1. Anxiety Disorder in Singapore
One in seven Singaporeans has experienced some form of mental health disorder in their life, according to a study by the Institute of Mental Health. It can happen to people of any age, children, young adults and elderlies alike. Awareness of mental health has gained significant improvement in recent years, with four in ten Singaporeans now believing that mental health is a more important health problem than cancer. Yet, over three-quarter of the population do not seek medical help for their mental conditions. Among those who eventually get treatment, many delay doing so for 12 months or more.
Anxiety disorder is among the most common mental illnesses, and also one of the top disease burdens in Singapore. Left untreated, the impact mental disorders cause can be lasting and costly. Thus, early diagnosis and treatment is critical to reduce the financial cost to individuals and society, boosts the patient’s chance of recovery and helps them live a happy, fulfilling life.
In this article, we discuss anxiety disorders and how to differentiate between anxiety disorder and regular daily anxiety, its causes, signs and symptoms, treatment, and tips to manage anxiety disorder in oneself or loved ones. You will also learn about the different types of anxiety disorder, including the much talked about but not so well understood OCD syndrome. The knowledge will help you gain perspective to sympathise better with what may look like ‘weird’ behaviours of the people around you.
2. What is Anxiety Disorder?
Anxiety is a normal body reaction. Everyone experiences anxiety in the face of stress or danger. An anxious reaction prompts the body to focus on dealing with the threat quickly and restoring safety. In that sense, it is a useful protective mechanism for humans. But when it is overwhelming and difficult to manage, it becomes a problem.
Anxiety disorder is an umbrella term referring to several anxiety-related mental conditions. In general, anxiety disorder happens when a person feels excessively anxious and responses to everyday matters with a level of nervousness, anxiousness and fear that goes beyond that of regular anxiousness. In some cases, the person is unable to relax and tends to ‘imagine’ threats and avoid social interactions as a result.
Anxiety disorder is a mental health condition, but its impact is of both physical and psychological nature. It can affect the person’s daily functions to a great extent, causing, for example:
- Constant fear for no apparent reason
- Inability to express real emotions
- Irrational fear
- Inability to reply to strangers
- Traumatic flashbacks
- Panic attacks
Anxiety disorder affects more than one in three cases of mental illness in Singapore.
So if you or someone you know feels anxious a lot lately, is this a sign of anxiety disorder? How do we know when it is just the nerves and not an anxiety disorder, or vice versa?
3. Differentiating Regular Anxiety with Anxiety Disorder
A characteristic sign of anxiety disorder lies in the fact that it happens for no clear reason or cause. Anxiety as a normal body response happens only when there is a threat, or stress causing factor. When the danger or stressor is removed or addressed, anxiety disappears and behaviour returns to normal. However, in people with anxiety disorder, anxiety does not go away even when there is nothing to worry about. Anxious and worrying thoughts become overwhelming, excessive and out-of-control.
Another way to differentiate between everyday anxiety and anxiety disorder is how much it affects daily functioning. Anxiety disorders often affect general health and daily activities in various ways, for instance by causing insomnia, headache, body pain, fatigue and memory loss. It may also impair social and professional functioning. Patients may avoid social interactions, have difficulty concentrating and making decisions, or find it impossible to relax.
Below is a comparison of normal anxiety and anxiety disorder to further illustrate the differences:
- Happens for a short period of time
- Is triggered by a specific realistic problem
- Goes away when the stressor is dealt with
- Behaviour and state of mind is restored quickly after the stress factor is resolved
- Example: feeling nervous before a big presentation; or feeling worried when walking in an unfamiliar and unsafe neighbourhood at night.
- Lasts for 6 months or longer
- Does not have a specific cause or reason
- Does not go away when the stressor is removed
- Is intense, out-of-proportion and out-of-control. A person with anxiety disorder seems to be trapped in their persistent negative thoughts and unable to get out of it, which is the reason medical intervention is necessary
- Example: feeling anxious that everything one says will be criticised or laughed at; or constantly feeling frightened that one would be attacked when walking in a familiar and safe neighbourhood.
4. Types of Anxiety Disorder
Anxiety disorder comprises a bucket of psychological conditions that have mental and physiological impacts on one’s daily life. These conditions feature as:
4.1. Generalised Anxiety Disorder (GAD):
People with Generalised Anxiety Disorder worry all the time about virtually anything and everything. They often experience restlessness which negatively impacts their daily functioning. GAD makes it difficult for people to control their emotions, which eventually keeps them on edge all the time for no apparent reason.
The symptoms of GAD usually constitute fatigue, heavy breathing, difficulty concentrating, muscle tension, insomnia, irritation from simple things, and blanking out. In Singapore, one in nine mental disorder cases is diagnosed with GAD.
4.2. Anxiety Disorder due to a Medical Condition:
Anxiety disorder can be a consequence of an underlying medical condition. Several medical conditions can affect the person’s mental capacity, resulting in anxiety, such as:
- Hormonal imbalance, for example, an overactive or underactive thyroid, or menopause or perinatal periods in women
- Heart disease: Details on how heart disease such as a heart attack or heart failure can cause mental problem are discussed in our dedicated article here
- Certain types of brain tumors and neurological disorders
- Alzheimer’s disease or a head injury
- A number of chronic diseases including diabetes, chronic obstructive pulmonary disease (COPD), asthma or chronic pain
- Other medical conditions such as B12 deficiency, lupus, etc.
- Side effects of a number of medications
- Excessive usage or exposure to stimulants or unsafe medications. For example, letting children consume too much energy drinks or other types of caffeinated drinks or eating food with too much MSG have been linked to anxiety disorder.
In these cases, anxiety disorder is a symptom of another underlying medical condition. Based on the patient’s history and other accompanying symptoms, the doctor will be able to determine whether anxiety is primary (not caused by any other medical condition) or secondary (caused by another medical condition) and advise treatment accordingly. In either case, it is essential to seek medical care to get diagnosed and treated before anxiety disorder becomes chronic.
4.3. Post-Traumatic Stress Disorder (PTSD):
Post-Traumatic Stress Disorder (PTSD) is commonly found in people who have experienced a traumatic and stressful event in their life such as a near-death accident experience, a cardiac arrest, a suicide attempt, war, sexual violence, abuse, etc. PTSD patients are unable to let go of their traumatic experience, which causes them to have disturbing thoughts and flashbacks. These flashbacks make it extremely difficult for them to return to their routine life.
PTSD patients usually experience insomnia, night sweating, heavy breathing, suicidal thoughts, and angry outbursts. They tend to be always on edge and can get triggered by simple things. It is very important for families and friends to understand the implications of PTSD, help monitor PTSD patients and seek clinical help from a psychologist. For PTSD patients themselves, it is essential to avoid such places, people, discussions and things that can remind them of their past traumatic experiences.
4.4. Panic Attack:
Panic attacks are unexpected, sudden episodes of intense fear and worrying. As the name suggests, the attacks occur out of the blue for no known reason. A range of symptoms arises in panic attacks like sweating, chest pain, heart palpitation, dizziness, nausea, and in some cases, stomach ache. Some patients with panic attacks report chest pain as if they were having a heart attack or dying. However, the symptoms of panic attack and heart attack differ in a number of ways:
- Chest pain has a sharp and stabbing feel
- Pain gets better with time
- Pain often subdues significantly in 20-30 minutes
- Chest pain has a squeezing feel
- Pain often gets worse, spreads to arms, jaws, shoulders
- Pain is often long-lasting
- Obsessive-Compulsive Disorder (OCD) is a psychological disorder that comprises repetitive actions and thoughts. Such patients have anxiety triggering points that cause them to perform an act repetitively. For instance, a person with germ and contamination OCD can be seen washing their hands and disinfecting items constantly. A person with a Symmetry OCD will be seen fixing things to perfect alignment and feel distressed if they cannot maintain symmetry.
- Social phobias are a set of psychological conditions where a person is anxious of social interaction for fear of social embarrassment. This is different from shyness. Shy people may also feel uncomfortable and awkward at social events but can overcome their shyness when others start to talk and engage with them. People with social phobia are constantly worrying about being judged or humiliated during social interactions. The excessive fear prevents them from interacting with other people, even when others try to interact with them.
5. Causes & Risk Factors of Anxiety Disorder
Among the numerous factors responsible for causing or triggering anxiety disorders, the most common ones are listed below.
- Medical Conditions
Several diseases and conditions such as heart disease, diabetes, COPD, etc. are directly or indirectly linked with anxiety, as mentioned above. Anxiety may go away when the underlying condition is treated or may require treatment in parallel with the underlying cause. In such cases, patients are recommended to inform the doctor of anxiety and all other symptoms to receive a holistic treatment plan.
Stress has been associated with many illnesses, including anxiety disorder and medical conditions that can cause anxiety, like cardiac attacks and diabetes. Anxiety disorder can be triggered by a highly stressful event, such as the loss of a loved one, a major financial setback, or by accumulation of smaller daily stresses over a long period of time, such as constant work pressure or ongoing relationship issues.
- Genetics, Personality and Family History
It is believed that some people and certain personality traits are more prone to psychiatric problems than others. Anxiety disorder is also observed to run in the family, further suggesting a genetic cause. Scientists have yet to confirm which specific genes are responsible for an inherited anxiety. The debate on whether personality traits are by nature or nurture is also yet to be concluded. For now, it is widely agreed that the pathway that activates anxiety response tends to be overly strong in people with anxiety disorder. The pathway gets stronger in a vicious cycle as anxiety disorder progresses, keeping the patient stuck in the condition.
Women are twice more likely to suffer from anxiety disorder than men. They are also more prone to multiple mental health disorders concurrently compared to men. The most common comorbidity is anxiety and depression.
Other causes and risk factors include a traumatic experience, brain injury, and usage of certain medications, etc.
6. Symptoms of Anxiety Disorders
Anxiety disorders have psychological as well as physical effects on the body. While more symptoms of anxiety are psychological in nature, some of them are observable as physical signs.
Psychological symptoms of anxiety disorders:
- Persistent fear and worry
- Feeling of being in danger for no reason
- Difficulty sleeping
- Frequent bad dreams
- Intrusive thoughts
- Difficulty concentrating
- Difficulty making decisions
- Fear of social interaction
Physical symptoms of anxiety disorders:
- Heart palpitation
- Difficulty breathing
- Sweaty hands or excessive sweating
- Cold, numbness in feet and hands
- Dry mouth
- Stomach ache
- Body ache
- Tension in muscles
- Frequent urination
If you or someone you know experiences any five of these symptoms, including psychological symptoms, contact your GP and health care professionals to get help. Anxiety disorders are treatable with counselling and medication.
7. Diagnosis & Treatment of Anxiety Disorder
Diagnosis of anxiety disorder involves tests, monitoring, and history examinations to evaluate the patient’s mental health and to determine if anxiety is caused by another underlying medical condition.
If a primary medical condition is found to cause anxiety, treatment involves addressing the underlying condition and eliminating anxiety. Sometimes, patients are referred to a psychologist for a thorough examination and treatment plan.
Psychotherapy, or talk therapy, is an essential method for treating anxiety disorders. Medications such as antidepressants and beta-blockers may also be prescribed to keep the symptoms under control. Find out more about how different medications can be used to treat mental health disorders in our article here.
8. Ways to Manage Anxiety at Home
Anxiety disorders are treatable and preventable, like many other medical conditions. It is not a sign of personal weakness or failing. It will not go away by itself like a flu either. The fact that many do not seek professional help promptly or do not seek help at all suggests that we still have a long way to go to spread awareness and destigmatize anxiety disorder in Singapore. This applies to both the patients and their various social circles, including their families, friends and colleagues.
8.1. Awareness and Prevention:
Educating oneself about anxiety disorders is the first step to help recognise the symptoms in oneself or others. If possible, it is also helpful to lend a sympathetic ear to someone you know who is going through anxiety disorder. Real life experience can provide more relatable and useful knowledge than just reading about the condition.
8.2. Seek Help:
People with anxiety disorders who do not seek help are often fearful that doing so will hurt their employment or relationship or reputation. However, untreated anxiety disorders can have an even more harmful impact on general health, work performance and personal relationships. If you suffer from anxiety yourself, consult a doctor, a psychiatrist and never be afraid to share your emotions and ask questions. If someone you know suffers from anxiety disorder and hesitates to seek help, do encourage them to make the first visit to the doctor, or call a helpline, whichever is more comfortable for them.
8.3. Join Support Groups:
Nothing is more inspiring than to uplift one another. Many people with anxiety disorders have benefited from joining support groups where they can express thoughts openly, share experiences and coping techniques, get and give others support. Below are some of the support groups you can consider joining as a volunteer or member:
- For seniors and elderlies: SAGE Counselling Center (SAGECC)
- For caregivers who suffer from mental illness or care for someone with mental illness: Caregivers’ Association of the Mentally Ill (CAMI)
- For all: Insight Center by Singapore Association for Mental Health (SAMH)
8.4. Manage Anxiety in Yourself:
In addition to medication and psychotherapy, an important part of managing anxiety and preventing recurrence is to manage stress and other triggers, and to maintain a new healthy anxiety response when faced with daily stressors.
Lifestyle habits that are helpful to manage anxiety include:
- Exercise regularly
- Eat healthy, nutritious and balanced diet
- Manage chronic conditions that can cause anxiety disorder if you have them
- Build a strong social network to support and lift you up when you are feeling anxious
- Learn anxiety management techniques
- Practise mindfulness or meditation
- Practise relaxation techniques
- Keep a journal
- Cut down or stay away from stimulants such as alcohol and caffeine
8.5. Help Others Overcome Anxiety Disorder:
Personal and social relationships are an important part in helping people with mental illness to recover from their conditions and prevent relapse. If you know someone with anxiety disorder, the best way to help is to let them know you are there for them without any judgment or expectation. Avoid statements like “It’s all in your head”, or “Just cheer up”, or “If I were you, I would…”, as they can sound insensitive, even hurtful at the receiving ends. It is also advisable to know your limit before stepping in to help a friend or family member with mental illness. Not everyone is equipped with the necessary skills to do so effectively.
9. Takeaway Message
Anxiety is a normal part of our daily life. But it can take a heavy toll on our mental and physical health when it persists and escalates into anxiety disorder. It is essential to determine the root cause of anxiety disorder and get professional help through counselling and medical treatment. The earlier help is sought, the higher chance there is to recover and live a calm and fulfilling life.
At Ninkatec, we care for your physical as well as mental well-being. Whether the anxiety you are going through is caused by overwhelming caregiver responsibilities, a physical condition, workplace stress, or any other reasons, we are here to help. Reach out to us through chat, call, email, or the form below for a private consultation.