Ever since she can remember, 21-year-old Emma Campbell has been living in a state of heightened anxiety. As a child she used to stay up worrying about school work and her family, becoming so anxious that, eventually, she stopped eating. She was seven when she first started suffering panic attacks, waking up out of breath and sweating almost every night for several years.
Campbell received therapy as a teenager, which offered her some respite. But panic set in once again when she left her home in North Yorkshire to attend university in Wales, where she is currently studying psychology. Although she is now taking antidepressants, which are often prescribed to treat anxiety, she says she still finds herself "on edge" most days. "I worry if I'm a good person. I worry about the future. Yesterday, I had a panic attack because I'd progressively convinced myself that this chesty cough I've got is lung cancer. I know deep down it's just a cough, but something takes over me and tells me everything is a thousand times worse than it really is."
Campbell suffers from generalised anxiety disorder (GAD), also known as chronic worrying. Anxiety UK, a charity supporting anxiety disorder sufferers, says it is one of the most common mental health problems seen by doctors in the UK. According to NHS Choices, it affects one in 20 adults. Research published in 2012 by the NHS Information Centre showed that the number of outpatient appointments for anxiety disorders increased from 3,754 in 2006-2007 to 17,470 in 2010-2011, with some experts putting the rise down to people feeling under pressure because of financial uncertainty.
As well as anxiety, symptoms include difficulty sleeping, irritability and heart palpitations. "People with GAD are physically and mentally exhausted," explains Dr David Baldwin, professor of psychiatry at the University of Southampton. "They have a sense of having lost control and they don't know how to solve their own problems." GAD is often confused with depression, particularly since the same antidepressants may be prescribed for both conditions, even though the symptoms are different.
"Depression is characterised by a sense of pessimism about the past. There's a lack of interest and a sense of slowing down," says Baldwin. "With anxiety, people don't focus on the past, they focus on the future and worry about what hasn't happened yet. There's also not the same sense of slowing down; if anything you have more nervous energy. Anxiety sufferers present more physical symptoms than depression sufferers, such as breathlessness, sweating and medically unexplained pain."
Mental health charities say they are concerned antidepressants are too often used as the first point of call to treat anxiety, when cognitive behavioural therapy (CBT) could prove more beneficial. Paul Jenkins, chief executive of the charity Rethink Mental Illness, says that in some cases people are "fobbed off" with medication alone: "No one should have to take any kind of medication unless it's absolutely necessary, and talking therapies have been shown to be just as effective as drugs for moderate to severe anxiety, so patients should be given a choice at the very least."
It has been announced that the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), which is used by clinicians internationally to help diagnose mental illnesses, will be relaxing its criteria for diagnosis of GAD when it's published at the end of May.
At present, the DSM defines the disorder as excessive worry about at least two life circumstances, sustained over a period of six months or longer. Patients must also be suffering from at least three out of the six symptoms of anxiety – restlessness, fatigue, muscle tension, irritability, difficulty concentrating and sleep disturbance – in order to receive a clinical diagnosis and treatment.
The new diagnostic criteria takes a far broader definition of GAD as excessive worrying about anything from "family, health, finances and school or work difficulties" for a reduced period of three months or longer, and only one of the six symptoms is required to reach a diagnosis. But there is growing opposition from clinicians and experts, who fear that everyday anxieties, which we all experience, may become seen as part of a wider disorder as a result of the relaxed criteria.
"There is an attempt here to attach psychiatric labels to aspects of human behaviour, and labels aren't helpful," says Prof Peter Kinderman, head of the Institute of Psychology at the University of Liverpool. "We all differ in the way that we are anxious. But what people need is a humane approach, to help them understand and address their moods, rather than labels and medication."
There are other methods that we can all use to keep our anxiety levels down. "Making lists is always good," advises Baldwin. "Start the day with a list of what you have to do and tick them off as you go. It gives you a sense of progress and that relieves worrying. Try to limit your worrying to certain times of the day. It sounds bizarre, but if you only allow yourself to worry for half an hour a day at, say, 8am, you will learn to put your worries to one side and get on with everything else."
For Campbell, coping with anxiety may be a struggle but she's gradually managing to keep it under control. "I've started to realise that there's a difference between the anxiety and my personality," she says. "I'm starting to open up more and not keep my worries bottled up. The worrying is still there, and my worries change all the time, but I know now that the anxiety isn't me, it's just this thing that messes with my brain sometimes."
