KNOW PTSD: Anxiety

People with PTSD are significantly more likely to also have an anxiety disorder.  So, what is the difference between the anxiety of PTSD and an actual anxiety disorder?  In fact, PTSD used to be considered an anxiety disorder, which makes the information out there on the internet a bit more confusing.  There is even some disagreement about why PTSD and Anxiety disorders co-occur so often.  In this blog I will try to clarify what anxiety is.  How anxiety and PTSD are similar and different.  How to know if you are experiencing the anxiety of PTSD or if you also have an anxiety disorder. And most importantly of all, how to manage anxiety symptoms.

What is Anxiety

Anxiety is an intense worry about things that have not yet happened.  To get a little more technical, it is when a person experiences a danger response (Learn more about Fight, Flight, Freeze or Fawn) to something that may happen in the future.  Anxiety is experience physically, cognitively and emotionally.

Possible Physical Symptoms

• Muscle tension
• Racing heart
• Chest Tightness
• Shortness of breath
• Sweating
• Upset stomach
• Difficulty sleeping
• Loss of appetite

• Feeling light headed
• Inability to relax
• Trembling
• Light headedness
• Restlessness
• Sinking feeling in heart or stomach
• Talking fast or stuttering

(These physical symptoms can also indicate health issues not related to anxiety and a Dr. should be consulted to eliminate possible medical causes of these symptoms)

Possible Cognitive Symptoms

• Uncontrollable worry
• Racing mind or overthinking
• Always expecting the worse
• Excessive need for reassurance
• Feeling disconnected from the world
• Feeling of unrealness or losing your sense of self

• Not experiencing anything good, or dismissal of anything good
• Avoidance of dealing with issue that is the focus of the anxiety (procrastination)
• Excessive worry about past event (particularly as those decisions may impact the future)
• Impulsiveness or indecision

Emotional Symptoms

• Fear
• Irritability & lack of patience
• Anger
• Sadness
• Emotions feel wrong
• Emotions change suddenly and drastically
• Emotionally don’t feel like yourself

Intersection of PTSD and anxiety disorders

It is not uncommon for people with PTSD to also have an anxiety disorder diagnosis, most commonly Generalized Anxiety Disorder (GAD).  Unfortunately, professional do not agree on why this is.  Here are the most commonly held beliefs about why PTSD and GAD are commonly diagnosed together (not in any particular order).

• Misdiagnosis: Some argue that the anxious symptoms of PTSD are being misdiagnosed as a separate disorder. PTSD and GAD (and other anxiety disorders) share a number of symptoms.  In fact, PTSD used to be considered an anxiety disorder.  Only in this most recent update to the diagnostic manual has PTSD been moved out of anxiety and into a new category: Trauma and Stress.
• Chicken/Egg Issue: One leads to another, but which way
  • Anxiety leads to PTSD: Some research shows that people with heightened anxiety (diagnosable or almost diagnosable) are more likely to develop PTSD in the future.
  • PTSD leads to an Anxiety disorder: Some people argue (although I don’t know of research to support this belief) that over time the anxiety symptoms of PTSD worsen and generalize.  In essence, becoming an additional disorder.
• Shared Susceptibility: There is evidence that some people are more likely to develop PTSD and that some people are more likely to develop GAD (along with many other mental health issues).  Both genetics and life experience has been found to have an impact on how likely someone is to develop PTSD or GAD.  It is possible that the same genetics or experiences that make someone susceptible to one issue could make them more susceptible to the other (I didn’t find any research that looked at this question).
• Appropriate Diagnosis: That some people really have both PTSD and an anxiety disorder. That both diagnoses are accurate, separate, and in need of treatment.

Similarities and Differences

So how are PTSD and GAD alike and not?  There are definitely some shared traits and there are also distinct differences between these issues.  Here       are two lists: one of their similarities and the other of the differences.

Similarities

• Excessive worry
• Not easily controlled
• Interferes with living life
• Excessive analyzing and thinking about
• Triggers: both can be reactivated by events that are similar
• Shared diagnostic symptoms
  • Sleep disturbance
  • Irritability
  • Memory issues
  • Muscle tension

Differences

• PTSD must have a causing traumatic event
• GAD’s worry is across multiple issues
• GAD can have restlessness
• PTSD may have hypervigilance (being always on guard)
• PTSD can have an exaggerated startle response
• PTSD often has flashbacks (involuntary reliving)
• PTSD has avoidance of
  • The feeling, thoughts, and memories associated with the trauma
  • External reminders of the trauma, also known as triggers (things that remind the person of the traumatic event and cause emotional upset and flashbacks)
• PTSD is about the past while GAD is about the future.

Treating Anxiety

So how do we treat Anxiety?  Many of the treatments for anxiety will help both PTSD anxiety symptoms and an anxiety disorder.  I know that learning to use these tips and tools may not be easy.  I recognize that making the list is a lot easier than using the list.  But please know that every small step you can take will make an improvement.  A word of warning: if your PTSD is still untreated some of these suggested treatments may actually be triggering and make the situation worse, do not use any that you suspect may have this impact.  Stop using any that trigger your PTSD.

7 Tools & Tips for treating anxiety

• Slow Down/Calm Down: When we are anxious everything speeds up and gets more intense. Learning ways to slow down and calm down is a vital part of countering anxiety.  Here’s a link to some of my favorite tools to achieve this: Free Calming Breath Handout
• Learn Your Triggers: It can be very helpful to know if you have certain things that you regularly become anxious about. Make a list of the things you become worried about.  If you don’t know, start a note and add whatever you are anxious about to that list each time you become anxious.  Look at that list after a week or two.  Do some issues keep showing up?  Those things could be triggers for you.
• Clarify: Part of what makes us anxious is the vagueness of what may happen.  If you are worried about an event that may happen, then ask yourself what would happen if that did happen.  If you’re anxious about not being able to pay your rent, ask yourself what happens if you actually can’t pay your rent.  Look up state law and check out your lease to discover what the next step will be.  Ask yourself what you would have to do to prevent or fix the situation.  Figure out what you would do if you are evicted.  Where would you go? What would you do? What you will probably discover is that although the options may REALY SUCK, but you would survive.  Have to move back in with your parents, that would really suck! But you will live through it.  Have to couch surf for a while (figure out which friends will let you crash on their couch), that would be really embarrassing.  But you would survive.  Would you and your stuff actually be out in the streets, could you sell some of your stuff to cover the rent?  No TV or couch would REALLY SUCK! But you would survive.    Even if what you are worried about is dying, you can do this exercise.  What would you feel if you died? What would your loved ones do?  In time, would they recover?  In time would they figure out how to make a good life without you?  It would REALLY SUCK for them! But they would survive.
• Befriend Your Anxiety: WTF? Yep, I wrote that.  Hear me out.  Anxiety is simply an overly sensitive threat assessment system trying to keep you safe.  Hating, getting mad at, or fighting with your anxiety will not help.  In fact, getting angry, upset, or beating yourself up when you become anxious just makes it worse.  How we endure things we dislike, or hate has an impact on our experience of that disliked or hated thing.  You know that coworker or classmate you despise, is it less unpleasant if you smile at them or if you scream at them?  Recognize that your anxiety will visit, and you will not like it when it does, but you will get through it easier by not antagonizing it.  Thank it for trying to keep you safe and leave it alone.  Address the thing the anxiety is pointing out.
• Act When You Can: Figure out if there is something you can do the positively impact the situation. If there is, do it.  If there is not, accept that right now there is nothing to be done.  Still anxious despite not being able to do anything? When can you do something?  What can you do then?  Tell your anxiety when you will do what in order to address the situation.  For example: “I know I am anxious about not being able to pay the rent next month.  I am already earning all the money I can.  There is nothing else I can do, right now.  If I am still short on the 25^th, I will … (sell my game system on Craig’s List, or I will suck it up and ask mom for the money (or whatever option you figure out you can do then) and yes that will suck! But I will survive.  I have a plan to handle the situation then.”
• Put it Away When You Can’t: Create a visualization of someplace you can put the worry about the thing you can not do anything about.  Practice putting small worries in there.  Practice with bigger worries too.  Tell the worry that you will come back and get it out when you can do something to address the issue.  Until then, it will be safe and secure in that place.
• Address the Root: Some anxiety is born out of experiences (you were homeless once and now you are scared about being homeless again). Examining and healing those root causes can have a drastic impact on your anxiety.  It is often helpful to get assistance when you decide to heal root causes.  If the anxiety you are struggling with is part of, or at the same time as, PTSD, I strongly recommend using a trained trauma therapist.

Anxiety can be part of PTSD.  It can also be its own independent issue.  Either way, anxiety can be treated and you can learn how to decrease its impact on your life.

Start Treating Your Anxiety

Today!