This post and others discussing specific mental disorders will reference the Diagnostic and Statistical Manuel of Psychiatry and Psychology, Edition Five (DSM-V). Apologies to my international readers, I’m just not familiar enough with the ICD to use it as a reference.
Please note: everyone’s experience of anxiety is different. This is general information meant to give you an idea of what to expect. Nothing in this blog is intended to diagnose or treat. Please see a psych professional if you or someone you love is suffering from depression.
The Anxiety Disorders
- Separation Anxiety Disorder
- Selective Mutism
- Specific Phobia
- Social Anxiety Disorder (Social Phobia)
- Panic Disorder
- Panic Attack (Specifier)
- Generalized Anxiety Disorder
Other anxiety disorders are anxiety caused by medication or substance abuse, anxiety caused by another medical condition and two varieties of “other” anxiety disorders (specified and unspecified).
Anxiety disorders can generally be divided into two categories: those that involve anxiety (fear of something that will happen/might happen) and those that involve fear of something that is currently happening. Separation Anxiety Disorder, Selective Mutism, and Generalized Anxiety Disorder involve anxiety. Specific Phobia and Agoraphobia involve fear. Social Anxiety Disorder (Social Phobia, Panic Attack Disorder, and Panic Attack (specifier) can involve either anxiety or fear depending on the individual.
Selective Mutism is only diagnosed among children and appears to be closely related to Social Anxiety Disorder. Separation Anxiety Disorder is primarily associated with children, but can be diagnosed in an adult.
Symptoms of Anxiety Disorders
With the exception of Selective Mutism, the main symptom of all anxiety disorders is an inappropriate or excessive fear response. The form the fear response takes varies, and the way it is described in each disorder varies. For most anxiety disorders the fear response needs to be ongoing for a long period of time. Generalized Anxiety Disorder’s first criteria is “Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).”
My experience with anxiety disorders is a combination of generalized anxiety, social anxiety, and panic attacks. My Living with Anxiety post last week was specific to generalized anxiety–it involved a great deal of fear of things that might happen and the majority of the fears I describe involved everyday, normal situations.
Where Generalized Anxiety Disorder is a near-constant fear response to everyday worries, other anxiety disorders are more situational. Social Anxiety Disorder is obviously related to social stuff–the fear response can be triggered by anything from performance, to being in large crowds, to family gatherings, to meeting and interacting with a stranger. Panic attacks are an extreme fear response that last for a short time. Panic Attacks can be triggered by a huge variety of things, but usually each person will have specific triggers related to their past experiences, phobias, or anxieties. Someone with generalized anxiety disorder who is frequently anxious about money may have a panic attack at the thought of losing a job, for instance.
Agoraphobia is often found with Panic Attack Disorder because for many people the only thing worse than having a panic attack is having one in public.
Separation Anxiety Disorder is anxiety about being separated from something that is a personal anchor. This anchor can be a person, a job, a safe place, etc. Being separated from this anchor triggers a fear response.
Each anxiety disorder has other symptoms apart from the fear response, but it is the fear response that makes these anxiety disorders.
Let’s take a closer look at fear responses for a minute. A “healthy” fear response follows the fight-flight-freeze pattern. You get a jolt of adrenaline to boost your body to peak condition until the cause of the fear is dealt with. You respond either by becoming aggressive (fight), getting away from the cause of fear (flight), or hiding and waiting for the cause of the fear to pass (freeze).
Adrenaline is rough on the body. It jumps your heart and respiratory rates, puts your muscles on hair trigger, shuts down your digestive system and does some really funky things to your senses. It is the biological equivalent of putting nitrous in your gas tank. Huge boost now, but you pay for it later.
As we’ve said before, mental illness is what happens when part of the mind metastisizes. In this case, it’s the fear response that’s turned into a life-eating mind-tumor.
In some cases the tumor creates unending fear responses. I swear I got at least 10 hits of adrenaline during the one hour I wrote that anxiety post. And each surge of adrenaline had to be diverted, controlled, sat on, because there was literally nothing to respond to. Factor in the way adrenaline burns through the body’s energy, the shutdown of your digestive system, and the difficulty sleeping when you’re getting constant hits of adrenaline, and you have a recipe for a life that swings between constant on-edge fear and utter exhaustion.
In other cases, the tumor creates supercharged fear responses. Imagine an adrenaline surge so strong you feel like you are getting a heart attack. Imagine your respiration speeding up to the point that you are hyperventilating and not getting enough oxygen. Imagine your muscles being flooded with adrenaline to the point that you are shaking so hard you can’t stand up. Welcome to panic attacks. Of course, being physically incapable of responding to the thing you fear usually just makes the fear worse. Which means the body sends out more adrenaline, and the feedback loop is off to a perfect start.
Mild forms of anxiety disorders can sometimes be ignored or written off “I’m just a worrier.” “I’m not really comfortable in crowds, but it’s no big deal.” ” ‘I can’t stand the thought of losing you.’ ‘Hey, I’m right here.’ ” The point where “normal” worries and concerns end and a disorder begins isn’t easy to pinpoint, even for professionals, but if your anxiety or fears are affecting your ability to do normal, everyday stuff, it’s time to talk to an expert.
Treatments for Anxiety
There are two types of anxiety medications, the ones you take every day to control and manage the disorder, and the ones you take “as-needed” that can stop a panic attack in its tracks. (The one time I went to the hospital with a panic attack, they gave me a shot and I was down in ten seconds flat. It was beautiful. I went to my doc the very next day and said “Prescribe me this. Now.” The pill version was only effective before the panic attack actually kicked in, but it was still a wonderful, wonderful thing.)
As with depression, everyone’s responses to medication will vary. The medication that worked for me might not work for you, and the medication that made my anxiety worse (yes, this can happen), might be exactly what you need.
Medication is a managing treatment for anxiety. It can’t cure the disorder, but it can keep it under control so you can get on with your life. The effectiveness of medication in treating anxiety disorders varies widely.
There are several forms of therapy that are generally used in treating anxiety disorders. Cognitive behavioral therapy (CBT) is effective 70-90% of the time in improving anxiety disorders, and creates “substantial” improvement in 30% of patients.
Other forms of talk therapy vary in their effectiveness, though none are as promising as CBT. The “talk therapy” of popular imagination is usually less than useless for anxiety disorder. Something called Intolerance of Uncertainty therapy has shown promise in treating Generalized Anxiety Disorder.
“Fringe” therapies (ie those that are not part of standard psych treatments and need more studies but has the support of most psych associations) such as art therapy, animal therapy, music therapy, etc may help anxiety disorders, there just isn’t enough information.
Trained service animals are very helpful in managing Panic Attack Disoders and some other anxiety disorders. Cats seem to be a popular therapy animal for anxiety disorders, but small dogs and other “lap sized” pets are common.
Breathing exercises, meditation, and biofeedback have at various times been popular for treating anxiety disorders. Their effectiveness varies widely.
Herbal treatments such as chamomile and lavender are generally mild enough to be taken safely, but definitely talk with your doctor about possible drug interactions. I have personally found that in some cases calmatives make the feeling of anxiety worse–if you are suppressing anxiety in order to function, relaxing enough to be aware of just how anxious you are can make it seem like the calmative triggered the anxiety.
Human touch has been shown to be very effective in dampening the fear response. Some people have had benefits from regular massage therapy, others have used cuddling as a home therapy. I’ve known a few people who when they started getting anxious would do each others hair, the social grooming acting as a calmative. Be aware that massage/cuddling/etc can have the same effect as herbal calmatives, relaxing you enough to really feel how anxious/afraid you are. Be aware also that given the sensory effects of adrenaline, some people cannot handle being touched during a panic attack or other anxiety episode. For these people touch may help to prevent or reduce anxiety, but only when the anxiety is not currently active.
Physical activity, whether going for a run or cleaning the entire house, can be a good way to deal with the burst of energy from adrenaline, reducing the stress of anxiety on the body and mind (and anything that lets you turn a mental disorder into a way to get stuff done is a good thing!)
When Anxiety and Polyamory Collide
Because of the many and varied forms of anxiety disorders, it’s impossible to succinctly sum up the way anxiety can impact polyamory. A phobia of dogs probably won’t affect polyamory at all unless one of your partners has a favorite pooch they want to introduce you to.
Separation Anxiety Disorder, if your anchor is one of your poly partners, can have some obvious impacts and may appear as jealousy or controlling behavior if people don’t understand what is going on.
Social Anxiety Disorder can make going on dates difficult, or turn meeting your partner’s new girlfriend into an absolute ordeal. SAD can also make a person seem abrupt or rude as their focus is more on not running screaming from the room than how to be polite which can make for awkward first meetings and misunderstandings. I once witnessed a 10 year friendship dissolve when one person developed extreme social anxiety. The friend with social anxiety was having trouble with their heater. The other friend asked a relative if they could help out. Having a stranger in her home triggered an extreme panic attack in the friend with social anxiety, who hid in her room the entire time relative as working on the heater. Relative complained about rudeness, other friend was extremely offended and upset that her relative was treated so poorly when he went out of his way to do a favor for the friend with social anxiety. Their friendship never recovered.
Generalized Anxiety Disorder can turn the normal worries and fears associated with polyamory into an unending nightmare, or might not have an impact at all, depending on the kinds of things your GAD focuses on. The exhaustion common to GAD and other anxiety disorders can have a similar impact to the exhaustion/enervation of depression, depending on how bad it is.
Ways to Manage Anxiety in a Poly Relationship
The biggest and most important thing is to understand the impact of anxiety on your partner. Asking someone with social anxiety to go out to the latest night club doesn’t work. Obviously someone with a phobia of heights is not going to enjoy a trip to the top of the Empir State Building.
But this applies in more subtle ways as well. If your partner’s social anxiety makes meeting your new girlfriend a challenge, then maybe you need to be okay with them not meeting. Or maybe they can talk over the phone, or using social media first.
Know what to do if your partner has a panic attack, and especially how they want you to react if they have a panic attack in public. Understand that someone with anxiety disorder may need to cut an evening short because they just can’t take anymore, and it doesn’t mean they didn’t have fun, or that they are trying to ditch you, it means that their illness is acting up and they need to go someplace safe to deal with it. Maybe you can go with them and help them deal, maybe you need to let them have some space. Either way it isn’t personal, it doesn’t mean they wanted to leave, doesn’t mean they didn’t really enjoy themselves. Just means anxiety is a bitch.
Learn your partners triggers and how to help bring them down. Learn how to give aftercare for panic attacks (yes, it’s a thing.)
Probably most important in terms of impact on poly relationships: If anxiety manifests in ways that look like jealousy or controlling behavior, do not follow standard poly advice for dealing with jealousy. Learn to tell the difference between anxiety-induced and jealousy-induced behavior. Treat jealousy like jealousy and anxiety like anxiety. Your partner has tools for managing anxiety for a reason. Use them! Treating anxiety like jealousy just compounds the problem.
How has anxiety influenced your poly relationships? What ways have you found to take care of your relationships in the face of anxiety?
This post is part of the Polyamory and Mental Illness blog series.