Yesterday, I received a call,
“Dr., I’m not eating, sleeping, no appetite, worrying constantly, only I don’t know why. I feel like I’m in trouble for some reason and I will be punished. Funny thing is, I’ve done nothing wrong. Not a thing. I got a letter from the IRS and when I saw it I almost had a heart attack. My husband had to open it, and it was just an address change. It’s been like this for about six months, I’m constantly on edge. I’m 34 years old and I haven’t done anything with myself. Maybe that’s why I feel so guilty. Can you help?”
ANXIETY IS TURBULENCE:
My first thought after reading this was that this woman is experiencing Generalized Anxiety Disorder.
What is Generalized Anxiety Disorder?
In psychiatric terms, Generalized Anxiety Disorder is:
Excessive worry for more days than not for at least six months
Difficulty controlling worry
Worry is associated with at least three of the following:
Restlessness
Fatigue
Irritability
Muscle tension
Sleep disturbance
Worry causes distress and impairment in daily activities
No physical cause for worry
No other cause can be found for worry
To be sure, many people experience this anxiety state. The depth of feeling ranges from mildly annoying to catastrophically immobilizing. It is one of the more common issues people seek me out. What must it feel like to be this woman?
There are a few biological-structural features of Generalized Anxiety Disorder
Generalized Anxiety Disorder is a Gray Matter (GM) dysfunction. This means that people who experience anxiety usually have more Gray Matter in three specific areas of the brain. The Hippocampus, Thalamus and the Amygdala. A more common way to describe this is that their memory, appetites, and emotions are larger and have greater reactivity. People don’t just start being anxious, they are structurally pre-dispositioned for it.
It is these structures that are at the root of turbulence in GAD. And, when they are overactive, there is what I like to call a “funnel effect.”
Symptoms of this include funnel feeling are a sense of spinning without forward movement, a loss of direction, and a fear at some point that everything will come crashing in. Below is a figure of how this phenomenon might look in the natural world.
The flow of life, for example, is blocked by what seems like an overpowering force. (The green circle). Life does go on, but it is disrupted and to get past the issue requires going around the block is the only way. But, the block is also pushing you higher, and higher in this picture means more intensity. The block isn’t pulling you in like a vortex, but it is pushing you up, higher, feeling more out of control (MAGNUS FORCE) of sorts and behind the block are more sources of turbulence that are small, but growing and they are what keep the central, large, circular force in place. The emotion described is a life out of personal control and getting worse, heading for a catastrophic end. The small circles are identifiable (daily hassle or setbacks, such as the car won’t start, a bill arrives in the mail, someone makes an unkind comment). But, the bigger block is unknown. With size, the issue becomes unrecognizable or unknowable and the larger it is the more mysterious and threatening it becomes. You want to run away from it, but it is pulling you in and pushing you up. It’s easy to see how this can move quickly to another disorder called “Panic Attack.”
How do you treat something like this?
What makes anxiety easier to treat than depression, per se. is that there are usually personal resources that I can work with. First, the anxious person always has energy. In fact, too much energy. In anxiety, the person is creating the energy (the big green circle is actually themselves in a mirror) and this alternate self has gotten out of control. Second, the fact that a person senses that things are out of control, means that the state is modifiable.
In the case above, the person is coming to me for help, she knows something is wrong and she is already describing how to fix her dysregulated state, what she wants to focus on (better sleep), and what she needs to to do get her life back in control.
Just like the adage, “storms pass.” Anxiety tends to follow this pattern. A person cannot stay in a maximum state of turbulence. One strategy is to help the person realize that they can alter their own state of being. I use hypnosis to demonstrate this in session, but other techniques incompatible with anxious turbulence can also be used. Relaxation, Mindfulness, deep breathing. These strategies are almost always part of an anxiety treatment protocol.
I will demonstrate how this works in my next entry.