I was cleaning out my office the other day and came across an old patient pamphlet on the topic of anxiety disorders. When I trained in an inpatient psychiatric unit over a decade ago, these pamphlets were handed out like candy to the new admissions on our unit. Then, just last night, I was talking to an old friend whose son was recently hospitalized after he chose to stop taking his medication to treat his bipolar disorder. She told me how, back when he was an eleven year old, he told her "Something is really wrong with me mom.." She claims that was the beginning of their family's journey through the mental health care system in trying to initially treat his overwhelming and debilitating anxiety. Between our conversation last night and finding that pamphlet the other day...I figured it was time to open the doors wide on this topic of "anxiety" and what it's all about once and for all.
Anxiety disorders represent the common cold of mental health. In and of itself, anxiety is not a "bad" thing to experience. It is meant to prepare us physically and mentally to successfully overcome literal danger. I've often said in therapy that it's perfectly o.k. and acceptable to wet onself and/or grab the nearest available "weapon" and/or freeze and/or get up and fight or run away if someone came busting into our session threatening to kill us. Any of those responses are "normal" in the context of reacting to an unexpected and immediate literal threat to your own personal safety. When the brain receives (for lack of a better term) the "Danger Will Robinson!" signal, our bodies start pumping out certain hormones designed to assist us in protecting ourselves to the fullest extent possible. Blood literally rushes to our extremities so we can run away---or use our fists---or pick up a weapon. Our pupils dialate so we can "see" better and more clearly all around us. Our breathing and heart rate increases; it's actually quite fascinating to understand how everything within the body works together to help us prepare for the "appropriate" reaction to danger...
The problems arise when we are thrown into this "high alert" mode interally and externally over "stuff" that is otherwise completely benign. I mean, when was the last time you had a melt down over the local mall being "too crowded" for you? When one's day-to-day anxiety ends up significantly impacting the person's ability to do his or her job...or go to school...or be socially active...or even leave their home and/or take care of oneself on a day-to-day basis, there are problems. Anxiety disorders are typically at the root of these aforementioned problems. WHICH anxiety disorder specifically is at the root of what's going on is what people like me are for. To help diagnose exactly which anxiety disorder is wrecking havoc and why---and then working to treat it successfully over time.
Phobias represent the first type of anxiety disorder a person may most struggle with. There are three main types of phobias. All phobias are based on irrational fears. This just means that the fear a person has about "whatever" is not realistic or rational. Remember back in the 50's when all those sci-fi movies came out such as "Them" (giant ants), "Attack of the 50' Foot Woman" (giant human), "The Blob" (giant jello), etc.? Well, simple phobias are like that. A peson is unrealistically and irrationally afraid of a specific object or situation. Some simple phobias are extremely easy to identify: flying, snakes, spiders, dogs, mice, heights, the inside of an elevator, etc. etc. Others are not so easy to identify: water, butterflies, dirt roads, urine, ATM machine, the inside of a bus, etc. etc.
The second type of phobia is referred to as social phobia, or social anxiety. With social anxiety, the person is unrealistically and irrationally afraid of being judged by others and/or doing something in front of one or more "others" that is embarrassing to themselves. Public speaking is the number one social phobia/anxiety issue we have as people. Dale Carnegie would have never made a nickel off this particular phobia had they not recognized the extent and magnitude of it going back several decades. After public speaking, meeting "new" people is the next largest issue for socialphobes. As you can imagine, this makes attending parties, classes at school, shopping, and a whole other host of "benign" social activities virtually impossible for those with this particular phobia. Using public restrooms is yet another common issue for those struggling with social phobia/anxiety. There are more, but you get the picture.
Lastly, agoraphobia is our third main type of single phobia. Agoraphobia literally means fear of the marketplace. Not marketplace like the local grocery store or shopping mall...but "any" place where other people are going to be. With agoraphobia, the person is most afraid of not being able to "escape" if they needed to. This is why so many agoraphobics never leave their home...sometimes for years or decades on end. A twist on this same theme are those individuals who manage to find and maintain a "job" of some kind or another---but can never leave that job/company. In this case, the person is avoiding their fear (and phobia!) by leaving home only to go to work---and coming back home again. Day in and day out. Year in and year out. Decade in and decade out.
Please keep in mind that simple phobias are like potato chips. You may think you can have just one, but generally speaking that's not how it works. A person can very easily struggle with some combination or all three "types" of simple phobias at the same time.
Is this the time I should also mention that any given anxiety disorder can also have specific or simple phobias attached. Sorry to have to break it to you this way, but that's the way it can be for those who are REALLY anxious and have been for a very long time. Call someone you trust and find out who is where and available to help you. You really can get and be better.
