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Does selfishness increase in periods of extreme anxiety

Does selfishness increase in periods of extreme anxiety



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Does an individual going through a period of extreme anxiety, show increased levels of selfishness during that period ?

When this period ends, does the individual returns back to normal levels of selfishness ?

The following extract is from this article, which describes the personal experience of a person with anxiety/depression.

When we're anxious, we become lost in our own thoughts, waging a battle so distracting in its intensity that it makes it nearly impossible to notice the outside world. It's not that we don't care, but rather that we're so distracted by our discomfort that it is only with great effort that we're able to look out and truly see others.

This somehow verifies my intuition, that extreme anxiety increases selfshiness. There is so much anxiety related activity in the head, that other aspects like other people, are neglected.

This is just a personal report though, I need more solid research data.


It is hard to argue that anxiety makes you more "selfish". Your definition of "extreme periods anxiety" is rather vague and hard to operationalize, same goes for selfishness in this context. The article you cited is not based on scientific literature but much rather a personal look on anxiety and selfishness. Therefore it is in no way conclusive evidence.

Anxiety is a natural body response to certain dangers. When anxiety becomes abnormal it can be diagnosed as an Anxiety disorder (see DSM V for criteria for certain anxiety disorders). There has been a lot of research on General Anxiety Disorder (one of the anxiety disorders) and the worry-process. However, too my knowledge there are hardly any studies that describe individuals become more selfish. Like I said, this is also definition question. Certainly people with anxiety worry more and are more focused on the thoughts in their head. However, as far as I know there is no convincing evidence that people with strong anxiety do not care about others except for themselves. On the contrary some people with Anxiety disorders excessively call their loved ones to make sure that they are alright.

Further reading: Butcher, Hooley and Mineka, Abnormal Psychology 16th Edition, Chapter 6.


What Does Long-Term Stress Do?

Stress changes every component of your body. In excess, stress makes the long-term outlook of your life considerably worse. Stress:

  • Reduces hormone function.
  • Damages organs.
  • Weakens your immune system.
  • Puts you at higher risk of cancer.
  • Causes memory loss and concentration issues.
  • Develops mental health disorders.

That latter point is important. Long-term stress is one of the key contributing factors in the development of numerous types of mental health disorders and puts you at severely increased risk of developing serious conditions like anxiety and depression. In addition, these conditions lead to further stress, resulting in a vicious cycle that can damage your quality of life.


Complex Causes of Perimenopausal Anxiety

Women report experiencing mood changes during perimenopause, including an increase in anxiety. Anxiety is extremely common during this time, and while some of the anxiety may be due to the changing hormones, there are other reasons as well.

Many believe hormones are solely to blame for the increased anxiety during perimenopause, and while this is not true, they certainly do play a role.

Hormones have a direct link to the production and management of neurotransmitters in the brain, including those that regulate anxiety levels. When the levels of neurotransmitters shift in the brain during perimenopause, it can lead to a considerable amount of mental stress and trouble coping - emotional changes that "feel" completely normal but are nothing more than a response to inadequate regulation of these neurotransmitters.

Yet hormones are not the only factor in that anxiety.

Body Changes

Women going through perimenopause often report body changes. Some of these bodily changes take place due to the hormonal shifts that naturally occur during this time, but body changes can also occur for other reasons.

Regardless of why a woman’s body is changing during this period, it can bring about a significant amount of stress. The more stress a woman feels, the more susceptible she is to having anxiety. Unfortunately, because of the strong mind/body connection (which has been substantially researched), the stress and anxiety a woman feels can actually trigger more changes in the body. This can become a vicious cycle.

Fear of the Changes

Perimenopause is a complex time for most women. And while a great deal of anxiety comes from the hormonal or body changes, much anxiety also comes from the fear of those (or other) changes, such as getting older. Perimenopause and menopause are substantial life events. All of the changes women go through during perimenopause can contribute to reflecting on the past, thinking about the future, and for some, trying to come to terms with mortality.

Perimenopause often begins between the ages of 30 and 40 when women have decades upon decades of life left. But it is often one of the first indicators or changes a woman goes through that is connected to getting older. This means can force women to consider their age, perhaps more than they had previously, and think more about their past and future. That causes a great deal anxiety.

Combine those feelings with the overall fear of eventually getting anxiety, and it's easy to see why this period can be so stressful.

Hot Flashes and Symptom Stress

Perimenopause symptoms, which of course can look a bit different for each woman, are, overall, quite stressful. One of the most commonly discussed are hot flashes. Hot flashes are sudden periods of intense heat that may occur at any time, but often occur at night. Hot flashes can make it difficult to sleep and cause considerable stress while awake.

Many women have to drastically alter their life to adjust for hot flashes, and often find that the adjustments they make are insufficient to reduce the stress that those hot flashes cause. In this sense, the hot flashes themselves start to cause ongoing distress, which can develop into anxiety. Additionally, when many women experience hot flashes, they fear more hot flashes occurring, which further contributes to anxiety.

Anxiety Increasing Perimenopausal Symptoms

Similarly, studies have shown that menopausal symptoms (and presumably perimenopausal symptoms as well) are made worse by stress and anxiety. For many women, the core issue may not be attributed solely to the perimenopause itself. Instead, the problem may be the stress, which then can cause perimenopausal symptoms to be worse, and in turn causes an increase in anxiety.

Finally, perimenopause tends to come at a time when there are other stressors in a woman’s life. Between the late 30's and early 50's, many women struggle with a variety of life issues, and what is sometimes blamed on perimenopause may be nothing more than life stress that happens to coincide with a very similar time. For example, many women going through perimenopause have children, and being a parent is a big contributor to stress in adults.

These are a variety of potential issues that can create some form of anxiety. And, most likely, the anxiety a woman feels during perimenopause is the result of an interaction of a combination of life stressors, and not quite as simple as saying "it is hormones.”


As Menopause Nears, Be Aware It Can Trigger Depression And Anxiety, Too

Teri Hines says she had a bout of depression during the lead up to menopause in her mid-40s. For many women, the lead-up to menopause can trigger mood issues.

Teri Hines was in her mid-40s when she started to notice that her body was changing.

Her period became irregular and more intense. "It increased in frequency, it increased in intensity and it increased in duration," she says.

She began to have hot flashes, gained weight and her energy levels took a nosedive.

"I just did not have the energy to do the things I wanted to do," she says, like the long morning walks she loved to take with her dogs, or planning solo travel.

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At the time, Hines lived alone in Philadelphia where she worked as an assistant principal at a school. She struggled to get out of bed and go to work, and she began to withdraw from friends.

Looking back, she remembers feeling isolated and unmoored. "It was such a fog over who I was, what I wanted, where I was going, what I was capable of accomplishing," she says. "I just could not find my footing."

Hines knew she was likely going through perimenopause, that is the years leading up to menopause, when women's monthly hormonal cycles become erratic as their bodies prepare to stop menstruating.

What she didn't realize — and many women don't know — is that the hormonal changes of perimenopause can bring changes in mood, and for some, a heightened risk of anxiety and depression.

"Women who have a previous diagnosis of major depression or anxiety disorder are going to be at a greater risk during the perimenopausal time," says Jennifer Payne, who directs the Women's Mood Disorders Center at Johns Hopkins University.

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And she warns that for these women, it's something to take seriously. "If you're having serious depression, and your functioning is affected, if you're having suicidal thoughts, or you feel completely hopeless, that is a major depressive episode that absolutely needs treatment," she says.

A vulnerable time

Perimenopausal mood swings often resemble symptoms of premenstrual syndrome women might feel sad, or sluggish, or irritable.

"I've had people say that they feel like they have PMS all the time," says psychiatrist Hadine Joffe, who leads the Connors Center for Women's Health and Gender Biology at the Brigham and Women's Hospital in Boston. "They just don't feel like they're in control of their mood and they feel edgy."

Generally though, these mood swings are manageable, she adds. "The good news is that most women will navigate their perimenopause without serious mental health issues."

But a significant number of women — about 18% among women in early perimenopause and 38% of those in late perimenopause — experience symptoms of depression. And symptoms of anxiety appear to be more common during this time leading up to menopause, including panic attacks.

Those most at risk are women with a history of mental illness, as well as women whose moods are particularly sensitive to hormonal fluctuations.

"Women who had postpartum depression or have always had significant mood changes premenstrually are going to be at risk of having more symptoms," says Payne.

It's not that women who develop serious anxiety or depression have any unusual or abnormal changes in hormones, she says. Rather, "it's likely that their brain is sensitive to normal, natural hormonal fluctuations."

"We know that in psychiatric illness, in general, the environment definitely plays a role," Payne adds. And during this time period, she says, there are often big life changes for women that can exacerbate their risk of having mental health symptoms

"Some women go through divorces, children go off to school, or leave the house, parents are getting older and need more caretaking," says Payne. "There are changes in career, etc."

"There's there's a lot of midlife specific stress that happens because of where people are in their life," adds Joffe.

When doctors don't pay attention

Hines was familiar with depression. She'd been depressed several times before and she had been proactive about seeking treatment.

"I had been an advocate for myself on depression and self-care and getting the right help, getting counseling," says Hines. "At times when I needed [it], using medication."

And over the years, she had learned to recognize her symptoms and triggers — often big life changes, either professional or personal.

Hines says antidepressants and counseling helped her get through the depression she experienced during the lead-up to menopause. Now, 57 and living in Smyrna, Del., she's feeling good. Hannah Yoon for NPR hide caption

This time though, she says, she was too focused on how her body was changing and missed the symptoms of depression.

"The physical nature of menopause consumes you and it's what we're taught to pay attention to," she says.

She did not know that her past history of depression put her at a higher risk of being depressed during perimenopause. But she did bring up her physical symptoms and her energy levels to her doctor early on during a regular appointment. But the conversation was disappointing, she says.

"I think she might have said 'you're about the age when you will begin to have these symptoms, you will begin to be perimenopausal,' " Hines recalls.

The doctor offered no tips to help with her symptoms or even any information about perimenopause, she says, not even the fact that on average it lasts for about four years, and for some women as long as 10 years.

This isn't uncommon. More than a 1,000 women wrote to NPR with their own stories about struggles during perimenopause. And a majority said that they had gotten little information or help from their physicians, especially for mental health symptoms.

"It's a very common situation for women, and doctors are not keeping up with that," says Payne.

This is partly because most physicians, even OB-GYNs, get little education about perimenopause, says Joffe.

Hines and many other women who wrote to NPR said they found they had to be in the driving seat when it comes to looking for and finding the right help or treatment.

Women need to be direct with their doctors about their mental health symptoms, says Joffe.

"Just the same as they would if they had a rash," she says. "They would make an extra appointment and that's the first thing they say: I have a rash."

Payne agrees. "The No. 1 thing that women can do is be honest with their doctors about their symptoms and what symptoms they're having and how severe they are," she says.

Treatments that work

Hines eventually got her doctor to pay attention and treat her mental health symptoms.

But it took her several years before she even realized that she might be depressed.

"That's when I made an appointment with my doctor and said, here's what I'm thinking, here's what I'm feeling, I think I might be depressed."

This time, her physician prescribed her an antidepressant. "The minute I went on it, I felt like I had the energy to tackle those other things that were ongoing," says Hines.

"Antidepressants can help a woman get out of her major depressive episodes," says Payne. "They can also be helpful for anxiety symptoms."

Research also shows that they can ease some of the physical symptoms of perimenopause, such as hot flashes and insomnia.

Hines also benefited from talk therapy, which studies show is also helpful for treating depression.

"I went on antidepressants and then I started going into counseling," she says. "Once I had it under control with counseling, then I was able to sort of wean the pharmaceuticals off, so that I could just use the counseling."

Joffe suggests women who are at this stage of life take steps to empower themselves. They should monitor symptoms carefully so they can have an informed discussion with their doctors.

Most of the time women just try to tough it out, says Joffe. "Women are tough. Women are accustomed to having to cope with physical discomforts and life challenges," she says. "And I think a lot of midlife women expect that this is a time of distress and discomfort and ill ease and that's normative."

But, she adds, it doesn't have to be that way. She points to resources like the North American Menopause Society's website, for example, which has helpful information about menopause as well as a tool to help women find local providers specializing in perimenopause.

"I want [women] to have permission," she says. "I want [women] to feel that they owe it to themselves and the people around them, that they aren't suffering."


Anxiety in the West: Is it on the rise?

According to some observers, anxiety is now snowballing in the United States. So, in this Spotlight, we ask whether anxiety truly is becoming more prevalent in the West and, if so, what may be causing it.

Share on Pinterest The story of anxiety is deep and long.

For many, anxiety is an ever-present uninvited guest in our circle of friends, among family members, and in communities at large.

It seems to be rampaging through society like a noncontagious cognitive plague, forming a low-level hum that hides in the corners of our collective minds.

In August 2018, Barnes & Noble — who are the largest book retailer in the United States — announced a huge surge in the sales of books about anxiety a 25 percent jump on June 2017. “[W]e may be living in an anxious nation,” one press release dryly notes.

Does this surge in interest reflect a genuine spike in anxiety, or are people simply more aware of it? In this article, we ask whether anxiety truly is increasing, if wealthier nations are bearing the brunt, and why anxiety seems to be sitting in the driving seat of modern society.

Many of us — a surprisingly high percentage, as we shall see — are all too familiar with how anxiety feels. For those who have not experienced anxiety first-hand, throughout the text, we have added excerpts from personal experiences.

Anxiety is a nebulous term that covers a great deal of psychological ground. At the thinnest end of the wedge, before an exam or a job interview, we might feel anxious. This is both understandable and normal it is not a cause for concern.

Anxiety is only a problem when it extends beyond logical worry in an unreasonable, unwarranted, uncontrollable way. Situations that should elicit no negative emotions all of a sudden seem life-threatening or crushingly embarrassing.

At the widest end of the wedge, anxiety can arrive as a symptom of another mental illness, such as panic disorders, post-traumatic stress disorder, phobias, or obsessive-compulsive disorder (OCD).

When anxiety is a person’s primary symptom, it may be referred to as generalized anxiety disorder (GAD). The National Health Service (NHS) in the United Kingdom summarize GAD neatly.

“People with GAD,” they explain, “feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue.”

GAD affects around 6.8 million people in the U.S. — or more than 3 percent of the country’s adults.

Another common form of anxiety is social anxiety, which affects people more specifically in social situations.

It might make someone very self-conscious, perhaps not wanting to eat or drink in front of others, fearing that people are talking about them, or worrying about being lost in a crowd. It comes in many forms.

Share on Pinterest Anxiety disorders are more common than one might think.

Today, “anxiety disorders are the most common mental illness in the U.S.,” affecting around 40 million adults — almost 1 in 5 people.

Globally, the World Health Organization (WHO) say that almost 300 million people have an anxiety disorder.

Anxiety disorders are not new, either. In fact, Robert Burton wrote this description in The Anatomy of Melancholy (1621) referring to a patient of Hippocrates. It will resonate with anyone who has ever experienced anxiety.

“He dare not come into company for fear he should be misused, disgraced, overshoot himself in gestures or speeches, or be sick he thinks every man observeth him.”

Interestingly, anxiety is not just a human experience, and evolution is ultimately to blame (or thank) as with other animals, humanity’s survival relies on our natural ability to feel anxious about genuinely dangerous situations and to be on guard.

It is when this life-saving mechanism is triggered at inappropriate times or gets stuck in the “on” position that it becomes a problem.

So, to the first big question: is anxiety really affecting us more now than it has in the past? Is anxiety on the up in the West, or, in a modern society where good mental health is a goal in itself, are we just more likely to notice and discuss it?

“ When it’s bad, it feels like an electric current building up inside of me and like it’s going to start shooting out of me, except it doesn’t, which is worse.”

Anon.

A large study that was published in the journal JAMA Psychiatry in 2017 set out to answer this exact question. In particular, the researchers looked at GAD.

One might expect that, since mental illness tends to be more common in areas of the U.S. that have a lower socioeconomic status, anxiety might also be more prevalent in countries with a lower socioeconomic profile.

Additionally, in less wealthy countries, people can be under substantial stress finding food, water, or safety might be an issue in some regions.

However, it is important to remember that GAD is about feelings of anxiety that are unreasonable. In a country where there is genuine struggle, higher levels of anxiety might rightly be considered justifiable and therefore not a diagnosable condition.

The study, involving 147,261 adults from 26 countries, concluded:

“The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries.”

In other words, within each country, GAD is more prevalent in less wealthy regions. However, as a whole, it is the residents of wealthier countries who are more likely to experience GAD, and their lives are more significantly impacted by it.

Breaking down the statistics, the scientists found that lifetime estimates for GAD were as follows:

  • low-income countries: 1.6 percent
  • middle-income countries: 2.8 percent
  • high-income countries: 5.0 percent

This is in line with other research that found a higher prevalence of anxiety in wealthier economies.

In the WHO’s Depression and Other Common Mental Disorders Global Health Estimates report that was released in 2017, they compare prevalence estimates of mental disorders across global regions.

When they compare the levels of depression, no single area has significantly higher rates. When it comes to anxiety disorders, however, it’s a different story the Americas are head and shoulders above all other regions, including Africa and Europe.

Interestingly, though the U.S. and the West in general do seem to be taking the lead in the anxiety stakes, it may not stay this way for long the very same report explains that common mental health disorders are increasing in lower-income countries “because the population is growing and more people are living to the age when depression and anxiety most commonly occurs.”

Added to this, anxiety tends to be less common in older adults. Also, because the average age of U.S. individuals is slowly rising, the percentage of people with anxiety disorders may gradually decline.

To conclude this section, although other countries might be catching up, it does seem that anxiety is more common in wealthier nations and perhaps the U.S. in particular — but is it getting worse?

“ Anxiety is mysterious. It can feel like an invisible cage that keeps you prisoner on your sofa, unable to move for fear of something that you can’t quite identify.”

Anon.

Much debate surrounds this question. Is anxiety on the rise, or are we simply more inclined to think and speak about it these days? This is a tough question to pick apart, but we must try.

The American Psychiatric Association ran a poll on 1,000 U.S. residents in 2017, and they found that nearly two thirds were “extremely or somewhat anxious about health and safety for themselves and their families and more than a third are more anxious overall than last year.”

They also noted that millennials were the most anxious generation.

In 2018, the same poll was repeated. Anxiety was shown to have risen again by another 5 percent.

Millennials were revealed to still be the most anxious generation.

It is crucial to remember, though, that increasing feelings of anxiety do not equate to a diagnosis of anxiety disorder.

Naturally, it is possible to feel more anxious than you previously did without it being classified as a mental condition.

Looking at the broader picture, several studies have charted the rise of mental health issues in the West.

For instance, a meta-analysis published in 2010 took data from studies that included over 77,000 young people the scientists found generational increases in mental health issues in 1938–2007.

Another report, using data from four surveys completed by almost 7 million people in the U.S., concluded that “Americans reported substantially higher levels of depressive symptoms, particularly somatic symptoms, in the 2000s–2010s compared to the 1980s–1990s.”

Outside of the U.S., the U.K. Council for Psychotherapy published a report in 2017 that assessed the mental health of full- and part-time employees. Their figures show that “workers reporting anxiety and depression have risen by nearly a third in the last 4 years.”

As for Europe at large, a huge analysis that was published in 2011 concluded that almost one third of adults had some type of mental health issue, with anxiety disorders being the most frequent.

However, this study was a follow-up to a similar pan-European review conducted in 2005, and the authors note that there were no significant increases between these years.

“ I have a list of possible problems in my head. If all the real problems are solved, I turn another one into a problem so that I can worry about it. These are constant facts of life. It is not increasing. It has always been like this.”

Anon.

The authors believe that the perception of a new wave of mental health issues may be an illusion, concluding that “the true size and burden of disorders of the brain in the [European Union] was significantly underestimated in the past.”

Another paper concludes that “it is difficult to find reliable evidence for a change in prevalence rates for anxiety disorders. Epidemiologic data obtained before the introduction of psychiatric classification systems […] are too imprecise to be comparable with modern studies.”

The study authors note that “the rate of treatment-seeking individuals increased, which may be the reason for the general impression that these disorders are more frequent.”

To add to the already complicated mix, anxiety disorders have a genetic factor. Researchers think that 30–50 percent of the variation in anxiety disorders within a population is down to our genes.

Levels of a condition that has a heritable component are likely to be more stable, since the prevalence of those genes won’t change much across a few decades or even centuries.


What does anxiety feel like and how does it affect the body?

Anxiety can impact physical and mental health. There are short- and long-term effects on both the mind and body.

While many people know about the effects of anxiety on mental health, fewer people are aware of the physical side effects, which can include digestive issues and an increased risk of infection. Anxiety can also change the function of the cardiovascular, urinary, and respiratory systems.

In this article, we discuss the most common physical symptoms and side effects of anxiety.

Share on Pinterest Excessive worry and nervousness are characteristics of anxiety.

People with anxiety can experience a range of physical and psychological symptoms. The most common include:

  • feeling nervous, tense, or fearful
  • restlessness , in severe cases
  • a rapid heart rate
  • fast breathing, or hyperventilation
  • sweating
  • shaking
  • weakness
  • dizziness
  • difficulty concentrating
  • sleep problems
  • nausea
  • digestive issues
  • feeling too cold or too hot
  • chest pain

Some anxiety disorders have additional symptoms. For example, OCD also causes:

  • obsessive thoughts
  • compulsive behaviors that aim to reduce the anxiety caused by the thoughts
  • periods of temporary relief, which follow the compulsive behaviors

Anxiety can have a significant effect on the body, and long-term anxiety increases the risk of developing chronic physical conditions.

The medical community suspects that anxiety develops in the amygdala, an area of the brain that manages emotional responses.

When a person becomes anxious, stressed, or frightened, the brain sends signals to other parts of the body. The signals communicate that the body should prepare to fight or flee.

The body responds, for example, by releasing adrenaline and cortisol, which many describe as stress hormones.

The fight or flight response is useful when confronting an aggressive person, but it is less helpful when going for a job interview or giving a presentation. Also, it is not healthy for this response to persist in the long term.

Some of the ways that anxiety affects the body include:

Breathing and respiratory changes

During periods of anxiety, a person’s breathing may become rapid and shallow, which is called hyperventilation.

Hyperventilation allows the lungs to take in more oxygen and transport it around the body quickly. Extra oxygen helps the body prepare to fight or flee.

Hyperventilation can make people feel like they are not getting enough oxygen and they may gasp for breath. This can worsen hyperventilation and its symptoms, which include:

Cardiovascular system response

Anxiety can cause changes to the heart rate and the circulation of blood throughout the body.

A faster heart rate makes it easier to flee or fight, while increased blood flow brings fresh oxygen and nutrients to the muscles.

When blood vessels narrow, this is called vasoconstriction, and it can affect body temperature. People often experience hot flashes as a result of vasoconstriction.

In response, the body sweats to cool down. This can sometimes be too effective and make a person feel cold.

Long-term anxiety may not be good for the cardiovascular system and heart health. Some studies suggest that anxiety increases the risk of heart diseases in otherwise healthy people.

Impaired immune function

In the short-term, anxiety boosts the immune system’s responses. However, prolonged anxiety can have the opposite effect.

Cortisol prevents the release of substances that cause inflammation, and it turns off aspects of the immune system that fight infections, impairing the body’s natural immune response.

People with chronic anxiety disorders may be more likely to get the common cold, the flu, and other types of infection.

Changes in digestive function

Cortisol blocks processes that the body considers nonessential in a fight or flight situation.

One of these blocked processes is digestion. Also, adrenaline reduces blood flow and relaxes the stomach muscles.

As a result, a person with anxiety may experience nausea, diarrhea, and a feeling that the stomach is churning. They may also lose their appetite.

Some research suggests that stress and depression are linked to several digestive diseases, including irritable bowel syndrome (IBS).

One study , of outpatients at a gastroenterology clinic in Mumbai, reported that 30–40 percent of participants with IBS also had anxiety or depression.

Urinary response

Anxiety and stress can increase the need to urinate, and this reaction is more common in people with phobias.

The need to urinate or a loss of control over urination may have an evolutionary basis, as it is easier to flee with an empty bladder.

However, the link between anxiety and an increased urge to urinate remains unclear.


Social anxiety increases visible anxiety signs during social encounters but does not impair performance

Preliminary evidence suggests that impairment of social performance in socially anxious individuals may be specific to selective aspects of performance and be more pronounced in females. This evidence is based primarily on contrasting results from studies using all-male or all-female samples or that differ in type of social behaviour assessed. However, methodological differences (e.g. statistical power, participant population) across these studies means it is difficult to determine whether behavioural or gender-specific effects are genuine or artefactual. The current study examined whether the link between social anxiety and social behaviour was dependent upon gender and the behavioural dimension assessed within the same study under methodologically homogenous conditions.

Methods

Ninety-three university students (45 males, 48 females) with a mean age of 25.6 years and varying in their level of social anxiety underwent an interaction and a speech task. The speech task involved giving a brief impromptu presentation in front of a small group of three people, while the interaction task involved “getting to know” an opposite-sex confederate. Independent raters assessed social performance on 5 key dimensions from Fydrich’s Social Performance Rating Scale.

Results

Regression analysis revealed a significant moderate association of social anxiety with behavioral discomfort (e.g., fidgeting, trembling) for interaction and speech tasks, but no association with other performance dimensions (e.g., verbal fluency, quality of verbal expression). No sex differences were found.

Conclusions

These results suggest that the impairing effects of social anxiety within the non-clinical range may exacerbate overt behavioral agitation during high demand social challenges but have little impact on other observable aspects of performance quality.


Theory

Emotion regulation strategies such as distraction, concentration, and updating, are believed to depend on working memory capacity (Miyake et al., 2000 Pe et al., 2013 Mammarella, 2014). When linked to the work of Cisler et al. (2010), who stated that emotional regulation plays a vital role in alleviating anxiety such that anxious experiences can be augmented or diminished, it can be suggested that increased working memory capacity via emotional working memory training can improve emotion regulation, thus, reduce symptoms of trait anxiety (see Figure 1).


Anxiety In Kids And Teens

Anxiety disorders are not exclusively adult afflictions either — angst can strike even young kids. According to ADAA, one in eight children struggles with an anxiety disorder. The Centers For Disease Control and Prevention (CDC) says 7.1% of children age 13-18 have some type of diagnosed anxiety disorder.

Prevalence rates of anxiety tend to increase with age and this increase is thought to be a function of how our thought processes mature. That is, as our thinking develops it plays a considerable role in viewing stressors. This is observed early on when signs of separation anxiety may first be seen when younger children start school and struggle to adjust to leaving the comfort of their home and family. A teen’s perspective of their world and how their peers view them (e.g., being embarrassed, bullied, or other public humiliating experience) are key factors in the manifestation of social anxiety and its onset most often appears during puberty.

Getting a handle on anxiety during childhood is important. Research has shown that children and teens with untreated anxiety disorders are at higher risk of poor performance in school, social avoidance, and substance use, as well as comorbidities including eating disorders and ADHD. Therapy, medication in some cases, and familial support can help kids manage their anxiety, learn coping mechanisms early on, and lead healthy lives.


What it means to have an anxiety disorder

Anxiety disorders essentially turn stressful thoughts up to 11, both in intensity and sometimes duration. While people without an anxiety disorder can experience manageable stress for short periods of time, often in relation to a specific situation, those feelings last much longer and may become all-consuming for someone with an anxiety disorder. For people with anxiety disorders, there is “often a disconnect in the estimation of danger…in anxiety-producing situations versus the actual or realistic threat,” Dr. Valerio explains.

As if this weren’t complicated enough, anxiety disorders can manifest in a number of ways. Here are some of the main ones to know:

  • Generalized anxiety disorder (G.A.D.): This describes excessive, persistent worrying that makes it hard to live your life as usual, according to the National Institute on Mental Health (NIMH). Among other issues, GAD can lead to restlessness, an inability to sleep, headaches, tense muscles, and irritability, the NIMH says. For a lot of people, this presents as all-consuming worries about minor matters, Zinbarg says, like being so concerned about making it to a morning appointment on time that they can’t sleep.
  • Panic disorder: This involves having repeated panic attacks (bouts of uncontrollable terror) without an obvious trigger. Along with that overwhelming feeling of dread, panic attacks are characterized by physical symptoms such as sweating, trembling, and feeling like you’re choking, the NIMH explains. Worrying about having another panic attack is another key diagnostic criterion. : This translates into an incredible fear of situations involving other people or where you have to perform in front of anyone. A lot of this worry centers around a fear of being judged or embarrassed, typically leading people to avoid situations that might have this result, the NIMH says. This is also called social phobia (meaning it’s intense dread centered around a specific circumstance).

In order for a doctor to diagnose you with these or other anxiety disorders, you need to meet specific criteria. For instance, your symptoms can’t be better explained by the use of alcohol or drugs, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). And, as crappy as it is, you’ll need to have sustained experiences of anxiety over time, since anyone can go through really stressful periods but not necessarily meet the criteria for an anxiety disorder. For instance, a diagnosis of GAD requires at least six months of symptoms, the NIMH says, and a diagnosis of panic disorder necessitates repeated panic attacks, not only one.


What it means to have an anxiety disorder

Anxiety disorders essentially turn stressful thoughts up to 11, both in intensity and sometimes duration. While people without an anxiety disorder can experience manageable stress for short periods of time, often in relation to a specific situation, those feelings last much longer and may become all-consuming for someone with an anxiety disorder. For people with anxiety disorders, there is “often a disconnect in the estimation of danger…in anxiety-producing situations versus the actual or realistic threat,” Dr. Valerio explains.

As if this weren’t complicated enough, anxiety disorders can manifest in a number of ways. Here are some of the main ones to know:

  • Generalized anxiety disorder (G.A.D.): This describes excessive, persistent worrying that makes it hard to live your life as usual, according to the National Institute on Mental Health (NIMH). Among other issues, GAD can lead to restlessness, an inability to sleep, headaches, tense muscles, and irritability, the NIMH says. For a lot of people, this presents as all-consuming worries about minor matters, Zinbarg says, like being so concerned about making it to a morning appointment on time that they can’t sleep.
  • Panic disorder: This involves having repeated panic attacks (bouts of uncontrollable terror) without an obvious trigger. Along with that overwhelming feeling of dread, panic attacks are characterized by physical symptoms such as sweating, trembling, and feeling like you’re choking, the NIMH explains. Worrying about having another panic attack is another key diagnostic criterion. : This translates into an incredible fear of situations involving other people or where you have to perform in front of anyone. A lot of this worry centers around a fear of being judged or embarrassed, typically leading people to avoid situations that might have this result, the NIMH says. This is also called social phobia (meaning it’s intense dread centered around a specific circumstance).

In order for a doctor to diagnose you with these or other anxiety disorders, you need to meet specific criteria. For instance, your symptoms can’t be better explained by the use of alcohol or drugs, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). And, as crappy as it is, you’ll need to have sustained experiences of anxiety over time, since anyone can go through really stressful periods but not necessarily meet the criteria for an anxiety disorder. For instance, a diagnosis of GAD requires at least six months of symptoms, the NIMH says, and a diagnosis of panic disorder necessitates repeated panic attacks, not only one.


Social anxiety increases visible anxiety signs during social encounters but does not impair performance

Preliminary evidence suggests that impairment of social performance in socially anxious individuals may be specific to selective aspects of performance and be more pronounced in females. This evidence is based primarily on contrasting results from studies using all-male or all-female samples or that differ in type of social behaviour assessed. However, methodological differences (e.g. statistical power, participant population) across these studies means it is difficult to determine whether behavioural or gender-specific effects are genuine or artefactual. The current study examined whether the link between social anxiety and social behaviour was dependent upon gender and the behavioural dimension assessed within the same study under methodologically homogenous conditions.

Methods

Ninety-three university students (45 males, 48 females) with a mean age of 25.6 years and varying in their level of social anxiety underwent an interaction and a speech task. The speech task involved giving a brief impromptu presentation in front of a small group of three people, while the interaction task involved “getting to know” an opposite-sex confederate. Independent raters assessed social performance on 5 key dimensions from Fydrich’s Social Performance Rating Scale.

Results

Regression analysis revealed a significant moderate association of social anxiety with behavioral discomfort (e.g., fidgeting, trembling) for interaction and speech tasks, but no association with other performance dimensions (e.g., verbal fluency, quality of verbal expression). No sex differences were found.

Conclusions

These results suggest that the impairing effects of social anxiety within the non-clinical range may exacerbate overt behavioral agitation during high demand social challenges but have little impact on other observable aspects of performance quality.


Theory

Emotion regulation strategies such as distraction, concentration, and updating, are believed to depend on working memory capacity (Miyake et al., 2000 Pe et al., 2013 Mammarella, 2014). When linked to the work of Cisler et al. (2010), who stated that emotional regulation plays a vital role in alleviating anxiety such that anxious experiences can be augmented or diminished, it can be suggested that increased working memory capacity via emotional working memory training can improve emotion regulation, thus, reduce symptoms of trait anxiety (see Figure 1).


What does anxiety feel like and how does it affect the body?

Anxiety can impact physical and mental health. There are short- and long-term effects on both the mind and body.

While many people know about the effects of anxiety on mental health, fewer people are aware of the physical side effects, which can include digestive issues and an increased risk of infection. Anxiety can also change the function of the cardiovascular, urinary, and respiratory systems.

In this article, we discuss the most common physical symptoms and side effects of anxiety.

Share on Pinterest Excessive worry and nervousness are characteristics of anxiety.

People with anxiety can experience a range of physical and psychological symptoms. The most common include:

  • feeling nervous, tense, or fearful
  • restlessness , in severe cases
  • a rapid heart rate
  • fast breathing, or hyperventilation
  • sweating
  • shaking
  • weakness
  • dizziness
  • difficulty concentrating
  • sleep problems
  • nausea
  • digestive issues
  • feeling too cold or too hot
  • chest pain

Some anxiety disorders have additional symptoms. For example, OCD also causes:

  • obsessive thoughts
  • compulsive behaviors that aim to reduce the anxiety caused by the thoughts
  • periods of temporary relief, which follow the compulsive behaviors

Anxiety can have a significant effect on the body, and long-term anxiety increases the risk of developing chronic physical conditions.

The medical community suspects that anxiety develops in the amygdala, an area of the brain that manages emotional responses.

When a person becomes anxious, stressed, or frightened, the brain sends signals to other parts of the body. The signals communicate that the body should prepare to fight or flee.

The body responds, for example, by releasing adrenaline and cortisol, which many describe as stress hormones.

The fight or flight response is useful when confronting an aggressive person, but it is less helpful when going for a job interview or giving a presentation. Also, it is not healthy for this response to persist in the long term.

Some of the ways that anxiety affects the body include:

Breathing and respiratory changes

During periods of anxiety, a person’s breathing may become rapid and shallow, which is called hyperventilation.

Hyperventilation allows the lungs to take in more oxygen and transport it around the body quickly. Extra oxygen helps the body prepare to fight or flee.

Hyperventilation can make people feel like they are not getting enough oxygen and they may gasp for breath. This can worsen hyperventilation and its symptoms, which include:

Cardiovascular system response

Anxiety can cause changes to the heart rate and the circulation of blood throughout the body.

A faster heart rate makes it easier to flee or fight, while increased blood flow brings fresh oxygen and nutrients to the muscles.

When blood vessels narrow, this is called vasoconstriction, and it can affect body temperature. People often experience hot flashes as a result of vasoconstriction.

In response, the body sweats to cool down. This can sometimes be too effective and make a person feel cold.

Long-term anxiety may not be good for the cardiovascular system and heart health. Some studies suggest that anxiety increases the risk of heart diseases in otherwise healthy people.

Impaired immune function

In the short-term, anxiety boosts the immune system’s responses. However, prolonged anxiety can have the opposite effect.

Cortisol prevents the release of substances that cause inflammation, and it turns off aspects of the immune system that fight infections, impairing the body’s natural immune response.

People with chronic anxiety disorders may be more likely to get the common cold, the flu, and other types of infection.

Changes in digestive function

Cortisol blocks processes that the body considers nonessential in a fight or flight situation.

One of these blocked processes is digestion. Also, adrenaline reduces blood flow and relaxes the stomach muscles.

As a result, a person with anxiety may experience nausea, diarrhea, and a feeling that the stomach is churning. They may also lose their appetite.

Some research suggests that stress and depression are linked to several digestive diseases, including irritable bowel syndrome (IBS).

One study , of outpatients at a gastroenterology clinic in Mumbai, reported that 30–40 percent of participants with IBS also had anxiety or depression.

Urinary response

Anxiety and stress can increase the need to urinate, and this reaction is more common in people with phobias.

The need to urinate or a loss of control over urination may have an evolutionary basis, as it is easier to flee with an empty bladder.

However, the link between anxiety and an increased urge to urinate remains unclear.


Anxiety in the West: Is it on the rise?

According to some observers, anxiety is now snowballing in the United States. So, in this Spotlight, we ask whether anxiety truly is becoming more prevalent in the West and, if so, what may be causing it.

Share on Pinterest The story of anxiety is deep and long.

For many, anxiety is an ever-present uninvited guest in our circle of friends, among family members, and in communities at large.

It seems to be rampaging through society like a noncontagious cognitive plague, forming a low-level hum that hides in the corners of our collective minds.

In August 2018, Barnes & Noble — who are the largest book retailer in the United States — announced a huge surge in the sales of books about anxiety a 25 percent jump on June 2017. “[W]e may be living in an anxious nation,” one press release dryly notes.

Does this surge in interest reflect a genuine spike in anxiety, or are people simply more aware of it? In this article, we ask whether anxiety truly is increasing, if wealthier nations are bearing the brunt, and why anxiety seems to be sitting in the driving seat of modern society.

Many of us — a surprisingly high percentage, as we shall see — are all too familiar with how anxiety feels. For those who have not experienced anxiety first-hand, throughout the text, we have added excerpts from personal experiences.

Anxiety is a nebulous term that covers a great deal of psychological ground. At the thinnest end of the wedge, before an exam or a job interview, we might feel anxious. This is both understandable and normal it is not a cause for concern.

Anxiety is only a problem when it extends beyond logical worry in an unreasonable, unwarranted, uncontrollable way. Situations that should elicit no negative emotions all of a sudden seem life-threatening or crushingly embarrassing.

At the widest end of the wedge, anxiety can arrive as a symptom of another mental illness, such as panic disorders, post-traumatic stress disorder, phobias, or obsessive-compulsive disorder (OCD).

When anxiety is a person’s primary symptom, it may be referred to as generalized anxiety disorder (GAD). The National Health Service (NHS) in the United Kingdom summarize GAD neatly.

“People with GAD,” they explain, “feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue.”

GAD affects around 6.8 million people in the U.S. — or more than 3 percent of the country’s adults.

Another common form of anxiety is social anxiety, which affects people more specifically in social situations.

It might make someone very self-conscious, perhaps not wanting to eat or drink in front of others, fearing that people are talking about them, or worrying about being lost in a crowd. It comes in many forms.

Share on Pinterest Anxiety disorders are more common than one might think.

Today, “anxiety disorders are the most common mental illness in the U.S.,” affecting around 40 million adults — almost 1 in 5 people.

Globally, the World Health Organization (WHO) say that almost 300 million people have an anxiety disorder.

Anxiety disorders are not new, either. In fact, Robert Burton wrote this description in The Anatomy of Melancholy (1621) referring to a patient of Hippocrates. It will resonate with anyone who has ever experienced anxiety.

“He dare not come into company for fear he should be misused, disgraced, overshoot himself in gestures or speeches, or be sick he thinks every man observeth him.”

Interestingly, anxiety is not just a human experience, and evolution is ultimately to blame (or thank) as with other animals, humanity’s survival relies on our natural ability to feel anxious about genuinely dangerous situations and to be on guard.

It is when this life-saving mechanism is triggered at inappropriate times or gets stuck in the “on” position that it becomes a problem.

So, to the first big question: is anxiety really affecting us more now than it has in the past? Is anxiety on the up in the West, or, in a modern society where good mental health is a goal in itself, are we just more likely to notice and discuss it?

“ When it’s bad, it feels like an electric current building up inside of me and like it’s going to start shooting out of me, except it doesn’t, which is worse.”

Anon.

A large study that was published in the journal JAMA Psychiatry in 2017 set out to answer this exact question. In particular, the researchers looked at GAD.

One might expect that, since mental illness tends to be more common in areas of the U.S. that have a lower socioeconomic status, anxiety might also be more prevalent in countries with a lower socioeconomic profile.

Additionally, in less wealthy countries, people can be under substantial stress finding food, water, or safety might be an issue in some regions.

However, it is important to remember that GAD is about feelings of anxiety that are unreasonable. In a country where there is genuine struggle, higher levels of anxiety might rightly be considered justifiable and therefore not a diagnosable condition.

The study, involving 147,261 adults from 26 countries, concluded:

“The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries.”

In other words, within each country, GAD is more prevalent in less wealthy regions. However, as a whole, it is the residents of wealthier countries who are more likely to experience GAD, and their lives are more significantly impacted by it.

Breaking down the statistics, the scientists found that lifetime estimates for GAD were as follows:

  • low-income countries: 1.6 percent
  • middle-income countries: 2.8 percent
  • high-income countries: 5.0 percent

This is in line with other research that found a higher prevalence of anxiety in wealthier economies.

In the WHO’s Depression and Other Common Mental Disorders Global Health Estimates report that was released in 2017, they compare prevalence estimates of mental disorders across global regions.

When they compare the levels of depression, no single area has significantly higher rates. When it comes to anxiety disorders, however, it’s a different story the Americas are head and shoulders above all other regions, including Africa and Europe.

Interestingly, though the U.S. and the West in general do seem to be taking the lead in the anxiety stakes, it may not stay this way for long the very same report explains that common mental health disorders are increasing in lower-income countries “because the population is growing and more people are living to the age when depression and anxiety most commonly occurs.”

Added to this, anxiety tends to be less common in older adults. Also, because the average age of U.S. individuals is slowly rising, the percentage of people with anxiety disorders may gradually decline.

To conclude this section, although other countries might be catching up, it does seem that anxiety is more common in wealthier nations and perhaps the U.S. in particular — but is it getting worse?

“ Anxiety is mysterious. It can feel like an invisible cage that keeps you prisoner on your sofa, unable to move for fear of something that you can’t quite identify.”

Anon.

Much debate surrounds this question. Is anxiety on the rise, or are we simply more inclined to think and speak about it these days? This is a tough question to pick apart, but we must try.

The American Psychiatric Association ran a poll on 1,000 U.S. residents in 2017, and they found that nearly two thirds were “extremely or somewhat anxious about health and safety for themselves and their families and more than a third are more anxious overall than last year.”

They also noted that millennials were the most anxious generation.

In 2018, the same poll was repeated. Anxiety was shown to have risen again by another 5 percent.

Millennials were revealed to still be the most anxious generation.

It is crucial to remember, though, that increasing feelings of anxiety do not equate to a diagnosis of anxiety disorder.

Naturally, it is possible to feel more anxious than you previously did without it being classified as a mental condition.

Looking at the broader picture, several studies have charted the rise of mental health issues in the West.

For instance, a meta-analysis published in 2010 took data from studies that included over 77,000 young people the scientists found generational increases in mental health issues in 1938–2007.

Another report, using data from four surveys completed by almost 7 million people in the U.S., concluded that “Americans reported substantially higher levels of depressive symptoms, particularly somatic symptoms, in the 2000s–2010s compared to the 1980s–1990s.”

Outside of the U.S., the U.K. Council for Psychotherapy published a report in 2017 that assessed the mental health of full- and part-time employees. Their figures show that “workers reporting anxiety and depression have risen by nearly a third in the last 4 years.”

As for Europe at large, a huge analysis that was published in 2011 concluded that almost one third of adults had some type of mental health issue, with anxiety disorders being the most frequent.

However, this study was a follow-up to a similar pan-European review conducted in 2005, and the authors note that there were no significant increases between these years.

“ I have a list of possible problems in my head. If all the real problems are solved, I turn another one into a problem so that I can worry about it. These are constant facts of life. It is not increasing. It has always been like this.”

Anon.

The authors believe that the perception of a new wave of mental health issues may be an illusion, concluding that “the true size and burden of disorders of the brain in the [European Union] was significantly underestimated in the past.”

Another paper concludes that “it is difficult to find reliable evidence for a change in prevalence rates for anxiety disorders. Epidemiologic data obtained before the introduction of psychiatric classification systems […] are too imprecise to be comparable with modern studies.”

The study authors note that “the rate of treatment-seeking individuals increased, which may be the reason for the general impression that these disorders are more frequent.”

To add to the already complicated mix, anxiety disorders have a genetic factor. Researchers think that 30–50 percent of the variation in anxiety disorders within a population is down to our genes.

Levels of a condition that has a heritable component are likely to be more stable, since the prevalence of those genes won’t change much across a few decades or even centuries.


As Menopause Nears, Be Aware It Can Trigger Depression And Anxiety, Too

Teri Hines says she had a bout of depression during the lead up to menopause in her mid-40s. For many women, the lead-up to menopause can trigger mood issues.

Teri Hines was in her mid-40s when she started to notice that her body was changing.

Her period became irregular and more intense. "It increased in frequency, it increased in intensity and it increased in duration," she says.

She began to have hot flashes, gained weight and her energy levels took a nosedive.

"I just did not have the energy to do the things I wanted to do," she says, like the long morning walks she loved to take with her dogs, or planning solo travel.

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At the time, Hines lived alone in Philadelphia where she worked as an assistant principal at a school. She struggled to get out of bed and go to work, and she began to withdraw from friends.

Looking back, she remembers feeling isolated and unmoored. "It was such a fog over who I was, what I wanted, where I was going, what I was capable of accomplishing," she says. "I just could not find my footing."

Hines knew she was likely going through perimenopause, that is the years leading up to menopause, when women's monthly hormonal cycles become erratic as their bodies prepare to stop menstruating.

What she didn't realize — and many women don't know — is that the hormonal changes of perimenopause can bring changes in mood, and for some, a heightened risk of anxiety and depression.

"Women who have a previous diagnosis of major depression or anxiety disorder are going to be at a greater risk during the perimenopausal time," says Jennifer Payne, who directs the Women's Mood Disorders Center at Johns Hopkins University.

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And she warns that for these women, it's something to take seriously. "If you're having serious depression, and your functioning is affected, if you're having suicidal thoughts, or you feel completely hopeless, that is a major depressive episode that absolutely needs treatment," she says.

A vulnerable time

Perimenopausal mood swings often resemble symptoms of premenstrual syndrome women might feel sad, or sluggish, or irritable.

"I've had people say that they feel like they have PMS all the time," says psychiatrist Hadine Joffe, who leads the Connors Center for Women's Health and Gender Biology at the Brigham and Women's Hospital in Boston. "They just don't feel like they're in control of their mood and they feel edgy."

Generally though, these mood swings are manageable, she adds. "The good news is that most women will navigate their perimenopause without serious mental health issues."

But a significant number of women — about 18% among women in early perimenopause and 38% of those in late perimenopause — experience symptoms of depression. And symptoms of anxiety appear to be more common during this time leading up to menopause, including panic attacks.

Those most at risk are women with a history of mental illness, as well as women whose moods are particularly sensitive to hormonal fluctuations.

"Women who had postpartum depression or have always had significant mood changes premenstrually are going to be at risk of having more symptoms," says Payne.

It's not that women who develop serious anxiety or depression have any unusual or abnormal changes in hormones, she says. Rather, "it's likely that their brain is sensitive to normal, natural hormonal fluctuations."

"We know that in psychiatric illness, in general, the environment definitely plays a role," Payne adds. And during this time period, she says, there are often big life changes for women that can exacerbate their risk of having mental health symptoms

"Some women go through divorces, children go off to school, or leave the house, parents are getting older and need more caretaking," says Payne. "There are changes in career, etc."

"There's there's a lot of midlife specific stress that happens because of where people are in their life," adds Joffe.

When doctors don't pay attention

Hines was familiar with depression. She'd been depressed several times before and she had been proactive about seeking treatment.

"I had been an advocate for myself on depression and self-care and getting the right help, getting counseling," says Hines. "At times when I needed [it], using medication."

And over the years, she had learned to recognize her symptoms and triggers — often big life changes, either professional or personal.

Hines says antidepressants and counseling helped her get through the depression she experienced during the lead-up to menopause. Now, 57 and living in Smyrna, Del., she's feeling good. Hannah Yoon for NPR hide caption

This time though, she says, she was too focused on how her body was changing and missed the symptoms of depression.

"The physical nature of menopause consumes you and it's what we're taught to pay attention to," she says.

She did not know that her past history of depression put her at a higher risk of being depressed during perimenopause. But she did bring up her physical symptoms and her energy levels to her doctor early on during a regular appointment. But the conversation was disappointing, she says.

"I think she might have said 'you're about the age when you will begin to have these symptoms, you will begin to be perimenopausal,' " Hines recalls.

The doctor offered no tips to help with her symptoms or even any information about perimenopause, she says, not even the fact that on average it lasts for about four years, and for some women as long as 10 years.

This isn't uncommon. More than a 1,000 women wrote to NPR with their own stories about struggles during perimenopause. And a majority said that they had gotten little information or help from their physicians, especially for mental health symptoms.

"It's a very common situation for women, and doctors are not keeping up with that," says Payne.

This is partly because most physicians, even OB-GYNs, get little education about perimenopause, says Joffe.

Hines and many other women who wrote to NPR said they found they had to be in the driving seat when it comes to looking for and finding the right help or treatment.

Women need to be direct with their doctors about their mental health symptoms, says Joffe.

"Just the same as they would if they had a rash," she says. "They would make an extra appointment and that's the first thing they say: I have a rash."

Payne agrees. "The No. 1 thing that women can do is be honest with their doctors about their symptoms and what symptoms they're having and how severe they are," she says.

Treatments that work

Hines eventually got her doctor to pay attention and treat her mental health symptoms.

But it took her several years before she even realized that she might be depressed.

"That's when I made an appointment with my doctor and said, here's what I'm thinking, here's what I'm feeling, I think I might be depressed."

This time, her physician prescribed her an antidepressant. "The minute I went on it, I felt like I had the energy to tackle those other things that were ongoing," says Hines.

"Antidepressants can help a woman get out of her major depressive episodes," says Payne. "They can also be helpful for anxiety symptoms."

Research also shows that they can ease some of the physical symptoms of perimenopause, such as hot flashes and insomnia.

Hines also benefited from talk therapy, which studies show is also helpful for treating depression.

"I went on antidepressants and then I started going into counseling," she says. "Once I had it under control with counseling, then I was able to sort of wean the pharmaceuticals off, so that I could just use the counseling."

Joffe suggests women who are at this stage of life take steps to empower themselves. They should monitor symptoms carefully so they can have an informed discussion with their doctors.

Most of the time women just try to tough it out, says Joffe. "Women are tough. Women are accustomed to having to cope with physical discomforts and life challenges," she says. "And I think a lot of midlife women expect that this is a time of distress and discomfort and ill ease and that's normative."

But, she adds, it doesn't have to be that way. She points to resources like the North American Menopause Society's website, for example, which has helpful information about menopause as well as a tool to help women find local providers specializing in perimenopause.

"I want [women] to have permission," she says. "I want [women] to feel that they owe it to themselves and the people around them, that they aren't suffering."


What Does Long-Term Stress Do?

Stress changes every component of your body. In excess, stress makes the long-term outlook of your life considerably worse. Stress:

  • Reduces hormone function.
  • Damages organs.
  • Weakens your immune system.
  • Puts you at higher risk of cancer.
  • Causes memory loss and concentration issues.
  • Develops mental health disorders.

That latter point is important. Long-term stress is one of the key contributing factors in the development of numerous types of mental health disorders and puts you at severely increased risk of developing serious conditions like anxiety and depression. In addition, these conditions lead to further stress, resulting in a vicious cycle that can damage your quality of life.


Complex Causes of Perimenopausal Anxiety

Women report experiencing mood changes during perimenopause, including an increase in anxiety. Anxiety is extremely common during this time, and while some of the anxiety may be due to the changing hormones, there are other reasons as well.

Many believe hormones are solely to blame for the increased anxiety during perimenopause, and while this is not true, they certainly do play a role.

Hormones have a direct link to the production and management of neurotransmitters in the brain, including those that regulate anxiety levels. When the levels of neurotransmitters shift in the brain during perimenopause, it can lead to a considerable amount of mental stress and trouble coping - emotional changes that "feel" completely normal but are nothing more than a response to inadequate regulation of these neurotransmitters.

Yet hormones are not the only factor in that anxiety.

Body Changes

Women going through perimenopause often report body changes. Some of these bodily changes take place due to the hormonal shifts that naturally occur during this time, but body changes can also occur for other reasons.

Regardless of why a woman’s body is changing during this period, it can bring about a significant amount of stress. The more stress a woman feels, the more susceptible she is to having anxiety. Unfortunately, because of the strong mind/body connection (which has been substantially researched), the stress and anxiety a woman feels can actually trigger more changes in the body. This can become a vicious cycle.

Fear of the Changes

Perimenopause is a complex time for most women. And while a great deal of anxiety comes from the hormonal or body changes, much anxiety also comes from the fear of those (or other) changes, such as getting older. Perimenopause and menopause are substantial life events. All of the changes women go through during perimenopause can contribute to reflecting on the past, thinking about the future, and for some, trying to come to terms with mortality.

Perimenopause often begins between the ages of 30 and 40 when women have decades upon decades of life left. But it is often one of the first indicators or changes a woman goes through that is connected to getting older. This means can force women to consider their age, perhaps more than they had previously, and think more about their past and future. That causes a great deal anxiety.

Combine those feelings with the overall fear of eventually getting anxiety, and it's easy to see why this period can be so stressful.

Hot Flashes and Symptom Stress

Perimenopause symptoms, which of course can look a bit different for each woman, are, overall, quite stressful. One of the most commonly discussed are hot flashes. Hot flashes are sudden periods of intense heat that may occur at any time, but often occur at night. Hot flashes can make it difficult to sleep and cause considerable stress while awake.

Many women have to drastically alter their life to adjust for hot flashes, and often find that the adjustments they make are insufficient to reduce the stress that those hot flashes cause. In this sense, the hot flashes themselves start to cause ongoing distress, which can develop into anxiety. Additionally, when many women experience hot flashes, they fear more hot flashes occurring, which further contributes to anxiety.

Anxiety Increasing Perimenopausal Symptoms

Similarly, studies have shown that menopausal symptoms (and presumably perimenopausal symptoms as well) are made worse by stress and anxiety. For many women, the core issue may not be attributed solely to the perimenopause itself. Instead, the problem may be the stress, which then can cause perimenopausal symptoms to be worse, and in turn causes an increase in anxiety.

Finally, perimenopause tends to come at a time when there are other stressors in a woman’s life. Between the late 30's and early 50's, many women struggle with a variety of life issues, and what is sometimes blamed on perimenopause may be nothing more than life stress that happens to coincide with a very similar time. For example, many women going through perimenopause have children, and being a parent is a big contributor to stress in adults.

These are a variety of potential issues that can create some form of anxiety. And, most likely, the anxiety a woman feels during perimenopause is the result of an interaction of a combination of life stressors, and not quite as simple as saying "it is hormones.”


Anxiety In Kids And Teens

Anxiety disorders are not exclusively adult afflictions either — angst can strike even young kids. According to ADAA, one in eight children struggles with an anxiety disorder. The Centers For Disease Control and Prevention (CDC) says 7.1% of children age 13-18 have some type of diagnosed anxiety disorder.

Prevalence rates of anxiety tend to increase with age and this increase is thought to be a function of how our thought processes mature. That is, as our thinking develops it plays a considerable role in viewing stressors. This is observed early on when signs of separation anxiety may first be seen when younger children start school and struggle to adjust to leaving the comfort of their home and family. A teen’s perspective of their world and how their peers view them (e.g., being embarrassed, bullied, or other public humiliating experience) are key factors in the manifestation of social anxiety and its onset most often appears during puberty.

Getting a handle on anxiety during childhood is important. Research has shown that children and teens with untreated anxiety disorders are at higher risk of poor performance in school, social avoidance, and substance use, as well as comorbidities including eating disorders and ADHD. Therapy, medication in some cases, and familial support can help kids manage their anxiety, learn coping mechanisms early on, and lead healthy lives.