We talk a lot about anxiety on Baggage Check, and how all of us struggle with it to some extent. Today we're focusing on how to know that maybe it's gotten to the point where it's problematic. How do you know when it's time to seek help? What everyday behaviors might be hiding anxiety beneath? For some surprising ways that excessive stress might affect your behavior to a really hurtful extent, tune in to today's Baggage Check.

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Dr. Andrea Bonior: The prevalence of anxiety symptomology has been going up for several years, even among people who wouldn't meet criteria to have an actual diagnosis of an anxiety disorder. So how do you know that your anxiety is something that is getting to the point where it needs treatment? Today, we're talking about how to tell that your anxiety is becoming a problem that could really use some professional help. A lot of us aren't feeling great these days, and we've talked about several self help tools on the show that can help you manage your day to day stress. But what about when you really need more? If you've ever wondered if your anxiety is normal or not, or whether it's a sign of a deeper problem, you'll want to listen to today's Baggage Check. Welcome. It's really good that you are here today. I'm Dr. Andrea Bonior, and this is Baggage Check: Mental Health Talk and Advice with new episodes every Tuesday and Friday. Baggage Check is not a show about luggage or travel. Incidentally, it's also not a show about the history of pleather. So let's get to it. We're talking about anxiety today, which doesn't feel that groundbreaking. We talk about anxiety a lot on Baggage Check. Of course, that's partly because that's what my specialty has been in research and in practice for so many years. It might also be because the book detox. Your thoughts about managing the self talk that's often involved in anxiety is something obviously near and dear to my heart. Maybe it's also that the world has grown so anxious that we talk about it a lot. I think it's probably all these reasons. So anxiety is a common topic here, but what we haven't tackled so much here, uh, yet are the signs that your anxiety is becoming a problem that might need more serious help, might need more serious of a look beyond just managing it with self help techniques. So, a few things off the bat, anxiety is a natural response to uncomfortable thoughts or situations or to threats, and it can definitely be helpful in certain ways. Anxiety can aid us in assessing danger. It keeps us engaged and ready and on our toes when we need to learn more about our environment or be critical in our assessment of a risk that we're in, anxiety can motivate us to strategize, to care for ourselves better, and to help keep us and others safe. But when anxiety becomes excessive, of course, it detracts from our life. Instead of helping us assess threat realistically, it hijacks our brain with fear. It impairs our ability to think clearly, so it makes us unduly, frightened and uneasy. Excessive anxiety can cause our bodies to feel uncomfortable in ways that are no longer helpful for us, and that, in turn, affects our mood. Excessive anxiety can make us irritable or negative, and in turn, that can get in the way of our relationships. For most people, anxiety comes and goes, and our nervous system's stress response. It adjusts accordingly. It recalibrates itself when it needs to in order to get us back to a functional way of interacting with the world. For some people, though, anxiety either repeatedly spikes too high or is chronically elevated beyond a functional level. Such folks may have any number of anxiety disorders, or even if they're not officially diagnosable with a disorder, they could still use some help. So let's see if you recognize yourself in any of these eight signs that your anxiety is needing to be taken more seriously. Number one, you constantly worry about unlikely events even after reassurance. So anxiety that is functional and rational is generally able to incorporate a realistic sense of risk. It can be adjusted with the right information gathering. You might still worry, but you can put that worry in perspective and not be totally overtaken by it. Anxiety that keeps spiraling out of control, on the other hand, that often feels resistant to reassurance, like a person who fears they have a disease even though tests have repeatedly ruled it out. Or a person who is so certain that their partner will leave them that they actually begin to drive their partner away by constantly needing to be reassured of their partner's commitment. Anxiety at this level is no longer functional. It makes things so much worse. Sometimes this has to do with our calculation of stakes versus odds. In a typical scenario, if something has an incredibly low likelihood of happening, the odds are super slim, like a plane crash. Then the realistic reasoning part of our brains can use that as evidence to quiet the alarm bells. But when our anxiety gets out of control, we start to over. Focus on the stakes of something like the fact that plane crashes, if they do happen, are often fatal, and we can't really find the comfort in the odds that we should be able to with our more reasoning brains. It's a fundamental miscalculation that really indicates that our threat detectors are getting too sensitive and they're starting to fire way too intensely. Sign number two your bodily symptoms of anxiety are causing distress. Anxiety often comes with physical symptoms, but in manageable cases, those symptoms pass or they can be coped with without too much of an issue. In extreme cases of anxiety, though, the physical symptoms become problems in and of themselves. And they only seem to get worse the more that they're noticed and the more that they disrupt things creates a vicious cycle. Let's be clear the stress response is not just mental, it is physical. These are real symptoms. Upset stomach, headache, heart palpitations, numbness, tingling, dizziness, shortness of breath they're all among the most common manifestations of anxiety in the moment. But there are others that can become chronic and be more long term, too. Hair loss, jaw and tooth problems, rashes, heartburn, back pain. They can all be anxiety related as well. And they can almost definitely interfere with daily life. Now, you've probably heard me say it before, but anytime physical symptoms are involved, it is always a good idea to get a full physical workup. And this whole issue is a double edged sword because certain people, women and people of color especially, might be more likely to be told that their symptoms, their medical symptoms are, uh, just anxiety or just stress. And they might have more substantial medical illnesses overlooked. So I do want to acknowledge that this is tricky here, but I also want to acknowledge that heightened stress really is associated with a lot of physical problems. It's real too, so we need to take that part seriously. And of course, as with most things in this vein, it can be something of a vicious cycle with physical symptoms causing more fear and anxiety and more fear and anxiety causing more physical symptoms. And the longer your stress is sustained, the worse your hippocampus is at turning off the stress response. It kind of falls down on the job. So pay attention to those physical symptoms. Number three difficulty concentrating or absent mindedness. Many different variables can contribute to changes in your ability to concentrate, from Add or ADHD, to depression, from sleep deficits to too many interruptions during your workday. And of course, certain neurological problems as well. But anxiety most definitely does this too. When this happens, a person's thoughts are just moving so quickly that the thoughts have difficulty landing anywhere. And when the person tries to focus on just one thing, the mental clutter of those worries, it gets in the way. It forces them to attend to whatever that intrusive threat is perceived to be. So it makes it difficult to focus on what they were supposed to be thinking about originally. People might lose things more often, forget why they walked into a room, miss deadlines or flake out on something they were supposed to attend to. It can certainly start making other people frustrated. But in these cases it's not carelessness, it's anxiety. And you can imagine how all of this is compounded if your sleep is disrupted too. Which leads us to number four sleep issues. So sleep issues are one of the top symptoms that people are experiencing worse since the pandemic. In terms of what they will say. The manifestation of their stress is for certain people struggling with anxiety, the link with sleep problems could not be more obvious. They lay in bed actively worrying about things, unable to fall asleep. For other people, the differences are more subtle, like waking up too early and being unable to fall back asleep or having an increased number of disturbing nightmares. Of course, different people have different types of nightmares. I remember when our kids were young, I would have a somewhat recurring nightmare that maybe I'd forgotten to feed my toddler daughter and she was wasting away in the corner somewhere. And meanwhile my husband would say, oh yeah, that's awful. I dream that I was decapitated nine times in a row by zombies. So whatever nightmares are to you, pay attention. Sometimes this really can be anxiety, because sometimes it really does mean that the quality of your sleep is not as good as it should be, because you're getting so stressed out even during sleep that you're not able to be in those deeper sleep phases for adequate amounts of time. Or maybe even the nightmares are actually waking you up. Anxiety makes us have more restless sleep in general. Our cortisol levels don't go down as much as they're supposed to. So the whole architecture of our sleep, as we would say, how much time we spend in different sleep phases, can change, so that even if we're asleep the same amount of time, we're not getting as much actual neurological rest. I know you're probably so tired of hearing me say the phrase vicious cycle, but this one could not be more classic. So please let me get away with it just a little bit more. When anxiety disrupts our sleep, it absolutely makes us even more anxious, because when we're sleep deprived, we are more hypersensitive to threat. Regular listeners. Know why? Because of evolution. Dum dum, um, dum dum. When we were sluggish and fatigued due to being underslept back in the day when cave bears were stalking us, that meant we needed some extra help looking out for threats. So our brains developed the adaptation of erring on the side of viewing everything as more threatening. It helped keep us alive. Now, since, mercifully, there aren't that many cave bears stalking us, trying to eat us, at least not on your average workday, that just means that we're more hypersensitive to threat and therefore more miserable. So sleep is so crucial to this whole question. Number five increased cynicism. People with increased anxiety often have increased irritability. Irritability and anxiety and fear. They're all very physiologically similar because they all involved increased arousal of your sympathetic nervous system. It's on higher alert. It's more reactive to threat. Oftentimes when this goes on for particularly long periods, it can start to just look like being mad at the world. Patience disappears and things start to turn kind of dark. Somebody can no longer go with the flow. They might find things grading that never bothered them before, whether it's noise or cluttered spaces or frustrating social situations. Anxious people may begin to turn this negativity inward as well. They might start doubting their ability to overcome obstacles. They might assess themselves with more negativity, or hopelessness or helplessness or cynicism, maybe more so than ever before. This is one symptom that does overlap pretty heavily with depression, especially when accompanied by the mindset that things won't get better. That hopelessness can be a real gut punch when it comes to mental health. Number six increased difficulties at school or work. When we aren't feeling our best mentally, it obviously becomes harder to actually have our best performance, or even to summon the motivation to try, we might be more likely to give up. Or even if we do try our best at the time we've got those distractions of our worry and that distress and that difficulty concentrating that can make even our best efforts fall short. A star student who suddenly stops turning in assignments, a conscientious colleague who now barely speaks up in meetings, or a business owner who just doesn't seem to care anymore. We may typically think of these as telltale depression symptoms, and it's true they involve anhedonia. That loss of pleasure, that loss of spark, that's such a classic hallmark of depression. But these signs are also classic for burnout or chronic stress or excessive anxiety as well. Number seven increased relationship conflicts. This is not always talked about, because maybe people think it goes against having compassion and empathy for people struggling with anxiety. But we can still have all kinds of compassion and empathy when saying that. Sometimes anxiety makes people absolute jerk stores of human beings. In m fact, I think it's particularly important to talk about this. Not so we can diminish our empathy for people with anxiety, but so we can add our empathy and understanding to those people we might have just otherwise dismissed as annoying intolerable, jackinapes. Anxiety can make you more difficult to be around. Let's face it. You may become less patient, less tolerant, less understanding, less enthusiastic, less encouraging, just more negative, more wuh-wuh of a type of presence. And friends and coworkers and loved ones may personalize this like they're the ones that did something wrong, or they might just get angry, or might just start avoiding you. And of course, those conflicts can then I know, you know, it turn into a self perpetuating cycle. People get frustrated, they have a conflict. Now things are even more negative, which adds to the person's anxiety, and they become more threatened, more curt, less positive in their interactions. And this is the classic spiral. But again, if we can apply some empathy to it, maybe that can lead us into a conversation, or somebody will be more likely to get help and get to the root of the problem with our help, before more damage is done. And finally, number eight feeling a sense of doom. Or that things are out of control. Look, excessive anxiety can be really hard to describe. Just like depression. There's a darkness to it, a cloud type of feeling, like a weight that's holding somebody down or keeping them trapped. Sometimes it can be really difficult for people suffering from anxiety to put into words what they're going through. They may feel like they're drowning in stress or that they're spinning out of control in their lives. The very definition of the anxiety disorder. Generalized anxiety disorder. Yeah, I know. It's a real creative diagnostic label. It's practically poetry. Anyway, gad for short. Generalized anxiety disorder. The very foundational aspect of that diagnosis is that the excessive worry feels difficult to control. It's not that the worry is unrealistic. That actually used to be the case in the past Diagnostic and Statistical Manual, but now it's, ah, that the worry, even if somewhat realistic, feels out of control. That's a really hard place to be. And some people might really focus on the physical symptoms of this, becoming certain that something is medically wrong with their bodies. For others, they just feel like they're so keyed up that they can't ever be at rest. Either way, it can be uncomfortable enough that it deserves some help. So this was meant to give you some ideas about whether or not you're detecting patterns in your own life or the life of somebody that you care about in terms of their experience of anxiety. Is there anything missing here that you've noticed? Anything that particularly resonated? Let me know. And if you're struggling at this very moment with a high stress level, why not check out our recent episode on visualizations to lessen anxiety? That is episode number 37. Thanks for joining me today. Once again, I'm Dr. Andrea Bonior, and this has been Baggage Check. With new episodes every Tuesday and Friday. Join us on instagram @baggagecheckpodcast. Give us your take and opinion on topics and guests. And you know, you've got that friend who listens to like, 17 podcasts. We'd love it if you told him where to find us. Our original music is by Jordan Cooper, cover art by Daniel Merity, and my studio security, it's Buster the Dog. Until next time, take good care.