Sunday, July 6, 2008

Topic 13: Anxiety

The goal of this topic is to help you identify how your sexual timeline is shaped by your anxiety. As you review your sexual history, think about the following information. How has anxiety increased your sexual behavior? Perhaps you have used sexual behavior to stop or reduce symptoms of anxiety. On the other end, your experience of anxiety may impair your sexual health and sexual behavior. In some cases, a person might have so much anxiety that they use chemicals to feel less anxious in order to engage in sexual behavior. Yet, in other cases, anxiety can lead to sexual functioning issues. As you review this material, think about how anxiety is present in your life and shapes your behavior and your sexual health.

Anxiety, in the simplest sense, is simply a sense of fear or uneasiness. Some anxiety is helpful in that it motivates us to do things. “I’m nervous that my boss will get upset if I don’t complete the project by Friday.” As such, anxiety can motivate us to get something done. In these cases, anxiety is a positive thing. For some people or some situations, anxiety can be a serious problem. In these extreme cases, anxiety disorders can be a serious medical illness.

If anxiety becomes pronounced, it can express itself in various ways. For example, you may have trouble sleeping. You might find you overly dwell on a particular situation and/or find it difficult to think or concentrate on other things. Your appetite or eating behaviors might change. Alternatively, you might have a sense of vigilance or a feeling of impending disaster, as if "something bad is going to happen. In some cases, anxiety can mask other mental health issues such as depression. Below are symptoms and types of anxiety. How do these symptom show up in your life?

Symptoms of anxiety:
• Feelings of apprehension or dread
• Trouble concentrating
• Feeling tense and jumpy
• Anticipating the worst
• Irritability
• Restlessness
• Watching for signs of danger
• Feeling like your mind’s gone blank
• Pounding heart
• Sweating
• Stomach upset or dizziness
• Frequent urination or diarrhea
• Shortness of breath
• Tremors and twitches
• Muscle tension
• Headaches
• Fatigue
• Insomnia

Types of anxiety

There is a range of anxiety disorders, with the most intense type of anxiety on top. Depending on the number and/or severity of symptoms, an individual’s diagnosis may change. It is recommended that if you experience a number of strong symptoms that you seek professional help.

Panic Disorder is an unpredictable attacks of anxiety that in clued a physical component. The physical expression is so intense that it can be consumed with heart attacks. Typical symptoms include some pain and a shortness of breath. Once a person has had this experience, they may change their behavior out of fear of having another similar attach. When this fear of another incident gets so bad, some people get to the point of withdrawing from public interaction. In these cases, a diagnosis of panic disorder with agoraphobia is a possible diagnosis. These individuals typically avoid public spaces out of a fear of losing control. Someone with this level anxiety requires medical attention. It is my opinion that this level of anxiety may have a genetic/biological component that needs to be evaluated by a medical provider. This type of anxiety has the most impairment in a person’s life.

Post Traumatic Stress Disorder (PTSD) is as it sounds, an anxiety reaction after to the fact that is triggered when similar situations appear. The classic example is the war veteran returning home. This diagnosis is highlighted recently in the press as veterans return from Iraq and Afghanistan. Less known events can trigger PTSD such as a car accident, witnessing a death or accident. Some clinicians have suggested that there might be a cumulative experience of trauma such as domestic abuse, physical or sexual abuse that can trigger PTSD.

Obsessive Compulsive Disorder (OCD) - The person suffering from OCD uses ritualistic and repeated behaviors to rid themselves of obsessive thoughts and anxieties. The key is the emphasis on behaviors or thoughts that repeatedly impairs an individual’s ability to function in the world. This might be expressed as perfection, or fear of not doing it write that leads to nothing getting done.

Generalized Anxiety Disorder (GAD) characterized by excessive anxiety and worry that is consistently present, and disproportionate to the event or circumstance that is the focus of the worry. One way this shows up is that if I looked at pornography, the “porn police” will track me down. Or, if someone finds out I’m gay, they will tell everyone else. The key to this type of anxiety is the “over the top” fear. It is not rational to most people. In these cases, it is my opinion that a biological component is often present with this level of anxiety.

Social Anxiety Disorder refers to anxiety is social situations. This can include simply being in public to more specific forms of public speaking. A person then is fearful of situations in which they may be subject to the scrutiny of others. This fear of judgment by others can lead to immobilization at the extreme end to forms of self medication such as alcohol or drug use.

Specific Phobias is the persistent fear of objects or situations. A typical example is a fear of heights, flying, or snakes. When these objects occur, a severe response occurs including feelings of fear, increased heart beat, etc. The experience doesn’t even need to be “real.” For example, someone afraid of snakes can be triggered by a snake on a movie or TV screen.

Adjustment disorder with Anxiety is the least severe. It often has no or only a minimal impact in a person’s life. A classic example is the anxiety associated with starting a new job. Will I be able to do it? Will people like me? This level of anxiety has a short life span.


Treatment for anxiety is varied. Depending on the severity, you might need to use all available treatment tools. In other cases, one or two might be appropriate. In nearly all of the serious cases of anxiety, I recommend some type of medication. Please consult a medical professional. The range, type, and levels of medications are simply too complex to fully document in this blog.

In addition to medications, there are a range of talk therapy approaches to treatment. Some of the most researched forms of treatment for anxiety are forms of cognitive behavioral therapy CBT. This work has as its core theory, a cognitive therapy approach (see Topic 5). The process of treatment is to evaluate the relationships between thoughts, feelings, and behaviors. Once this examination is done, it is important ot identify and implement strategies to address the thoughts, feelings and high risk situations.

Other approaches to treating anxiety include bio feedback, systematic desensitization, flooding, and exposure techniques. Each theory has their approach and should be used under the proper supervision. I recommend that you talk with a clinician regarding their training, experience and treatment plan when you start a treatment approach.

There are also a number of alternative approaches to treating anxiety. They are listed here (based on other resources).

  • Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
  • Stop or reduce your consumption of products that contain nicotine (a stimulant)
  • Review over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
  • Exercise daily
  • Take a nice, long bath. You can use bath oil.
  • Take a walk outside.
  • Tighten the muscles in your toes. Hold for a count of 10. Relax and enjoy the sensation of release from tension.
  • Muscle tension is most commonly experienced in the back of the neck and shoulders. One easy way to get rid of such tension is to tighten the neck and shoulders, holding for 5-10 seconds before releasing.
  • Close your eyes and rest them, take a deep breath through the nose, exhale through your mouth, and repeat a few times. When breathing in, let your stomach expand as much as possible. Concentrate on breathing slowly and calmly, thinking of your slow breathing as calming your entire body as a whole or in parts. Leave your breath out for a relatively long period of time.
  • Mentally scan your body from head to toe. Are there any areas of tension? If so, take a few deep breaths, hold, then release slowly, saying "relax" to these parts. Think of the muscle as being soft and limp.
Meditation Activities
  • Draw
  • Journal
  • Listen to relaxing music
  • Tell yourself "I am relaxed" as you carry out breathing exercises. You can also think about positive words like "peace", "serenity".
  • Visualize a soothing image (e.g. lying on a warm beach).

As you review the material on anxiety, they key is to reflect on how anxiety is related to your sexual behavior. Could anxiety impair your sexual functioning? Might you be using sexual behavior to reduce anxiety? Could anxiety lead to different types of sexual behaviors (such as casual sex out of a fear of getting hurt in a committed relationship?) These are simply questions to start the conversation.

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