I have THIS kind of anxiety. Not that. What type are you? And does it matter?
The biggest mistake occurs when we insist that life and people should fall into neat categories. The more closely you look, with the backdrop of your own personal experience, the more you will see that life is not so neat.
Neither is mental health. How can it be? Ultimately, we are dealing with people. And people and their realities (conscious or not) cannot be put dumped into neat, mutually exclusive categories. We are all messy.
But the psychological profession needs these categories to know where to start with treatment.
General patterns do tend to emerge between groups of people. Anxiety sufferers tend to suffer with worry. Depressed people tend to suffer with hopelessness and guilt.
But any anxiety sufferer can tell you that he also feels depressed from his worry, and any depressed sufferer can tell you that he feels worried about his hopelessness. Both can also tell you that some days they are high functioning and feel fine, but on some others days, they feel that nothing can save them.
See, it’s not so neat. It’s messy. When we are dealing with human issues, it is messy.
And honestly does finding the right category even matter? Ultimately all I am really concerned with is how I can ease my suffering despite all the shit I'm in.
Driving yourself insane about which category you belong to is not going to get you closer to a life liberated from anxiety.
In fact it plunges you deeper into worry and creates a new set of problems. You waste a lot of time and mental health in the process, and aren't anywhere close to the solution you were looking for.
Anxiety sufferers are particularly prone to this happening, because of the very nature of their condition – Worry!
So before we go on, I have to make a suggestion to hold and judge these terms very lightly. In the end, it matters very little which "category" you belong to on any particular day.
- Generalized Anxiety Disorder (GAD) – Marked by a chronic, high level of anxiety that is not tied to any specific threat. People with this disorder worry constantly about yesterday’s mistakes and tomorrow’s problems. They worry about minor matters related to family, finances, work and personal illness. They often dread decisions and brood over them endlessly. Their anxiety is frequently accompanied by physical symptoms such as trembling, muscle tension, diarrhea, dizziness, faintness, sweating & heart palpitations.
- Phobic Disorder – In a phobia, an individual’s troublesome anxiety has a specific focus. A phobic disorder is marked by a persistent and irrational fear of an object or a situation that presents no realistic danger. Certain types of phobias are relatively common, including acrophobia (fear of heights), claustrophobia (fear of small, enclosed places), brontophobia (fear of storms) and hydrophobia (fear of water).
- Panic, Attacks, Panic Disorder and Agoraphobia – If, for no clear or rational reason, you are consumed by a wave of fear-like symptoms, it may be a panic attack. These paralyzing attacks are accompanied by acute physical symptoms of anxiety. Gradually, sufferers begin to worry about whether and when they will have future attacks, leading to a fear of the fear. This is the point when it is said to be panic disorder. A panic disorder is characterized by either having recurrent panic attacks or worrying about having them constantly. As if going through panic attacks is not dreadful enough by itself, sufferers further worry about how they are perceived by others. The paralyzing fear is difficult to explain and often results in receiving pity or blame , both of which add further shame and hence further anxiety. The sufferer tries to escape all of this by avoiding people. He may reach a point when he is afraid to leave the house for anything at all, and becomes a prisoner confined to his own home. This condition is called agoraphobia.
- Obsessive-Compulsive Disorder – Marked by persistent, uncontrollable intrusions of unwanted thoughts (aka, obsessions, also called Pure-O anxiety) and urges to engage in rituals (compulsions). Obsessions often center on inflicting harm on others, personal failures, suicide or sexual acts. People troubled by obsessions may feel that they have lost control of their mind. Compulsions usually involve stereotyped rituals that may temporarily relieve the anxiety produced by one’s obsessions. Common examples include constant handwashing, excessive arranging and counting of things, and excessive cleaning of things that are already clean.
- Post-traumatic stress disorder – Involves enduring psychological disturbance attributed to the experience of a major traumatic event such as war, rape, domestic violence, automobile accident, plane crash, natural disasters such as earthquakes. Common symptoms include re-experiencing the traumatic event in the form of nightmares and flashbacks, emotional numbing, alienation, problems in social relations, an increased sense of vulnerability and elevated anxiety, arousal, anger and guilt
- Obsessive Compulsive Personality Disorder (OCPD) - Characterized by an inflexible adherence to rules or systems or an affinity to cleanliness and orderly structure. OCPD people may be mistrusting of others who may not hold the same convictions or understand their need for things to be just right. They may have trouble delegating, trusting others, sharing responsibilities or compromising. They may be obsessively clean or hygienic. OCPD is different from OCD in that the person isn't so terrified with his own situation or imagination (as in OCD). Instead he believes that others have more reason to change than he does. He may realize it's a tall order, but remains unconvinced that the one who needs more flexibility is he, himself. In that sense, he suffers less with physical symptoms of fear. But at the same time, he does suffer with compromised personal relationships due to his strict rigidity, rules and black-and-white thinking.
- Social Anxiety - As the name suggests, it is a fear of being judged, scrutinized, watched, observed and evaluated in social or performance situations. Moreover, the person worries that his internal chaos (i.e., anxiety) will become visible and transparent to others, so he works harder to prevent his anxiety from being unmasked.
- Hypochondria - Obsession with the thought of possible doom/death because of an un-diagnosed illness. The person is hyper vigilant about his bodily processes and sensations and endlessly researches and practices ways to get them back to a "perfect" state defined as normal by him. Reassurances from medical tests and/or his doctor only temporarily relieves his anxiety, but once that wears off, the person returns to his intense state of anxiety.
At their core, they all have one thing in common and that is the bottom line of it all :
And because behavioral efforts to “control” these obstacles don’t go well , you experience (self-defined, self-induced) trauma after trauma, failure after failure. “I should not think this”, “Why do I still remember this”, “Why am I so negative”.
Confrontations with such repeated “failures” and negative interpretations of them, causes you to suffer, usually by fearing even more - further adding to your anxiety. It really can be a downward spiral.
To a large extent, ALL sub-types make you obsessional. There is an OCD tendency in all of them.
First, THE GOOD NEWS:
You have a good, healthy intention to heal yourself. You want to erase fear that comes from negative, scary, demeaning thoughts? You want to be more brave, less afraid, more courageous, less terrified, more peaceful? Nothing can be a better sign of good mental health.
Now, the BAD NEWS
You bark up the wrong tree. Thoughts, memories and sensations are not yours to control and manipulate. Yes, their force can be overwhelmingly powerful, causing you to feel crippled with fear in the moment. There is science behind that. Parts of your brain (particularly, the amygdala ) fire up, making the present-moment symptoms harder to tolerate. It’s all very real and it’s happening to you.
But the truth still remains - you started at the wrong place. You cannot, and do not need to control/erase/manipulate thoughts and memories. Even scientific research (1) shows us that.
Non-anxious people know this, and that’s why they don’t judge themselves too harshly for having thoughts.
But the anxious person feels like he must have done something to produce these uncomfortable thoughts and sensations, and this belief and the associated guilt tears him apart. He then attempts to neutralize such feelings by once-again trying to get rid of the guilt-provoking thoughts and sensations. It’s a circular loop that you remain stuck in.
Counter-intuitively, you need to do the exact opposite.
You need to climb into your thoughts, memories and sensations, and then, despite all of them you need to do something that you actually can control - Behavior.
The cause of your anxious experience is the same. And the treatment is the same.
The reason it all comes down to behavior is because we do not have control over anything else but behavior. Behavior is also independent of how long you have had your anxiety and what type it is, as long as it moves you in the direction of your values.
Additionally, once you perform an un-anxious behavior, you create a positive memory. Memories are one of four things that feeds your amygdala. If your amygdala "remembers" that there was a time when you behaved un-anxiously despite anxiety symptoms (thoughts/sensations), it will no longer trigger when facing the same stimulus/trigger.
The only two categories I like to “divide” anxiety sufferers into are based on the nature of triggers. Whether those triggers are people issues or not. This affects length of treatment.
Consider phobic disorders (e.g. fear of airplane), panic attacks (fear of sensations), panic disorder (fear of panic attacks), agoraphobia (fear of having panic attack outside), OCD (fear of not performing compulsions), PTSD (fear of past memories).
In ALL of these, your triggers originate and terminate in you, or within you. Your thoughts. Your sensations. Your memories.
Compared to Generalized Anxiety Disorder (GAD) and Obsessive Compulsive Personality Disorder (OCPD), your physical symptoms are more intense and there is no doubt that you are in pain.
But EVEN YOU KNOW that the fear is irrational. And thus, it is easier for you to identify desired healthy behavior in line with your desired life goals and values.
“I want to overcome my fear of airplanes so I can be closer to my family.” “I want to overcome my fear of panic attacks because it takes away from the life I want to live” “I don't want to be traumatized by my memories because I deserve to live a good life, despite my past trauma.”
You need just ONE episode of success over your triggers and immediately your recovery takes place. You get an instant confidence boost. You witness that you overcame your fear while your triggers existed, either in front of you (airplane, spider, clowns) or within you (thoughts, memories, sensations).
Just one positive, successful episode is enough to start the upward spiral to full recovery.
That’s why therapists and doctors find that phobias are easier and quicker to treat.
These take longer to treat.
Sufferers of GAD, OCPD, Social Anxiety and even depression and bipolar disorder struggle with living and interacting with the world in general.
For them, their triggers appear to be outside of them. People, and relationships with people – past and present.
They do not easily recognize that the challenge comes from their own interpretations of life events. Because of their black and white styles, they are more likely to indulge in excessive guilt and blame - oscillating between self and others - over how things turned out.
The treatment is still the same. It starts with behavior. But first you have to be able to recognize that your previous behaviors have to be dropped. You have to know your distortions. Which takes time, intention and a great deal of effort.
Next, you have to figure out what new behaviors you want to adopt. It's not always easy. How do you identify appropriate behavior? So much of what is “appropriate” falls in grey, subjective areas when it comes to dealing with the world, its people as well as you, yourself.
Also, here the triggers are people (not objects), and because we cannot demand people to change for us to experience life in a better way, any new behavior requires you to creatively figure out a way to honor yourself as well as the world you live in.
So what does the person do? How does he select behaviors best suited for him?
Next, we ask them to work with their own values. But for many, they are not clear on their values. Consumed for so long with self-doubt, shame, anger, hurt and worry, they most likely have not developed values for themselves. Allowing themselves to develop values and ground themselves in their own values will take more time than it does in other types of anxiety.
Lastly, while you are doing this recovery work (sometimes for years), your triggers will not stop existing and disappear into thin air. One day it's your mother, next day it's your friend, then it's the rude cab driver and then on other days, it's you yourself.
While it is true that there is a common theme across all your triggers, when you just start out in therapy, it may seem like your triggers change shape and form everyday. Thus, it may be a while before you see that you have overcome fear over your triggers.
Bottom line is that with GAD, OCPD, depression and bipolar disorder, treatment takes longer, while symptoms are not as severe as in a panic disorder.
But recovery and healing CAN and DOES take place. In the end, it depends on how badly you want it.
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