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What About Worry?

Brendan Greer, MD, MBA
June 14, 2004

Everyone worries. It's normal. Some people, actually quite a few, worry more than is good for them and can have disorders of worry, or "Anxiety Disorders". Worry, of course, has been around as long as people have had things to worry about. The disorders of worry probably have been, too. Nowadays we are beginning to have an understanding of the several different kinds of anxiety disorders and some ways to diagnose and treat them.

First, what is "anxiety", anyway? And how does it differ from "fear"? I'll start with an example. If you walk into a room and unexpectedly you come across a hungry, loose tiger there, you will most likely have fear. You may experience the fear emotionally, and also you may have physical signs, such as an increased heart rate, sweatiness, rapid breathing, a desire to flee or do something to protect yourself. You may walk past an empty room, however, and have apprehension, worry, concern that a tiger just might be in the room. You may even have physical signs as if you were afraid. You are suffering from anxiety. 

So "anxiety" is a way we respond to internal threats, imagined threats, vague threats, conflictual threats, and fear is a response to real external threats or potential threats. You can have anxiety about an upcoming final examination, and then fear it as you walk in to take the test.

We have come to recognize a whole family of Anxiety Disorders, and today I'm outlining one: Generalized Anxiety Disorder. It is, as it's name suggests, characterized by general anxieties which tend to land on almost every issue in someone's life. The worry is excessive, constant over many months or, usually, many many years, and it cannot really be controlled. The person may suffer from physical or mental restlessness, easy tiring, difficulties with concentration and focus, physical tension, and various problems with sleep (most often in my experience it is that "my mind just won't shut off when I go to bed and I can't fall asleep"). It is surprisingly common, easily one in twenty people may suffer from it. It probably runs in families. Adverse experiences can predispose a person to it. Patients usually tell me they've been anxious since they were kids.

Because Generalized Anxiety Disorder is such a persistent state, the person with it often assumes it is the only way to be, but others usually can identify him or her as the one who "worries all the time". The person with it usually constantly works hard to alleviate any sources of anxiety, and this can have both negative and positive effects. In families, it can be negative and lead to a person being experienced as irritable or controlling at a difficult extreme. Or it can be positive, and the person is experienced as organized, on top of all the details, reassuringly in charge.

What to do? If you worry about it, ask. Ask yourself how much you are anxious; ask others in your life how they experience you; ask your physician, or a counselor or psychiatrist. It is very treatable, and today we have a wide variety of therapeutic and medicine-based ways to approach an individual's particular version of Generalized Anxiety Disorder.

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Dr. Brendan Greer, MD, MBA is a practicing psychiatrist and CFR's Medical Director. He can be reached at 215-382-6680.

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