It is safe to say that anxiety is ubiquitous. No one escapes the experience. That being said, anxiety is not necessarily pathological or an indication of a psychiatric disorder. Believe it or not, anxiety can be a necessary experience. Many of us need a certain level of anxiety to succeed because it does have a motivational value. Consider the athlete or performer who acknowledges significant anxiety before their event only to succeed admirably at their task.

This is where the positive helpful aspects of anxiety ends. There is a critical threshold that once reached turns helpful anxiety into a problematic emotional state. Once the anxiety gets to this level it has a negative deleterious impact on performance and function. When most severe, this level of anxiety can be incapacitating. It can cause one to freeze, become immobilized and avoidant. Agoraphobic, resulting in essentially becoming housebound is an extreme outcome. Imagine being so fearful and frightened that going for a walk around the block becomes an impossible overwhelming task.

It would be helpful at this juncture to help clarify what we mean by the word “anxiety”. We all use this word but do we ever think of clarifying for ourselves what we mean by it? As I have discussed in previous articles, the use of language in my field is absolutely critical because psychiatrists do not have the luxury of extensive biological testing to clarify the nature of the symptoms our patients present with. Getting one to be as concrete as possible explaining what they mean by the words they use becomes essential. It is not unusual to find that a person complaining of being depressed may be in fact experiencing an anxiety disorder. The opposite also occurs, with anxiety complaints actually reflecting a depressive disorder. Like the old sayings, “it’s all in the fine print”, or “the devil is in the details.”

I find that it can be helpful to understand anxiety as being composed of two components, components that can occur concomitantly or in isolation. Psychic anxietyrefers to the experience of pathological worrying, overthinking, apprehension/fear, catastrophic thinking (taking the worry to the worst possible outcome no matter how irrational it may be) and a head that won’t turn off. One can imagine how debilitating this state can be. Problems with focus, attention, problem solving and memory often result. Experiencing this type of anxiety is like being in one’s own torture chamber 24/7.

Somatic anxiety refers to the physical experience of anxiety. Symptoms include racing heartbeat, shortness of breath, rumbling stomach, headache, back pain, sensation of hot and cold and muscular tension all reflect this type of anxiety. One feels an adrenalin like surge as if ten cups of coffee were consumed in a short period of time. Apprehension and fear often accompany this physical state. A pathological vicious cycle ensues because the fear state then activates even more intense physical discomfort and so on.

An indicated, somatic and psychic anxiety can coexist or they can present singly as psychic or somatic. Generally speaking, psychic anxiety often is the trigger for the somatic component. When the psychic anxiety is effectively treated the somatic component improves along with it. Cognitive behavioral and pharmaceutical interventions can target both aspects of anxiety but may require different approaches to each. Treatment is essential, not to diminish the personal suffering that ensues but also to prevent the significant health risks that can develop into a variety of medical illnesses. High blood pressure, cardiac disorders, cancer, a compromised immune system, headaches, stomach ulcer, etc are all examples of the significant health consequences of untamed anxiety states.

The good news is that once successfully identified, anxiety disorders can be treated. I have been impressed with the effectiveness of cognitive behavioral therapy and pharmacologic interventions. It is important to identify the presence of anxiety problems early. The outcomes are most gratifying.