Medical Resources for Writers: Anxiety

We traumatize our characters all the time with violence—witnessed or experience—traumatic life events, or stress beyond their wildest dreams. It is not a far-stretch to assume that your characters might be experiencing things beyond their ability to handle. So, when you are terrorizing your characters, think about what level of terror you are creating. The goal of this post is to explain what happens in the body during these elevated levels of stress.

​As always, this is not a tool to diagnose or treat any mental illness in anyway.

Anxiety is defined as “a vague feeling of dread or apprehension.” This can be caused by different triggers—external or internal. It is not the same as fear, however, which is feeling afraid or threatened by an identifiable external stimulus that represents danger to the person. Anxiety is unavoidable in life, but it becomes a disorder when it begins to significantly impair daily routines, social lives, and occupational functioning.

​People suffering from anxiety disorders have unusual behaviors like panic attacks, unwarranted fear of objects or life conditions, uncontrollable repetitive actions, re-experiencing traumatic events, or unexplainable or overwhelming worry.

There are 3 basic stages to anxiety: Alarm, resistance, and exhaustion. They are characterized by the following:

Alarm: Adrenaline rushes the body and the blood sugar goes up in expectation of being expended on an action.

Resistance: The digestive system sends blood to muscles, lungs, and heart. Heart rate increases, breathing rate increases, and oxygenated blood goes quickly through the body. If the person is able to relax or adapt during this stage, things go back to normal.

Exhaustion: Body stores are depleted, yet the body is still being triggered to respond. There is not much capacity left. If this is left in a chronic state, it can lead to depression.

Anxiety is very uncomfortable. Logical thought can be difficult which makes getting out of the cycle difficult. People generally try to get out of the stress response by “adaptive measures.” These can be positive measures: relaxation techniques, imagery, breathing slowly, meditation, etc. Ineffective measures lead to things such as tension headaches, pain syndromes, and decreased immune systems.

Differences in levels of anxiety:

Mild Anxiety: wide perceptual field, sharpened senses, increased motivation, effective problem-solving, increased learning ability, restlessness, fidgeting. ‘butterflies in stomach,’ difficulty sleeping, hypersensitivity to noise.

Think secret agent going in on a mission. A little bit of anxiety is appropriate for the task at hand.

Moderate Anxiety: perceptual field narrowed to immediate task, selective attention, cannot connect thoughts or events independently, in ‘auto-pilot,’ muscle tension, diaphoresis, pounding pulse, headache, dry mouth, high pitched voice, faster rate of speech, GI upset, frequent urination

Think someone who just walked away from a car accident.

Severe Anxiety: perceptual field reduced to one detail or scattered details, cannot complete tasks, cannot solve problems or learn effectively, behavior geared toward anxiety relief is usually ineffective, does not respond to redirection, cries, ritualistic behavior (OCD symptoms), severe headache, nausea, vomiting, diarrhea, trembling, rigid stance, vertigo, pale, elevated heart rate, chest pain

This is on the verge of hysterics. Think the woman on Airplane.

Panic: perceptual field reduced to focus on self, cannot process any environmental stimuli, distorted perceptions, loss of rational thought, doesn’t recognize potential danger, cannot communicate verbally, possible delusions and hallucinations, may be suicidal, may bolt and run, or totally immobile and mute, dilated pupils, increased blood pressure and pulse, flight, fight, or freeze

Thank God, this stage doesn’t last very long.           

If a person reaches panic levels, they are in danger. Those around them who are part of the ‘support group’—family, friends, health care providers—primary focus should be on maintaining safety as they may harm themselves. Going to a small, quiet, and non-stimulating environment may help. Panic levels can last from 5-30 minutes. Talking to the person in a quiet, rational, reassuring voice is key.

But we’re talking about fictional characters, so ethics be damned! Wanna ramp up the tension? Have your character be in a state of panic and the person with them does everything WRONG. Conflict is key to your stories. Nothing is more interesting than watching someone do it the WRONG way!

Anxiety can be used a plot device and character arc as well. The more terrified of X the greater the sense of accomplishment when the goal is reached. In a previous post, I talked about Batman and how he harnessed his fear of bats to become a creature to be feared. So what causes anxiety in your characters? Is it a traumatic childhood that they need to face? Were they victimized in some way? How can they rise above their fears, defeat the underworld, rescue the princess, or save the kingdom? This is a story arc, or at minimum a character arc.

This has been a broad overview of what anxiety is. Next post will be about individual disorders related to anxiety.

Psychiatric-Mental Health Nursing, by Sheila L. Videbeck, fifth ed., Wolters Kluwer/Lippincott Williams & Wilkins, 2011.