What Causes Anxiety

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Anxiety may be caused by a mental condition, a physical condition, the effects of drugs, or a combination of these. The doctor’s initial task is to see if your anxiety is a symptom of another medical condition.

Common causes of anxiety include these mental conditions:

These common external factors can cause anxiety:

  • Stress at work
  • Stress from school
  • Stress in a personal relationship such as marriage
  • Financial stress
  • Stress from global occurrences or political issues
  • Stress from unpredictable or uncertain world events, like a pandemic”
  • Stress from an emotional trauma such as the death of a loved one
  • Stress from a serious medical illness
  • Side effect of medication
  • Use of an illicit drug, such as cocaine
  • Symptom of a medical illness (such as heart attackheat strokehypoglycemia)
  • Lack of oxygen in circumstances as diverse as high altitude sickness, emphysema, or pulmonary embolism (a blood clot in the vessels of the lung)

The doctor has the often-difficult task of determining which symptoms come from which causes. For example, in a study of people with chest pain — a sign of heart disease — 43% were found to have a panic disorder, not a heart-related condition.

Anxiety

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Anxiety is a feeling of unease, worry or fear which, when persistent and impacting on daily life may be a sign of an anxiety disorder. Generalised Anxiety Disorder, which is one common type of anxiety disorder, is estimated to impact 5.9% of adults in England1.

Symptoms

Symptoms of anxiety include changes in thoughts and behaviour such as2:

  • Restlessnes
  • A feeling of dread
  • A feeling of being “on-edge”
  • Difficulty concentrating
  • Difficulty sleeping
  • Irritability

It can also involve physical feelings such as dizziness, nausea, heart palpitations (a noticeably strong, fast heartbeat), sweating, shortness of breath, headache, or dry mouth.

Occasionally feeling anxious, particularly about events or situations that are challenging or threatening, is a normal and extremely common response. However, if feelings of anxiety regularly cause significant distress or they start to impact on your ability to carry out your daily life, for example withdrawing or avoiding contact with friends and family, feeling unable to go to work, or avoiding places and situations then it may be a sign of an anxiety disorder2.

Types of Anxiety Disorder

There are different types of anxiety disorder, each of which will have slightly different symptoms and treatment. Some examples of anxiety disorders include2-5:

  • Generalised Anxiety Disorder
  • Panic Disorder (regular sudden attacks of panic or fear)
  • Post-traumatic stress disorder (PTSD)
  • Social Anxiety Disorder
  • Obsessive-Compulsive Disorder (OCD)
  • Specific Phobias (overwhelming and incapacitating fear of a specific object, place, situation or feeling)

Causes

There are many different factors that may contribute to the development of mental health problems like anxiety disorders. These factors include biological factors (for example genetics6, experience of chronic physical illness or injury7 and psychological or social factors (experiences of trauma or adversity in childhood8, struggles with income or poverty1, employment status1, family and personal relationships, and living or work environment1.

Getting Support

There are a range of approaches for treatment and management of anxiety disorders, and the most appropriate method will vary depending on the type and severity of anxiety disorder, and personal circumstances.

Some common approaches to managing and treating anxiety disorders include:

Psychological Therapies:

This can involve working through thoughts, feelings and behaviours with a clinical psychologist or other mental health professional in regular sessions over a set period of time.

Cognitive Behavioural Therapy (CBT) which helps to teach strategies for recognising and overcoming distressing or anxious thoughts, is one of the most common therapies for treatment and management of anxiety disorders2,3,5.

Self-Help and Self-Management:

This involves specially-designed resources (like information sheets, workbooks, exercises, or online programmes and courses) to support people to manage their feelings of anxiety in their own time.

Some of these approaches may involve the support of a therapist or other mental health professional, and some may be entirely self-led2-5.

Group Support:

Group sessions with other individuals experiencing similar problems where people can work through ways of managing anxiety. Some groups may involve the support of a therapist or other mental health professional2.

Medication:

Your GP or other healthcare provider can discuss different medication options to manage both the physical and psychological symptoms of anxiety. There is a range of medication that can be used to manage anxiety and it is important to discuss with your GP which one would be most appropriate for your circumstances2.

For more information about medication for anxiety disorders, visit the NHS Choices website.

Other Approaches

There may be other treatments or approaches available that are not outlined here. If you are considering support for anxiety disorders, we recommend getting in touch with your GP or primary care provider to discuss which approach may be best for you.

Dogs for Bipolar Disorder

Service dogs have a long history of providing assistance to people with physical challenges and are increasingly used to aid those with psychiatric challenges. Psychiatric service dogs are extensively trained to perform specific tasks to meet the individualized needs of their handler and are permitted access to public places in accordance with the Americans with Disabilities Act (ADA).1

Psychiatric service dogs can be trained to assist people living with bipolar disorder as well as other mental health challenges, including autism, schizophreniapost-traumatic stress disorderdepression, and panic disorder. The tasks a service dog is trained to perform to aid someone living with bipolar disorder ​depend on the individual’s circumstances and personal challenges and needs.

The Role of Service Dogs for Bipolar Disorder

The ultimate function of a psychiatric service dog is to alleviate or diminish the negative effects of bipolar disorder on the handler’s life. Examples of tasks a dog might be trained to perform for its human partner include:

  • Bring medication or remind their partner to take prescribed medicine at a specific time(s)
  • Awaken their partner at a specific time each day
  • Remind their partner to go to bed at a specific time to keep sleep cycles regular
  • Bring a portable phone to their partner or call 9-1-1 if the handler exhibits behaviors that might indicate a manic episode or severe depression
  • Interrupt potentially dangerous behaviors in their partner by nudging, nagging, or distracting with play
  • Alert the handler to the telephone, doorbell, or smoke alarm if their partner is asleep or possibly sedated due to medication
  • Calm or interrupt hypomanic or manic behaviors by leaning into their partner, or placing their head in the handler’s lap
  • Provide a link to reality if their partner experiences delusions during a manic episode2

While not considered a service dog function per se, the emotional support provided by a canine helper is often as valuable as the tasks the animal performs.

The presence of the dog can also help ground an individual with bipolar disorder and introduce a sense of stability and routine.

Laws Relating to Service Dogs

It is important to note that to qualify for the protections and allowances of the ADA, both the individual and the canine must meet specific criteria. In short, an individual must have a disability and a service dog must be specifically trained to meet the needs imposed by that disability.

  • An individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.
  • The ADA defines a service animal like a dog individually trained to do work or perform specific tasks to provide assistance to an individual with a disability. If a dog meets this definition, it is considered a service animal under the ADA, regardless of whether it has been licensed or certified by a state or local government.3

Importantly, a psychiatric service dog differs from an emotional support dog, also called a comfort dog. While emotional support dogs certainly provide love, companionship, and comfort to their human partners, they are not trained to perform specific tasks that aid the handler in daily functioning. As such, emotional support dogs are not covered under the ADA.3

Other Considerations

If you’re living with bipolar disorder and considering getting a psychiatric service dog or an emotional support dog, talk with your doctor to determine what type of canine companion is best for you. A psychiatric service dog involves a considerable financial commitment because of the extensive training required, which may take up to two years to complete. Depending on your specific needs, however, you may consider this an invaluable investment.