When does ‘normal’ anxiety become an anxiety disorder?
Andy Garland Therapies - Counselling Cardiff - Mental Health Services Cardiff - Cardiff Therapists - When does ‘normal’ anxiety become an anxiety disorder?

We're living in a state where worries and nerves are to be expected, so it can feel tricky to notice when these feelings become a sign of something bigger. At a time when the cost of living is rocketing, political turmoil rumbles on and environmental disaster seems imminent, it'd be strange not to be a little anxious.

That makes it hard to tell when 'expected' negative feelings become a serious mental health issue, and thus tricky to work out when we need to seek additional support. After all, if it's normal to be anxious, how do you know if something's wrong? Is there a line between a 'healthy' amount of anxiety and a major problem? Sometimes, a little bit of anxiety is not only healthy, it can even help us.

"We have a repertoire of feelings - sadness, joy, shame - anxiety is one of them," explains Counselling Directory member Dr Joyline Gozho. "Anxiety is normal; it prepares the mind and body to deal with danger. Anxiety was our ancestors' evolutionary tool, which enabled them to stay safe from dangerous predators and survive.

"If anxiety is situational, proportionate to the situation and not overwhelming, it can propel us through difficult situations in life. Anxiety also helps us stay alert, safe, problem-solve and execute tasks in a robust and timely manner.

For example, if you have an exam coming, anxiety can have a positive impact in motivating you to fiercely prepare for the exam. The physiological changes and catastrophic thoughts of failing may enhance your enthusiasm to study harder. During the exam, anxiety may increase your focus, and the hypervigilance may enhance your ability to pay attention to detail." The situation of anxiety matters. If you're feeling anxious in response to an obvious, genuinely alarming trigger - a big interview, speaking in public, going skydiving - that's unlikely to be a sign of a disorder. It's when your anxiety doesn't seem to be in reaction to anything, or isn't proportional to the size of the trigger, that it becomes a problem.

It's also important to keep an eye on the intensity of your anxiety. Sweaty palms and a little worrying is fine, but when the symptoms of anxiety are overwhelming you, that can be a sign of a disorder - even if this is in response to a naturally anxiety-inducing situation. "When we think about what is healthy and what is not, we use the concept of our ability to function," notes Dr Tina Mistry. "That is different for everyone so it is very subjective.

Andy Garland Therapies - Counselling Cardiff - Mental Health Services Cardiff - Cardiff Therapists - When does ‘normal’ anxiety become an anxiety disorder?

"The way we define a 'disorder' is recurrent and persistent symptoms that impact the daily functioning of a person's life. So what that might look like is a person reporting five or more of the following symptoms that are stopping the person from living their normal day-to-day life:

- Feeling nervous, restless or tense
- Having a sense of impending danger, panic or doom
- Having an increased heart rate
- Breathing rapidly (hyperventilation)
- Sweating
- Trembling
- Feeling weak or tired
- Trouble concentrating or thinking about anything other than the present worry."

If anxiety is disrupting your life or holding you back, it's well worth talking to a medical professional about treatment, whether that's therapy or medication. That's the case even if anxiety only pops up in certain situations or isn't happening all the time. A little bit of anxiety about an interview isn't a big deal, but if you're so panicked by it that you end up cancelling, tanking the interview or feel unwell for the entire day despite the chat taking only 10 minutes, that's not something you should just have to put up with.

"Often mental health practitioners use screening tools like the generalised anxiety disorder scale (GAD-7), which is a self-report assessment to see how the person is being affected by their symptoms," adds Mistry. "If a person scores above 10 then that is a good indicator that their symptoms are in the clinical or abnormal range. Anything less than this would suggest mild anxiety." One more difference between anxiety and an anxiety disorder is time. How much time in your life is anxiety sucking up? "Anxiety becomes problematic when the normal physiological and behavioural responses to danger are either exaggerated, remain present for longer periods of time, when the responses are persistent (chronic) and when they intensify, leaving the subject feeling utterly overwhelmed," Gozho explains.

If you feel like you're experiencing low-level anxiety that's not disrupting your life, it's well worth taking steps to manage it. Mistry says: "There are lots of ways we can manage symptoms without professional help. The foundations of great health start with simple things: good nutrition, good sleep, movement and social connection.

"Above this, you can use techniques such as deep belly breathing to help manage physical symptoms of anxiety. This simple technique is about taking an inhale for for seconds through your nose and exhaling through your mouth gently for at least five or six seconds. Practising this a few times helps to calm the body. "Another technique is to shake your arms and legs. The idea is that you shake the tension off or out of your body (I like playing Taylor Swift or Florence at this point). Other tools could be to practise mindfulness, reflective journaling or talking about life's stresses to your closet and trusted friends."

But if you feel like your anxiety levels are tipping into damaging territory, it's crucial to seek professional support. "Apart from generalised anxiety, anxiety can manifest in various forms such as health anxiety/hypochondriasis, obsessive compulsive disorders (OCD), agoraphobia, panic disorder, specific phobias, social anxiety, hypochondriasis, or post-traumatic stress disorder (PTSD), Gozho tells us. "It is helpful to label anxiety because if left untreated, anxiety can worsen over time, leading to functional impairment. This negatively impacts one's quality of life and mental health overall. It is vital that people have the awareness of what anxiety is and seek treatment in a timely manner."

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