I am one of those people that worries all the time. If there is an issue at work or at home that is of concern, I will up at 2.00 am in the morning wondering how best to solve it and worrying about it until I am sure it is solved. When all is as well as it can be I will find something to worry about – the plans for the future, pension funds (or lack of them), my kids health, anything and everything. In many ways this has been a good thing, as it has helped me always plan ahead, find solutions to problems and be aware of challenging situations as they develop, or even before they do. In many ways this has been a bad thing, as it means I get irritable and stressed when things are not working out well, and I am at the age when this continued mental ‘strain’ has the potential after many years of being the ‘status quo’ to cause cumulative physical damage to my body resulting potentially in such clinical conditions as migraines, high blood pressure, heart attacks, and strokes amongst others. There is clearly a genetic or physical environment component to this ‘worry’ state, as my father was very similar, and always seem to be worried when he was not almost overly exuberant and happy (there never was a middle ground with him, which made life as a child both fun and challenging), and for most of his adult life until he suffered a series of heart attacks in his early fifties, he smoked ninety cigarettes a day (and was in his early years ‘proud’ of this fact and his capacity to smoke prodigiously, given that in his era it was the ‘done thing’ to smoke) and was never to be seen without a cigarette in his hand, surely as an antidote for and a mechanism to assist him to cope with the stress he felt on a daily basis and which he surely worried about continuously. I have noticed since the advent of the mobile phone, during meetings I sit in at work, or when I go out for a social evening, folk around me check their phone for text messages or emails on a regular basis, with some folk doing so seemingly every few minutes, which is also surely a pathological sign of something ‘worrying’ these folk, or of a ‘worry’ type of personality in these folk who seem to need to check on information coming to them on an almost continuous basis. All these got me thinking about ‘worry’ – known clinically as anxiety – and what causes it to occur, and why some folk appear to feel it more than others and seem to be ‘highly sensitive’ to stressful situations.
Anxiety is defined as a worry about future events before they occur, and is different, though related, to the concept of fear, which is defined as a psychological reaction to current events. Related to both concepts are those of stress, homeostasis and allostasis. The theory of homeostasis suggests that our natural preferred state of existence is one where we are in ‘equilibrium’ with the environment in which we live, and our body and mind are in a ‘steady state’, free of requirements, needs and challenges. When this steady state we exist in is challenged, for example by low energy levels in the body, we notice this as a stressor to our steady state existence (‘hunger’ is the mechanism by which we ‘notice’ this particular stress factor), and this stress induces us to respond to it, by in this example generating actions and plans that will allow us to source and eat food, thereby increasing our body’s energy ‘levels’ back to the state in which we are comfortable and ‘happy’ with. Similarly if we become hot, we move to a place where cooler conditions exist. In more complex examples, if our social or community life changes in a way we feel uncomfortable with, we make plans and enact changes that will attenuate this social stress by either moving to a new place or environment, or taking steps to remove whatever or whoever is causing us discomfort if it is in our power to do so. The process of achieving stability, or homeostasis, using behavioural and psychological changes, has recently been described as allostasis (though some of us believe this is an unnecessary definition as the definition of homeostasis incorporates what is now described as allostasis). These allostatic responses attenuate stressful changes, or changes which are at least perceived as stressful by us, by means of releasing stress hormones in the body (for example cortisol) via the hypothalamic-pituitary-adrenal gland pathway in the body, or by activating the autonomic nervous system (for example the sympathetic nerves which are responsible for initiating ‘fight or flight’ responses in the body), or by releasing cytokines (which are humoral blood-borne ‘signallers’ which also induce a number of physical body responses to stress), or other systems which are generally adaptive in the short term. These pathways all induce a number of ‘general alarm’ or ‘specific response’ changes in the physiological systems and different organs in the body, such as increasing the concentration of glucose in the blood and re-distributing it to areas of the body that need it most as a result of the induced stress, increasing cardiac output, blood pressure and blood flow to specific organs in the body such as the muscles while reducing blood flow to the digestive and reproductive system, and altering the immune system response, amongst others – which all in turn lead to symptoms one ‘feels’ such as dry mouth, rapidly beating heat, increased breathing rate, shaking muscles, nausea, diarrhoea, and even dizziness and confusion in extreme conditions. Like all things, some stress and occasional activation of this stress response ‘allostatic’ system is beneficial to one both for reducing the targeted stress and for making the response systems more efficient by ‘practice’. But, like all things, if the stressor is not removed, or if multiple different stressors occur at once, and these responsive systems remain ‘wide open’, this can result in a status of ‘chronic response fatigue’ in these systems, and ultimately cause damage to the body by the very mechanisms which are designed to protect (for example a raised blood pressure allows blood to pumped quickly to targeted organs requiring increased blood flow for their optimal function, but chronically raised blood pressure causes ‘backflow’ problems to the heart which leads to heart failure eventually, or ‘forward flow’ problems to other organs such as the kidneys, which are eventually damaged by continuously increased blood pressure over a period of time). What is defined as the ‘allostatic load’ is the ‘wear and tear’ of the body (and mind) which increases over time when someone is exposed to repeated or chronic stress, and represents the physiological consequences of chronic exposure to the hormonal and neural responses described above which are ultimately damaging to the person who is ‘feeling’ the stress and whose body is continuously trying to react to it.
All of these allostatic responses are reactive to an already occurring, or perceived to be occurring, stressful situation or environment, and the sensation of fear would be the psychological accompanying emotion associated with perceiving such already occurring situations. But as described above, anxiety is somewhat different, in that it is a worry about future, rather than already occurring events. When one is anxious, one is thinking about all the potential, rather than actual, implications of possible scenarios that could occur based on ones ‘reading’ of current situations or events occurring around one that may, rather than will, occur and potentially impinge on one and possibly cause stressful situations at some time point in the future. Interestingly, anxiety ‘uses’, or is at least associated with, a number of the physical allostatic ‘response’ systems described above, such as the hypothalamic-pituitary-adrenal system, autonomic and interleukin systems, and a number of the symptoms of anxiety are associated with activity of these ‘fight or flight’ response systems and the physiological perturbations they induce. In episodes of acute anxiety (also known as panic attacks), symptoms including trembling, shaking, confusion, dizziness, nausea and difficulty breathing occur, all of which are induced by the allostatic stress-related pathways described above. While some anticipation of the future and resultant planning for it can only be good for one from a long term safety and security perspective, and therefore occasional anxiety can also be beneficial in ‘encouraging’ the planning of and ‘making ready’ future reactive plans for potential stressors one is concerned about after ‘reading the runes’ of one’s current life, generalized anxiety disorder is a clinical condition that is characterized by excessive, uncontrollable and often irrational worry about future events that occurs in between three and five percent of the population word-wide, where folk have a high level of anxiety about everyday problems such as health issues, finances, death, family / social / work problems, or anticipated catastrophic situations which are not commensurate with their actual level of probability of occurring. Individuals with chronic anxiety disorder have a wide variety of ‘psychosomatic’ (body and mind) symptoms, including fatigue, headaches, nausea, muscle aches and tension, numbness in their hands and feet, fast breathing, stomach pain, vomiting, diarrhoea, sweating, irritability, agitation, restlessness, sleep disorders and an inability to either control the anxiety and / or its physical symptoms. If not adequately controlled, generalized anxiety disorder can result in a number of what are known as chronic ‘lifestyle’ disorders, such as high blood pressure, diabetes, migraines, heart attacks and strokes, as well as depression or irritable bowel syndrome, as well as a host of what are defined as ‘psychosomatic’ disorders’. What causes an individual to develop a generalized anxiety disorder is currently not well understood (it occurs more often in folk who have a family history of it), but it most often begins to manifest itself between the ages of 30-35, but can also occur in childhood or late adulthood, and appears to ‘tap in’ and chronically activate the allostatic physiological response mechanisms described above.
Another interesting ‘relative’ of anxiety disorders is what has become known as the Highly Sensitive Person (HSP) ‘disorder’. Folk who are highly sensitive people have a high degree of what is known as sensory processing sensitivity, or in other words they appear to respond to, or be aware of physical body symptoms of stress and anxiety, or to social or environmental situations, to a greater degree than folk who do not ‘suffer’ from this disorder. Folk who have HSP ‘feel’ all these body allostatic responses in an extremely sensitive way, via mechanisms that are still currently not well understood. Because of this, they are also ‘hyper-aware’ of social situations or environments that may trigger the ‘release’ of these physiological anxiety / stress-related response pathways in their bodies (or vice versa and they may be hyper-aware of these social situations because of their natural ‘up-regulated’ physical sensory state). This HSP state is either a curse or a blessing (or both), as it makes folk who ‘suffer’ from it prefer low stimulation environments and try to construct their lives to avoid over-stimulation, and predisposes them potentially to higher risk of chronic stress / anxiety related disorders, but it also make them ‘feel’ life more, have more insight into and early awareness of developing social situations that others may not even be aware of, and make them more ‘intuitive’ to what is going on around them. Whether HSP folk have higher levels of anxiety or greater incidence of a generalized anxiety disorder is currently not well known, but given both ‘tap into’ the same allostatic physical body systems and mechanisms make it more likely that this is indeed so. It must be noted that the concept of a highly sensitive person has been differentiated from that of a hypersensitive person, who are defined as folk who over-react to any stimuli or slight. Folk with HSP may simply be quiet, appear introverted or ‘shy’, or are able to ‘hide’ their HSP ‘condition’, while hypersensitive folk are typically very challenging to deal with socially, but they also may have underlying anxiety as a cause of their over-reactions, ‘temper-tantrums’ and rages. The treatment of all of these different anxiety related disorders is challenging, and requires lifestyle change, psychological intervention (such as cognitive behavioural therapy) and / or medication, but there is always a relatively poor cure rate and a high degree of recidivism, and folk with anxiety and stress related disorders need to themselves understand, acknowledge and work on their underlying condition, though the problem for doing so is that a hyper-sensitivity responsive ‘state’ or condition is very difficult to understand, let alone treat. A number of folk use smoking, alcohol consumption, or avoidance behaviour, as methods of ‘dealing’ with their anxiety or high level of sensitivity, but these short term ’emollients’ create their own specific problems and may themselves paradoxically increase anxiety and stress in those that use them as a stress / anxiety reducing mechanism.
Worry, therefore, can be a useful thing to prepare one to enact future potential responses to what one is ‘picking up’ in one’s current circumstances that causes one to worry, if it continues for a short period of time only and if it is about a specific issue. Worry, if chronic or if it is a clinical disorder, through the allostatic pathways and circuits it uses to initiate and mediate ‘fight or flight’ body changes, can cause a wide array of unpleasant symptoms and diminish one’s quality of life, and can ultimately cause major physical damage to one’s body if one does not manage it carefully, or treat it as something that needs to be ‘cured’. The ‘trappings’ of modern society such as mobile phones and increased work and social connectivity and immediate communication capacity have many benefits, but these can also ‘tap into’ and reinforce these anxiety-related allostatic pathways and create continuous stress of their own making – it is likely that those folk who compulsively reach for their phones to check their messages every few minutes almost certainly have an anxiety disorder, or are prone to developing one, and future research is surely needed to ascertain the veracity of this possibility. I myself am a ‘worrier’, and almost certainly am a highly sensitive person, as was my father before me. This has created blessings and challenges both for us and those around us – life can be beautiful, but life can also be challenging, on a daily basis, with most of it ‘raging’ around in our own minds rather than in the ‘real’ life around us per se. At twenty five, I would have said the benefits of being and living such as a highly sensitive person and ‘worrier’ surely outweighed the challenges – the rose surely smelt better, the rain surely felt softer, the love was deeper, the anger stronger, the passion for life greater to and for us compared to how most folk around us probably experienced their less ‘perceived’ life. However, now I am about to reach the age of fifty, and am reaching the ‘tiger territory’ period of life for high blood pressure, heart attacks and other ‘diseases of a lived life’, I am not so sure, and the thought of a calm life, without worry, without stress, lived in soft colour and tranquil shades and hues, seems to be perhaps the better one, and one that should have been chosen as preferential way of living all those years ago, or at least changed to now I am more aware both of my own highly sensitive ‘condition’ and the potential negative effects such a life can have on one’s physical response mechanisms and body organs and physiological systems. But, at the end of the day, can one ever really ‘choose’ one’s own ‘sensitivity to stimuli’ levels? Perhaps our own anxiety and stress levels, or at least our own perception of them, were set in our ancestors body’s thousands of years ago and passed down to us, even if they are redundant as a ‘need’ in our modern life, and are therefore almost impossible to materially change despite our wishes and best efforts to do so. More research is needed to better understand if sensitivity to stimuli levels, and indeed those of anxiety itself, can ever be permanently attenuated, or rather if they stay permanently ‘as is’, and one merely learns rather how to cope and ‘deal with’ them better with the passing of time or with enhanced understanding, treatment or therapy.
One’s life will surely happen to oneself, as it does for each of us as we move through life and its challenges, whether one worries about it or not, or whether one ‘feels it’ more or less, I guess, but in many ways it surely ‘feels’ more like it is ‘happening to one’ when one worries about it than when one does not – though doing so appears to damage one’s physical survival mechanisms by over-use as part of the process. It must be wonderful to live a life in the always warm, always comfortable environment which is the one in which has no worries. But, equally, one can never maintain a hot fire without some internal combustion occurring which creates the heat, or even more so, put out a fire once it has been burning for a long time and has created the ‘heat’ which is manifestly evident in the life lived with maximal sensitivity to stimuli and responsivity to all around it. Would one choose to put this ‘fire’ out and reduce the ‘heat’ in oneself if one could do so? How one answers that question will perhaps ascertain for oneself where on the spectrum of anxiety and sensitivity to stimuli scale one is, or at least where one would like to be (without the need to reach for one’s mobile phone to get the answer to it as we do these days, or lighting up a cigarette in order to help one reflect on it like they did in my old man’s days). I’ll ponder this question myself as I listen with delight to the sound of the birds chirping in the garden outside that ‘feels’ as if they ‘pierce’ my ears, as I sip my coffee and go through what I have written this morning wondering if it has been a good or bad writing session, as I bang the table in frustration when I discover that my printer has run out of ink and I can’t print it out for my records, and as at the same time I worry if I have all my ‘ducks in a row’ ahead of those important meetings I have at work on Tuesday after the public holiday Monday. Reflect, reflect, reflect. Worry, worry, worry. For some there is no peace, even on the quietest of days!