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Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and  are treatable.

Anxiety refers to anticipation of a future concern and is more associated with muscle tension and avoidance behaviour.

Fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction – either staying to fight or leaving to escape danger.

Anxiety disorders can cause people to try to avoid situations that trigger or worsen their symptoms. Job performance, schoolwork and personal relationships can be affected. In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:

· Be out of proportion to the situation or age-inappropriate

· Hinder ability to function normally

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, specific phobias, agoraphobia, social anxiety disorder and separation anxiety disorder.

When the pathways designed to be activated, in the case of extreme threat, are triggered on a regular basis, it can be life changing as our daily activities become full of fear and worry. We sometimes do not realise we are experiencing anxiety and instead believe incorrectly, that our highly stressful existence helps us to keep our performance at an optimum level.

Mindfulness based approaches are extremely useful for helping to create some distance between our thoughts and actions, short-circuiting our often-automatic behaviours. Anxiety and stress are about fear of the future and a constant mounting up of what “must be done,” can easily start to become overwhelming. When practised regularly, mindfulness can help us to be more aware of our internal and emotional state in the present moment and treat ourselves with more compassion. 

Types of Anxiety Disorders

Generalized Anxiety Disorder 

Generalized anxiety disorder involves persistent and excessive worry that interferes with daily activities. This ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Often the worries focus on everyday things such as job responsibilities, family health or minor matters such as chores, car repairs, or appointments. 

Panic Disorder

The core symptom of panic disorder is recurrent panic attacks, an overwhelming combination of physical and psychological distress. During an attack several of these symptoms occur in combination:

· Palpitations, pounding heart or rapid heart rate

· Sweating

· Trembling or shaking

· Feeling of shortness of breath or smothering sensations

· Chest pain

· Feeling dizzy, light-headed, or faint

· Feeling of choking

· Numbness or tingling

· Chills or hot flashes

· Nausea or abdominal pains

· Feeling detached

· Fear of losing control

· Fear of dying

Because the symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness. They may go to a hospital emergency department. Panic attacks may be expected, such as a response to a feared object, or unexpected, and apparently occurring for no reason. The mean age for onset of panic disorder is 20-24. Panic attacks may occur with other mental disorders such as depression or PTSD 

Social Anxiety Disorder (previously called social phobia) 

A person with social anxiety disorder has significant anxiety and discomfort about being embarrassed, humiliated, rejected, or looked down on in social interactions. People with this disorder will try to avoid the situation or endure it with great anxiety. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public. The fear or anxiety causes problems with daily functioning and lasts at least six months.

Phobias, Specific Phobia

A specific phobia is excessive and persistent fear of a specific object, situation or activity that is,  generally, not harmful. Patients know their fear is excessive, but they cannot overcome it. These fears cause such distress that some people go to extreme lengths to avoid what they fear. Examples are public speaking, fear of flying or fear of spiders.

Anxiety is often implicated in other areas such as addictions, trichotillomania (hair pulling), dermatillomania (skin picking), body dysmorphia, compulsions, and separation anxiety. Two of the most well-known anxiety related problems are panic attacks and post-traumatic stress( see section on Trauma)
 

Abuse can be broken down into many categories’ including:

· Physical Abuse

· Domestic violence or abuse

· Sexual abuse

· Psychological abuse Financial or material abuse

· Modern slavery

· Discriminatory abuse

· Organisational or institutional abuse

· Neglect or acts of omission

· Self-neglect

Abuse effects many across society and is oblivious to class or culture. It can be viewed as any premeditated act towards another that causes them upset or harm, in an attempt to gain some form of power or control by the abuser, over the victim. Here it is worth acknowledging that often it can be the result of the abuser’s own history and entrenched feelings of inadequacy and shame.

 
Although abuse can happen at any stage of life, we are particularly vulnerable as children. 

ACEs

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). For example:

· experiencing violence, abuse, or neglect

· witnessing violence in the home or community

· having a family member attempt or die by suicide

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with:

· substance use problems

· mental health problems

· instability due to parental separation or household members being in jail or prison

ACEs are linked to chronic health problems, mental illness, and substance use problems in adulthood. ACEs can also negatively impact education, job opportunities, and earning potential. However, ACEs can be prevented.

It is often the behaviours that we adopt as a natural attempt to limit the immediate impact of the abuse, which result in later maladaptive behaviours. The wide range of abuse encompasses not just early years but also experienced by numerous adults in their personal relationships. 

Domestic violence is also commonly known as:

· Family violence

· Relationship violence

· Intimate partner violence

· Child abuse

Again, we see a pattern of abusive behaviour through which a person seeks to control and dominate another person.

Domestic violence does not take the form of a single incident. It is ongoing behaviour that gradually undermines the victim’s confidence and ability to leave the violent person. The severity and frequency of violence often escalate over time.

This violence takes many forms, none of which is mutually exclusive. While physical violence may be the most visible form, others such as sexual, emotional, social, spiritual, and economic abuse can be equally harmful.

Examples include:

· isolating a victim from family and friends

· controlling their access to money

· diminishing their self-esteem

· preventing them from practising their religious beliefs

· intimidating them, and

· threatening them.
 

A traumatic experience is any event in life that causes a threat to our safety and potentially places our own life or the lives of others at risk. As a result, a person experiences elevated levels of emotional, psychological, and physical distress that temporarily disrupts their ability to function normally in day-to-day life.

Whilst it is normal to have strong emotional or physical reactions following a distressing event, some people have difficulty moving on with their lives. On most occasions these reactions subside as a part of the body’s natural healing and recovery process. When this does not happen longer term reactions can include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea. 

In some cases, Trauma can impact deeply the mind, body, and emotions. Clients can be constantly triggered by their traumatic experiences, controlled by emotions, like shame, anxiety, anger, depression, and fear, even turning to substance abuse, and other self-harming behaviours as a coping mechanism.

Whilst the traumatic event is in the past,  it is the unseen, implicit, scars and bruises that remain very much in the present and are susceptible to triggering.

 

Post-Traumatic Stress Disorder (PTSD)

PTSD is one of the most well-known trauma disorders. People develop PTSD following a traumatic event. While it is common for initial symptoms to begin in the days following a traumatic event, symptoms can even begin to surface months later. Symptoms can be grouped into four categories:

· Intrusive thoughts about the event, including nightmares and flashbacks

      · Avoidance of anything that reminds you of the trauma

     · Behavioural changes such as insomnia, withdrawing from loved ones, and engaging in reckless or self-destructive behaviours

· Cognitive disturbances like irritability, negative thoughts about self or others, and fear/paranoia

Complex PTSD

When individuals are exposed to repeated or prolonged trauma, such as childhood abuse, they develop a slightly different condition known as complex PTSD (C-PTSD). This shares many similarities to post-traumatic stress disorder, but also has some unique symptoms including:

· Poor emotional regulation, which manifests as outbursts of extreme emotions like rage and depression

· Negative view of self

· Trouble forming healthy relationships

· Behavioural difficulties like substance abuse, impulsivity, and self-destructive actions

· Detaching from self (depersonalization) or reality (derealization)

· Forgetting the trauma

· Losing core values and beliefs

Although some mental health professionals treat complex PTSD as a distinct condition, the Diagnostic and Statistical Manual of Mental Disorders (DSM) categorizes the symptoms under PTSD.

Acute Stress Disorder (ASD)

Acute stress disorder is very similar to PTSD but is shorter in duration. ASD symptoms develop immediately after a traumatic event and last three days to one month. If symptoms persist beyond a month, the individual has developed PTSD.

Second-hand Trauma

Second-hand trauma is also known as trauma exposure response or secondary traumatic stress disorder. It results from exposure to the first-hand trauma of other people. Symptoms of secondary traumatic stress include:

· A sense of hopelessness or helplessness

· Feeling like you can never do enough to help

· Hypervigilance

· Guilt

· Fear

· Anger

· Negativity/cynicism

· Chronic fatigue

Second-hand trauma can happen to anyone, but it commonly affects professionals who work with trauma victims such as counsellors, social workers, first responders, doctors, nurses, and other healthcare workers.

Mindfulness can enhance present-moment awareness, increase self-compassion, and strengthen a person's ability to self-regulate—all important skills that support trauma recovery 

Emotions are wonderful things; they can take us to the heights but unfortunately to the depths as well. It might be that the same emotions keep resurfacing and take over the emotional landscape, such as fear, anger, or remorse. It might be that something has happened in a person’s life, and they are overwhelmed with their emotional reaction.

The following can be emotional problem areas.

· Suppression of emotions. The person does not want to feel or talk about emotions and does not have the right outlets for expressing their feelings. They may want to cry but cannot.

· Lack of understanding emotions. The person has a big blank in their feelings or cannot identify if what they feel is an emotion or illness. They feel the sensation but are sometimes not clear what the emotion is. Emotions can be mistaken for physical illness, and people who do not completely understand their emotional life may go to their GP or hospital more often.

· Avoidance of emotional situations. Trying hard not to talk about or look at anything that might stir up feelings.

· Difficulty controlling emotions. They are sometimes overwhelmed by their feelings, and they find themselves yet again losing control.

· Unprocessed emotion. Stressful situations or trauma has happened, and the feelings just keep on surfacing and do not seem to easily resolve – or it could be that they are in an unsolvable conflict and inevitably the emotional distress will continue until the situation is resolved.

There is a survival advantage in being able to recognise and act on physiological states such as hunger, thirst, or pain. However emotional overwhelm is a state of being beset by intense emotion that is difficult to manage. It can affect your ability to think and act rationally. It could also prevent you from performing daily tasks.
Emotional overwhelm may be caused by stress, traumatic life experiences, relationship issues, and much more.

Emotional overwhelm occurs when the intensity of your feelings outmatches your ability to manage them. An individual is most likely to be overwhelmed by negative emotions, such as anger, fear, or guilt. However, people experiencing mania can become overwhelmed by euphoria.

 If you are feeling overwhelmed, it may be difficult for you to pinpoint exactly why. Often there are many stressors contributing to emotional overwhelm rather than one event. Your emotions may bleed into unrelated parts of your life. 

Here are some common signs that you are being overwhelmed by your emotions:

· You have a disproportionately big reaction to seemingly insignificant situations. For example, you may panic when you cannot find your keys. 

· You feel physically ill or fatigued without knowing why.

· You have trouble focusing or completing even simple tasks.

· You find yourself withdrawing from friends and family.

· Your emotions colour your perception of the world. For example, intense grief may have you feeling sad even during pleasant occasions.

You will likely feel a state of emotional overwhelm at some point in your life. Sometimes, this overload stems from a single big stressor. It is common to feel overwhelmed after surviving a traumatic accident or losing a loved one. 

Yet overwhelm can also occur due to many smaller stressors. For example, missing your bus may not feel like too big of a deal by itself. But if you have been fighting with your family, having trouble sleeping, and are hungry from skipping breakfast, a missed bus can be the proverbial “last straw” of the day. 

Some emotions may overwhelm you more easily than others. You may find it easier to manage your anger than to tolerate extreme fear or sadness. If you have many conflicting feelings at once, emotional overwhelm can be especially likely. 

Some mental health conditions, such as anxiety or depression, have emotional overwhelm as a symptom.

CONSEQUENCES OF EMOTIONAL OVERWHELM

Emotional overwhelm can make it difficult to take care of yourself. You may forget meals, skip rest breaks, or struggle to fall asleep. These behaviours can in turn lower your ability to think rationally, making it even harder to cope with overwhelm.

If left unchecked, this cycle can lead to physical health problems. You may experience unexplained pain or develop persistent fatigue. As negative emotions increase, your body's ability to fight off infection may decrease. 

Emotional overwhelm may also impact your social life. You may find yourself lashing out at others or avoiding conversation. These behaviours may strain your relationships with loved ones or professional colleagues.

HOW THERAPY CAN HELP WITH EMOTIONAL OVERWHELM

Therapy is often a helpful way to sort through difficult emotions, especially those that occur because of stress or trauma. In therapy, you may be able to:

· Understand the roots of your overwhelming emotions

· Explore ways to self-soothe, such as meditation

· Address recurring stressors that contribute to overwhelm.

· Learn new skills to deal with any stressors that cannot be prevented

· Treat any mental health issues contributing to overwhelm

With each concern that is resolved, you will find that dealing with other stressors becomes easier. Even focusing on one or two issues can significantly reduce your distress. 

Whilst understanding the root of these patterns of behaviour intellectually is helpful, it is not enough for true healing. Counselling and psychotherapy can help to facilitate emotional experiences that can profoundly alter how you relate to yourself and future events in your life.

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

· Feeling sad or having a depressed mood

· Loss of interest or pleasure in activities once enjoyed

· Changes in appetite — weight loss or gain unrelated to dieting

· Trouble sleeping or sleeping too much

· Loss of energy or increased fatigue

· Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)

· Feeling worthless or guilty

· Difficulty thinking, concentrating, or making decisions

· Thoughts of death or suicide

Symptoms must last at least two weeks and must represent a change in your previous level of functioning for a diagnosis of depression.

Grief and depression can co-exist for some people, the death of a loved one, losing a job or being a victim of a physical assault or a major disaster can lead to depression. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression. 

Distinguishing between grief and depression is important and can assist people in getting the help, support, or treatment they need.

 
Risk Factors for Depression

Depression can affect anyone—even a person who appears to live in ideal circumstances.

Several factors can play a role in depression:

· Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.

· Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.

· Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are pessimistic appear to be more likely to experience depression.

· Environmental factors: Continuous exposure to violence, neglect, abuse, or poverty may make some people more vulnerable to depression.

Sometimes it is not clear why we feel low and at other times it is more obvious why we are suffering. Depression can affect both the sufferer and those around them. Low mood is not uncommon especially when life throws up difficult events, however for most this soon passes. For some however, when depression sets in, the low mood experienced does not abate. Persistent low mood or a more severe clinical depression that interferes with daily living, may include thoughts of suicide or not wanting to carry on. 

If you are experiencing thoughts or feelings that you might harm yourself or that you cannot go on, contact someone immediately, if you have no-one available you can walk into A&E. You can see your GP or the out of hours GP service. If you have taken an overdose or cut yourself badly dial 999.The Samaritans operate a service 24 hours a day, 365 days of the year, for people who are at risk of suicide, call 08457 909090. Or contact a friend, family, or someone you trust.  
 

People with a non-normative sexuality or gender may feel alienated from society. These feelings may cause mental health issues that bring them to therapy. Other people may seek therapy for issues related to sexual intimacy. Worries about sexual issues can profoundly affect a person’s mood, thoughts, and well-being.

People may fear others will think their sexual concerns are inappropriate. They may not wish to talk to their partners, family, or friends about these issues. This can cause anxiety, frustration, a sense of aloneness, isolation, and shame. These feelings may lead to further distress. Finding the right therapist can offer a person a safe place to share. People may share their fantasies, fears, memories, or desires about sexuality

ISSUES TREATED IN THERAPY

Therapists can help people find the source of their sexual concerns. This might include helping someone explore their gender or sexual orientation. They may also address emotional barriers in relationships. Doing so can enhance sexual experiences. 

Therapy for issues related to sexuality may help with:

Gender Dysphoria,

Also known as gender incongruence. This may be experienced by transgender individuals and others whose gender does not align with the gender they were assigned at birth. Some people may develop mental health concerns, because of distress, experienced with gender dysphoria. This incongruence itself is not a mental health condition, just as being transgender is not a mental health condition 

Although a person’s sexual or romantic orientation or gender identity may not be a source of distress, people who identify as lesbian, gay, bisexual, transgender, queer, questioning, asexual, or any other orientation or gender identity may find that the social stigma of living as a minority is a source of stress or anxiety. Whether for issues associated with one’s sexual, romantic, or gender identity or for concerns related to mental health, finding a qualified mental health professional who has experience and familiarity with the challenges members of the LGBTQIA community often face can be critical.

ISSUES FACED BY THE LGBTQIA COMMUNITY

Despite rapidly growing cultural acceptance of diverse sexual and romantic orientations and gender identifications, oppression, discrimination, and marginalization of LGBTQ people persists. Coping with discrimination and oppression, coming out to one’s family, and sorting out an “authentic” sense of “self” in the face of social expectations and pressures can lead to higher levels of depression, anxiety, substance abuse, and other mental health concerns for LGBTQ people.

Research shows that youth who identify as LGBTQ are at an increased risk of suicidal ideation and self-Harm, particularly when they also experience discrimination based on their sexual or gender identity. 

Counselling and psychotherapy can provide a safe and encouraging space for an authentic exchange where you can explore whatever is necessary for you to find a way of being that fits well with your intrinsic, authentic self, free from judgement

When looking at Disorders and syndromes comes an acceptance of the complexity of these presentations and how they are defined. Knowing the difference is an important start to this section.

 · A disease is a pathophysiological response to internal or external factors.

· A disorder is a disruption to regular bodily structure and function.

· A syndrome is a collection of signs and symptoms associated with a specific health-related cause.

· A condition is an abnormal state of health that interferes with normal or regular feelings of wellbeing.

Disorders can be classified into the following areas:

· Mental

· Physical

· Genetic

   · Emotional

     · Behavioural

 · Structural

Mental Disorders are any condition characterized by cognitive and emotional disturbances, abnormal behaviours, impaired functioning, or any combination of these. Such disorders cannot be accounted for solely by environmental circumstances and may involve physiological, genetic, chemical, social, and other factors. Specific classifications of mental disorders are elaborated on in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (see DSM-IV-TR-:DSM-5 and the World Health Organization’s International classification of Diseases. 

Due to many syndromes and disorders being interwoven in complex ways within an individual, not only can labels therefore be limiting and sometimes stigmatising but also not overly helpful.

My integrative approach uses a mechanistically transdiagnostic approach, which identifies psychological processes that underlie a given class of disorders (e.g., overvaluation of shape and weight for eating disorders). This allows acknowledging the diagnosis, whilst working importantly with the person that underlies the diagnosis, focusing on their individuality and their unique complexity.