Anxiety

Anxiety disorders are the most common mental disorders[1]: nearly 1 in 3 people will meet symptom criteria for an anxiety disorder in their lifetime.[2] However, you don’t need to have an anxiety disorder for anxiety to affect your life and to want to change it. Therapy is an extremely effective tool in addressing the root causes of anxiety – whether there is a disorder present, or not – helping you to have a more fulfilling life.

Anxiety has a number of different faces – social anxiety (or social phobia), performance anxiety, panic, anxiety attacks, PTSD – and can manifest in a variety of different ways: it can feel sudden and unexpected or it can have a slow build up and linger, it can be overwhelming or it can sit in the background making you feel "on edge," it can be attached to a specific activity or it can be an ambient part of your life. Because of this and its high prevalence, there is sometimes a confusion, even among mental health professionals, about whether or not anxiety is truly a disorder.

Is Anxiety Really a Disorder?

It is true that anxiety has an adaptive function, but anyone who has had a panic attack or turned beet red and start sweating uncontrollably at the mere thought of speaking to a crowd knows that experience is anything but advantageous. So how does an anxiety disorder differ from the more general forms of anxiety and worry we all feel?

Experts on anxiety sometimes refer to the difference through reference to the "smoke detector principle".[3] Consider when you are cooking fajitas and your smoke alarm goes off. Did it malfunction? Although it seems like it should know when you are cooking and when there is a real fire, smoke detectors are overly sensitive by design. That is because the false-positive (i.e., a smoke detector going off when there is no fire) is merely irritating but the false-negative (i.e., a smoke detector not going off when their is a fire) is deadly. Similarly, your anxiety response was evolved to detect the slightest threats because the false-negative could have meant disaster to your ancestors. In these circumstances, your anxiety is real, and it may even be intense, but it isn't a "disorder".

But what about when your smoke detector goes off all the time? Or never goes off even when there is tons of smoke? Or goes off randomly throughout the day? Or is miscalibrated so that it only goes off when something benign is happening? Or when it goes off it generates such a loud noise that you can’t even think straight enough to leave the building?

In these cases, your smoke detector is not working properly. Analogously, anxiety responses can be dysfunctional: if you are anxious all the time, or never, or randomly, or when something that should not cause you anxiety (e.g., someone loving you) causes you to be anxious, or if your anxiety response is so severe that you cannot do anything but curl up into a ball, your anxiety may not be adaptive - you may have an anxiety disorder.

Therapy for Anxiety

Anxiety disorders are very treatable, but you don’t need to have an anxiety disorder to benefit from therapy for anxiety. In fact, most people seeking therapy for anxiety likely do not have a disorder and are helped by therapy!

Just as grief, relationship difficulties, family disputes, and lack of motivation are not disorders but nevertheless painful conditions that therapy can help with, even adaptive anxiety can be unwelcome and therapy can help manage it. This is because, as Robert Spitzer (the designer of the modern DSM system) succinctly explained: "Diagnosis and need for treatment are not the same."[4]

We can have a greater control over our anxiety than we tend to think. Instead of simply succumbing to your anxiety, therapy can help you develop skills lessen its impact on you by reducing its intensity and helping you to manage the feelings when they are intense.

[1] American Psychiatric Institution. (2023). Anxiety Disorders. Retrieved from: https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders

[2] Harvard Medical School. (2017, August 21). National comorbidity survey. Retrieved from: https://www.hcp.med.harvard.edu/ncs/index.php

[3] Nesse, R. M. (2018), The smoke detector principle: Signal detection and optimal defense regulation. Evolution, Medicine, and Public Health, (1).

[4] Spitzer, R. L. (1998). Diagnosis and need for treatment are not the same. Archives of General Psychiatry, 55.