WHY we become ill with anxiety disorders

[NoPoet]

Tu ne cede malis sed contra audentior ito
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Hi all,

Some of you have seen my "PsychoPoet Research Initiative" threads. Well this is looking to be the next one. This post will be updated as I discover more useful or up to date information.

I've been studying the reasons WHY so many people suffer from anxiety and depression, and WHY medication, therapy etc are not always completely successful.

I believe I am onto something that could lead to a permanent cure for all or most of us who suffer from anxiety related disorders. Yes, I know that sounds a bit over the top, but hear me out.

You may have seen some of this stuff in my other threads, especially the threads I created since starting CBT. I'm trying to bring it together in one major thread, a kind of survival guide for all anxiety related conditions. Some of this stuff may be completely new to people, which is a shame, because this is the stuff that is really going on behind the scenes of our illness, and it is my firm belief that a lot of people are going to benefit if they put some of this stuff into practice.

In the Beginning: Why do we suffer anxiety disorders?

Is it possible that we suffer from anxiety-related conditions, not just because we are more vulnerable than other people by our nature (which is beyond the scope of this thread because I'm not God, luckily for chavs), but because we have failed to develop proper coping strategies?

We instead rely on basic, natural strategies that are good for short-term relief but create problems in the long run. Avoidance and denial are two perfect examples. Both of these lead to building tension, increased stress, and eventually they spill over into other areas of our lives until we simply cannot handle anything, but we cannot avoid or deny them any more. Wham, you have a breakdown.

We cannot prevent a predisposition towards fear, melancholy or anxiety because, as previously mentioned, we are not God. This isn't an episode of Voyager where we can spend ten minutes spouting technobabble and suddenly re-write our DNA.

The role of the Ego in anxiety disorders

People with ego problems (as in identity and self-esteem, not as in arrogance), are probably more likely to develop inefficient coping strategies, since they secretly believe they cannot handle life, they're not good enough, they're not worthy, etc.

Let's face it, you are not really going to struggle with life if you possess a total self-assuredness, and your response to danger is naturally "bring it on!".

Ego problems may be the cause behind a lot of anxiety related disorders such as depression. True, these disorders are often brought about by a person's environment, eg loss of a job during a recession and you can't afford your mortgage, or being abused as a child etc, and depression in particular is regarded by some as a "force for change" - a strong warning that something in your life needs to be change immediately - but why is it that some people simply cannot seem to cope, where others just can? Why do some people develop depression after a loss, or GAD when under threat?

It is my belief that the ego has a massive role to play in our mental health. If we unconsciously believe that we are worthless, we are vulnerable, we are going to suffer, people won't accept or like us, we are going to fail because we lack talent etc, we are basically on a collision course with fate: something will eventually happen that we feel unable to cope with, and that's when disorders develop.

If you're reading this and it sounds like I'm talking about you, you definitely have issues with your ego, and you might find that these are not only the original source of your current illness, they also act as rocket fuel for the illness once it has taken over.

So where does this leave us? Well, for a start it explains a number of things, not just about your current condition but about many things throughout your life. Do you feel alone and friendless? Maybe you pine to have friends and be out in the world, but you just can't hack it? Maybe you just can't face starting something new in case you fail and get laughed at, or when you do start something new you spend so long trying to get it perfect that your own hobbies exhaust you rather than relax you. Maybe you're scared to talk to the opposite sex in case you're rejected.

You have a negative belief system. (You might call this an inferiority complex if it relates entirely to a sense of worthlessness in relation to others and their work.) A negative belief system generates negative thoughts, which in turn generate negative feelings and negative behaviour. Over time, this can grow and complicate, until negative thoughts run rampant, destroying your confidence and in extreme cases, your will to do anything, maybe even live.

Every time the expected outcome does happen to you - so you do speak to someone you fancy, but they tell you to sod off, or you cock it up completely and make a fool of yourself - it reinforces your negative belief system. You believe it even more completely. You are even less likely to try again in future. You become even more trapped, you suffer even more distress, and have actual physical proof that your negative beliefs are valid.

A more serious problem is how negative belief systems are self-reinforcing. You make the feared outcomes happen. You may be so convinced that other people won't like you that your behaviour pushes people away. You are so convinced that you don't deserve to be in a relationship that your partner gets fed up of your clinginess and constant requests for reassurance, and you split up; or you just don't get together with anyone. You constantly pass up chances for happiness and change because you don't believe good things can happen to you, and that nothing good does ever happen anyway.

So, you fear that you will always be alone because you are somehow cursed or repugnant, but it is your behaviour and attitude that drive other people away or prevent them from getting close to you.

You curse the world, you curse fate and most of all you curse yourself, never knowing for one minute how things can be any different.

Unhelpful treatments for ego problems and negative belief systems

Cue a trip to the doctor's for some counselling and medication! Unfortunately, your doctor doesn't have a clue what's "wrong" with you, and it may be several weeks before you get any kind of help, during which time your self-sustaining condition deteriorates.

You might get antidepressants, which can help you to feel better in general, but they don't fix the core beliefs or the ego problems which made you ill in the first place. There is the issue of side effects, which can make you feel worse for a while at a time where you desperately need some relief.

You may get counselling, which can get your life back on track and improve things considerably, but unless you have an exceptionally talented, perceptive and/or qualified counsellor, the counselling might not go deep enough. Person-centred counselling gives you a wonderful opportunity to vent, but it doesn't get into the ego, the id, mental defences etc, it won't really go into your past, and it can make you reliant on the counsellor (yet another ego issue which this article will discuss at some point). It will tell you what you need to change about your thinking and behaviour, but it won't tell you how.

Also, the NHS or your country's equivalent may only offer a limited number of sessions which may have a long waiting list. This is the BANE of people who need help quickly but have to wait for protracted periods.

Why do people not recover, or suffer from a relapse?

It is my belief that people who don't recover, or who recover and subsequently relapse, have not identified or successfully dealt with something that is central to the problem.

Even if a person was working diligently to change for the better, they might still relapse, so how does that work? Well it's the same thing with "treatement resistant" depression, where people have tried between 3 and 6 different therapies and medications but are still depressed. If you read research into this, medication treatment has significant drop-out rates, which means people are giving up on the medication for some reason.

It may be that most people who give up on meds do so as soon as the first side-effects hit, and the side effects don't disappear within the first few weeks. In some cases, and I have been stupid enough to do this, people reduce or drop their doses when they have been feeling better for a while, or they run out and can't be bothered to get an immediate replacement prescription. Going "cold turkey" from medication has a very high probability of causing a relapse into the illness. Even missing a few doses can put you back several weeks.

I'm not going to be arrogant and say everything I just said above applies to everyone. At this stage, there's no way to know why some people simply don't respond to medication or therapy. You should bear in mind that 80% of people who suffer from depression recover without any treatment at all, because they develop adequate coping strategies: exactly the sort of thing we can't do - yet.

Medication seems to be the first line treatment for anxiety and depression, although some modern research shows that a lot of sufferers could be cured without medication if their illness was treated quickly enough with the appropriate therapy. We all know someone who knows someone who's been on antidepressants for 14 years. Maybe some people do need them for years, but if you think about it, do you really believe that if you received appropriate therapy and worked every day on your recovery skills, you will need treatment for that long?

How is medication going to change the fact that at your core, you are a naturally nervous person who developed a deep-seated inferiority complex? It can paper over those cracks, but it you've ever felt like there's a "toxic energy sump" inside you, draining your vitality and confidence away into a bottomless vortex, this means that behind the scenes you have a negative belief system that is in action even now, even though you can't consciously hear it or see it.

Filling the void: Changing your negative belief system

This is the bit that will require commitment on your part. By commitment, I mean you must be devoted to it, you must put effort and work into it, you must put serious consideration into the causes of your problems. You must be prepared to spend weeks working on it to see the slightest benefits; you must understand and accept that if you've had problems all your life, it is may be a couple of years before you have resolved all of these problems and "internalised" the new way of living.

Internalising something means accepting it as a true part of yourself. At the minute, if someone calls you names, you accept that what they say is true because you already believe it yourself. You are allowing your negative belief system to be reinforced.

A few weeks or months further down the line, if someone calls you a name, you are going to be able to simply shrug it off, and maybe even think "Who does that moron think he is?" If you start a new project, you may not have total confidence, but the thought of failure will be motivating rather than daunting ("If I fail, who cares, I'm not doing this to prove anything to the world, I'm doing it because I love it and I'll give it a bloody shot!").

Life is like a game of tennis. Life WILL hit you in the face with the ball until you learn to return its serve.

= More to follow =

[Pipkin]

Hi there,

I find this topic very interesting and I imagine that you're finding it a very broad field of research. I say that because, interestingly, the majority of what you've said doesn't apply to me. I've never really had a problem with confidence and I still believe I can achieve what I want to if I'm determined and I want it enough. I find that, in many ways, suffering from GAD has made me stronger, more determined and, ultimately, more successful. Having said all that, I still can't shake it off though have become very skilled in coping and hiding it.

There are a couple of areas you haven't mentioned which I can relate to and are extremely relevant. One is heredity - I don't mean social conditioning and environment (although, that is another factor), I mean genetic traits. For some reason, anxiety runs through the male line of my family and there's no denying this is, to some unknown extent, responsible for my anxiety. The second is control and fear of losing it. Many of us expend vast amounts of time trying to control the uncontrolable in order that we have more security and certainty in our lives. For me, this doesn't stem from personal insecurity rather the need to minimise risk. This trait has made me much more staid as I've grown older.

There is a final consideration which might be viewed as quite controversial - deep down, some people don't want to rid themselves of anxiety. No matter how hellish it can be, anxiety sits there in the corner like a smelly old dog you can't bear to part with. There is some security in familiarity. I'm not necessarily saying this relates to me or that it's by any means universal. It is an undeniable truth for some, however. Some people (and this does apply to me) have suffered from anxiety for so long and from such a young age, we can't remember the people we were before. Anxiety had made us who we are today. It's quite frightening to think we could have been completely different people without it, and not necessarily better.

Happy to contribute to your research, if you think it may help.

Take care

Pip x

[debbsi]

great reading so far - looking forward to reading more, I think youve definatly hit the nail on the head with me about the negative belief system xx

[theharvestmouse]

I grew up being quietly self confident, I never suffered from any sort of self esteem issues until my anxiety became really bad in my 20's and suddenly I did start questioning everything a it affected my self confidence and also self esteem. I have rebuilt it a bit but I still suffer from some issues that hit me quite badly.

[Ingenious]

Thanks PsychoPoet, a very interesting read.

I have found from experience that the real changes for our better mental health can only happen when we are brave and go after the root causes.

Sadly, medication and many other treatments are only intended to ease the symptoms in many cases (but not all, for example if your illness is due to a chemical imbalance then a drug to correct it is a sensible start). This is why, as you have said, we often get better in the short term but then relapse.

Part of the problem as I see it is our culture now is "instant" and we always want immediate results. We also have a blind faith in science, technology and medicine to offer instant cures. So the idea of spending many hours in therapy (self help or professional therapy) or to invest hours each day in productive activities like meditation seem almost silly when you can just take a tablet and be done with it.

[NoPoet]

Hi, thanks everyone, at this stage you can consider this thread an "alpha" as there is a lot to learn, and I've learned loads from reading the above replies.

Pipkin - The whole research initiative thing suffers from "mission creep" as I keep finding new things to write about. Your anxiety seems to have been very character-building, and it is very good to see someone who is learning something from it. A lot of people think the anxiety is just horrible and has nothing to teach them but I disagree.

As for heredity, it's not clear whether it's in our genes or whether anxiety is a learned behavious passed down through close interaction. We learn by mimickry as infants. There is a doctor who actually cured people of schizophrenia, but when the cured people returned to their families some of them relapsed: the ones with dysfunctional families. I am not for one minute accusing anyone's family of being dysfunctional but there is an apparent link between mental well-being and home life.

The fear of losing control thing is indeed critical, since anxiety disorders are linked to a sustained sense of threat. This is something I'm still working on in CBT and it will probably be many weeks before I start to get the hang of it. Anything anyone can contribute regarding this will be more than welcome. The thread will be updated to cover this subject.

On a slightly related note, perfectionism is linked to fear eg of failure/being mocked, which would link into the ego thing. I'd be interested to know how many depressives/anxiety sufferers are perfectionists.


There is a final consideration which might be viewed as quite controversial - deep down, some people don't want to rid themselves of anxiety. No matter how hellish it can be, anxiety sits there in the corner like a smelly old dog you can't bear to part with. There is some security in familiarity. I'm not necessarily saying this relates to me or that it's by any means universal. It is an undeniable truth for some, however. Some people (and this does apply to me) have suffered from anxiety for so long and from such a young age, we can't remember the people we were before. Anxiety had made us who we are today. It's quite frightening to think we could have been completely different people without it, and not necessarily better.
Exactly this. It's not that we don't want to be anxious, it's more a case of "better the devil you know" - as you said, familiarity. In another thread I said how I am scared of what I'll be without the anxiety - a fear of emptiness - however if you think about it, the times where we are not anxious, we tend to feel really good!


I grew up being quietly self confident, I never suffered from any sort of self esteem issues until my anxiety became really bad in my 20's and suddenly I did start questioning everything a it affected my self confidence and also self esteem. I have rebuilt it a bit but I still suffer from some issues that hit me quite badly.
Your first sentence backs up what Pipkin says, and I find it really interesting that you both had no confidence issues before the anxiety illness. It may be that you both have a predisposition towards anxiety, but as children you never became "dysfunctional" like some of us did. It's hit you now in later life. That would tally with you "questioning everything" which is a real confidence destroyer depending on the questions and the answers. I think everyone reaches the point where they question everything, most people probably just find agreeable answers and move on, but we don't because we can't. Not yet.

Ingenious raises more excellent points. I personally blame Hollywood and television. Again and again we see pandemics cured with relatively minimal consequences (eg the admittedly excellent Dustin Hoffman film "Outbreak"), or people being saved by technobabble and returning to duty the same day they turned into an alien killer-insect and back.* Society is moving into the information age where everything moves at the speed of wi-fi. Unfortunately, we poor humans still operate at the speed nature intended. There is the new conflict.

Therapy, meditation, sef-improvement etc are so useful it's hard to believe they aren't taken seriously. It seems that in Western culture, people who don't conform are derided. People who work hard and try to do well seem to come off second best to laughing thugs. We need to learn that while we can't control that, we can learn what can and can't be controlled or at least influenced, and accept that we are still safe even when we aren't in control.

Again, I'd be interested to see how many of us have some kind of fear, however deep-seated, that they are not in control. Surely fixing that would eliminate much of the fear of our illness, if nothing else.

* I remember reading an article mocking Star Trek: The Next Generation, saying that only an American starship would have a counsellor stationed on the bridge. My mum raised a good point though - going through what the characters go through every day, the average person would snap very quickly! You never really see this until they introduce the much-loved Lieutenant Barclay, and even then it's played for laughs.

[debbsi]

I am an anxiety suffered - mainly health anxiety, and have had some mild depression in the past. I was very low on confidence as a child and adolescent, inparticularly as a small child I remember I hated being laughed at, and as a result avoided sport and putting my hand up in class which only reinforced my low self-esteem, even now I will not take part in any sport. As an adult my confidence grew, I concentrated on my good points (mainly my intelligence) and have built on it - and now attend university. However all my colleagues think I am really confident but I dont like speaking in front of large groups of people or using the phone. I hate speaking to men, especially if they are attractive!! I never thought I was a perfectionist but it takes me weeks to write an essay, I go over and over it, panicking that I may have missed something or done it wrong. I set out in my degree aimed for a first, but reality tells me thats unlikely - but yet I am disapointed if I get anything less for a piece of work. So there you go, I am confident in some things, but many things I am not, I have OCD traits according to my CBT therapist. I just wish I could 'let my hair down' and really be myself - the self that comes out after a few glasses of wine which reduce my inhibitions!

---------- Post added at 17:15 ---------- Previous post was at 17:14 ----------

PS - Both my parents, grandmother and brother all have very anxious personalities, my dad has been on meds for years and years, my mother wont admit she is depressed - but I know she is - so I have also been brought up in an anxious household

[NoPoet]

Hmm, thanks for sharing that Debbsi, that really deepens the plot! We now seem to be seeing two types of sufferer, those who were formerly confident and who lost that confidence (which may have led to their illness), and those whose lack of confidence and personal circumstances were so significant they were probably always heading for some kind of "breakdown".

We are also seeing people who are capable of high-level functioning - jobs, study, relationships - who are still sufferers of anxiety and are held back in some respects. How come we can be so good in some ways and so bad in others?

I did create a positivity mp3 about the "fear of fear" which had some small success, or at least it didn't get me any death threats, so maybe I should put together some kind of motivating, encouraging mp3 and see what results that brings? It would have to be listened to daily over a period of days or weeks, preferably for at least 15 minutes a time. I've nearly finished a "fear of blips" one which is very strongly encouraging, so I could post that?

[debbsi]

post away - I for one would be very grateful to give anything a go x

[NoPoet]

http://yourlisten.com/channel/content/125074/Coping_With_Blips?rn=afyit3p93s3k

Here you go :)

[AnotherNewYear]

Interesting posts so i thought I would throw my two cents in.

I have 'suffered' for 21 years with panic disorder / HA / PTSD (which has brought on several periods of Agoraphobia).

I am and have always been confident, self assured and have high self worth/value - I have a great family and friends - I work full time, run a house, have a social life and attend University studying for a degree.... in some (probably mad) way my illness fills me with more confidence because i am able to lead a fulfilling life despite this crippling illness ....every day that i am able to beat this crap I stick two fingers up at anx ...and that makes me feel good every day.

On the hereditary slant - I have several Aunts (who i saw very little of growing up) who suffer with Anx but no immediate family suffer.

Thanks for the post it was an interesting read.

[Kendra]

My first bout of PA/Anx/Depression was 12 years ago when my parents split!! My mam cracked, I had to run the house, look after my little brother, work full time etc etc etc.

I crashed and burned ended up with PAs/Anx/depression. Didn't leave the house for months couldnt function anything!!

I am luck I have gone for 12 years not to have anything but obviously this is now in me and when I am stressed, rundown, worried all these negatives then this is what happens to me after a build up!! I am confident to a point but not over confident. I am however a really bad worrier who goes over and over situations that have happened. I wont let them lie, I am also a negative person as in glass is half empty not half full if you catch my drift..........

So I am just wondering do I cause my own chemical inbalance in my brain????? How does it happen????? Cos I am stressed etc????

When I am "normal" even though I am a worrier or negative I thought I didnt let it get to me too much but I obviously do??

Oh I dont know, what I have wrote probably hasnt made any sense at all!!!

[lauz_lea]

Throughout my life, I have had several "episodes", starting at the age of 15. I've explored many theories as to how/why they came about, but what appears to be the most likely cause now (and this is still being explored by myself and my GP) is that it is hormonal. For years I was told I would suffer with depression/anx for the rest of my life and to just take the meds and get on with it, but I always felt there was something more.

My two earliest episodes where within a short time of being on the contraceptive pill. The first time I suffered I never took any AD meds (I was only 15) and suffered terribly for 18mths, the vast majority of that time being in a perminent state of DP and DR. I came off the pill and within a few months was "me" again. At that time I never put two and two together, I was very young and didn't understand what was happening to me. The second episode was a few years later, again after being on the pill for a short time. Again, I never put two and two together but I took the AD meds I was prescribed AND stopped taking the pill. Several years later I learned of the link between hormones, the pill and the problems that hormonal imbalances can cause.

This time however, it is not from being on the pill, it is more likely to be menopause related. Having actually had a varying range of hormone tests I KNOW that there is a hormonal element and am currently keeping a diary/record for my GP as it is cyclical (on a fortnightly basis).

I've learnt many things this time around, one of which is that I give the symptoms too much concern. Imagine a set of old style weighing scales - the symptoms on one pan, and the cause on the other. For me, the symptoms had the most weight, but where up higher than the cause (as if I was putting them on a pedistal). I was paying them too much regard and holding them in the highest importance, instead of looking at the cause of the symptoms and the reasons that my scales were out of balance. By adjusting how I think and addressing the cause of the symptoms, I have fixed the scales - the symptoms carry no weight now, or at least are equal to the cause. I can't have one without the other, but it is the importance I give them that matters.

So Poet, at long last I can say that both the elephant and the giraffe are going to the party - you're still invited ;)