Facing Down Midlife Anxiety
Long-dormant conditions may emerge in middle age, with damaging effects on your health
I've had phobias and anxieties my entire life. At age 17, an ambulance rushed me to the hospital for what turned out to be an anxiety attack. Recently, my anxieties have resurfaced, and worsened. Two years ago, when I was 52, I had another attack and another ambulance ride. I've also experienced fear of flying and of driving on freeways, as well as phobias related to open spaces and, ironically, claustrophobia. My anxiety appears to run in cycles. I'll go for weeks or months without incident and then, for no apparent reason, break into a sweat in the canned goods aisle of the supermarket.
Our anxieties not only affect us in the moment. They appear to have long-term implications for our health as well. A study released a year ago by researchers at Brigham and Women's Hospital found that intense anxiety can lead to faster biological aging and possible health problems in middle-aged and older women. Specifically, the study found that phobic anxiety in that population was linked with shorter telomeres, the DNA sequences at the ends of our chromosomes that protect them from deteriorating. Telomeres are considered to be key markers of biological aging, and shortened telomeres have been associated with a higher risk of cancer, heart disease, dementia and premature mortality.
If that's the case, anxious women like me are living on borrowed time.
A Range of Concerns
It's normal, of course, to feel anxious when a stressful situation warrants it, but it becomes a problem when the anxiety gets out of hand and seeps into everyday life. Anxiety is classified as a psychological disorder, explains Don Lynch, professor of psychology at Unity College in Maine, when it results in a degree of functional impairment, like preventing someone from driving on the freeway or going to the supermarket.
We can experience a variety of such disorders, each categorized by specific symptoms, ranging from generalized anxiety disorder to post-traumatic stress disorder, obsessive-compulsive disorder, social phobia and others. "People can also be diagnosed with more than one," Lynch says. "For example, someone may suffer from generalized anxiety disorder and a panic disorder."
Overall, anxiety disorders affect as many as 18 million adults in the United States, according to the Anxiety and Depression Association of America. Generalized anxiety disorder, characterized by persistent, excessive worry about everyday things, affects 6.8 million adults. Most of them are older than 50 when they receive a diagnosis.
The disorders may surface during midlife but that's not necessarily when they begin, Lynch emphasizes. Often, the demands of balancing a full-time job, raising children and other commitments help mask a condition that has lain beneath the surface for years.
"Often people who become phobic or develop an anxiety disorder later in midlife were never properly diagnosed or treated earlier in life," says Dr. Prakash Masand, chief executive of the online health resource Global Medical Education and a former professor of psychiatry at Duke University Medical Center. "Phobias typically start between ages 15 to 17 and anxiety issues appear usually between 23 and 30."
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Are You at Risk?
Some people are more likely than others to develop an anxiety disorder. Common risk factors include:
Being female Women are twice as likely as men to have generalized anxiety disorder, panic disorder or specific phobias, and have a greater tendency to experience post-traumatic stress disorder and major depressive disorder as well. The reason is most likely differences in brain chemistry, especially after menopause. "Hormonal changes in women may trigger anxiety and depression," Masand says.
Health issues High blood pressure, arthritis, heart disease and the hearing and vision problems typically associated with midlife can all spur depression and lead to the development of anxiety conditions as we age, especially, Lunch says, when they turn our thoughts to our mortality.
Changing life situations Stressful shifts in midlife and beyond – job loss, retirement, changing family roles or the death of a parent or spouse – may all bring on anxiety. Men who have defined themselves by their careers, for example, may become anxious and depressed once they retire. "You lose your identity, which brings up feelings of insecurity and a lack of self-worth," says Dr. Friedemann Schaub, author of The Fear & Anxiety Solution. "Retirement means a whole new chapter. Chances are you loved the work routine, so these new challenges can feel scary."
Mothers and fathers may both feel a loss when grown children leave home and their major parenting role ends. The work of parenting can provide us with an external comfort zone, Schaub says, and when it's gone, we may be left alone to face our fears for the first time in many years. "If you identified yourself through your kids, or your business, you may have lost touch with yourself," Schaub says. "Trying to figure out what you really want can bring up anxiety."
Be mindful of how you communicate with and about yourself, Schaub says, as negative thoughts can be self-fulfilling. When you find yourself worrying needlessly, take action to counterbalance unproductive thoughts. "See your anxiety as a little child," he says. "Imagine talking to it like an adult talking to a child. Reassure it, and your negative self-talk can decrease by 75 percent. Try this with five negative thoughts a day." Meditating or listening to relaxing music can also help. Or try talking to a therapist, who can serve as a compass to guide you through your issues.
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If these direct tactics don't work, see a doctor for a thorough medical evaluation. A physician may or may not suggest medication, but the key is starting with an accurate diagnosis. "Treatments will depend on the type of disorder," Masand says. "Certain medications work well with one disorder and not another. It's very important to find out what type of disorder you have to be treated adequately and appropriately."
Anxiety is often a signal that it's time to explore larger, long-ignored questions about our lives. "Maybe you have regrets you want to address, which may be at the root of your anxiety," Schaub says. "It's best to have a plan rather than fighting or ignoring it."