Most anxiety disorders are the result of fears that have been biologically programmed through the course of evolution. Nature endowed us with anxiety for one purpose only – to help us survive.
Hundreds of thousands of years ago, a sudden surge of adrenaline, a racing heartbeat, and rapid, shallow breathing saved human lives. This was the body's immediate mobilization to either flee from a predator or fight it. Today, however, this same ability, which once saved millions of lives, has evolved into panic disorder that interferes with everyday life.
Our need for social connection is also rooted in evolution, as it was essential for the survival of our ancestors. In the past, however, the cost of public failure was extraordinarily high: one wrong word could lead to social exclusion or even death. This is where social anxiety disorder has its origins.
Feelings of disgust and the fear of catching an infection from dirty dishes or a doorknob are not signs of being overly fussy—they are simple evolutionary phenomena. Our ancestors developed a strong aversion to potentially spoiled food and contaminated objects. People with obsessive-compulsive disorder are also prone to hoarding: they accumulate books, food, and objects they do not actually need. This tendency would have been highly beneficial during the Stone Age, when resources were scarce. Locking the door nine times out of fear of a wolf was forgivable, but forgetting to lock it the tenth time could be fatal. Evolution has never been concerned with our emotional comfort.
If one of our ancestors miraculously survived a predator attack near a river, it was crucial that they never forgot the experience. Under overwhelming stress, the brain would literally "burn" every detail into memory—the smells, the sound of breaking branches, the time of day—so that the person would never let their guard down in similar circumstances again. This extreme survival mechanism has evolved into what we now know as post-traumatic stress disorder.
Generalized anxiety disorder is the result of our ancestors' vigilance taken to the extreme. Their brains were constantly scanning the horizon for potential threats. What now keeps us awake at night and exhausts our nervous system was once essential for the survival of our species.
Ironically, life has become much safer in most modern countries, and we have found ourselves trapped by our own progress. Our fears no longer help us survive—they simply prevent us from enjoying life.
Every anxiety disorder includes a fear of anxiety itself. In fact, many people with anxiety experience more than one type of anxiety disorder.
Anxiety can be divided into two core symptoms: fear and worry. These symptoms lie at the heart of all anxiety disorders.
The primary symptoms of anxiety disorders are fear and worry. Additional symptoms, such as fatigue, sleep disturbances, difficulty concentrating, and others, often overlap with those seen in depression. Because of this, it can sometimes be difficult for clinicians to determine whether anxiety or depression is the primary condition.
Let's take a look at several types of anxiety disorders:
- Generalized anxiety disorder
- Panic disorder
- Social anxiety disorder
- Post-traumatic stress disorder
- Obsessive-compulsive disorder
The latter is increasingly being classified as a separate diagnostic category; however, for the purposes of this discussion, we will include it.
At the core of generalized anxiety disorder are anxiety and worry, but they are generalized and "free-floating" in nature. Additional symptoms include excessive arousal, fatigue, difficulty concentrating, sleep disturbances, irritability, and muscle tension.
The main symptoms of panic disorder include anticipatory anxiety and worry related to panic attacks. Additional symptoms consist of the sudden panic attacks themselves, as well as phobic avoidance or other behavioral changes driven by fear of future panic attacks. In many cases, the panic attack perpetuates itself, becoming both the cause and the consequence.
Social anxiety disorder is characterized by anxiety or fear related to activities performed in public or while being the center of attention. Associated symptoms include predictable panic attacks that occur in specific social situations, as well as avoidance of those situations.
The main symptoms of post-traumatic stress disorder include anxiety triggered by re-experiencing a traumatic event, as well as worry and other PTSD symptoms such as hyperarousal, an exaggerated startle response, sleep disturbances (including nightmares), and avoidance behaviors.
Obsessive-compulsive disorder is a condition in which a person is troubled by uncontrollable intrusive thoughts and attempts to relieve the resulting anxiety through repetitive behaviors.
Studies have shown that approximately 70% of people with anxiety disorders either receive inappropriate treatment or do not receive treatment at all.
The modern world is full of anxiety and uncertainty. Yet today, even a major mistake is unlikely to bring us to the end of our evolutionary journey. The risk of dying in an elevator is approximately one in a billion, while the risk of dying in an airplane crash is about one in a million.
Our primitive fear has served its purpose.