Anxiety is different from stress. Anxiety comes from a concern lack of control over circumstances. In some cases being anxious and worrying over a problem may generate a solution. Normally, however it will just result in negative thinking.
Albert Ellis listed the five main unrealistic desires or beliefs that cause anxiety.
The desire always to have the love and admiration of all people important to you. This is unrealistic because you have no control over other peoples minds; people can have bad days, can see things in odd ways, can make mistakes or can be plain disagreeable and awkward.
The desire to always be thoroughly competent. This is unrealistic because you only achieve competence at a new level by making mistakes. Everybody has bad days and makes mistakes. Once of the benefits of training with better athletes is that you can see them making mistakes and having bad days too.
The belief that external factors cause all misfortune. Often negative events can be caused by your own negative attitudes. Similarly your own negative attitudes can cause you to view neutral events negatively. Another athlete might find something positive in something you view as a problem.
The desire that events should always turn out the way that you want them to and people should always do what you want. Other people have their own agendas and do what they want to do.
The belief that everything that has happened in the past will inevitably condition and control what has happened in the future. Very often things can be improved or changed if you try hard enough, or look at things in a different way.
ANXIETY-STATE
a transitory experience of fear and apprehensiveness, specific to the situation
ANXIETY-TRAIT
a stable, long term pre disposition to the easy arousal and maintenance of a state of apprehensiveness
ANXIETY DISORDERS
GENERALISED
Anxiety is a universal experience, which has an important protective function in the face of danger. It becomes morbid when symptoms are out of proportion to external circumstances or if they persist long after a threatening situation has been averted. However there is no clear distinction between the features of normal and pathological anxiety. Symptoms of anxiety are prominent in other psychiatric disorders, such as depressive illness and schizophrenia, so it is important to look for features of these conditions before making a diagnosis of anxiety disorder. Several physical illnesses can also present with anxiety.
These need to be considered in the differential diagnosis but special investigations are necessary only when there are suggestive features in the history or clinical examination.
If operational criteria are used generalized anxiety disorder has a prevalence of between 2.0 and 5.0% with women being more susceptible than men.
Etiological factors
Genetic studies indicate there is a small genetic contribution. Many patients appear to have personality traits of high anxiety and poor tolerance of stress but perhaps the most important factors are unexpected life events, which the patient cannot handle. Sometimes these are relatively minor events, within the range of everyday experience. A particular pattern of anxiety, known as posttraumatic stress disorder, follows the major traumatic events involved in sudden, unexpected disasters such as floods, accidents and terrorist activity.
Clinical features
They are conveniently divided into two groups, psychological and somatic and are shown in the information box below.
SYMPTOMS OF ANXITEY DISORDER
Psychological
Apprehension
Fears of impending disaster
Irritability
Depersonalization
Head ache
Somatic
Tremor
Sweating
Palpitation
Chest pain
Breathlessness
Increased blood pressure
Any of these can from the main presenting symptoms; if somatic symptoms predominate the patient is likely to regard himself as physically ill, a view which is often shared initially by the
doctor.
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