Occasional anxiety, such as nervousness before an airplane flight or a medical procedure, is normal, but those feelings are temporary. When your worrisome feelings persist or become severe, however, you may have an anxiety disorder.
For older adults, understanding and coping with anxious feelings can sometimes be especially challenging, says T.H. Eric Bui, MD, PhD, associate director for research at the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital. “Many individuals who suffer from anxiety disorders experienced their first symptoms, including worries or fear, in childhood or adolescence,” he explains. “When older adults report anxiety, it is frequent that they have a long-standing history of being anxious. However, while they were able to manage their anxiety in the past, in response to a major stressor, such as the death of a loved one or due to aging, older individuals may lose their ability to cope with this anxiety. The anxiety then becomes overwhelming, distressing, and impairing.”
What Is Anxiety?
The American Psychological Association defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.” Other physical symptoms can include a rapid heartbeat, sweating, dizziness, and trembling.
“Feeling anxious or stressed can be adaptive,” Dr. Bui says. “For example, feeling stressed is a normal response to a threat. In fact, the stress response means that our body and our mind are getting ready to face, cope, and deal with a danger.”
Indeed, most people experience temporary worries or fears at various points throughout their lives. Often the concerns are focused on a particular event or circumstance. Once there is resolution, the feelings usually subside or you develop a way to cope so that the worries don’t become overwhelming.
“For example, if you have to take an important exam next week, the anxiety and stress will push you to study more,” Dr. Bui says. “Mild levels of stress during the examination will also make you perform betterÑyou will be more ‘awake’ during the exam. It is only when the anxiety and stress is overwhelming, very distressing, or interfering with social or work functioning that it is a problem and warrants intervention or treatment. In other words, if the anxiety is no longer helpful, then the individual might want to seek help.”
People with an anxiety disorder tend to have recurring and intrusive thoughts and worries that can’t be easily dismissed or controlled. Finding a healthy perspective on intrusive concerns may be difficult. Their quality of life may suffer and their ability to maintain a job, enjoy healthy relationships, and just function from day to day all may be compromised.
What Causes Anxiety?
An anxiety disorder can affect anyone at any age. Certain circumstances can increase the risk of developing anxiety. Among the more common risk factors are:
- Childhood trauma, such as abuse or witnessing a traumatic event.
- Serious illness that triggers worries about treatment and recovery.
- Mental disorders, such as depression. It’s common for someone with depression also to have an anxiety disorder.
- Drug or alcohol abuse, which can worsen feelings of anxiety.
- Chronic stress related to work, family, money or other factors.
- A blood relative with an anxiety disorder, as mental disorders can run in families.
“Similar to other psychiatric disorders, the causes of anxiety are multifactorial,” Dr. Bui says. “There are genetic, personality, and environmental risk factors for anxiety disorders.”
When to Seek Help
Unlike a physical health crisis, such as heart attack or a car accident, mental disorders such as anxiety can slowly invade your everyday thoughts and feelings. You may not be aware at first how serious your worry and fears have become.
As with many other psychiatric disorders, the first step is to recognize that one has pathological levels of anxiety, Dr. Bui says. “If the anxiety or stress experienced is very distressing or if it is interfering with the ability to socialize, work, or enjoy life, then it would probably be useful to seek professional help.”
If you find yourself avoiding situations because of worry or turning to alcohol or drugs to calm your worries, it’s time to get some help. And if you are starting to have suicidal thoughts, seek emergency medical treatment.
For some people, anxiety is a side effect of medication or a symptom of an underlying medical condition. Heart disease, chronic pain, thyroid disease, respiratory problems, and withdrawal from alcohol or anti-anxiety medications may lead to feelings of anxiety. If you feel that your anxiety is related to a physical health issue, talk about your concerns with your doctor. If you have no personal or family history of anxiety and you don’t avoid situations out of worry, your anxious symptoms may be due to an underlying medical condition.
Easing Your Worry
Once you have recognized that your anxiety is not subsiding and may be getting worse, ask your primary care doctor if he or she could refer you to a specialist, Dr. Bui advises.
“In the meantime, it would be important to maximize other things that can help decrease anxiety, such as exercising regularly and decreasing alcohol intake,” Dr. Bui recommends.
Anxiety treatment with a mental health professional can take on many forms. Dr. Bui says that cognitive behavioral therapy (CBT) is the gold standard psychotherapy approach. CBT helps you understand that how you think about a situation affects how you feel and act. One of the main goals of CBT is to help you identify unhelpful and unrealistic thoughts and concerns and then develop problem-solving strategies that will change your thinking. Dr. Bui adds that SSRI antidepressants are the gold standard pharmacotherapy approach for treating an anxiety disorder. For many people, however, medications may not be necessary, or may be taken temporarily as part of a treatment plan that also includes CBT or other form of talk therapy.
“Recently, there has been emerging evidence supporting the efficacy of mind-body approaches for anxiety disorders,” Dr. Bui adds. “In our lab, we are about to complete a study comparing the efficacy of CBT to yoga for generalized anxiety disorder.” Research is also underway comparing an SSRI antidepressant to mindfulness meditation training for all anxiety disorders.
Just remember that while temporary feelings of anxiety are normal and often helpful, prolonged periods of worry can be harmful. And because anxiety can often be treated successfully, restoring a positive quality of life, you owe it to yourself and those close to you to seek treatment and begin easing your fears.