This is the first of my new series of blog posts – 3Bs; the brain, the body, the behaviour. Each post will be focussed on a mental health problem/illness/disorder and will outline what’s going on in the Brain, and how this affects the Body and the individuals Behaviour (hence, the 3Bs.) Hopefully this will help educate people about how mental health is not just “all in someones head”, and how in a lot of cases it is a neurological problem that can seriously affect someones physical health and also how they go about their daily lives. This is the first post, and as clearly illustrated above, is on anxiety.
What is anxiety?
Anxiety is a perfectly natural and normal physical reaction the body has when faced with danger, something fearful, or something worrying. For example, it’s perfectly normal to feel anxious when you’re about the sit the most important exam of your life, or if you’re faced with a pack of lions in the middle of nowhere, or if you’re faced with your parents three days after you’ve shouted at them and stormed out in the middle of the night (I know which scenario i’d prefer..). However a lot of people feel irrational anxiety on a daily basis, and it begins to take over their lives. This is what happens when someone develops an anxiety disorder.
What is an anxiety disorder?
According to the World Health Organisation, anxiety is the most common mental illness. There are 6 main types of anxiety disorder:
- Generalised anxiety disorder -> An anxiety disorder marked by excessive wory, but this worry is not specific to a situation or object
- Panic disorder -> Defined by uncontrollable panic attacks. The individual is hit with a wave of terror and fear and this triggers a panic attack.
- Obsessive compulsive disorder -> Repetitive obsessions and compulsions (not just being tidy and clean!!)
- Social anxiety disorder -> Intense fear of social interactions and situations, and copes by avoiding them completley
- Phobias -> Fear and anxiety related to a particular situation or object
- Post-traumatic stress disorder -> Anxiety after and related to a traumatic event
In this blog post I will be looking at how anxiety, as a healthy response and as a disorder, effects the body and the behaviour (e.g. symptoms of anxiety) by looking at what is going on in the brain when an individual experiences anxiety.
There are two circuits of activity that go on inside the brain when an individual is faced with stimuli that they may fear or be anxious about.
- “The shortcut” – This circuit is the brains way of quickly getting the body to be alerted to the stimuli. The brain automatically engages the area of the brain called the amygdala. The amygdala is linked to fear and pleasure.
It sends signals to the other areas of the brain associated with fear, including the locus ceruleus which is responsible for a lot of the classic symptoms of anxiety (which we shall dicuss later.) This means that the body is usually feeling anxious before the body realises why.
This is called the fight or flight method. It is an evolutionary method of survival. It is a normal reaction to a stressful or anxious situation, but when prolonged can be diagnosed as an anxiety disorder. It is the brains way of beginning to analyse the situation to decide whether the body should fight the situation or object they are confronted with, or whether they should flee from it. This is where the second circuit comes in.
- “The high road” – This is where the sensory information takes route in more specific detail in order to decide the bodies reaction. Whatever the object is, it would have be seen, or touched, or heard, or smelt or, in some rare cases, tasted. An area of the brain called the Thalamus processes these sensory cues. Olfactory (smell) and tactile (touch) stimuli however bypass the thalamus and go straight to the amygdala (mentioned above), and this tends to produce a stronger memory and feeling associated with the cue.
The thalamus however, has the job of sending these cues, depending on what sense they are (sight, smell, touch, smell or taste) to the relevant area of the brain including the cortex.
The cortex, once it receives these messages, determins if they require a fight or flight response. It uses the hippocampus (also associated with emotions) and hypothalamus (associated with memory) to determine this, depending on any previous encounters with the same stimuli and what emotions it has previously created.
- Outside of these two circuits that decide what the body is going to do, the brain is busy already dealing with the stimuli they are faced with.
The hypothalamus, along with the pirtuitary glands activate the production of a hormone called cortisol in the adrenal glands. Cortisol is the ultimate stress hormone. If you are particularly stressed your cortisol levels will be high. However, too much of this hormone can block circuits associcated with the hypothalamus which can make it difficult to organise and retain memories.
The brain also decides to ignore any functions that are energy wasting so they can focus on the stimuli, this includes functions such as digestion.
Furthermore the frontal and temporal lobes of the brain are areas where immediate emotions occur, including dread and negativity. Therefore dopamine is a hormone that is usually released which can affect an individuals behaviour.
Using what I have just outlined above, plus extras, we’ll now look at how anxiety can affect the body in both the long term and the short term.
- As explained above, the hormone cortisol is released into the blood as a reaction to a stressful situation. As a response to this, the liver produces more glucose. This creates a spike in blood sugar levels which can be damaging in the long run. This increase of cortisol can also effect the skin, creating eczema breakouts. It can also trigger the flare up of psoriasis. It creates sweating problems, breathing problems, and heart problems. It’s a bloody pain in the arse, basically.
- After anxiety has passed, the brain may still continue to release the stress hormones. In those with an anxiety disorder this is common. This can cause headaches, muscle tension, loss of sexual desire, and also an increased risk of developing clinical depression.
- As a reaction to the anxiety, the muscles immediately seize as a reflex reaction. This may not seem too bad, but it can cause discomfort such as pins and needles, cramp, but also once the muscles relax it can make the body feel tired and achy.
- Anxiety causes cardiovascular reactions including a rapid heart rate and palpitations. This is a response to the body needing oxygen to get to the brain and around the body quicker in case it needs to fight or flight. As a result of this the blood flow is increased and redistributed around the body. This can cause some people to become pale, and others to become flushed. Furthermore, a rapid heart rate can cause high blood pressure and can increase the risk of heart disease in the long term. The spleen is also more active as it discharges more blood cells to distribute more oxygen around the body. With the heart pumping harder, it also means the lungs need to work harder to get oxygen in and out of the body. Breathing becomes rapid and difficult, and for many a panic attack may feel like they are being choked and are struggling to breath at all.
- Short term anxiety has been found to actuall boost the immune system. However, too much anxiety and prolonged anxiety can interfere with the ability to fight off illnesses as your body and brain are too busy trying to fight off the stimuli which is causing you anxiety.
- As mentioned above, the body and brain stop concentrating on energy wasting processes such as digestion.
Taking all of this into consideration, let’s look at the surface symptoms of anxiety and hopefully we can understand exactly why people behave the way they do because of what is going on inside their brain and body:
- Fear of leaving the house, leading to social withdrawal – This is a very common symptom of individuals with anxiety. They may not leave the house because they are worrying about a lot of different situations which may or may not occur if they were to leave the house – it is like a fear of the unknown. They may also be worried about their symptoms of anxiety. For example if we look at what I went through above, they may be scared of going into a panic attack and being scared to not be able to breath, to wet themselves in public, to sweat and shake and have tired muscles out in public. Its a very demeaning situation to be in, in a public place, when you feel like you cannot function properly because your brain and body are going into fight or flight overload.
- Loss of sleep and drowsiness – If the individuals cortisol level is high, they may find it difficult to sleep. They may also be unable to sleep because of any worries they may have. This will cause daily fatigue and drowsiness. Having a panic attack or high levels of constant anxiety is also extremley tiring.
- Inability to relax – Because of high cortisol levels, the body will be in constant fight/flight mode, making it impossible for an individual with an anxiety disorder to relax due to being on constant edge and waiting for something negative to happen, or just waiting for the uncontrollable feeling of anxiety to pass.
- Drug/alcohol abuse – A lot of individuals turn to drug or alcohol abuse when faced with an anxiety disorder. Drugs tend to numb an individuals feelings whilst taking them, as does alcohol, and even tobacco is well known for reducing short-term stress. However in the long term drug and alcohol abuse can worsen an anxiety disorder and in many cases can actually trigger further mental health problems.
- Poor memory – When an individual has a panic attack, they sometimes struggle to remember it, where they were or what they were doing before the attack. This will be due to the high levels of cortisol blocking the circuits to the hypothalamus, as mentioned above.
- Vomitting/urination/decefecation – As mentioned above, the body shuts down systems which can appear to be wasting energy. The main one here is digestion. This can cause the bladder and bowels to become weak, and it is very common for people to defecate or urinate without any control, or to vomit, due to the shutdown of their digestive system.
- Other symptoms – Sweating, pounding heart, and a shortness of breath are the classic symptoms of feeling anxious and are all due to the loceus ceruleus responding to the brains fight or flight response. In severe cases it can cause people to pass out, but this is also the body’s way of avoiding the anxiety-triggering situation all together and the body can just shut down due to having not enough energy to cope.
So when you lay it out like this, anxiety is – when used as an evolutionary survival instinct – pretty helpful. Gets our heart pumping, gets our brain going, stops systems that we dont need for a minute so we can concentrate on survival. However, as a prolonged disorder, it’s absolutely bloody terrible. It can affect an individual every single day with every single situation. It can cause embarrasing situations, especially when it triggers a panic attack which can totally debilitate a person.
So next time someone says they’re feeling particularly anxious, just have a little think before you tell them to “get over it” or that “they’ll be okay”, just remember that their brain can’t just get over it as it’s already one step ahead of them by getting them ready for fight/flight reponse, and in their head they’re not going to be okay – they’re going to get sweaty, and pale, and can’t relax and may possibly puke, or wet themselves, or just pass out.
When you look at it like that, it’s a pretty scary situation to be in – so just ask them what you can do to help, listen to them, and ride it out with them, help them to breath, sit them down, and focus on what they want. Because they will be okay, they just don’t feel like it at that moment in time.