Editor's note: A new article in Glamour magazine addresses the growing health crisis for young women: anxiety. Many spa clients look for relief from anxiety symptoms in your spa. How are you addressing their needs? Are you recommending that they see their physician for extreme cases? Read this article to find out more about the condition and how you can help.
Anxiety. It’s a term that’s often tossed around in conversation—as a casual synonym for stress, or worry, or that feeling you get when you look at your to-do list. But for 40 million Americans, anxiety disorders are debilitating and omnipresent, and women are twice as likely to suffer as men, according to the Anxiety Disorders Association of America. “There is an intense, constant fear that is hard to describe,” says Laura Rowe, 34, of Denver. “It’s a sinking feeling in your stomach—almost as if someone is stalking you and you never know when those arms are going to wrap around you and drag you away.” And more and more of us are being diagnosed: A recent study of about 63,700 college students found that five times as many young adults are dealing with high levels of anxiety as in the late 1930s (itself a stressful time!).
How prevalent is it?
The signs of anxiety’s prevalence among women are everywhere: Ads for anti-anxiety drugs run frequently on TV shows often aimed at women; young female stars, like the actress Amanda Seyfried, confide their own experiences in the press; websites like findthelight.net attract thousands of users. And though no national data of rates in women exist, many experts believe the surge is not just media hype—it’s real. “I think there’s little question that there’s more anxiety today, and that women, in particular, are feeling it,” says JoAnn E. Manson, MD, chief of the division of preventive medicine at Boston’s Brigham and Women’s Hospital. “I see it not only among patients but with friends, colleagues and people I interact with daily.”
That staggering statistic
One general practitioner—not a psychiatrist—estimates that one in five of the patients she sees now is there for anxiety issues, making it one of the most common reasons young women show up in her exam room. Megan Catalano, 34, of Berkeley Heights, New Jersey, is living proof of all the statistics. “In my M.F.A. program last year, Xanax was everywhere,” she says. “I always thought my anxiety was a quirk particular to me. It was shocking to realize how many of my girlfriends and classmates felt the same way.”
How underdiagnosed is it?
Ironically, despite the condition’s seeming ubiquity, experts Glamour spoke to agree that anxiety is actually underdiagnosed among women. “The average length of time between the onset of symptoms—the time a woman starts feeling bad—and when she gets actual diagnosis is between nine and 12 years,” says Robert Leahy, PhD, a clinical professor of psychology and psychiatry at Weill Cornell Medical College in New York. “And of those who are diagnosed, only a very small percentage get adequate help.”
Why don’t women seek help?
Part of the problem, say doctors, is that a woman with anxiety may fail to seek help quickly, even if she’s seriously on edge. “To her, that is normal,” says Richard A. Friedman, MD, a professor of clinical psychiatry at Weill Cornell Medical College. “If you’re a healthy woman and you come down with the flu, you know you’re sick. You know what it’s like to feel good, and you know you feel worse now. But if you have this sickness that’s been hanging on since you were five, that’s your baseline. You believe it’s normal, and that everyone else must feel this way too.” It took Bassey Ikpi, 34, a writer and performer in Washington, DC, nine years of panic attacks and stress headaches before she finally realized that what she had was a real medical condition. “Anxiety is a very real and serious—yet treatable—disorder. I didn’t know that until I took a college-prep psych class,” she says. “All of a sudden I was like, This is me. This is what I have.”
The confusing symptoms
And when women do seek help, doctors often confuse their symptoms with those of other mental-health conditions. Kristen Nilsen, 27, of Arlington, Virginia, remembers having her first panic attack as a child. When she finally found the courage to see a doctor at age 17, she was told she had depression and was prescribed meds that didn’t ease her attacks. She wasn’t correctly diagnosed with generalized anxiety disorder and panic disorder until she was 23, and didn’t find a medication that worked for her until four years after that. “Anxiety can be just as debilitating as a physical injury, but it’s often not given the same immediate attention that, say, a broken leg would receive,” says Nilsen. “If I could shout it from the tallest building, I would: Seek help. You deserve to live an unafraid life.”
What is “normal” anxiety?
So what is anxiety? And why are so many young women grappling with it now? “Anxiety is a normal emotion which helps us recognize real problems and solve them. In its healthy form, anxiety helps you perform at your top form when you’re adjusting to, say, a new job or a new baby,” says Terrie Moffitt, PhD, a professor of psychology and neuroscience at Duke University in North Carolina. “That said, in some people anxiety grows out of proportion and becomes disabling. Generally, we say anxiety is not normal when it lasts days beyond a specific stressful event, or when it interferes with a person’s life.”
The kinds of anxiety disorders
There are multiple, distinct types of anxiety disorder: The most common is social phobia, which is an extreme fear of being judged by others. There’s also panic disorder (with its trademark panic attacks), and generalized anxiety disorder, defined as persistent and unrealistic worry. But all anxiety disorders share common denominators: Unlike depression, which is marked by unshakable sadness, they feel physically more like fear, with symptoms like insomnia, heart palpitations and headaches. And they happen young: Nearly three quarters of afflicted adults develop symptoms by age 22.
Why is anxiety so common?
As for the rise in anxiety, experts point to a range of factors. “There is a sense that the world is not as safe as it used to be, and that creates a lot of anxiety,” says Leahy. In any given day, he argues, women worry about environmental hazards, their job security, the odds of their boyfriend cheating (see: Tiger and Jesse James). “There’s so much stressful news that it starts to take a toll on you,” says Susan Nolen-Hoeksema, PhD, a professor of psychology at Yale University who specializes in stress and women’s health. “If I watch CNN for an hour, I [get] fidgety.”
Fine—and all true. But wasn’t the Great Depression stressful too? And why should we get more worked up about Tiger than, say, our grandmothers did over a social system that kept many of them from working outside the home or dating whomever they wished? Are our modern lives really that much more stressful? “The answer appears to be yes,” says anxiety researcher Jean Twenge, PhD, a professor at San Diego State University and author of Generation Me. “Anxiety rates have risen steadily over the past seven decades, during good economic times and bad.”
How pressure can lead to anxiety
She believes the rise is related to a cultural shift, over the last 70 years, away from “intrinsic” values—appreciating things like close relationships and having a real love for your work—toward more “extrinsic” ones, like money and status. In fact, her research found that anxiety rates rose at the same pace with this change in mindset. “Recent generations have been told over and over again, ‘You can be anything you want to be. You can have the big job title. You can have the big bank account.’ And in the case of women, ‘You can have this perfect body.’ That puts a lot on a person’s shoulders—and it’s also not really true. These are things that aren’t always under your control, but that disconnect creates a lot of anxiety about how hard you need to work to achieve them—and a deep fear of failure,” she explains. “And although these extrinsic values—the latest iPad, the cutest shoes—seem important, all the evidence shows that at the end of the day they don’t leave us very happy or satisfied.”
Why women are more anxious now than in previous generations
The argument, in other words, is that our grandmothers and great-grandmothers were able to tune out their stresses in part because they had more satisfying personal values to fall back on. They also probably had more quiet time to contemplate their worries in a productive way—something in short supply now.
Are women too connected?
“Everyone works all the time, and there are no boundaries between work and personal life anymore,” says a 29-year-old Glamour reader from Jersey City, New Jersey, who recently began struggling with panic attacks. “Your to-do list is enormous, and then you have to go home, cook dinner, work out, check in with friends, spend time with your boyfriend or family. There’s just a lot of pressure.” Nolen-Hoeksema agrees: “People feel they should always be on, and that they could be called upon at any moment to do something. Our e-mail and iPhones are constantly pinging, which keeps anxiety heightened all the time.” That’s exactly what exacerbated Ikpi’s panic attacks a few years ago. “Every time my cell phone rang, or I heard an e-mail or text come through, I’d get this overwhelming feeling of dread,” she says. “My heart raced. I got nauseous and dizzy and couldn’t breathe. It was so intense at times that I truly believed I was going to die.” At that time, she was experiencing two to three panic attacks each day.
Why Facebook friends won’t cut it
Social networking, experts say, is also problematic, since connecting virtually with a friend is not the same as seeing them, hugging them or hearing the tone of their voice. “Having a Twitter- or Facebook-only friend,” says Twenge, “is like having a junk food relationship.” You may be keeping in touch, but without face-to-face interaction, you miss out on the true bonding that studies show can help protect against mental health problems.
Why are women more likely to get anxiety?
All of these factors hit women harder than men because, experts are learning, we may be wired to worry. Just-released research from the Children’s Hospital of Philadelphia suggests that the female brain may be more sensitive to stress hormones and less able to adapt to high levels of them. We also have a well-known propensity to ruminate and let problems roll around and around in our heads, says Nolen-Hoeksema: “We’re more aware about our feelings, and we get more hung up on them than men do.” And yet another emerging theory is that our diets are having a biological impact on our anxiety levels: “A diet high in sugar and saturated fat can disrupt brain functioning,” says Fernando Gómez-Pinilla, Ph.D., a professor of neurosurgery and physiological science at UCLA, who researches the effects of diet on mood disorders. “That contributes to mental disorders, particularly anxiety.”
How to get relief
Thankfully, experts say there are several proven ways to soothe those feelings of panic and fear. Here, strategies to calm anxieties both extreme and everyday: . The link between exercise and improved mental health is almost irrefutable. “I’m a therapist—a ‘head guy’—and I was shocked at how effective our research showed exercise to be. It can work as well as medication,” says Michael Otto, PhD, a professor of psychology at Boston University. Beyond alleviating pent-up angst, physical activity can actually teach your brain to be anxiety-resistant. “The physical stress that working out has on the body engages a lot of the same responses that mental stress does,” says Michael Hopkins, a researcher at the Neurobiology of Learning and Memory Laboratory at Dartmouth College. “Your heart beats faster; your blood pressure goes up. Over time, exercise appears to train the body to handle those changes, so when anxiety strikes, your body says, ‘Oh, OK, this is like when we go jogging. I know how to deal with this.’” And nearly every woman Glamour interviewed agreed workouts improved her symptoms. “It releases so much of the tension I have built up in my mind,” says one student in Mooresville, North Carolina. “After a run I feel clear and at peace.”
Exercise three to four days a week
Eat more whole foods, less junk. “The vitamins, minerals and other compounds in food act almost like medications on the brain,” says Gómez-Pinilla. Australian research recently found that women who ate a whole-foods diet, with lots of fruits, vegetables, whole grains, lean meat and fish, were 3% less likely to experience anxiety. (By comparison, women on a diet high in refined, processed foods and saturated fats were 50% more prone to depression.) “Eating too much of the wrong kind of foods produces an inflammation effect that can cause disease in our brains,” says David Heber, MD, PhD, director of the Center for Human Nutrition at UCLA. Fruits and vegetables, on the other hand, have the opposite effect and fight inflammation. And foods rich in omega-3 fats (like salmon and walnuts) and those containing tryptophan (like skim milk and turkey) can be like natural Xanax when eaten on a regular basis, says Gómez-Pinilla. “When my doctor suggested I change my diet, I kind of thought, Really?” says anxiety sufferer Nilsen. “But cutting back on all the starchy fast foods I was eating and getting more fresh produce made a huge difference. I was less lethargic and emotional.”
Nix caffeine. Caffeine can also increase anxiety—and even trigger panic attacks, according to research. “Most of us sip our morning coffee and don’t notice if it makes our heart rate and blood pressure go up,” says Jonathan Abramowitz, PhD, director of the Anxiety and Stress Disorders Clinic at the University of North Carolina at Chapel Hill. “But women with panic disorder are really tuned in to their body channel, and they’ve got the volume turned way up. They sense those internal changes, which feel so similar to the onset of a panic attack, and become so stressed that they actually bring one on.”
Try mind-body therapies. “Relaxation techniques are effective in so many aspects of your life, but they’re particularly good for generalized anxiety disorders,” says Otto. “They should be taught as a requirement in school, as the fourth R: reading, ‘riting, ‘rithmetic and relaxation!” Yoga, meditation and hypnotherapy have all been shown to help, as can deep breathing, relaxing to soothing music, and massage. “When we’re stressed, most of us breathe shallowly from our chest, which triggers the sympathetic nervous system—that’s the classic ‘fight or flight’ reaction,” says Lizabeth Roemer, PhD, a professor of psychology at the University of Massachusetts, Boston. “If you inhale and exhale more deeply, that activates the opposite, parasympathetic response. Your body physically settles down.” Also, “this type of relaxation prompts the release of feel-good endorphins,” which can buffer against the biological response to stress, says London-based clinical hypnotherapist Georgia Foster.
Find the right treatment. You should be able to tell after one to two months whether the lifestyle changes above will make a difference. If they don’t, you might need therapy or medication intervention. It’s fine to turn to your GP; you don’t need to start with a psychiatrist. She may refer you to a therapist, or prescribe medication. But tell her all of your symptoms in detail. More and more women are doing so, and their assertiveness is paying off. “Emergency rooms used to be flooded with people thinking they were having a heart attack when really it was a panic attack,” says Edna B. Foa, Ph.D., director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania. “Now a lot of women with anxiety problems diagnose themselves because they’re more educated. It’s become part of the culture we’re in to be able to talk about anxiety without feeling you’re going to be judged.” No judgment, just help. That’s what every woman deserves.