Everyday anxiety or anxiety disorder?

Jerilyn Ross is one of the nation’s leading experts on anxiety disorders. In her new book, “One Less Thing to Worry About,” she explains the difference between having normal worries and having an anxiety disorder that interferes with your quality of life. An excerpt.

Chapter 2:
‘Am I just a worrier, or is there something wrong with me?’
Most of us would agree that a young mother’s anxiety is prob­ably normal when, for example, she’s not sure she’s holding her baby correctly when she burps him, whether his rash is a sign of a serious illness, or what to do when he won’t stop crying. How­ever, if the same young mother refuses to be alone with her child for fear of harming him, won’t pick him up because she’s afraid she might have germs on her hands and will contaminate him, or is afraid to call the pediatrician when her child is running a fever for fear of saying the wrong thing and making a fool of herself, she may indeed have an anxiety disorder.

Most of the time, the difference is obvious, especially to the person with the problem. The young mother who won’t pick up her baby is aware that her behavior is irrational yet feels power­less to change it. She may go to great lengths to hide the seem­ingly senseless and often embarrassing behavior, making excuses for why she cannot pick up the baby after she’s touched some­thing she considers “germy” — complaining of back pain, for in­stance — and manipulating her husband, friends, and family members into doing it for her.

At times the person may try to justify the behavior to herself, even though she is aware that the anxiety doesn’t make sense. For example, a young woman who refuses to be alone with her child for fear of harming her might think, I know there is no way in a million years I would or could ever harm my child, but there’s no telling what might happen when that awful feeling comes over me — I just can’t risk losing control. Yes, the feeling is terrifying, but as I tell my patients, although the feeling is frightening, it is not dangerous. People with anxiety disorders have scary thoughts, but they’re just that — thoughts that have gone awry. They are not predictors of imminent actions. They are just thoughts; and thoughts alone, however scary, don’t make people do things they don’t want to do.

So if you have irrational, anxious thoughts about places, ob­jects, or situations that pose no real threat of danger and that lead you to behave in ways that you perceive as irrational, you may have an anxiety disorder. We’ll talk more about the specific symp­toms of the different types of anxiety disorders later in this chap­ter, but for now, let’s continue with getting a clearer picture of what is and what is not normal anxiety.

The fact that so many journalists continue to ask this question tells me that no matter how many times and in how many ways I and others try to answer it, either we haven’t succeeded or all of us need constant reassurance that the anxiety symptoms we peri­odically experience are normal. We want to know we’re okay. And once we know we’re okay, we want to know how to calm our anxieties. Normal or not, anxiety feels bad and adversely af­fects our sense of well-being. In many cases, it also erodes our health.

Whereas we have language to describe the symptoms and manifestations of anxiety in general, we have no reliable diagnos­tic tools to measure the nature and severity of any one person’s ex­perience of it. There aren’t any blood tests or X-rays that can tell me, for example, how the intensity of one person’s panic attack compares to that of another, although we are moving in that di­rection. Researchers at Massachusetts General Hospital have found that the brains of people with post-traumatic stress disor­der and those who suffer from a phobia manifest atypical activity in the areas that deal with fear, suggesting that such people expe­rience apprehension more intensely than the rest of us. And Jill M. Hooley, Ph.D., at Harvard has found scientific evidence of what a lot of us have known since we were kids: that the brain’s anxiety mechanism starts cranking when people listen to an au­diotape of a parent criticizing them.

That said, one way to approach the issue is to ask yourself: “To what extent is anxiety interfering in my life?” Do you feel un­comfortable whenever you enter an elevator but stay on anyway, or did you quit your job when you learned your company was moving to a high- rise building? Do you make a point of washing your hands before eating and after taking the subway, or do you feel compelled to scrub them every time you touch a doorknob or shake hands with someone? Do you sometimes have trouble falling asleep after a rough day at work, or do you have chronic insomnia that leaves you perpetually exhausted no matter how your day goes?

You might also want to ask yourself whether or not you be­lieve your anxiety is rational. Sure, it makes sense to be apprehen­sive about driving over an icy bridge at three in the morning in the midst of a hailstorm. But is it rational to drive half an hour out of your way, morning and evening, to avoid a bridge that, if you took it, would cut your commute in half? And no one would argue that chest pain, heart palpitations, and hyperventilation are signals that you should get yourself seen by a doctor right away. But something is awry when a healthy twenty-five-year-old woman with no family history of cardiovascular disease ends up in the emergency room five times in three weeks convinced that she is having a heart attack, even though each visit ends with the doctor assuring her, based on extensive (not to mention expen­sive) tests, that there is nothing wrong with her heart.

Is your anxiety causing you to make significant changes in the way you conduct your life? Do you find yourself catering to your anxiety, changing the things you do or the way you do them in an attempt to allay the unpleasant feelings? I am not suggesting, mind you, that there aren’t very good reasons to make changes in your life. You would probably agree that it would make sense to cancel a romantic getaway weekend with your husband if your daughter had been running a fever for three days and you felt it was neither wise nor considerate to leave her with your elderly in-laws, or because the government had just issued a terror alert for the country you were planning to visit. But you might not agree that the actions of one of my patients made sense when, some years ago, she canceled an anniversary trip to a resort in Acapulco because a guidebook mentioned that there were nu­merous stray cats in the city. This woman was so phobic about cats that the thought of even glimpsing one was enough to make her forgo a vacation she had been planning for months and antic­ipating for years.

Similarly, you  wouldn’t question the anxiety you might feel about getting back onto a ski lift after the last ride up the moun­tain left you dangling in midair for thirty minutes, driving home alone at night after some thugs threw beer cans at your car win­dow, or moments after the school nurse called to tell you that she was pretty sure the fall your child took on the playground didn’t cause a concussion. Each of these scenarios presents circum­stances under which a stable, well-adjusted person would have sufficient reason to feel anxious. But what if your anxiety didn’t make sense to anyone, including you? What if it was so perva­sive and chronic that it led you to make decisions that were detri­mental to your career, your family, your social life, or all of the above?

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That’s what was happening to Melissa, who first came in for treatment in January 2003. She was thirty-two and worked as an assistant buyer of women’s accessories for an upscale department store. She was married and the mother of a nine-year-old boy, and, except for a slight rash on her neck that reddened as she spoke, appeared to be the picture of health and self-confidence. I asked her what had brought her in to see me.

“My anxiety is running my life,” she said. “I wake up with it and I go to sleep with it, although I usually don’t stay asleep very long. I worry about everything. I mean everything. Sometimes I feel like there’s a motor inside my body that just  won’t stop. And the craziest part is that most people look at me, my life, my job, my family, and think I  don’t have a care in the world!”

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