The Worrywart's Companion
    McGraw-Hill, 1997, 2009

     Copyright notice at bottom

When Is Worrywarting a "Disorder"?
Dr. Beverly Potter

Chronic, unrelenting worry generates anxiety.  A little anxiety is good.  You need it to function, to get the juices going so you can perform well.  But continuous anxiety debilitates.  It paralyzes you and causes you to pull back, to avoid situations.  High levels of anxiety interfere with performance, especially brain work.  There are a number of disorders and phobias maintained by anxiety.  Perhaps you wonder if you have such a disorder. It is helpful to review them briefly. 

Anxiety is feeling of apprehension and uneasiness triggered by a vague or ill-defined threat.  Experiencing anxiety is an inevitable part of life-especially with our modern, stressful lifestyles.  There are many situations in which you would expect to feel some anxiety such as when preparing for a speech or undergoing a job interview, for example.

Even if you are unable to specify what you are anxious about the distress is very real nonetheless. Your heart races, you sweats, your muscles tense up. Worry is often the culprit behind the nervous, uneasy anticipation of trouble.

Anxiety becomes a problem when it drives your life and pushes you to avoid situations.  Then anxiety may go over the boundary from normal to being a "disorder." Anxiety experienced by people with "anxiety disorder" is the same as that experienced by people without any disorder, only it is more intense, lasts longer and triggers certain actions. In other words, whether anxiety is considered normal or a problem is a matter of degree and impact.  If the anxiety interferes with normal living or dictates your actions, chances are anxiety has gotten the upper hand, threatening to control your life.  As strong as the anxious feelings and thoughts are, sometimes you may not know you are suffering anxiety, which can be quite frightening since you don't know what to attribute your distress to.

Fear and anxiety are similar in many ways.  Both trigger the same physical symptoms from simple muscle tension to a pounding heart, and both can engender a sense of helplessness, confusion, apprehension, worry, and negative thinking. The difference between the two lies in the nature of the threat that triggers it. Anxiety triggers can be very vague and hard to pinpoint, in contrast, fear is triggered by a clear threat, such as a man standing in the shadows along a path you are walking upon, for example.

An obsession is a persistent idea, image, or impulse that is bothersome and intrudes into your thinking.  Worrying about whether or not a particular action was performed, such as turning off the heater before leaving the house is an example of a common obsessive thought.

Scary thoughts, as obsessions are often called, include frightening thoughts of harming other people or yourself. Imagining an urge to jump off a bridge when crossing it is an example.  Some obsessions revolve around images of unacceptable sexual behavior, like imagining an urge to throw off your clothes and run down the street, for example. Sometimes the obsession is an impulse to violate social norms such as the urge to swear in church.

When plagued with an obsession, hard as you try you can not get the offending thought out of your mind.  It keeps coming back, intruding and haunting, while you shock yourself with scary thoughts, and worry that your are going crazy.
A compulsion is an action or behavior that is repeated in ritualistic or repetitive fashion. A compulsion operates in much the same way that superstition does when you carry a magic charm to bring good fortune or ward off harm.  When you meet with no harm, carrying of the charm in the case of superstition or engaging in the compulsive act is rewarded. Similarly, the compulsive action is intended to produce or prevent some future event even though in reality it actually has no bearing on the event.

A compulsion can be a normal behavior carried out in an excessive manner, such as constantly brushing your teeth, or excessively washing your hands, for example.  Checking things over and over is a common compulsion.  Going back repeatedly to make sure the heater is turned off when leaving on a vacation is a compulsion we've all engaged in at one time or another.  Other common compulsions include counting things, like the squares in the sidewalk or the steps to the corner store. 

Compulsions usually begin as attempt to deal with anxiety. For example, counting and paying attention to detail can reduce distress because it distracts you. Counting can become a compulsion because it works-for a while. The compulsive behavior temporarily relieves the distress, but the anxiety always comes back. And when it does, the compulsive behavior becomes even more entrenched, so that you must count the number of steps to the store or you'll explode in panic.

Compulsive actions are usually a response to obsessive thoughts. They go hand in hand and the disorder is often called "obsessive compulsive." Uncontrolled obsessive thoughts drive the desperate compulsive behavior. For example, a man obsessed with worries of germs contaminating him might compulsively wash his hands ten or fifteen times an hour. While his hands are, in fact, clean-and even chapped from so much washing, he nonetheless still feels unclean and worries about germs spreading, so he washes his hands again and again. Compulsive behaviors are usually harmless since they tend to be little more than a normal behavior engaged in excessively.  Compulsions become problems when they interfere with your life, cause you or those close to you emotional distress or when you can't control them.
Panic Attacks
A panic attack is an intense state of anxiety that occurs for no apparent reason. The anxiety episode comes out of the blue, sometimes quickly without warning; in other cases the panic builds gradually over a period of time.  Most panic attacks are unexpected, lasting about a half hour.

About 5% of Americans-over 10 million people-suffer from panic attacks. Physical sensations experienced during panic are several, including shortness of breath, choking, palpitations and accelerated heart beat accompanied by chest pain or discomfort.  The symptoms can be so intense that you may think you are having a heart attack or stroke.  There are many cases where a panic victim has been carried off in an ambulance to the emergency room, only to be told that there is nothing physically wrong. Sweating, faintness, nausea and abdominal distress are common. Flushes or chills, trembling and shaking, combined with numbness or tingling in the fingers, toes, and lips is also common. Many people say they experience a sense of unreality and an intense fear that they are losing control and going crazy.

Your mind runs a mile a minute during panic attacks, flooding you with uncontrollable scary thoughts, bewilderment, and, well-panic. Often there is an extreme apprehension about dying, going insane, having a heart attack, embarrassing or hurting yourself or other people. People who experience panic attacks dread them and make great efforts to avoid anything that might trigger one. They begin monitoring their physical and emotional state obsessively, constantly searching for small signs of an on-coming panic attack. It's this dynamic of hypervigilence and compulsive avoiding of anxiety-inducing situations that sets the stage for agoraphobia

Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is severe anxiety resulting from a traumatic event such as military combat, rape, assault, natural disaster, major surgery, observing or being in a serious accident.  The underlying dynamic seems to be severe trauma combined with helplessness-the inability to escape the trauma or to protect yourself from it. Daniel Goleman, author of Emotional Intelligence, describes it as "horror frozen in memory."  People suffering from PTSD have uncontrollable reoccurring images of the event and nightmares about the trauma. So vivid are the memories it feels as if the trauma is occurring in the present.  The more horrendous the original trauma, the more indelible the memory

Ordinarily people get over traumas, in time they desensitize.  But people afflicted with PTSD seem to have a lowering of the threshold for alarm so that they react to ordinary situations as if they were full-blown emergencies. Each panic episode reinforces the traumatic learning. PTSD sufferers experience a general emotional numbness and have a reduced ability to feel pleasure. 

Spontaneous relearning that usually occurs over time fails to occur.  If you are suffering PTSD your ability to relearn is impaired resulting in an abnormal persistence of emotional memories. The panic reaction seems to be imprinted right into your neural circuits. Small, seemingly insignificant and ordinary things can set off the panic response which becomes almost an automatic knee-jerk-type reaction. 

A phobia is an extreme or abnormal fear that has no real basis. in the situation where the fear is experienced. The fear focuses on a specific object or situation and is present only when that object or situation is encountered.  Insects and spiders, flying in airplanes, being in closed spaces, darkness, heights, bridges, and elevators are frequent phobic objects.  Phobias are surprisingly common-afflicting about 10% of the population or over 20 million people-and generally don't create too much of a problem since it is usually easy to avoid the feared object. The only time most phobias become a problem is when the feared situation can't be avoided or when it involves your work.

There are many kinds of phobias.  Social phobia is quite common, afflicting many people who don't think of themselves as phobic.  Social phobia, sometimes called performance anxiety, is an intense fear of embarrassment and of humiliating yourself in front of people, especially when performing.  Fear of public speaking is probably its most common form.  Other examples include difficulty eating in public, extreme self-consciousness when using public bathrooms, fear of writing one's name in front of other people, and fear of blushing.  Severe cases of shyness and stuttering could be included. 

People usually think of agoraphobia as a fear of leaving one's house. While agoraphobic people often become home-bound it is having a panic attack in public that is so feared. When you have agoraphobia you experience severe anxiety accompanied by dizziness, profuse sweating, racing heart with chest tightening, hyperventilation and difficulty swallowing. You can become disoriented, have tunnel vision and be confused about what's going on. Feeling nauseous and having diarrhea are common complaints.  The 13 million people afflicted with this debilitating condition try to avoid situations where they might have a panic attack and experience these frightening feelings. This avoidance propensity quickly curtails the victims lifestyle until, in many cases, he or she can not leave home at all!

The types of situations avoided vary from person to person and time to time.  Commonly avoided situation include traveling away from your house-even short distances, crowds, standing in line, being on a bridge or in an elevator, public transportation, making a left turn from a turning lane, driving on freeways, going into a theater or a restaurant.  What all these situations have in common is that they are viewed as traps from which the terrified agoraphobic can not escape quickly if panic should come on. The list of situations avoided tends to increase with each panic attack and your activities usually narrow until fear and avoidance dominates your life.  It may get so bad that you need a companion, sometimes called a "safe person", to travel even short distances or enter new situations.

The Role of Worry in Anxiety Disorders
The boundaries between the various anxiety disorders blurs with much overlapping. Panic attacks play a pivotal role in both agoraphobia and post-traumatic stress, for example. Social phobias are similar to agoraphobia since both exhibit fears of social embarrassment, is another example. The fine distinctions are only relevant to therapists and other experts. If you think you are suffering from any of these anxiety disorders it's a good idea to consult with a professional-your physician, a counselor or therapist. 

Anxiety Disorders Are Learned
 The engine driving  anxiety disorders is negative dialoguing or self-talk, sometimes called negative thinking or worry. You are not born with an anxiety disorder, you learn it. Certainly some people are more emotionally sensitive and may even have an inherited propensity to anxiety.  But anxiety disorders are acquired and worry is an important component.

Unrelenting chronic worry drives you from simple anxiety along the path to increasingly severe anxiety responses.

It is a frightening process, one where you often believe you are unique in your distress.  You feel alone and misunderstood, without hope and without help. Fears that you are mentally ill compounds your anxiety. Soon you watch for the smallest physical signs of anxiety and then react with alarm if any symptom is noticed.  It becomes a vicious cycle of anxiety and worrying about being anxious until you work yourself into a full blown panic. 

Worrywarts Fear Losing Control
Maintaining control is an enormous issue to everyone, but most especially worrywarts.  Anxiety that comes out of the blue makes you feel like you are losing your grip on things.  What if you fall to pieces on the job or in a restaurant?  What a frightening idea.  But this is just the kind of fear people with anxiety disorders worry about?  Worry is an attempt to keep control-to foresee pending danger and pull in the reins to protect yourself.  But paradoxically, worry generates the very anxiety it is suppose to control so that it becomes an ever escalating vicious cycle of anxiety and worry.  When you really look closely at what is going on you'll see that your mind is filled with negative self-talk-an unending anxiety provoking conversation that you carry on with yourself.  And it is this negative dialogue you carry on with yourself, this worry that propels the problem. 

Trying to stop worrying is not the solution.  You can't stop and trying to do so will only create more anxiety and worry.  You can, however, change the way that you worry. You can stop worrywarting and start worrying smart.  Worrywarting is a bad habit-one you can change. It is hard to do, especially in the beginning as it is with all bad habits.  In the forthcoming pages you will discover several strategies and techniques for becoming a smart worrier.

When To See A Professional
One of the signs that worry has veered over the line into the pathological is when the anxious thoughts are so intrusive they overwhelm all other thoughts, continually sabotaging attempts to pay attention to whatever task is at hand. This book is not meant to replace psychiatric or medical treatment. If you are currently in therapy or undergoing medical treatment for anxiety or a related condition, you should continue that treatment.  The techniques in this book could help, but you should have your therapist or doctor decide how to the techniques can be integrated into your treatment program. 

If you are experiencing extreme levels of anxiety, have panic attacks, or suffer from excessive fears, especially the fear of becoming anxious or panicing, seeing a licensed practicioner is advised. There are many medical conditions that can cause high levels of anxiety, including hyperventilation syndrome, hypoglycemia and low blood sugar, hypertension, mitral valve prolapse, PMS, inner ear disturbances, certain mineral deficiences, cardio-vascular problems, concussions, brain rhythm irregularities and environmental toxins. If you are taking medication for a medical condition, that medication may be triggering anxiety.  If you use or are withdrawing from "recreational" drugs or alcohol, this could be a source of anxiety 

David Burns, author Ten Days to Self-Esteen, suggests that you seek the advise of a professional if you feel hopeless and suicidal, if you have been depressed for more than a month, if you feel so overwhelmed or discouraged that you cannot function effectively at school or at your job, if you cannot relate to other people in a positive and satisfying way, if you hear voices or have hallucinations or unusual experiences that others cannot readily understand, or if you have aggressive sexual or violent outbursts you cannot control


Copyright;  The Worrywart's Companion: Twenty-One Ways to Soothe Yourself and Worry Smart, Dr. Beverly Potter, 1997, 2009, McGraw-Hill.
This article may be downloaded or copied for personal use.  Any other use requires permission form Beverly Potter.