When it comes to mental illnesses, depression often gets the most attention and research funding. But, according to Wall Street Journal reporter Andrea Petersen, anxiety is more prevalent.
Anxiety disorders typically emerge earliest, with warning signs sometimes appearing in toddlers and even babies. They can be debilitating and can be "gateway illnesses" to other problems, such as depression and substance-abuse disorders. Moreover, Petersen reports, they can be deadly, leading to suicide.
Petersen, whose reporting has focused on health, psychology and neuroscience, has delved into the science and treatment of anxiety disorders. (An estimated three million Canadians, or 11.6 per cent, aged 18 and older, reported having a mood or anxiety disorder, according to a federal 2014 survey on living with chronic diseases in Canada.) But her interest in this topic is also deeply personal. Having struggled with anxiety through childhood, she was eventually diagnosed with an anxiety disorder as a university student, after suffering a prolonged panic attack. Of the 11 different anxiety disorders listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is used as a standard diagnostic tool for clinical care, Petersen had symptoms of four: panic disorder, generalized anxiety disorder, specific phobia and agoraphobia, characterized by avoiding places for fear of experiencing a panic attack.
In her new book On Edge: A Journey Through Anxiety, Petersen chronicles the impact her anxiety has had on her relationships, work and parenting. She also explores the possible origins of anxiety disorders, weaving interviews with leading researchers in with her personal anecdotes.
As Petersen explains to The Globe and Mail, her anxiety will likely never go away, but she's learning to live with it:
What does a panic attack feel like?
It basically feels like you're dying or going crazy. It's these periods of intense, blinding terror, coupled with very, very strong physical symptoms. A lot of people think of anxiety as stress or worry. But anxiety is really a whole-body experience, and a panic attack is sort of the epitome of that. My panic attacks tend to be characterized by a racing heart, a shortness of breath, visual changes, I feel dizzy and light-headed and get tingling in my face and my hands.
According to the DSM, a panic attack is supposed to peak within about 10 minutes and it gradually subsides. I'd say generally that does happen, but when I had my – for lack of a better word – breakdown in college, I felt like I had this five-week-long panic attack. There were peaks and valleys to it, but those intense physical symptoms and the terror didn't really abate that much.
You mention in the book that many of your acquaintances have been surprised to learn you have anxiety. How have you kept it from them?
If I'm not having a panic attack, it's something I can hide. You can't see the worry churning in my head. While worry may be taking up 70 per cent of my brain, I still have that 30 per cent that allows me to fake it. Especially when I was younger, I was embarrassed by it, so I would take great efforts to be perceived as totally fine.
At the end of the day, not only are you exhausted by the physical wear and tear that happens to your body by being in this perpetually amped-up state, there's the emotional hiding and the disconnection you feel from other people because you either don't want to burden anyone with your worries, or you're afraid of being perceived as weak or not capable.
What are some of the common misconceptions about anxiety that you'd wish to dispel?
Anxiety is a normal human emotion, and it's based on this threat-detection system that we and most other organisms have to protect us from threats. But some people don't quite understand that it can be so impairing. It's not just an issue of being stressed-out and if you just did some deep breathing, or just tried to relax or take a vacation, you wouldn't have this problem.
I also think it's wonderful that people are being more open about mental illnesses, but I feel like there's still this stigma that having an anxiety disorder means somehow that you're weak or that it's a moral failing. I don't think that's the case at all.
In what ways have the people around you helped when you've gone through rough periods?
When I was kind of falling apart in college, I didn't appreciate it at the time, but my parents made me go back to school. Because my symptoms were so physical, I was bounced from doctor to doctor, and I wasn't diagnosed for a year. I had dropped some classes and I wanted to stay home, but my parents told me I couldn't. I felt pretty betrayed at the time. But once anxiety gets entrenched, what often causes impairment is you stop doing the things you want to do in your life. Those avoidance behaviours are actually associated with harder-to-treat and more chronic illnesses.
I've also had many close friends sit with me, hold my hand and get me through intense periods of time. I was lucky to have incredibly patient and supportive boyfriends in college, who would take me to class and immediately take me home when I needed a break. One of the upsides of anxiety is I've had to be vulnerable, and that has created a level of intimacy in my friendships that I might not have had if I didn't struggle with this.
When you were dating, you started telling your dates early on that you had anxiety. What was that like bringing it up?
I had one boyfriend in particular who couldn't cope with my anxiety. After that experience, I realized I wanted someone who was smart and funny and kind, but also someone who could deal with my anxiety. So I treated it like having a [sexually transmitted infection]. On the second date, I'd tell them, "This is the condition I have. I've had it since college. I definitely deal with it, but it waxes and wanes. It's chronic and it's probably not going to go away forever."
The lucky thing is, after I started doing that, I met my husband shortly after.
When it came to dealing with anxiety while at work, how did you talk to your employers about it?
I didn't. I'm lucky that medication works for me, and it does not work for everybody. Cognitive behavioural therapy worked for me as well. Fear of hurting my career is what ultimately drove me to begin medication in my late-20s. I had a full-time job as a reporter for the Wall Street Journal. I knew there was no time-out from the working world.
I always had a couple close friends at work whom I could be very open with. So if I had a panic attack in the middle of the day, I could e-mail my friend and say, "Can you take me for a walk?" But I didn't tell my current editors until I'd actually finished the proposal for this book. They were great. I was really lucky. But I did purposely wait until I had a 20-year track record in journalism, in my chosen field, to out myself. I'm hoping others won't have to wait that long.
You mention in the book that researchers are looking at anxiety in toddlers and babies. What does anxiety look like in children so young?
There are certain risk factors for who will develop anxiety, and some of them are apparent in babies as young as four months old. Based on pioneering work by Jerome Kagan at Harvard University, there's a whole battery of tests that they do. They dangle novel toys in front of the baby, they put a little swab of alcohol under the baby's nose, they expose them to strange voices. And it's basically to see how the baby responds to novelty in the environment.
About 20 per cent are what they call "high-reactive." They thrash their arms and legs and they're obviously distressed. And those babies tend to become behaviourally inhibited by toddlerhood. So they're socially reticent and exhibit clinging behaviour. And those children who stay behaviourally inhibited are at much higher risk of developing anxiety disorders by adolescence.
But there are other risk factors, like experiencing trauma in childhood. Even being sick as a kid or witnessing the serious illness of a parent is a risk factor. Certain types of parenting, like controlling parenting, increase the risk of developing anxiety. There's very interesting work looking at the interaction between the environment and genes as well.
What do anxiety prevention and intervention programs for toddlers and preschoolers entail?
I looked at a program at the University of Maryland. It's focused on children who are behaviourally inhibited. A lot of these kids are already meeting criteria for anxiety disorders at age three and four. There's two components to it. One is social-skills training for the kids. So it's really teaching them how to identify their own emotions, how to make friends, how to have conversations with other kids.
The other element is working with parents because often what parents of anxious kids do is they naturally start protecting their children. They see their kids in distress, so they say, "You don't have to go to that birthday party," or "You don't have to go to ballet class if you don't want to." Or they'll even speak for their children, like when a kid doesn't want to say hello to someone. That reinforces the message that their children aren't capable and the world is a dangerous place. So part of it is to train the parent to stop doing that and to ignore anxious behaviour and really promote brave behaviour.
What measures have you taken with your own daughter to build her confidence?
A lot of kids do not stay behaviourally inhibited. As a toddler and preschooler, she was much more shy and skittish and very, very sensitive to rejection. Since then, she's gotten much more confident. She's still, I believe, not necessarily going to be the most extroverted kid.
One thing I did early on was I really focused on her sleep because the evidence was pretty clear that kids who have sleep problems, insufficient sleep or difficulty sleeping are at much greater risk of later developing anxiety or depression. So that was something I was pretty militant about.
Expectant women who are dealing with anxiety and depression have to weigh the risks of staying on medication while pregnant against the risks of going off medication. How did you navigate that decision for yourself?
I went and saw a reproductive psychiatrist. I had a pregnancy and, unfortunately, there was a terrible fetal anomaly, and so that pregnancy ended. But I had a major resurgence of anxiety. I was on Prozac at the time, and the reproductive psychiatrist I saw basically told me I had to stay on medication. So I did.
There's a growing number of reproductive psychiatrists who are really focused on helping women manage their medication and to manage their symptoms during pregnancy. The risks of relapse is very high for people who go off medication, and some of the concerns for the baby are actually the same for staying on the medication and being exposed to anxiety and depression in utero.
The one message I would like to get out to the medical community is that while it's great the psychiatry community and reproductive psychiatrists are really focusing on helping women navigate this, I don't think there's enough focus on non-drug treatments for pregnant women. I think everyone would agree the ideal scenario would be to not have that SSRI [selective serotonin reuptake inhibitor] exposure and not have exposure to maternal anxiety or depression.
In some cases, it seems your anxiety has served you well. For instance, it led to doctors catching a cancerous spot on your cheek. How do you know when to trust your anxiety?
One thing that has been incredibly helpful is having a primary-care doctor who I really trust. I call her "Dr. G" in the book, and she is really sort of an interpreter of my very noisy and sometimes unreliable body. I do tend to have all sorts of weird symptoms and I need someone to help me navigate them.
She doesn't dismiss things out of hand, saying, "Oh, that's just your anxiety talking." And she's also not having me run to an MRI machine every time I have an ache or pain.
Sometimes, she'll say, "This is why I've ruled out whatever it is you've read on the Internet," or "Let's see if you do some of the techniques that have helped your anxiety in the past, and we'll see if this goes away."
But there are other really grown-up, adult things that help, like getting enough sleep, eating right, exercising. We're all taught to do this. For people with anxiety, that boring stuff is even more important.
This interview has been condensed and edited.