Everyone experiences occasional bouts of anxiety, as it’s a normal part of the human experience. However, for millions of children, adolescents, and adults, anxiety plays a significant role in their day-to-day lives. It causes significant distress, interferes with their ability to function, and robs them of the joy they deserve. In severe cases, anxiety can be debilitating, making it impossible to hold down a job or finish school.
According to the Anxiety and Depression Association of America, 40 million U.S. adults suffer from an anxiety disorder, making it the most common type of psychiatric disorder in the country. Sadly, despite the fact that anxiety disorders often respond very well to proper treatment, two-thirds of those individuals are never treated for their anxiety .
For some individuals who suspect or know something is wrong, it can be difficult to consider the possibility of a “mental illness”, let alone actually have it confirmed with an evaluation. But perhaps one of the major reasons that so many people never get treated is because the disorder goes unrecognized and undiagnosed. Why? Because many of the signs are subtle – they remain “under the radar” or are simply accepted as normal.
Knowledge and awareness play an important role when it comes to recognizing the need for treatment. Following is a brief look at several subtle signs of an anxiety disorder. Keep in mind that there are several different anxiety disorders (e.g. social anxiety, generalized anxiety, and panic disorder), so the subtle signs can vary significantly from one person to the next. Also, in of and themselves, many of these don’t automatically signal the presence of an anxiety disorder. However, if you identify with any of them – and especially if you experience two or more on a regular basis – a closer look and evaluation is warranted.
We all feel like avoiding unpleasant things from time to time, but individuals with certain anxiety disorders frequently engage in avoidant behavior. Their goal is not just to avoid something unpleasant, but to avoid the intense anxiety and distress that occurs when faced with the object, place, or situation. For example, individuals with social anxiety disorder will go to great lengths to avoid social events or being in the spotlight. Someone with a phobia related to flying would rather spend 3 days driving 1500 miles than 3 hours on a plane. Individuals with PTSD (posttraumatic stress disorder) will do whatever they can to avoid any place, person, or situation that reminds them of the traumatic event that triggered their disorder.
It’s one thing to have an unwanted thought cross your mind from time to time; it’s quite another when the disturbing thought keeps popping into your head multiple times a day – or even an hour. Recurrent obsessive thoughts are one of the hallmark features of OCD (obsessive-compulsive disorder). The persistent thoughts feel intrusive and inappropriate. They’re also usually irrational (e.g. worrying about leaving the door unlocked despite having checked it multiple times in the past few minutes, or fearing that you’ve suddenly “turned gay” despite having never felt an attraction to the same sex). The thoughts can come in various forms, including impulses, images, and ideas. They may or may not be accompanied by compulsive behaviors, such as excessive cleaning, counting, or meticulously keeping things in a certain order.
It’s very hard to focus or concentrate on anything when you’re worried, tense, nervous, self-conscious, in a panic, overwhelmed, or stressed – all of which are common manifestations of underlying anxiety. Despite your best efforts to focus on the task at hand, you often find yourself distracted by the negative thoughts and feelings. Although poor concentration is one of the symptoms of depression, it can also be an indicator of an anxiety disorder.
Self-destructive “Nervous” Habits
Also known as compulsive behaviors (although not the same type of compulsions associated with OCD), many people who struggle with anxiety engage in these self-destructive habits. For example, although compulsive nail biting (onychophagia) can develop out of habit, it’s frequently a sign of anxiety. The same goes with compulsive hair pulling (trichotillomania) and skin picking (dermatillomania). When the behavior is due primarily to anxiety, it typically intensifies as the anxiety intensifies. For someone experiencing severe anxiety, these self-destructive behaviors can cause significant physical pain and damage, including bleeding, infection, and permanent scarring.
Bruxism is a condition that involves frequently grinding or clenching the teeth. Although it could be included with the nervous habits listed above, it gets separate mention because many people with bruxism engage in the behavior while they’re asleep (“sleep bruxism”). While bruxism can be caused by several different things, anxiety is one of the more common culprits.
Food, alcohol, and drugs are often used to self-medicate unpleasant feelings. If you’re struggling with an anxiety disorder, you may find yourself reaching for a drink or other substance to “calm your nerves”. It’s one of the reasons for the oft-used phrase, “I need a drink”, when faced with a stressful situation or unwanted emotions.
If you frequently find yourself turning to comfort foods, alcohol, or any type of drug that relaxes you (e.g. benzodiazepines, such as Xanax, or street drugs, such as marijuana) when you’re feeling anxious or stressed, or when you can’t shut off your brain at night when you want to fall asleep, the possibility of an anxiety disorder should definitely be considered.
Sense of Dread
Many people who have an undiagnosed anxiety disorder, especially GAD or PTSD, often struggle with a frequent feeling or sense of dread. It can be subtle, even though very intense, and may manifest in a physical manner rather than a conscious thought. For example, you may feel a “heaviness”, particularly on your chest, and find it difficult to relax your body. It’s not unusual to also feel restless or on edge. Quite often, you can’t really explain it or shake it off – it’s just there, hanging over you like a very dark, ominous cloud.
While excessive worry may seem like an obvious indication of an anxiety disorder, not everyone sees it that way, which is why it’s worth mentioning. For example, Jenny started her family late in life, having her first child at 42. With 2 young boys by the age of 45, anxiety became a daily part of her life. Every scraped knee and minor cut triggered fearful thoughts, such as “what if something much worse had happened?” And any news story of a child’s death or kidnapping sent her mind racing and escalated her fear.
By the time her oldest boy was in the first grade, Jenny was so worried about something bad happening to one of her children that she very rarely had a good night’s sleep. She also often felt tired, irritable, and tense. Jenny assumed that it’s normal and even expected for a mother to worry so much about her children. Despite her distress, seeking treatment never occurred to her.
While everyone worries from time to time, people like Jenny get stuck in the never-ending mental barrage of “what ifs”. Worst-case scenarios frequent their thoughts, filling them with dread and fear. This pattern of excessive worry is typical of generalized anxiety disorder (GAD).
Anxiety is often accompanied by restlessness. When you’re anxious, you may find it hard to sit still for any length of time. Pacing and hand wringing are two types of restless behavior, and not uncommon for someone feeling especially anxious. Restlessness interferes with sleep and concentration, and tends to make your entire body feel tense. If you often feel restless, anxiety may be the reason.
It’s not uncommon to become irritable when you feel scared, worried, stressed, or “on edge”. Sometimes the irritability associated with anxiety disorders is due to the problems the anxiety is causing in your life, such as strained relationships or problems at work due to impaired job performance. It may also be due to the fatigue you experience when you’re not sleeping well (as a result of anxiety). Unfortunately, the consequences of your frequent irritability (e.g. conflicts at work) can trigger even more anxiety, making it a vicious circle.
Susan suffered with undiagnosed anxiety much of her adult life. Like Jenny, she worried excessively about her children. She also worried constantly about money, her job, and potential health issues. It’s no surprise that she also frequently complained of stomach problems, heartburn, and irregularity.
The body-mind connection has long been recognized, although it still doesn’t get the attention it deserves. Many people who struggle with digestive problems, such as a frequently upset stomach, bouts of constipation or diarrhea, and IBS, also struggle with anxiety. In fact, anxiety is often a cause (or at least one of the causes) that’s often overlooked. Your body is simply unable to properly and efficiently digest food when it’s constantly tense.
Anxiety can also indirectly lead to problematic digestion. For example, when you’re stressed, worried, or overwhelmed, you’re more likely to eat foods that aren’t particularly healthy. You may also skip meals, drink too much, or eat too fast – none of which are good for your digestive system.
Frequent fidgeting can be due to habit, boredom, or ADHD, but it’s also often an indication of anxiety. While fidgeting can include any of the self-destructive behaviors mentioned earlier, it also includes things like brushing away lint, constantly straightening your clothing or items in front of you, swinging your leg while sitting, fiddling with a cell phone or remote control, or tapping your fingers or feet.
People who are shy or timid are also often anxious, at least to some degree. Those who are extremely shy very often suffer from social anxiety disorder. They fear being criticized, judged, ridiculed, scrutinized, and rejected by others. They also tend to be very self-conscious, worried and often assuming that others are paying close attention whether or not they actually are. Regardless, the assumption exacerbates their anxiety.
One of the worst things about extreme shyness is that it can become a self-fulfilling prophecy. Very timid individuals fail to develop good social skills. When they do have to engage in social situations, their awkwardness and discomfort often elicits the very criticism and rejection they fear, which reinforces their anxiety and avoidant behavior.
Individuals who struggle with perfectionism often struggle with considerable anxiety as well. In fact, the excuse that everything has to be “just perfect” is often a smokescreen for the fear of not being good enough, being judged, making mistakes, or failing. Many perfectionists use the excuse of “high standards” and “being hard on themselves”, when in reality, they are gripped with anxiety. Rather than face their fears and complete something, they may start a task over again and again or fuss endlessly about details. Perfectionism is not uncommon in individuals who are highly self-conscious or have OCD.
Anxiety is always rooted in fear. As a result, it’s difficult for anxious individuals to fully trust anyone or anything, including themselves. Those who struggle with GAD often find it hard to believe that anything can work out for the best, and have a hard time accepting or trusting reassurances from others. Individuals with PTSD often find trust very difficult, especially with individuals or situations that elicit memories or emotions related to past trauma. For example, a woman who’s survived a brutal rape may have a hard time trusting men, not to mention her ability to protect herself or escape should she ever feel threatened.
Anxiety disorders are treatable and can even be overcome with proper treatment. Cognitive behavioral therapy is generally regarded as one of the best therapeutic approaches for anxiety disorders. It helps your recognize irrational and unhealthy thought patterns and behaviors, and teaches you how to replace them with healthy and empowering ones. Medication, particularly SSRIs (selective serotonin reuptake inhibitors, like Paxil and Zoloft) may also be recommended as part of treatment to help alleviate anxiety symptoms. However, medication should not be used as the sole treatment for any anxiety disorder.
If you find yourself frequently feeling stressed, worried, overwhelmed, tense, or afraid, and if any of the subtle signs listed above resonate with you, it’s time to talk to someone. Contact a mental health professional for an evaluation. The distress and negative emotions don’t need to rule your life; they can be managed and even overcome. You deserve a happy life free from frequent or constant anxiety.