It was almost too easy. Wanda came into my office and openly and freely admitted in one of her first statements to me, “I’m a worrier. People have been calling me a ‘worrywart’ all my life.” From that moment on, it was difficult to think of Wanda in any terms other than “Wanda the worrywart.”
Wanda recognized that worry, a deep feeling of ongoing anxiety, was likely linked to the host of ailments she experienced. Treatment of Wanda’s worry became as much our concern as treatment of her physical symptoms.
As a whole, we are a nation of worriers. The 2018 Gallup World Poll over stress, worry, and anger revealed that work, money, and family are constant sources of stress for most people in the United States. More than half of all adult Americans stated in this report that they worry most about work or money.1
Anxiety disorders are the most common mental illness in the United States. About nineteen million Americans are afflicted. A Time/CNN poll taken eight months after the 9/11 attack on our nation revealed that at that time nearly two-thirds of all Americans thought about the terrorist attacks at least “a few times a week.”2
As is the case with fear, anxiety has been associated with a host of deadly conditions including cardiovascular diseases, hypertension, colitis and Crohn’s disease, irritable bowel syndrome, ulcers, headaches, skin disorders such as psoriasis, eczema, and stress acne, and a decreased immune response, which can open up a person to even more serious illness.
Many people, however—unlike Wanda—don’t see any harm in their tendency to worry. Let me ask you today:
Do you lie awake worrying about whether you are about to lose your job? Do you feel a knot in the pit of your stomach when you think about the stock market or your retirement plan?
Do you fret all morning when your boss comes into work in a bad mood?
Do you feel as if you go to bed drained of all hope and energy after watching several hours of prime-time news and programs that seem to be about nothing but violence, terror, or war?
Do you know you are sacrificing your health for the sake of worrying about the next step in your career?
WHAT IS AN ANXIETY DISORDER?
Anxiety is the unpleasant sense of apprehension that accompanies physical symptoms such as sweaty palms, shallow breathing, rapid heart rate, and general nervousness. Anxiety is more abiding than fear—it is a feeling that lingers long after an actual threat has passed.
Anxiety that is of less intensity is what we call “fretting” or “worry.” Anxiety, however, can also be of high intensity. In those cases, an anxiety disorder may exist. In the medical world, we call this pathologic anxiety.
Anxiety disorders are fairly common. They include generalized anxiety disorders, post-traumatic stress disorders, panic disorders, obsessive-compulsive disorders, and phobias.
Some anxiety disorders are more dangerous to the physical body than others. The most threatening are those that create a release of stress hormones that doesn’t shut down after a particular experience or event is over. Let’s look at these in more detail.
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is an anxiety state that is usually chronic. People with GAD feel anxiety about a wide variety of life circumstances, pretty much all the time. If they aren’t fretting over the high cost of milk today they may be worrying about what might happen to skew their vacation plans or whether they forgot to check all the doors before leaving on an errand. For those with GAD, life always has something that warrants their concern. They usually can’t imagine why others aren’t more concerned, and they sometimes feel that it is up to them to be concerned since nobody else seems to be.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) usually occurs in the wake of a terrifying ordeal, such as rape, car-jacking, armed robbery, or any other major traumatic event. A number of Vietnam veterans suffered from PTSD. This form of anxiety disorder may also occur during a divorce or after the death of a loved one.
Those with PTSD can spend an entire day replaying mental and emotional tapes of the stressful event or series of events they have experienced. They may suffer from nightmares. They sometimes overreact when harmless events or inanimate objects trigger memories of their traumas.
One of my patients, whom I’ll call Andrea, was robbed while she was working at a quick-stop store on the edge of town. A masked gunman entered the store just as she was closing up for the evening. He forced her to lie facedown on the floor while he held a gun to her head. After taking some money from the cash register, he fled.
Today, more than a year after the event, every time Andrea hears a door creak open, smells the aroma of the cleaning fluid that was used on the quick-stop store’s floors, or drives by a quick-stop store, she becomes extremely anxious.
For some, the post-traumatic stress response occurs many years after the event. One man told me about experiencing such a PTSD incident while he was touring Israel several years ago. He heard the launch of a test rocket while he was in the far northern area of the Golan Heights and he immediately fell to the ground in a full-body, prone position. He could hardly get up—he was nearly frozen in that position for several minutes. Fortunately, he and his wife were with a tour guide on a private tour so he had little residual embarrassment associated with this attack. He was concerned, nonetheless, that he could still experience fear so intensely, since it had been thirty years since he was a soldier in Vietnam. He told me, “I couldn’t believe how strongly I felt that automatic response to hit the deck. I thought all that was behind me.” For some, PTSD never goes away completely.
Panic Disorder
An amazing number of Americans—4.7 percent of adults in the United States—are affected by panic disorders.3 With a panic disorder, overwhelming feelings of terror or anxiety seize a person suddenly and without warning. A panic attack may happen while a person is driving her car on a busy interstate, or while he is in an auditorium filled with PTA parents. A brooding sense of impending doom often accompanies panicky feelings. The fact that a person doesn’t know when and where a panic attack may occur just adds to his overall anxiety.
An amazing number of Americans—4.7 percent of adults in the United States—are affected by panic disorders.
A panic attack triggers a typical stress response, shooting adrenaline into the sufferer’s bloodstream. As is the case with sudden fear and other toxic emotions, this adrenaline rush causes the heart to beat faster and harder. It is not uncommon for a person with a panic disorder to have heart palpitations and even chest pains, to the point that he thinks he is having a heart attack. The person may also have sweaty palms and a dry mouth and experience nausea, abdominal pain, trembling, dizziness, or a choking sensation.
A man named Mike came to me with an extreme case of panic disorder. He had a panic attack at least once a week, and usually while he was driving. Suddenly he would feel chest pain, numbness down his left arm, palpitations of the heart, and shortness of breath. Thinking he was having a heart attack, he immediately drove himself to the nearest emergency room. Adding to his overall state of anxiety, of course, was the fact that Mike never knew when he really might be having a heart attack.
Mike had a fairly high monthly bill for emergency-room treatment until he finally received treatment for panic disorder.
During a panic attack, a person’s blood pressure may skyrocket to an extremely high level. One of my patients had a blood pressure reading of 220/140 during a panic attack he experienced in my office. As soon as the attack was over, his blood pressure returned to 120/80. Such a dramatic stress response in the body, over time and repeated attacks, may cause a person to develop hypertension, cardiovascular disease, or stroke.
Obsessive-Compulsive Disorder
Yet another type of anxiety disorder is the obsessive-compulsive disorder. With this, disturbing ideas or images flood the person’s mind—this is the obsessive part of the disorder. The sufferer then creates routine, repetitive rituals to rid the mind of these images. One of the most famous characters in theatrical literature depicting an obsessive-compulsive disorder is Lady Macbeth in Shakespeare’s Macbeth. Lady Macbeth saw the image of blood on her hands after she committed a murder. She washed her hands again and again to rid herself of the feelings of guilt associated with this mental image. Her hand-washing, of course, had no effect whatsoever—it was a meaningless and repetitious behavior because it did not absolve her of her guilt. Such a routine and repeated ritual is the compulsive part of an obsessive-compulsive disorder.
One of the most common obsessive-compulsive disorders involves anxiety about germs. People with this condition routinely and ritualistically wash their hands after touching any object at all—even a doorknob, pencil, or telephone. Others draw back rather than risk shaking hands with a person. Some people with this particular disorder wash their hands hundreds of times a day.
Many people who have this anxiety disorder realize that the rituals they are performing make little sense. Nevertheless, they are unable to stop.
I once witnessed an extreme example of this behavior in a patient named Eloise. This middle-aged woman washed her hands incessantly and worked tirelessly, day and night, to keep her house free of germs. She vacuumed and cleaned from sunup to sundown. Anyone who entered her house had to take off his shoes at the door. She followed her guests around with a spray bottle, disinfecting doorknobs and countertops they touched. You can imagine how stressful life was for those who visited Eloise. The fact is, Eloise’s behavior was stressing her out. When she came to my office, she was nervous, fidgety, and exhausted from her endless cleaning routine. I was able to help her with medication and a referral for psychotherapy.
The disorders I’ve mentioned here—generalized anxiety disorder, post-traumatic stress disorder, panic disorder, and obsessive-compulsive disorder—all cause stimulation of the stress response. And that leads to elevated levels of adrenaline and cortisol.
ANXIETY’S MORE EVERYDAY FORMS
General Worry
About nineteen million Americans suffer from anxiety disorders, but far more suffer from mild anxiety that has not yet developed to the disorder state. Experiencing severe or continual anxiety isn’t necessarily pathological—meaning that a person has an emotional or mental disturbance. In many of these people, worry has simply become a mental habit. They automatically tend to see events in their lives in terms of worst-case scenarios. If his teenager takes the car out in the evening, he spends the entire time the child is away worrying that he may be killed in an accident. If she plans a trip home to visit her grandchildren, she worries that a terrorist might be on her plane.
The worrier may lie awake at night going through a series of “what if” possibilities. As with any mental habit that becomes ingrained in the brain, this habit of general worry tends to get worse over time.
Dread
Dread leads to distorted thinking, a state that can lead to lack of hope and despair. The greater the anxiety and dread, the greater the release of stress hormones.
Worry about Things
Many people have anxiety that is not person-related, but rather thing-related. As a nation, we seem to be consumed with the concept of consuming! Instead of human beings, we’re becoming “human doings.” We collect things, store things, hold garage sales to rid ourselves of things, purchase space to store other things we rarely use, and spend countless hours shopping for things to replace, update, or add to the stuff we already own. Many people shower their stuff with overcare. They spend hours every week sorting, cleaning, and generally fiddling with their material possessions, especially perhaps those of the electronic variety that they are still figuring out how to work.
A woman told me just recently that she always knew when her college-age son was stressed out. She said, “He’d either go fishing, which was relaxing, or he’d spend hours that he could have spent studying in sorting all of his fishing lures and tackles.” This young man was into overcare of his material stuff—in his case, this concern about things was a reflection of stress, not a cause of stress.
The Bible has strong words for those who overcare about money and possessions:
“He who trusts in his riches will fall, But the righteous will flourish like foliage” (Prov. 11:28).
Jesus taught, “Seek first the kingdom of God and His righteousness, and all these things shall be added to you” (Matt. 6:33). Seeking the kingdom of God includes being genuinely grateful for the things the Lord has given to you, and being determined to spend quality time alone with God in prayer and quiet reflection on His Word. Seeking first the kingdom is in contrast with striving to acquire wealth, status, or possessions. It is also in sharp contrast with striving to control people or situations.
THE LINK BETWEEN ANXIETY AND DISEASE
A significant number of physical complaints and serious diseases have been linked to anxiety, including cardiovascular disease, ulcers, irritable bowel syndrome, and illnesses related to decreased immune function. One of the foremost ailments is the headache—both the tension headache and the migraine.
Tension causes about 90 percent of all headaches.4 You are a rare individual if you’ve never suffered one. Tension headaches usually occur during a stressful season at work, a high-tension time in a relationship, or a difficult financial period. I can only guess how many people stay up late doing their taxes on April 15 only to lie awake afterward with a major tension headache.
Anxiety creates stress that particularly strikes the muscles in the upper back and neck. As these muscles tighten and become overfatigued, they spasm and create headaches.
Migraine headaches, in contrast, generally are vascular in origin. Their cause is the dilation of blood vessels in the head. The same stress that causes a tension headache may trigger the thundering pain of a migraine, but the body internalizes the stress in the blood vessels rather than the muscles.
If you routinely experience headaches, your body is trying to tell you that something is wrong and you need to take action. Many times what is wrong is too much stress—you may be too anxious or too worried. Simple relaxation techniques and refocusing thoughts work well in many people to abort a headache before it can become full-blown.
Anxiety and Cardiovascular Diseases
An anxiety disorder—whether post-traumatic stress disorder, obsessive-compulsive disorder, or generalized anxiety disorder—turns on a stress response that causes epinephrine to flood the body. Blood pressure is very vulnerable to epinephrine. Too much epinephrine, and blood pressure can skyrocket. When this happens, the smooth endothelial lining of the arteries can develop very tiny nicks and tears. This damage frequently occurs at the points where the arteries branch out, especially in the coronary and carotid arteries.
If the person’s blood is loaded with fatty deposits that make platelets stickier and more susceptible to forming clumps, the environment is ripe for the formation of cardiovascular disease and plaque buildup.
Several research studies have shown anxiety disorders leading to greater risk of carotid artery disease. In one study covering a four-year time span, men who experienced anxiety for an extended period of time showed a higher increase of plaque in the carotid arteries than men who did not have sustained anxiety.5
Research studies have documented a link between coronary artery disease and panic disorders, as well as between cardiovascular disease and worry. One study showed that anxiety and sudden death appear to be connected. In this study, researchers concluded that ventricular arrhythmias (a dangerous rhythm of the heart) may have been the mechanism for sudden death among individuals with anxiety disorders, as opposed to a heart attack that generally involves blood clotting.6
Research studies have documented a link between coronary artery disease and panic disorders, as well as between cardiovascular disease and worry.
Anxiety and Ulcers
For many centuries Chinese acupuncturists have believed that the stomach and spleen are connected to the emotion of anxiety. They may well be right. We are learning more about the mind-body connection all the time, and when it comes to ulcers, this theory seems to have bearing on the activity of a particular bacteria.
Medical researchers today believe that up to 95 percent of patients with duodenal ulcers and 80 percent of patients with gastric ulcers are infected with heliobacter pylori (H-pylori).7 How can anxiety and a bacteria be related?
First, stress significantly slows down the release of digestive juices, including hydrochloric acid and digestive enzymes. The body shunts blood flow away from the digestive tract and redirects it to the muscles to prepare them for a fight-or-flight response.
Another way of saying this is that stress turns on the sympathetic nervous system and turns off the parasympathetic nervous system. It is the parasympathetic nervous system that aids digestion—it is the nervous system that operates when a person is calm and relaxed. This is one reason it is important to be relaxed and comfortable when you eat.
When the stomach and digestive tract have a decrease in digestive juices, the microscopic bacteria called H-pylori can thrive.
Most people who have this bacteria do not exhibit symptoms. But when the mucosal lining of the stomach or small intestine gets damaged by aspirin, ibuprofin, and other anti-inflammatory medications, or from alcohol or infection, these bacteria can do great damage in that area. An ulcer forms when there’s a break or hole in the mucosal surface that is greater than five millimeters in size.
Once damage or irritation occurs, H-pylori colonization can produce even more inflammation. Most peptic ulcers (both gastric in the stomach and duodenal in the first part of the small intestines) are the result of the combination of H-pylori and anti-inflammatory medication.
How does this relate to anxiety? We know that the United States has a far higher incidence of ulcers in proportion to its population than third world nations do.8 The prevailing theory is that Americans suffer more stress and have more anxiety disorders—which results in symptoms such as pain and soreness from the stress hormones released into the body. To compensate for the pain and soreness, we take more anti-inflammatory medications.
Anxiety and Irritable Bowel Syndrome
Another common disorder linked to anxiety is irritable bowel syndrome (IBS), which is the most common gastrointestinal disorder in the United States. IBS affects approximately one out of every five Americans. Nearly 40 percent of office visits to gastroenterologists are IBS related.9
The symptoms of this syndrome include abdominal pain and cramping, abdominal bloating or swelling, constipation and diarrhea, mucus in the stool, and an unnatural, extreme urgency to have a bowel movement.
When the body’s stress response kicks into high gear, this causes the large intestines to move spontaneously, which generally results in diarrhea. The colon increases contractions, or peristalsis, to dump out whatever is in it to decrease the “load” a person has to carry if he is put into fight-or-flight mode.
At the same time the brain signals the large intestines to empty, it sends the opposite signal to the small intestines. Motility, or spontaneous movement, decreases. At times the stress reaction can cause too much decrease in the small intestines without significantly increasing the activity of the large intestines. This results in constipation. It is not uncommon for those with irritable bowel syndrome to experience alternating bouts of diarrhea and constipation.
Anxiety and Other Digestive-Tract Diseases
Stress can aggravate other diseases of the stomach, intestines, and bowels, such as ulcerative colitis and Crohn’s disease. These diseases very often tend to go into remission when a person brings his stress levels under control.
Anxiety and Decreased Immune Response
Chronic anxiety produces stress, and as is true for all stress-producing emotions, the result is a depressed immune response. This, in turn, results in greater susceptibility to infections, including the common cold.10
ANXIETY’S MOST SEVERE RESULT
While most anxiety attacks do not lead to death, extreme anxiety can cause death. The Bible gives us a dramatic story related to a severe anxiety attack. The story involves a husband and wife named Ananias and Sapphira (see Acts 5).
This couple had made a display of a very generous offering before all of their friends at the time when the Christian church was just beginning in Jerusalem. The presence and miracle-working power of God appeared in dramatic ways in this first group of believers in Jesus. While the believers themselves, including Ananias and Sapphira, were deeply committed to accepting and following Jesus as Messiah, many of their Jewish family members were not. The new believers were ostracized from the society at large. In order to live, they pooled their resources. Many sold their lands and other possessions in order to share with those who had nothing and were in danger of starving. Ananias and Sapphira had announced that they would be among those who were selling all for the sake of the new church.
There was only one problem: they didn’t turn everything over to the church. They kept back part of the money they received for the property they sold. They pretended to give the total sum as an act of great faith and generosity, when in truth they were lying to their fellow believers. The way the story appears in the Bible, Ananias and Sapphira seemed to want the social prestige and recognition that came with the making of a wholehearted gift. Their gift was not an act of faith, nor was it a gift made with the pure motives of love and goodwill.
By divine insight, the apostle Peter recognized that Ananias had been deceitful. He said to him as he laid the gift of money at Peter’s feet, “Why has Satan filled your heart to lie to the Holy Spirit and keep back part of the price of the land for yourself? While it remained, was it not your own? And after it was sold, was it not in your own control? Why have you conceived this thing in your heart? You have not lied to men but to God.” When Ananias heard these words, he “fell down and breathed his last” (Acts 5:3–5).
Three hours later when Sapphira showed up, not knowing what had happened, Peter confronted her and asked, “Tell me whether you sold the land for so much?” She said, “Yes, for so much.” Peter realized she had been in on the deceit and told her what had happened to Ananias. The Bible tells us, “Then immediately she fell down at his feet and breathed her last” (Acts 5:8, 10).
Ananias and Sapphira both experienced sudden death, very possibly from an arrhythmia or heart attacks brought on by panic attacks. Both of these individuals found themselves in a situation in which they felt suddenly exposed, suddenly subjected to the ridicule of those they thought they were going to impress, suddenly confronted with the reality that they were likely to be shunned rather than applauded, rejected rather than embraced. They faced a man who was a spiritual giant and very much in authority. Sudden exposure, a turn of events to one’s disadvantage, and unexpected confrontation: each of these is a situation that tends to produce high anxiety. In their case, it was a triple whammy of anxiety, and the results were profound.
Seek treatment for the root of your anxiety before it deals a deadly blow.
Mark Twain once said, “I have been through some terrible things in my life, some of which actually happened.” Many of us spend too much time worrying about the future or worrying about what happened in the past. We then spend much of our lives allowing failures from the past or fears of the future to dominate our thinking.
Philippians 4:6–7 says “Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known unto God; and the peace of God, which surpasses all understanding, will guard your hearts and minds through Christ Jesus.”
In Matthew 6, Jesus teaches freedom from anxiety. In verse 25 Jesus says, “Therefore I say to you, do not worry about your life, what you will eat or what you will drink; nor about your body, what you will put on.” In verse 34 Jesus said, “Therefore do not worry about tomorrow, for tomorrow will worry about its own things.” In other words, live in the present and don’t worry about the future or fret about the past. Instead of worrying we should pray and give thanks. An attitude of gratitude and thanksgiving relaxes the body and calms the mind. Follow the advice in 1 Peter 5:7, which says “[cast] all your care upon Him, for He cares for you.”