Anxiety is a subjective feeling of apprehension or uneasiness that stems from the anticipation of danger, the source of which is largely unknown. It is usually accompanied by largely psychological and physical symptoms. Being anxious is part of everyday living. People worry about everything in general. We cannot control many of these things and they weigh on our minds and make us anxious. Generally, anxiety is à term that describes a normal feeling that people face when they are stressed and threatened. The typical feelings are being disturbed, restless, and tense, and these can be triggered- by experiences of life such as loss of job, marital breakup, serious illness, critical accident, or the death of a close relative or friend. It can also be observed during stressful situations like examination, interview, stage performance, etc. In these situations, these feelings are appropriate and the condition lasts for a brief period. People suffering from anxiety are always anticipating. Something fearful and the worst possible scenario in any given situation.

ANXIETY AND FEAR

“anxiety” and “fear is usually used synonymously. Strictly speaking, they are different in their. The term fear generally refers to a specific threat. It is a psycho-physiological response to a consciously recognized real danger, which may be external or internal. For instance, seeing a snake or being diagnosed as a patient with cancer. The term “anxiety, on the other hand, means a non-specific threat. It is due to internal psychic conflicts. The individual cannot pinpoint the source of danger. Sigmund Freud, therefore, named it ‘free-floating anxiety”.  To a certain extent, anxiety can be very useful in normal life. A certain level of anxiety is desirable to attain success in an Professional and personal life. One would not prepare 1 or examination or reach office in time, if there was no anxiety. When the symptoms of anxiety persist for a long time and start accepting the performance of an individual and disturbing his Social and emotional life then it becomes alarming. At this stage, it is called “anxiety disorder”.

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FACTORS CONTRIBUTING  TO ANXIETY

Anxiety can happen at any age and some people say they have been nervous and anxious all their lives. Thus, anxiety is the problem of the mind that can cause problems in the body. There are several factors that can contribute to anxiety:

1. Genetic factors.

2. Brain biochemistry.

3. An overactive “fight or flight response

4. Strenuous circumstances.

5. Learned behavior.

Genetics plays an important role as it influences a person’s brain chemistry and can make certain people more vulnerable. The brain is made up of nerve cells and they communicate with each other with the help of chemicals called “neurotransmitters They are the brain’s chemical messengers and help in regulating mood. Sometimes there is some kind of interference in the process and it can lead to a chemical imbalance, which can lead to anxiety and similar emotional problems. Two mood-regulating neurotransmitters called serotonin” and “dopamine is especially important in this regard.

ANXIETY IN PAKISTAN

In Pakistan, the state of mental health is very pathetic. Psychological problems are increasing with time throughout the country. People have been exposed to socio-political instability, economic uncertainty, unemployment, violence, unstable regional conflicts, and personal frustrations. These are the risk refactors for psychiatric disorders. living conditions in our cities, like Karachi and Lahore, can easily aggravate the problem. The following factors can contribute to increasing the cases of anxiety:

1. Unlimited load shedding of electricity and gas.

2  Unsteady water supply.

3. Price hike.

4. Excessive corruption.

5. Broken roads.

6. Environmental pollution.

7. Noise abuse.

8. Lack of traffic sense

9. The prevailing sense of insecurity

According to an estimate, nearly 35% of Pakistanis have been suffering from various mental ailments including anxiety disorders. Due to the prevailing environment of ignorance, illiteracy, and superstition in the country, patients suffering from this disorders are considered abnormal. These patients avoid Unsteady water supply, seeking treatment due to the stigma attached with availing professional help. This further adds to their misery.

TYPES OF ANXIETY

Anxiety can be divided into two broad categories:

          1.  Trait Anxiety 

It is a common observation that some Individuals experience high levels of anxiety very frequently. They consider many trivial situations as dangerous which others do not. Such individuals are said to have “trait anxiety Disorders such as “anxiety states and hypertension maybe associated with trait anxiety

         2. State  Anxiety:

Most individuals respond with acute Anxiety only to specific situations. This type of anxiety is known as state anxiety”. Panic attacks and phobias are typical examples of this type of anxiety.

INTENSITY OF ANXIETY

For descriptive purposes, it can be divided into three categories

     1:Mild Anxiety:

In mild anxiety, the individual is able to focus realistically on most of what is happening to him. His

senses are alert and his attentiveness and motivation a increased.

     2. Moderate Anxiety:

In moderate anxiety, the individual is able to focus only partially on what is happening around them. His perception is decreased and his attention becomes selective. Such a person commonly shows complaining, arguing, and teasing behavior. His anxiety may be converted into physical symptoms.

    3. Severe Anxiety:

In severe anxiety, the individual is unable to focus at all on what is happening to him. All his senses are badly affected. His behavior becomes automatic and his energy is drained. Psychologically, this is an extremely painful condition.

CLINICAL MANIFESTATIONS

Anxiety can lead to a large number of clinical features.

Cardiovascular System:

1. Headache.

2. Palpitations.

3. Tachycardia.

4. Hypertension.

Gastrointestinal System:

1. Dryness of mouth.

2. Increase or decrease in appetite.

3. Nausea and vomiting.

4. Abdominal cramps.

5. Diarrhea.

Central Nervous System:

1. Restlessness.

2. Irritability.

3. Apprehension.

4. Confusion

5. Insomnia

Respiratory System:

I. Dyspnoea.

2. Feeling of fullness in throat or chest.

Muscular system:

1. Coarse tremors of hands.

2. Trembling, twitching, or shaking.

3. Feeling of fatigue.

4 Increased muscle tension, as clenched jaw or stiff neck.

Urinary System:

1. Frequency of micturition.

Skin:

1, Itching

2. Flushing of the face.

3. Increased perspiration.

4. Cold and clammy skin.

5. Pallor of skin.

6. Numbness of extremities.

Eyes:

1. Widely dilated pupils.

Emotional Symptoms:

1. Restlessness and irritability.

2. Feeling of insecurity

3. Feeling of inadequacy.

4. Excessive worrying.

5. Talking and joking excessively.

6. Inability to concentrate or make decisions.

7. Hyperactivity.

8. Exaggerating or distorting facts.

9. Fear of sudden death or insanity.

10. Complaining and crying

11..Striking out verbally or physically.

12. Depression.

13. Withdrawal from society.

14. Problems in interpersonal relationships,

15. Neglect of family or home

KINDS OF ANXIETY DISORDERS

There are many kinds of anxiety disorders:

   Generalized Anxiety Disorder

It is characterized by one, or more, real or imaginary belief that lasts more than six months. Anxiety can happen at any age and some people say they have been nervous and anxious all their lives. Thus, anxiety is a problem of the mind that can cause problems in the body. Women are more susceptible to generalized anxiety. They are more vulnerable because they are already suppressed in the patriarchal society and biologically more prone due to hormonal changes. The patients go to the doctor but for physical ailments, such as palpitations, irritability, dizziness, trembling, insomnia, muscle aches, gastro-intestinal upsets, etc.

   Obsessive-Compulsive Disorder

This type of anxiety disorder is characterized by obsessions and compulsions in the life of the patient. Obsessions are thoughts or impulses that occur again and again over which a person has no control. Compulsions are those rituals that a patient feels he must perform to control disturbing thoughts and hence can find relief from anxiety those thoughts stimulate.

   Post-traumatic Stress Disorder

This disorder is caused by frightening and life-threatens events such as an accident, violence (rape, abuse, assault) or natural disaster (earthquake, flood, fire) and cause severe fear. A response that can be flashbacked in the forms of a nightmares fear, worry, and stress.

    Social Anxiety Disorders

 It is a deep fear of social situations and inscribed by feelings of extreme anxiety about being judged by others and may lead specific object or situation which is considered as irrational towards avoidance behavior by others.

Specific Phobias

 These are marked by an intense, uncontrollable fear reaction to a and excessive by the patient, For example, fear of lizard, dog, height, etc. Phobias usually make people avoid what they are afraid of.

   Panic Disorders

Panic disorders are characterized by episodes of intense fear that occur suddenly, for no apparent reason, and are often disabling. Panic attacks are frightening but physically harmless episodes, which can occur at any time, for instance, while driving, shopping, riding on public transport, etc. Panic attacks are discrete sessions of intense fear or discomfort during which some of these symptoms develop suddenly and become intense within few minutes. The symptoms include:

1. Palpitations.

2. Sweating.

3. Hot flashes

4. Chills.

5. Dizziness.

6. Shortness of breath.

7. Numbness of extremities.

8. Confusion.

9. Tremors or shakes.

MANAGEMENT OF ANXIETY

There are many ways in which anxiety can be controlled. Experts suggest certain ways to decrease the level of anxiety in daily life. Some of them are:

Seeking professional help is a step in the right direction. A treatment plan with a combination of psychotherapy and medications can be very helpful. Various studies have proved that generalized anxiety responds best to cognitive-behavioral therapy. In this kind of therapy, the patient learns to see situations and problems in perspective and learns the techniques to reduce the anxiety level. Panic attacks can be treated with a combination of psychotherapy and medications, and patients are taught relaxation techniques as well.