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    Published on 27 October 2022

    We all get the nerves occasionally. But when does worrying become a health concern? Learn how to tell the difference between normal anxiety and anxiety disorder.

    Being anxious or nervous during stressful times is a normal human response. However, if such feelings become so intense that they interfere with your ability to work, study, eat or sleep – it may be time to seek some support. 

    This is what normal anxiety looks like. Your nervous system fires up with ‘fight or flight’ hormones that raise the heart rate, heightens your focus and gives you a boost. In most cases, this little spike of nervous energy eases off, and you relax again. 

    In fact, day-to-day anxiety during critical moments is part of the body’s natural survival instinct, said Dr Lui Yit Shiang, Senior Consultant, Department of Psychological Medicine, National University Hospital (NUH).

    “An appropriate level of anxiety has allowed us to adapt to challenges in our everyday lives and allows us to evolve favourably to thrive in variable environments,” he explained. “In other words, a bit of tension or sense of urgency may propel us to achieve more and overcome the odds.”

    When worry overwhelms

    However, when situations become intensely overpowering, or when our internal systems overload, this anxiety can transform from an adaptive response to a disease state. 

    “Imagine a student signing on too many modules in a semester, or a delivery personnel accepting too many orders within a short span of time,” said Dr Lui. “If left in such overwhelming situations, or if the person gets overrun, the anxiety escalates out of control and gives rise to unhelpful responses within the body and mind.”

    In such cases, anxiety no longer allows the person to adapt favourably, but rather impairs their functioning and may even lead to other undesirable states such as depression, lapses in memory, and self-harm.

    Some common symptoms of anxiety disorder include:

    • Chest pain/discomfort

    • Numbness in areas of the body

    • Difficulties remaining calm and staying still

    • Light-headedness

    • Strong sense of fear, panic, unease

    • Heart palpitations

    • Breathing difficulties

    • Sweating

    • Blurring of vision

    • Shaking and trembling

    Apart from physical symptoms, people with anxiety disorders also often display cognitive symptoms centred around a constant sense of threat, hypervigilance about anything and everything, and a constant negative perception towards conversations and media. 

    Patients may also experience emotional symptoms such as being constantly fretful, being on edge, always having a gloomy outlook, and being restless though everything is well. 

    “These symptoms prevent the person from coping with the difficult situations, and in turn cause further distress to the affected body and mind…if these are left unchecked, they may evolve into depression, paranoia, recluse states, and suicide,” Dr Lui added.

    Identifying and treating anxiety

    There are several types of anxiety disorder. Some common ones include:

    • Generalised anxiety disorder (GAD): Inability to control excessive anxiety most of the time, for at least six months. People with GAD may experience rapid heartbeat and shortness of breath throughout the day.

    • Panic disorder: Experiencing recurrent panic attacks, which cause a sudden surge of intense fear/discomfort that reaches a peak in a short time and may lead to hyperventilation or feeling like passing out.

    • Agoraphobia: A significant fear about being in situations/places where they cannot escape from, such as being in enclosed places, outside the home, in public settings or crowds.

    • Social anxiety disorder: Excessive worry and nervousness in social, public or performance situations.

    Mental health professionals may provide diagnoses on the type of anxiety symptoms experienced by an individual. This, Dr Lui stressed, is an important first step in managing anxiety disorder. 

    “Most often, Singaporeans may brush early symptoms aside or continue to expose themselves to overwhelming situations or place themselves in extremely stressful spots,” he shared.

    But if identified and treated early, anxiety can be prevented from evolving into a disease state. Depending on the severity level of the patient’s anxiety, treatment options may include self-care, mental health first aid, medication, or therapy. 

    These interventions can help patients manage the signs and symptoms of anxiety disorders so that they can regain their daily function, said Dr Lui. 

     “The key thing is to recognise these unhelpful anxiety responses and learn to control these thoughts and emotions, and cope with the physical occurrences through more helpful strategies like mindful breathing, muscle relaxation, distraction,” he said. 

    He concluded: “It’s also important to learn to step away from unhelpful overpowering situations, and tell yourself that it's OK not to be OK.”

    In consultation with Dr Lui Yit Shiang, Senior Consultant, Department of Psychological Medicine, NUH.

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