Is it an Anxiety Disorder, or Normal Anxiety?

How can you tell a difference? Is therapy worthwhile if it’s “only normal anxiety” and not a disorder?

What Is Anxiety?

Anxiety is your birthright as an owner of a brain and nervous system; there’s nothing abnormal about it. It’s a physical sensation we often first notice as a tightness or weight on the chest or abdomen, and can present in many other ways. It can pop up in response to internal or external stressors and that’s generally a good thing (in the same way that having pain receptors is a good thing).

An internal threat in this case could be a feeling that you have but are not okay with, like anger, guilt, certain sexual feelings, etc. Your brain categorizes anxiety as important information; your mind and body are sending you a red flag about a potential threat, so it is given priority. Severity ranges from mild and subtle up to panic attacks, or completely frozen and dissociated.

There are also anxiety disorders, which refer to situations where anxiety is intense and life disrupting, chronic, out of proportion to stressors, and self-sustaining. Check out panic disorder, for instance.

We can immediately see that the term ‘anxiety’ has a common problem in psychology: it is used both clinically and colloquially in different ways, with lots of gray in-between. For example: you could experience a single panic attack in your life, which is not a disorder and not everyday anxiety. I’d like to talk here about the “normal” kind.

“Normal” Anxiety

You’re giving a presentation in front of peers. You walk into a gathering where you don’t know anyone. You’re about to talk to your doctor about test results. We can all relate. It is often unconscious (AKA out of your awareness at the moment) at both low and even higher levels.

Most people describe anxiety initially as a slight tightening in the chest or abdominal muscles. We often discharge this kind of anxiety into our voluntary muscle groups, also called ‘striated muscles’. There is an inability to feel physically calm and relaxed.

Examples of Symptoms of Anxiety

• Fidgeting with hands
• Bouncing your leg
• Clenching your jaw
• Tightening a specific muscle group that could cause or worsen pain
• Tension in shoulders, neck, face, or hands
• Sighing (expansion of intercostal muscles)

At higher levels, we may feel also anxiety in involuntary muscle groups. These are called ‘smooth muscles’, found in the airways, bowel, and blood vessels. Examples include:

• Stomach and GI issues
• Nausea
• Migraines
• Blood pressure changes
• Dizziness
• Unexplained abdominal pain
• Bladder dysfunction
• Mental fog, mind going blank, tunnel vision, concentration issues

[Note: This does not mean that IBS, migraines, and high blood pressure are always caused by stress and anxiety. You would have much better luck checking with a doctor. However, you can also ask any doctor how many people they see with medically unexplained chronic pain or gut issues (I have), and you might be surprised at what they say. Often, these doctors are sympathetic to the idea that their patient is actually suffering from anxiety and stress. But telling someone suffering from very real, chronic pain that they may benefit more from psychotherapy than a medical intervention is a difficult conversation.]

Where Does Anxiety Come From?

Importantly, we don’t only feel these symptoms of anxiety in response to external stimuli. Our interpretations of events can make us anxious. This is what Cognitive Behavioral Therapy (CBT) is built around. More interestingly, our own internal feelings can make us anxious. This logic sounds strange: isn’t anxiety also a feeling? I’d like to focus here for the rest of the post. Language is often imprecise in psychology, but consider:

• You’re replaying the argument from earlier today with someone who was speaking cruelly. A wave of heat and anger wells up, but you learned early in life that being angry is bad and even dangerous. So, instead: anxiety. Being openly angry with another person makes you nervous, so it automatically gets covered up before you’re aware of what’s happening. Instead of just feeling very natural anger that wants to rise up in you, you sigh and feel tight, or shut down. Maybe this anger even gets turned onto yourself, where it feels safer and more familiar. “Why didn’t I just stand up for myself…?!”
• You remember the last time you saw their face, and you feel a pressure. Tears want to come. The grief feels huge and scary, bottomless, like you will lose yourself inside of it. It’s threatening. Within a second, instead of crying and allowing sadness to wash over you, you pace and feel nauseous. This pushes aside the grief for a bit longer.
• You say “I love you” to your partner but you’re not sure that you really mean it or feel it. You feel a little twinge when you say it because it seems fake. Sex is similar: you think you ‘should’ want it, but when trying to be intimate and close you instead feel a little anxious or awkward. This anxiety might tighten you up and create sexual dysfunction and/or barriers to real emotional closeness in your relationships. Maybe you were taught that sex is bad or dangerous. Maybe your parents were uncomfortable saying “I love you” or hugging, unable to openly show you affection.  A lack of emotional closeness negatively influences a child’s social development and can lead to interpersonal issues as an adult.

This is very frequently the pattern that I see especially with “normal” anxiety. Look carefully:

• A feeling builds. You may be able to intellectualize about it but it’s not freely felt, though it pushes up for expression. Sadness, anger, guilt, even positive feelings of closeness with another person. In childhood, where emotions run freely and we are implicitly taught how to manage them through repeated experiences with attachment figures, certain feelings can get tagged as unacceptable.
• The feeling is threatening for some reason, so the smoke alarm kicks on and immediately it is replaced or muddled by anxiety, which may be automatic and out of your awareness in the moment.
• Now that you are feeling anxious you have some habitual and automatic (i.e. unconscious) ways of responding to reduce it, similar to how we automatically self-soothe when in pain. Examples include: Nervous laughter when nothing is funny; people pleasing and submissiveness; obsessively ruminating; frantic activity to distract yourself; minimizing and ignoring your experience (“it’s not that bad”/”suck it up”); alcohol and drug use, etc. These are Defenses against anxiety, also known as ‘defense mechanisms’ or ‘defenses’ for short.

We all do this. We have unconscious feelings constantly in our bodies (See: acclaimed neuroscientist and Head of the Department of Neurology at the University of Iowa College of Medicine, Dr. Antonio Damasio), some of which make us anxious due to implicit learning. Defenses can be helpful and healthy by affording us some control with overwhelming experiences. They are usually adaptive when first established in childhood. Carried into adulthood, defenses can leave you unfulfilled or even destroy your life.

How Does Therapy Help Anxiety? What Is The Best Kind of Therapy for Anxiety?

In therapy, one initial goal is to highlight this whole process and see if you’d like to do anything about it. Sometimes it’s helpful to strengthen your defenses against intense anxiety (e.g. coping skills). Often, the most beneficial move is to help you identify and bypass defenses, get to the core emotion and cleanly feel it so that your brain and body can process it and get flowing again (This could happen quickly, or we can take a much slower and more gentle approach).

Other times, we’ll just build your awareness of this whole structure and work on allowing yourself to fully accept that this is you, and that that is perfectly okay and normal and doesn’t exclude you from living a life in line with your values and goals. Paradoxically, acceptance can be a path toward radical change.

My practice at Witt Psychotherapy is informed by Experiential Dynamic Therapy which is specifically designed to work with these kinds of issues and processes. I am also trained in Cognitive Behavioral Therapy which is considered the gold standard in working with anxiety disorders. If you’d like to know more, book a session or consultation to get started.