Anxiety

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Anxiety is a common response to stress. Anxiety activates a fight-or-flight response that can help to keep a person safe when presented with dangerous situations.[ Reference 1 ] It can also bring a sense of heightened awareness of one’s surroundings and enhance decision-making. This is particularly helpful for service members in the combat and operational environment.

Although anxiety can be beneficial in some situations, it can interfere with work productivity, interpersonal relationships, and overall functioning when it becomes persistent or overwhelming. Experiencing stressful incidents can be a risk factor for developing an anxiety disorder. Research suggests that generalized anxiety disorder (GAD), the most common anxiety disorder, affects at least five percent of active duty service members.[ Reference 2 ]

Symptoms of Anxiety

Anxiety is expected in everyday life and is the body’s way of communicating when an individual feels stressed or unsafe. Anxiety symptoms might include worrying, fidgeting, irritability, sweaty palms, increased heart rate, and muscle tension.

While anxiety is normal, it is important to recognize when symptoms become persistent or recurrent to the point of causing significant distress or impairment in functioning.[ Reference 4 ] An individual may experience symptoms such as poor concentration, gastrointestinal symptoms (e.g., nausea and vomiting, diarrhea, etc.), muscle tensions, pounding heartbeat, headaches (e.g., tension headaches or migraine), restlessness or feeling on edge, trembling, sleep disturbances, rumination, and difficulty controlling worry.[ Reference 5 ] Service members experiencing these symptoms should be encouraged to talk to their doctor or a mental health provider.

Risk Factors for Anxiety

Service members are exposed to military-specific stressors prior to, during, and after military operations inducing traumatic losses or exposure to dangerous or life-threatening conditions. Listed below are military stressors that can provoke anxiety.[ Reference 6 ]

Combat Stressors

  • Experiencing personal injury
  • Killing of combatants
  • Witnessing the death of an individual
  • Learning of the death of another unit member

Operational Stressors

  • Prolonged exposure to extreme environmental conditions (e.g., desert heat, arctic cold)
  • Fewer opportunities to communicate with friends and family
  • Prolonged separation from family and other support systems
  • Cumulative effects of combat stressors over multiple missions, such as losing several unit members over time

In addition to military-specific stressors, general risk factors for anxiety include:

  • Family history of mental health disorders[ Reference 7 ]
  • Gender (women are more likely to experience anxiety symptoms)[ Reference 8 ]
  • Biological/genetic factors[ Reference 9 ]
  • Environmental factors (e.g., social and peer interactions, conditioned fear)[ Reference 10 ]
  • Exposure to childhood adversity (sexual or physical abuse, neglect)
  • Exposure to trauma and stressful life events[ Reference 11 ]

Resources

The following resources can support service members, leaders, and providers in addressing anxiety.

  • Veterans on Handling Anxiety This web page from Make the Connection, a U.S. Department of Veterans Affairs online resource, offers information on how to recognize the signs of anxiety and strategies for dealing with it.
  • Stress & Anxiety The Real Warriors Campaign website offers a variety of resources on anxiety.
  • Anxiety Disorders This web page from the National Institute of Mental Health provides a comprehensive overview of anxiety disorders, including signs and symptoms, risk factors, and treatments and therapies.
  • Anxiety Disorders Screening Tools Two screening tools for anxiety are offered by the Center for Integrated Health Solutions (CIHS), which is funded jointly by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) and run by the National Council for Behavioral Health.
  • Online Assessment Measures These patient assessment measures from the American Psychiatric Association can be administered at the initial patient interview and during treatment to monitor progress. They include instructions, scoring information, and interpretation guidelines.
  • Counseling Options for Service Members and Their Families  This web page from Military OneSource provides a list of options for in-person, web-based, and phone counseling for service members and their families.

References

  1. American Psychological Association. (2018). Stress effects on the body. Retrieved from http://www.apa.org/helpcenter/stress-body.aspx.
  2. Deployment Health Clinical Center. (2017). Mental health disorder prevalence among active duty service members in the military health system, fiscal years 2005–2016.

  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition. Arlington, VA: American Psychiatric Association
  4. American Psychiatric Association. (2017). What are anxiety disorders? Retrieved from: https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders.
  5. American Psychiatric Association. (2017). What are anxiety disorders? Retrieved from: https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders.
  6. Department of the Army. (2016). Army Techniques Publication (ATP) No. 6-22.5: A leader’s guide to soldier health and fitness. Retrieved from: https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/atp6_22x5.pdf
  7. Blanco, C., M.D., Rubio, J., Wall, W., Wang, S., Jiu, C.J, & Kendler, K.S. (2014). Risk factors for anxiety disorders: Common and specific effects in a national sample. Depression Anxiety, 31(9), 756–764.
  8. Moreno-Peral, P., Conejo-Cerón, S., Motrico, E., Rodríguez-Morejón, A., Fernández, A., García-Campayo, J., … & Bellón, J.Á. (2014). Risk factors for the onset of panic and generalized anxiety disorders in the general adult population: A systematic review of cohort studies. Journal of Affective Disorders, 168, 337-48.
  9. Kendler, K.S., Neale, M.C., Kessler, R.C., Heath, A.C., & Eaves, L.J. (1992). The genetic epidemiology of phobias in women. The interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia. Archives of General Psychiatry, 49, 273–81.
  10. Grinde, B. (2005). An approach to the prevention of anxiety-related disorders based on evolutionary medicine. Preventive Medicine, 40, 904-909.
  11. Hudson, J. L., Flannery-Schroeder, E., & Kendall, P. C. (2004). Primary prevention of anxiety disorders. In D. J. Dozois & K. S. Dobson (Eds.), The prevention of anxiety and depression: Theory, research, and practice (pp. 101-130). Washington D.C.: American Psychological Association.