What Causes Excessive Anxiety, Fear, and Worry?

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By Mike DuBose with Dr. Surb Guram, MD

Occasionally feeling worried, stressed, and fearful is a part of human life. It’s normal to be concerned about applying for a job, saving enough for retirement, or learning the results of a medical test, for example. In some cases, a little bit of stress can even be healthy because it can push us to accomplish important things we might otherwise delay.

However, for some individuals, worry, tension, and fear become overwhelming, negatively impacting their social lives, work, and relationships. This is the point where anxiety becomes a serious problem. Anxiety disorders are one of the most common mental health issues, with nearly 44 million Americans experiencing this heightened anxiety, fear, and worry.

With such great numbers of sufferers, the chances are high that you or someone you love has experienced significant anxiety. Sadly, nearly 70% of people with anxiety disorders do not seek treatment, according to the Anxiety and Depression Association of America. As with depression, a related problem, some may feel ashamed or embarrassed about seeking help for their anxiety disorders. However, it’s a perfectly legitimate illness, and treatment is necessary for good health!

Untreated anxiety disorders have the potential to cause both mental and physical harm. Researchers say that individuals with anxiety disorders are at higher risk for developing chronic medical conditions, experience more severe symptoms, and have a greater risk of death when they become ill. For example, there is a connection between anxiety and heart disease, as reported in the October 2017 Harvard Heart Letter: “People with anxiety disorders have inappropriate ups and downs that can cause high blood pressure and heart rhythm disturbances.” (Conversely, being diagnosed with heart disease is very likely to increase anxiety levels!)

Some individuals may recognize their anxious feelings, but still have trouble controlling their worries and fears. Others may not be able to pinpoint the root of their anxiety at all. They know they are worriers and overly fearful, but say, “That’s just the way I am” and try to live with it! However, individuals can greatly improve their lives by seeking treatment. An effective first step toward getting help is to gain an understanding of anxiety and its most common forms.

What Is Anxiety?

The American Psychological Association (APA) calls anxiety “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.” Anxiety is a natural reaction to stressors such major deadlines, relationship and family problems, life changes, or scary situations. Triggers like these activate the body’s genetic “fight or flight” response, setting off “alarms” in the body (like rapid heartbeat and hyperawareness of one’s surroundings) that helped our ancestors confront danger or escape. Nowadays, however, we’re unlikely to need to scare off a bear or run from a tiger. As noted in Medical News Today, “Anxieties now revolve around work, money, family life, health, and other crucial issues that demand a person’s attention without necessarily requiring the ‘fight-or-flight’ reaction.”

Normal anxiety becomes a disorder when the body’s mental and physical response to stress is disproportionate to the event that triggered it. Individuals with anxiety disorders experience far more stress, both in intensity and in duration, than is necessary to deal with whatever issues they are facing. Columbia, SC-based psychiatrist Joshua Fowler, MD said, “What I generally explain to patients and parents about anxiety is that it presents as uncontrollable worry. This can manifest in a number of ways depending on the individual and their age.”

In an attempt to cope, individuals may try to avoid objects, locations, or events that they know cause their anxiety. Unfortunately, doing so can impact their ability to function at work, home, school, and social events, especially if their anxiety is triggered by activities and situations that are fairly commonplace. Interpersonal relationships may also suffer.

Anxiety disorders and depression are often described as “two sides of the same coin.” They may occur together and feed off of one another: Hara Estroff Marano noted in a Psychology Today article that “half of those with chronic anxiety also have clinically significant symptoms of depression.” For more information about depression and how it relates to anxiety, read our published article “Understanding Depression: The Road to Darkness”.

What Causes Anxiety Disorders?

As with depression, the exact causes of anxiety disorders are unknown, and triggers vary by individual. Through research, however, scientists have identified several likely culprits. It has been shown that anxiety disorders can run in families, indicating that genetics and environmental factors (how a person is raised, for example) play a major role. Other risk factors include experiencing a buildup of smaller stressful situations, having a certain personality type, being subjected to a traumatic event, and exhibiting other mental health disorders.

Brain chemistry is likely one of the major contributors to anxiety. In some people, it seems that “circuits” in the brain are arranged differently than is typical. This leads them to respond abnormally to stress, which can turn into an anxiety disorder. Particularly, the amygdala, which is the part of the brain that decides what is worthy of worry and alerts the body, is thought to be linked to anxiety disorders.

When it comes to specific phobias (including agoraphobia and social anxiety disorder) and separation anxiety, a person’s history and environment are particularly relevant when searching for causes. Negative experiences, especially those endured as a small child, are a major influence behind related fears later in life. These events can teach the brain to become oversensitive to perceived dangers, putting the mind and body in an alarmed state when it does not need to be.

If you are having difficulties with anxiety and do not have a family history (a sibling, parent, or possibly a grandparent with mental issues) or a traumatic event in your past that could explain it, it’s possible that your anxiety is the first sign of a medical illness. According to the Mayo Clinic and other health professionals, the following have all been linked to anxiety:

  • Heart disease, especially mitral valve prolapse
  • Diabetes
  • Hyperthyroidism (overactive thyroid)
  • Meniere’s syndrome (an inner ear disorder)
  • Respiratory disorders, including chronic obstructive pulmonary disease (COPD) and asthma
  • Drug abuse
  • Withdrawal from alcohol, anti-anxiety drugs (benzodiazepines), illegal drugs, or other medications
  • Chronic pain
  • Irritable bowel syndrome
  • Rare tumors that generate certain "fight-or-flight" chemicals produced by the body
  • Hormonal issues stemming from menopause, postpartum depression, premenstrual syndrome, or Cushing’s syndrome

Some prescriptions can also cause or enhance anxiety, including:

  • Albuterol, salmeterol, and theophylline (used to treat asthma)
  • Blood pressure medicines, including methyldopa
  • Codeine (for pain)
  • Oral contraceptives and other hormones
  • Amphetamine-based drugs like Adderall, Ritalin, Strattera, Benzedrine, and Dexedrine
  • Steroids, including cortisone, prednisone, and dexamethasone
  • Thyroid products like Levoxyl
  • Phenytoin (an antiepileptic)
  • Levodopa (for Parkinson’s disease)
  • Quinidine, a drug used to prevent irregular heartbeat
  • Some antidepressants, including Wellbutrin, Effexor, and Prozac

Even seemingly innocent over-the-counter drugs can cause or increase anxiety. According to WebMD.com, these include medicines that contain caffeine (such as Anacin, Empirin, Excedrin, NoDoz, and some cough medicines) and decongestants such as phenylephrine (including Sudafed PE).

Consuming certain foods and drinks can lead to anxiety as well:

  • Alcohol can cause anxiety symptoms when it is absorbed into the body, according to the Mayo Clinic. Although some people use alcohol to boost their confidence in social situations, once the feeling starts to wear off, they often end up feeling even worse than before!
  • Refined sugars, like those found in cookies, candy, pasta, ketchup, sodas, and white bread, cause blood sugar levels to rise and fall rapidly. These fluctuations can make anxiety sufferers feel tired and upset, worsening their mood and potentially leading to more anxiety.
  • Caffeine is a stimulant, which means that it increases heart rate and flushes the body with adrenaline. For those who already struggle with anxiety, caffeine can make them even more restless and jittery. In some, it can trigger panic attacks. It also makes it harder to sleep, which can raise anxiety levels even more!
  • Plants from the nightshade family (tomatoes, eggplants, potatoes, goji berries, and peppers, as well as spices made from the plants like paprika or red pepper flakes) contain glycoalkaloids, which block the enzyme acetylcholinesterase in humans. Overstimulation of the nervous system is a potential result in sensitive individuals.
  • Salt can increase anxiety. It raises blood pressure, and it can also deplete the body’s supply of potassium, which is used to keep the nervous system functioning smoothly.
  • Packaged and fast foods like beef jerky, salad dressing, and potato chips can contain monosodium glutamate (MSG), a flavor enhancer. This additive can boost the brain’s levels of glutamate, an excitatory hormone that increases stress and anxiety. Many processed foods, such as non-dairy creamer, French fries, and doughnuts, also contain trans fats, which have been shown in studies to increase anxiety.
  • Aged, cured, fermented, or cultured foods like cheese, pepperoni, salami, and red wine contain histamine, which elevates adrenaline levels. This triggers the body’s “fight or flight” response, increasing anxiety.

In addition, some aspects of our modern lifestyle, although not medical causes of anxiety, can certainly exacerbate it. Take social media, for example. Looking at images of others’ “perfect” bodies, homes, meals, and parties on social media outlets like Pinterest or Facebook, some people may begin to worry that they’re failing in comparison. (However, it’s important to note the time and effort that goes into staging these idealized images—they only allow viewers to see the best results, not the hundreds of other tries that may have also taken place.) Young individuals seem to be particularly susceptible to social media-fueled stress and anxiety: a study published in the Journal of Affective Disorders in 2017 found that “more social media use was linked to greater odds of having an anxiety disorder.”

Other technological advancements also contribute to anxiety. Excessive smartphone use is often linked to pressure to be constantly available for work and social purposes—an unrealistic expectation that can certainly increase stress and anxiety. Many people now keep their smartphones on hand constantly throughout the day, subjecting themselves to a ceaseless barrage of anxiety-producing text messages, telephone calls, social media notifications, work e-mails, and other communications. In fact, participants in a recent British study checked their phones an average of 85 times per day—about 5 times per waking hour! All of these distractions not only make it harder for workers to focus on their jobs, which can raise stress levels, but also increases anxiety when they’re separated from their phones—what if they’re missing an important client e-mail, for example?

Another modern anxiety trigger may come in the form of negative TV news. With the rise of 24-hour news networks, reporters often feel pressure to analyze—or even sensationalize—their stories, rather than simply reporting the facts, and to report on the same subjects over and over. To stay competitive in the ratings, many news stations now focus on topics that evoke emotional reactions in their viewers. Often, this means that they’re reporting on negative issues like potential war with North Korea, political arguments or hated politicians, school shootings, terrorism, and natural disasters. Unlike in earlier times, when news was slow to travel, we now receive bad news instantly from all parts of the world! Unfortunately, humans naturally have a negativity bias, which causes them to pay more attention to threats and dangers. Originally, this was a survival mechanism, but now, it can make them disproportionately focused on sad and alarming news, which carries over to their emotions. Even years ago, in 1997, one study indicated that a group of participants shown an entirely negative news broadcast (versus an entirely positive one or one that was emotionally neutral) was more likely than the other two groups to overemphasize their personal worries. With more and more negative stories coming out every day, watching too much news causes many people to worry, experience stress, and even become angry over what is being reported!

We also spend a lot more time sitting than our ancestors did, and this sedentary behavior may impact our mental health. According to a recent review of nine studies published in the journal BMC Public Health, taken as a whole, the studies showed “‘moderate evidence’ that increased sedentary behavior is associated with higher anxiety risk,” reported Laura Geggel of Live Science. Although the link between sedentary lifestyles and anxiety is not fully clear, the reviewers suggested that poor metabolic health, disrupted sleep patterns, and social withdrawal could be at least partially to blame.

Insufficient sleep is another potential anxiety trigger, according to recent studies. People who are constantly exhausted tend to be more emotional and may be overly sensitive to common stressors, making them more anxious. Indeed, UC Berkeley researchers “have found that sleep deprivation amplifies anticipatory anxiety by firing up the brain’s amygdala and insular cortex, regions associated with emotional processing. The resulting pattern mimics the abnormal neural activity seen in anxiety disorders.” Harvard University also reported on a major study of 10,000 adults where “people with insomnia were 20 times more likely to develop panic disorder.” Another possible explanation for the link between lack of sleep and anxiety was raised in a recent study published in the Journal of Behavior Therapy and Experimental Psychiatry. In the research, sleep-deprived participants’ gazes lingered longer on negative images than those of well-rested people, indicating that there may be a link between insomnia and persistent negative thinking.

Another potential stressor is the workplace. In many companies, employees are expected to work long hours, produce beyond their limits, and compete with their peers. They hate the constant anxiety imposed by supervisors’ unrealistic expectations, but they’re too worried about losing their jobs to speak up. These feelings are even more prominent when employees feel like they lack opportunities for input. As Joni Johnston, Psy.D., explained in a Psychology Today article, “In particular, jobs with high demands (such as workload, time pressure, and role conflict) and low control (with low autonomy and authority) and rewards (money, esteem, career opportunities) increase stress and, hence, risk for psychiatric ill health.” Unfairness and biased treatment by supervisors are also major contributors to work-related anxiety, Johnston said. The result: stressed-out employees whose performance suffers, ironically, due to their fear and worry. In fact, in a Monster.com study of almost 7,000 workers, a whopping 61% said they had been physically ill due to workplace stress, and roughly half said they’d missed work due to the effects of their anxiety-producing jobs!

Types of Anxiety Disorders

The American Psychiatric Association focuses on six main types under the general category of anxiety disorders. They include:

Generalized anxiety disorder, which is marked by constant, persistent worry and fear that interferes with an individual’s normal daily life. Often, routine, simple tasks, like household chores or car maintenance, are the focus of the anxiety. The worry that the person with generalized anxiety disorder (GAD) feels about these tasks is greatly magnified in terms of how important or difficult they truly are.

In addition to intense worrying, generalized anxiety disorder sufferers often endure physical symptoms, including:

  • Difficulty sleeping (trouble falling asleep or staying asleep)
  • Restlessness or feeling “on edge”
  • Fatigue
  • Chest palpitations
  • Inability to concentrate
  • Procrastination
  • Finding it hard to make decisions
  • Having an unrealistic outlook about problems or events (always thinking of the worst-case scenario)
  • Irritability and impatience
  • Headaches
  • Nausea
  • Diarrhea
  • Muscle tension or soreness
  • Sweatiness
  • Trembling or shaking

These symptoms take place over the course of at least six months, although they may wax and wane in intensity over time. Although anxiety can present itself at any time in the life cycle, people with GAD usually begin showing symptoms sometime between childhood and middle age; Anxiety.org says that the average age of onset is 31. Women are about twice as likely to have GAD than men are. Generalized anxiety disorder often coexists with other anxiety disorders, obsessive-compulsive disorder, depression, and/or alcohol or other drug addiction. According to the APA, GAD is one of the most common anxiety disorders.

Harvard Heart Letter recommends consulting a mental health professional about the possibility that you may have GAD if you answer “yes” to more than three of the following questions:

  1. Do you worry a lot about all sorts of events or activities (as opposed to a specific thing like flying, becoming ill, or being embarrassed in public)?
  2. Have you been worrying nearly every day for at least six or more months?
  3. Are you experiencing at least three of these symptoms?
  4. Restlessness
  5. Irritability
  6. Fatigue
  7. Muscle tension
  8. Difficulty concentrating
  9. Trouble sleeping
  10. Do you experience trouble controlling your worries?
  11. Do your symptoms cause you considerable distress?
  12. Are you sure your symptoms can’t be explained by the following factors?
  13. Medication or other substance you’re taking (including caffeine)
  14. A traumatic experience

Panic disorder is set apart from other types of anxiety disorders by the sudden, unpredictable episodes of terror that strike its sufferers. Called “panic attacks,” these instances of extreme terror or anxiety are both physically and mentally overwhelming…to the point where some individuals actually go to the emergency room, thinking they are having a heart attack! According to the APA, when a panic attack strikes, several of the following symptoms occur:

  • Palpitations, pounding heart, or rapid heart rate
  • Fear of losing control
  • Feeling as if you are dying
  • Sweating
  • Trembling or shaking
  • Shortness of breath or smothering sensations
  • Chest pain
  • Dizziness, light-headedness, or fainting
  • Feeling like you are choking
  • Numbness or tingling
  • Chills or hot flashes
  • Nausea or abdominal pains
  • Feeling detached

Fortunately, panic attacks usually only last ten minutes or less; rarely, they may last up to an hour. To be diagnosed with panic disorder, an individual must undergo recurrent panic attacks. Although they are usually unpredictable, sometimes a certain event or situation (say, going to the doctor) can trigger attacks. Panic disorder typically surfaces in most sufferers’ early twenties, and they may also experience other mental disorders like post-traumatic stress disorder (PTSD) and depression at the same time. In addition, people with panic disorder often become anxious about when they will have their next attack, which leads them to avoid situations, activities, or objects that they believe may be triggers.

Phobia comes from the Greek word “phobos,” which means “fear.” This disorder is a persistent, intense, excessive avoidance of an event, item, or situation that is not inherently harmful. It’s important to note that simply being afraid of something does not mean you have a phobia; for the disorder to be present, you must be absolutely terrified of something to the point of irrationality (although you will likely understand that the fear is not rational). Phobias can cause symptoms mirroring those of panic attacks when people are exposed to the object of their fear. According to Anxiety.org, some of the most common phobias center on fears of flying,the unknown or unfamiliar, spiders, snakes, heights, animals, thunder and lightning, small places, and public speaking.

Phobias can often be traced back to an event where the person was harmed, experienced trauma such as domestic or sexual assault, saw someone else injured, or heard a story about someone else being endangered by a specific situation or object. (Phobias can also be passed down through genetics or upbringing, with the child absorbing the parent’s irrational fear). Children are particularly impressionable, and the fears they learn can become rooted in the subconscious and last throughout life. Having a panic attack in a certain situation can also lay the groundwork for a phobia of that situation; likewise, phobias may cause panic attacks. The APA estimates that, in any given year, up to 9 percent of Americans have a phobia!

Agoraphobia is defined by the American Psychological Association as “the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms.” This disorder makes it particularly difficult to function normally, because it is linked to avoiding necessary activities like being in open spaces, crowds, or enclosed areas or taking public transportation.

Some people who are severely agoraphobic become distraught at the prospect of leaving their homes or community at all! They are likely to resist experiences with the unknown or changes to their daily routines due to their fear. As with other anxiety disorders, the fear a person experiences due to agoraphobia is not consistent with the actual danger of the situation.

Social anxiety disorder is another distinctive type of phobia. Medical News Today notes that social anxiety disorder “includes a range of feelings, such as stage fright, a fear of intimacy, and a fear of humiliation.” Essentially, many avoid situations where they could be judged, rejected, or embarrassed in front of others. Fear of public speaking is one facet of social anxiety disorder.

The National Institute of Mental Health (NIMH) lists the following social anxiety disorder symptoms:

  • Experiencing high anxiety about being with other people and having a hard time talking to them
  • Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected
  • Being very afraid that other people will judge them
  • Worrying for days or weeks before an event where other people will be
  • Staying away from places where there are other people
  • Having a hard time making friends and keeping friends
  • Blushing, sweating, or trembling around other people
  • Feeling nauseous or sick to your stomach when other people are around

Like agoraphobia, social anxiety disorder can have a huge impact on quality of life, as it can cause avoidance of social situations and isolation. The disorder often develops during puberty, and negative childhood or teenage experiences like bullying, sexual abuse, trauma, or family problems can all be triggers. It is not an uncommon issue, though—the Anxiety and Depression Association of America estimates that 15 million adults have some form of social anxiety disorder!

Separation anxiety disorder occurs when someone has extreme anxiety or fear of being separated from a person or place that gives him or her stability. The following are some symptoms of separation anxiety:

  • Recurrent, significant distress when separation from home or loved ones occurs or is anticipated
  • Worry about possible harm or death befalling loved ones
  • Persistent and excessive worry that something bad (like a plane crash or being kidnapped)will lead to separation from people you care about Reluctance or refusal to go to school or elsewhere because of fear of separation
  • Being overly fearful about being alone or without loved ones at home or in other settings
  • Inability to sleep when away from home or without being near a loved one
  • Recurring separation-themed nightmares
  • Experiencing ongoing physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from loved ones occurs or is anticipated

Although many of these symptoms are more common in children than adults, separation anxiety disorder can actually occur in people of all ages, as long as the feeling is beyond what is normal for the person’s age and lasts for an extended period (four weeks for children and six months in adults). It often occurs alongside depression, excessive worry, and/or panic disorder. Being apart from the person or place that is the focus of the separation anxiety can prompt panic attacks in some sufferers.

The bottom line: On a fortunate note, anxiety disorders are highly treatable, and those who seek the appropriate help can live much happier, healthier lives with less worry and fear. Regardless of your age or circumstances, it’s never too late to take a new road of happiness with less worry, fear, and anxiety!

Read about treatments of anxiety disorders in the next article in this two-part series, “How to Prevent and Treat Anxiety."

About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at katie@dubosegroup.com.

Mike DuBose, a former licensed counselor, received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, and personal articles, as well as health articles written with Dr. Surb Guram, MD.

Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.

Katie Beck serves as Director of Communications for the DuBose Family of Companies. She graduated from the USC School of Journalism and Honors College.

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