It started with a slightly cold tingly sensation on her palms. Somebody must’ve cranked up the aircon, Melanie thought as she vigorously rubbed her hands together and walked towards the washroom. As she topped up her make-up, the sensation developed into a palpitation and she could feel cramps develop in her stomach. The pressure of the impending meeting with the senior management who were going to decide whether she was going to get a pink slip or a transfer to a mofussil branch was tightening its grip on her. Within seconds, Melanie felt her lungs were being squeezed and she could barely breathe. As she crumbled on the floor and hot tears began to flow, all Melanie could do was scream for help.

The uncertainty of the situation triggered a panic attack in Melanie, explains consultant psychiatrist Dr Rasha Bassim. Never mind the fact that Melanie was aware that her days in the company were numbered, she still was not mentally prepared for what was to happen. With bills to pay and family to look after, Melanie was in desperate need of a secure job.

Having said that, Dr Rasha points out triggers do not lead to anxiety, they just switch the symptoms’ button on. ‘There is a difference between triggers and causes,’ she explains. ‘While causes of anxiety consist of multiple factors such as upbringing, genetic predisposition and earlier life experiences that make anxiety a part of the person, triggers on the other hand are events and issues that ignite the symptoms or worsen them,’ adds Dr Rasha.

As the World Health Organization (WHO) devotes 2017 to depression and the fact that it is now the leading cause of ill health and disability worldwide, Dr Rasha, from the Priory Wellbeing Centre in Dubai’s Healthcare City, says it is about time healthcare policies across the world stop giving mental health the elephant-in-the-room treatment. As the name of WHO’s campaign – ‘Depression: Let’s talk’ – suggests, there’s a lack of support for people with mental disorders. The problem is aggravated by the social stigma attached to it which prevent many from accessing the treatment they need to live healthy, productive lives.

According to the latest estimates from WHO, more than 300 million people globally are now living with depression, an increase of more than 18 per cent between 2005 and 2015. While anxiety and depression are separate disorders, they can and do occur together.

The problem has reached mammoth proportions in the UAE as well. According to research published last year, about 20 per cent of the population suffers from some kind of anxiety disorder in the UAE. Talking about the demographic nature of the problem, Dr Rasha says the problem is more pronounced among expatriates, who have to deal with the added pressure of coping with separation from friends and family and displacement from their home country. ‘The sense of uncertainty and need to hang onto stressful jobs for maintaining financial security, together with a lack of or deficient social support networks such as family, extended family and friends, culminates in a magnified effect of anxiety triggering factors and hence worsens the symptoms and multiplies the rates of clinical presentations,’ she explains.

So what is anxiety disorder? 
Is it really that monster that lurks in the dark crevices of our mind feeding on our fears and insecurities? ‘There is normal or healthy anxiety that one feels prior to an exam or a job interview, which tends to put the person on high alert and makes them prepare better for the event and then there is Generalised Anxiety Disorder. GAD is a psychological condition characterised by extreme or excessive worry about certain aspects in life, such as work, social relationships/events, or financial issues. This worry is usually disproportionate to the actual matters and can interfere or negatively affect how you function in daily life,’ explains Dr Rasha.

Apart from a constant state of anxiety, Dr David Baldwin, professor of psychiatry at the University of Southampton, says the symptoms of GAD include difficulty sleeping, irritability and heart palpitations. ‘People with GAD are physically and mentally exhausted,’ he explains. ‘They have a sense of having lost control and they don’t know how to solve their own problems.’

In Melanie’s case, she felt she had a valid reason to be a worrywart since there was a lot at stake. But the negative emotions were very evidently corroding her self-confidence. She felt incapable of devising a Plan B and the stress was having a deep impact on her health too. From the time she came to know that the company was going to undergo structural changes and that she might receive the short end of the stick, she started taking medication to help her fall asleep. She constantly felt a pain in her neck and shoulder area and the urge to visit the washroom frequently. ‘These are some of symptoms of an anxiety disorder that one needs to look out for,’ says Dr Rasha. ‘The others are persistent worry or fear that is overwhelming even on trivial issues; anticipating the worst outcomes; being irritable or restless at times, easily provoked and experiencing tightness in the chest.’

And that’s not all – there are some physical symptoms as well. ‘These are sweating, dry mouth, muscle tension, neck and shoulder pain, headache, bowel changes tingling and numbness of hands and feet,’ says Dr Rasha.

Talking about how the condition manifests itself, the doctor says that apart from the mentioned symptoms, she has seen several anxiety-related patients who suffer from alcoholism and/or eating disorders. ‘Whenever two disorders co-exist, the prognosis and management can be complicated,’ she points out.

So how is GAD different from depression? Don’t both focus on an overwhelming sense of incompetency as far as dealing with life’s situations are concerned? Dr Baldwin explains. ‘Depression is characterised by a sense of pessimism about the past. There’s a lack of interest and a sense of slowing down,’ he says.

‘With anxiety, people don’t focus on the past, they focus on the future and worry about what hasn’t happened yet. There’s also not the same sense of slowing down; if anything you have more nervous energy. Anxiety sufferers present more physical symptoms than depression sufferers, such as breathlessness, sweating and medically unexplained pain.’

Even though Melanie understood that stress had taken over her emotional and mental state, she did not seek medical help, assuming that the symptoms will automatically disappear once she was out of the situation. She internalised the trauma, afraid that if she shared it with her family and friends they too would get worried and might think less of her.

‘While women tend to believe that if they ignore a problem, especially an emotional one, it would eventually disappear, men on the other hand, ease their symptoms through substance abuse, both seeking professional help only when they reach a chronic stage,’ observes Dr Rasha.

As Melanie was wheeled in to a hospital and tests, including an electrocardiogram, showed that she had a healthy heart and was an otherwise healthy woman, the doctors advised her to meet a psychiatrist to understand the nature of her problem. The doctor had a couple of sessions with Melanie to know more about her and the various symptoms that she had been showing. ‘Clinicians carry out screening via focused questionnaires and psychometric assessment tools,’ says Dr Rasha while explaining the procedure involved in diagnosing the problem.

In Melanie’s case, the fact that she came from a family where people were intentionally or unintentionally judged by their achievements and she did not have a friend around her to hold her hand and help her jump over the gaping emotional chasm that she was faced with, compounded the problem. The prospect of losing her job was the final straw that lead to her undoing.

Once she was seen by the psychiatrist, Melanie was put on anti-anxiety medication and she began Cognitive Behavioural Therapy (CBT) where her psychiatrist – over a set of sessions – made her aware of her negative thoughts, helped her view challenging situations more clearly and respond to them in a more effective way. While the medication helped her calm down the therapy empowered her to become more solution-oriented. She is now able to manage her thoughts and has significantly managed to lower her levels of anxiety.

If it is any consolation, Melanie is not alone in this phenomenon. She represents a massive section of society that is like a duck – calm and poised on the outside, but pedalling hard to stay afloat inside.

As actor Robin Williams, who battled depression all his life, once said, ‘all it takes is a beautiful fake smile to hide an injured soul and they will never notice how broken we really are.’

Struggling to cope with the pressure of everyday life, Dr Rasha says, people today are overwrought with anxiety as they try to appear strong and capable in the face of adversity. ‘What is adding to the complexity of the problem is easy access to information and news and social media,’ she says. Elaborating further, she says the internet enables the viral spread of news and graphic pictures of war, strife and humanitarian crisis, which creates fear or awakens a sense of insecurity among those who already suffer from some form of anxiety disorder.

So what is the way forward? How do we come out of the darkness? ‘Since, as expats, one of our core issues is the fact that our support system – family and friends – is not at arm’s length, we need to build a parallel support system,’ says Dr Rasha. ‘To start with, pursue a hobby or take up a new one that you’ve always wanted to do. It gives you a chance to bond with like-minded people, some of whom could become your good friends over a period of time – your new support system. It is also important that we follow a regular exercise regime. It keeps both our body and mind healthy.’

Medication, she believes, should only be the last resort and should be taken only when prescribed by a doctor.

Whatever be the form of rope that pulls us out from the depths of darkness, it is imperative that we address our emotional troubles just as we would our physical ones. ‘For overall well-being, it is important we don’t sweep our emotional health under the carpet,’ says Dr Rasha.

Anxiety: Fact or fiction

Dr Rasha Bassim throws light on a list of myths and misconceptions associated with anxiety disorder.

Like other mental health disorders, anxiety is falsely thought to result from, or be a sign of, a weak personality with an inability to endure stress. The reality is that anxiety is a mental disorder resulting from a complex display of biological factors (genetic, hormonal, biochemical) and social factors (childhood upbringing and other life experiences). There are many myths that are associated with anxiety disorders. Let’s clear those up.

Myth There is only one type of anxiety disorder.

Truth There are many types of anxiety disorders. These are:

  • Generalized anxiety disorder
  • Obsessive compulsive disorder
  • Panic disorder
  • Post-traumatic stress disorder
  • Phobias
  • Social anxiety

Myth Medication is the only form of treatment for anxiety.

Truth Cognitive behavioural therapy is the core treatment. Medication can be prescribed in cases of more severe disorders.

Myth It is usually obvious when someone has anxiety.

Truth Not true! You might be sitting next to a well-groomed smiling young woman or man who is experiencing heart palpitations, has tingling in both hands, a dry mouth and chest tightness and you could have no idea.

Myth You just need to eat healthily, sleep well and exercise and your anxiety will go away.

Truth Yes, this advice is very important to ease the symptoms, however the disorder will not be cured. You need to do more than just reduce levels of stress – you need to learn more about your symptoms, understand your thought processes, and re-learn how to process stressful situations in your life.

Myth You don’t have to treat it, it can go away on its own.

Truth Anxiety does not fade away on its own, and if left untreated, it gets complicated with new symptoms, and can lead to depression.

Myth Anxiety disorders are not common.

Truth Anxiety disorder is the one of the most common mental health illness. According to the WHO, anxiety disorder is the most prevalent and can impact up to 18.2 per cent of the population.

Myth Medications for anxiety are addictive.

Truth There are a number of anti-anxiety medications used for the treatment of anxiety that are not addictive. A qualified psychiatrist can advise on these.

Myth Anxiety attacks will make you faint.

Reality You may feel dizzy, but it is unlikely that you will faint.