiety increase so much in the teenage to young adult years?
Before I started researching for this article, I didn’t really understand what anxiety was. I knew it involved things like panic attacks, worrying, phobias, and stress, but my picture of the disorder was broad and shaky. Although, I could safely say I am a person with the jitters of sorts. I overthink and get anxious or even paranoid about things and situations every once in a while and I can feel restlessness and discomfort ascending through.
Once I began to research, I realized that anxiety is difficult to define because it is, by definition, a broad range of conditions. The DSM-5, the diagnostic manual for mental illnesses, actually lists 4 different disorders under the banner of Anxiety Disorders: panic disorder, phobias, generalized anxiety disorder, and social anxiety disorder.
These disorders are united by a common symptom: excessive and persistent stress and worry that is disproportional to the situation at hand.
Anxiety disorders aren’t just stress and fear about public speaking or the exams; they include full-blown, uncontrollable bouts of worry and panic around events that most of us can manage fine.
Anxiety is also inexplicable: sufferers can’t typically explain why they feel and react the way they do, owing to the very neurological basis of anxiety that we will dig into later.
Panic disorder refers to people who suffer from persistent panic attacks like the one I experienced- but unlike me, people with panic disorder have consistent attacks that can interrupt daily and social functioning.
Phobias, as the name implies, are anxiety disorders related to specific situations or objects, such as water, heights, spiders, and public spaces, which are called arachnophobia, hydrophobia, acrophobia, and agoraphobia, respectively. There’s even a phobia of long words, which was cruelly named hippopotomonstrosesquipedaliophobia.
Generalized anxiety disorder, which is what many of us think of as just anxiety, is a more underlying feeling of worry, restlessness, and chronic stress that leads to exhaustion and poor functioning.
Finally, social anxiety disorder is specific to anxious feelings surrounding social interactions, which often prevents people from forming relationships or attending social events. Someone with panic disorder might not have general and chronic feelings of anxiety, and someone with social anxiety might never have panic attacks- each disorder has the overlapping quality of worry, but it can manifest in many different ways.
If you think you might have an anxiety disorder, it’s useful to think of what situations make you anxious and worried- it might turn out that you have a phobia or social anxiety disorder, not a generalized anxiety disorder, even if you feel worried much of the time.
All in all, nearly one-third of people will develop an anxiety disorder at some point in their lifetime- and as we will discuss later, the majority of these people will develop it during adolescence.
Anyone who knows someone with anxiety or struggles with the disorder knows that it can be debilitating. The stress and worry that comes with an anxiety disorder can make it nearly impossible to function daily.
Fear and worry are primarily regulated by two brain systems: the amygdala and the HPA axis. I suffer from vasovagal syncope, which means I get light-headed at the sight of blood and may even pass out due to my brain’s increased signal of lowering my blood pressure in aid of my fight-or-flight response.
The amygdala is responsible for emotion in the brain, especially the fight-or-flight response that is intrinsic in all mammal species in response to environmental threats.
The amygdala also handles fear conditioning, which is when a certain situation becomes mentally associated with fear and harm.
Fear conditioning was discovered in a series of experiments called the Little Albert experiments, in which infants were conditioned to fear domestic rats. At first, the infants were given rats to play with, without any aversive stimulus.
However, the experimenters soon started playing a very loud noise when the rat was presented, causing the babies to cry. After a few repetitions of this pattern, rat and loud noise, the infants’ amygdala began to associate the rats with the aversive loud noise. When the rats were presented to the infants without any sound, the infants still cried because the rat now triggered the feeling of fear of the loud noise.
The other brain system involved in anxiety is the HPA axis, or hypothalamic-pituitary-adrenal axis, which is often activated by the amygdala. This system consists of the hypothalamus, pituitary gland, and adrenal glands, which actually sit right above the kidneys.
The HPA axis is responsible for the feeling of stress, which is defined as a threat to homeostasis. Basically, we feel stress whenever we think that our mental or physical equilibrium is being threatened, whether by the environment, pathogens, or even thoughts.
Our bodies want to be in a state of internal balance, and when this balance gets thrown off, physically or mentally, our bodies react with an immediate stress response to try to right the damage.
The HPA axis performs a chain reaction to release the hormones for the stress response, most importantly cortisol. It is these hormones that makes you feel the stress that you encounter on a daily basis.
Anxiety, especially social anxiety, panic disorders, and generalized anxiety, tend to be diagnosed during adolescence. Anxiety disorders typically appear right around the time of puberty- 12 or 13 years old, according to a survey conducted by the Harvard Medical School.
Half of all people who develop anxiety do so by age 14, and three-quarters develop it by age 24. About 8 percent of adolescents have diagnosed anxiety disorders, a number that has been climbing steadily since the 1950s.
Surprisingly, anxiety is relatively even between the sexes in childhood, but in adolescence, twice as many girls develop anxiety disorders as boys. Evidently, something is going on just around puberty and in the years following puberty that amps up our risk of developing anxiety disorders, especially among adolescent girls. Something is going on as our brains enter adolescence that makes us especially susceptible to anxiety disorders, and which makes girls at even higher risk.
Why do we develop anxiety disorders at our age, and what makes some people- girls in particular- more susceptible than others? Why are anxiety disorders on the rise? What can we do to protect ourselves and relieve suffering?
We cannot forget about the unique pressures that we experience as adolescents and young adults. The adolescent years are the time when we become more autonomous, independent, and academically pressured. We are gaining independence from our parents right at the time when school, sports, and activities become high-stakes and stressful. This has never been as true as it is now, with college or university admissions rates plummeting as higher education becomes increasingly cut-throat.
Along with the increase in competitiveness in academic capabilities, counselors across the world have noted a surge of panic disorders and generalized anxiety among some of their best and brightest students. While only about 10 percent of adolescents have diagnosed anxiety, 80 percent of students at a high-performing high school reported being somewhat or extremely stressed on a daily basis, and the majority tended towards the extreme end, according to a study by NYU.
It’s no surprise that students or young adults are struggling to cope with today’s amount of stress; there’s a nearly constant stream of cortisol circulating in our veins, and for those of us with genetic and biological predispositions for anxiety, the academic world is the perfect trigger for anxious tendencies to blossom.
All of us struggle with some level of cortisol overload, and some of us have especially sensitive amygdalas that put our stress over the edge and into full-blown anxiety disorders. The picture is pretty grim, but certainly not hopeless. Remember, our brains are plastic. This not only means that they are susceptible to outside influence, but that we can also change our brain structure and chemistry through our own actions, behaviors, and thoughts. This holds absolutely true of anxiety disorders.
We have the power to overcome anxiety through deliberate practice and by challenging the thoughts and feelings that arise when we feel worry and stress. Though the brain is a physical organ, that doesn’t mean we can’t control how it responds and behaves. Just like we can learn motor skills like hitting a golf ball or doing a pirouette, our brains can be trained to respond in new and healthier ways to the world.
With help from a therapist, family, and possible medications, we can change our brains for the better.
For those of us who struggle with anxiety, the most important thing is not to give up, and to continue confronting situations that make us anxious and worried. The brain cannot change without exposure to the things that make it uncomfortable.
With the help of a support network, you can learn to retrain your brain when it is exposed to your anxiety triggers. Anxiety is a physical, neurobiological problem, not a character fault. With treatment and perseverance, you can and will put the worst of your anxiety behind you.
After having my little caffeine-induced panic attack, I found myself revisiting mediation and spiritual practices that I hadn’t thought about in years, and for that I’m grateful.
Anxiety is not fun, and it’s not ideal, but it does have the power to give us a lot of perspective about life, happiness, peace, and meaning.
If you have anxiety, try not to regret the stress and worry, but to welcome in a period of healing and transformation that can only happen when we hit bumps in our lives and to make better, clear headed decisions down the road.