Anxiety: Is There a Test to Diagnose Anxiety? Exploring Psychiatric Approaches
Anxiety is a common emotion that plays a variety of roles in our lives. To the practiced and attuned mind, it can serve as a guide, alerting us to red flags or that something does not feel right. To the average human, it is a nuisance; ebbing and flowing with the demands of life when there is too much to do, leaving us stressed and feeling overwhelmed. But when anxiety is persistent and interferes with school, work, relationships, or causes substance use, it may be regarded as a disorder and intervention is [over] due.
Different types of providers will approach the evaluation and treatment of anxiety differently. In this article, we will review what anxiety is, its symptoms, and how conventional, integrative, and functional psychiatry providers assess a patient for anxiety. Finally, we will discuss my approach to helping my clients reduce and heal their anxiety.
Some Facts and Statistics on Anxiety Disorders
As a culture, we have a tremendous amount of anxiety and have labels for the dozens of different ways our discomfort manifests. Under the chapter dedicated to anxiety, the Diagnostic Statistics Manual (DSM) lists eleven anxiety disorders, many well known in our culture: Generalized Anxiety Disorder, Panic Disorder, Obsessive Compulsive Disorder, and Specific Phobia, to name a few.
There are also a number of other anxiety disorders, such as Illness Anxiety Disorder, Posttraumatic Disorder, or the Adjustment Disorders, which sit outside of the chapter designated to anxiety. As an added complication, some people with anxiety will be misdiagnosed with Bipolar Disorder or Attention Deficit Hyperactivity Disorder due to a rushed assessment or an inexperienced provider.
One in five adults, and one in three adolescents, had an anxiety disorder just this past year. Anxiety disorders were the most common mental health condition found in a national comorbidity survey, with a lifetime prevalence of 32%, beginning for most individuals at the age of six years. Anxiety impacts hormones such as cortisol (a steroid hormone produced by the adrenal glands, often called the "stress hormone"), and systems that regulate digestion, metabolism, immunity, cardiovascular health, and substance use. Chronic anxiety increases risks for most health conditions, from cognitive problems to heart disease to irritable bowel syndrome, to name a few. Despite how common anxiety is, only one-third of patients will receive treatment.
In addition to low treatment rates, some treatments will be ineffective for certain individuals. Surprisingly, approximately 50% of patients who receive gold-standard treatments will continue to have symptoms. This is crucial because it highlights that there are additional causal factors being overlooked in the assessment and treatment of anxiety in conventional care, given that even with the best care, half of the clients continue to suffer. Later, we will discuss how I use functional psychiatry as an integrative provider to assess and treat the root cause of anxiety.
Symptoms of Anxiety: How Anxiety Shows Up
As there are many different anxiety disorders, symptoms have a varied and wide range, often mimicking other physical and mental health issues, like a heart attack or an attention deficit problem. Signs of anxiety may include irritability, insomnia, nightmares, panic attacks, or avoiding social situations due to a fear of being judged.
Anxiety can jeopardize focus during a class or an important meeting, provoke gastrointestinal symptoms during a date, lead us to continue drinking at a party when we’re meeting new people, make it difficult to acknowledge our feelings, or incapacitate us in panic when we feel triggered.
Anxious Kids
Anxiety symptoms in children can manifest in various ways, often differing from those seen in adults. Children with anxiety may exhibit excessive worry about everyday activities, such as school performance or social interactions. They might experience physical symptoms like stomachaches, headaches, or fatigue, which can sometimes be mistaken for other medical conditions.
Behavioral changes are also common, including irritability, restlessness, and difficulty concentrating. Some children may become overly clingy or avoid situations that trigger their anxiety, such as attending school or participating in social events. Trouble falling asleep and frequent nightmares can also be indicators of anxiety in children. Recognizing these symptoms early and providing appropriate support and intervention can help mitigate the impact of anxiety on a child's overall well-being.
Anxious Adolescents
Adolescence is a stressful time in a number of ways: academic pressures, puberty and hormonal changes, social media, pressure from peers, and expectations regarding gender and sexuality. For adolescents, irritability, reactivity to emotional and social stressors, hypervigilance, substance use, avoidance, and sometimes behavioral outbursts related to the avoidance, can be common manifestations of anxiety.
Regardless of whether the individual surviving this onslaught acknowledges the problem or not, anxiety disorders are characterized by persistent symptoms causing marked impairments in multiple domains: relationships, home-life, academic and professional success, athletics and recreational activities, operating a vehicle, and other areas of a person’s life. These features differentiate anxiety disorders from typical worries that are anticipated responses to developmental and life stressors.
Denial and Insight: It Can Be Hard to Know What is Happening
Sometimes, it is difficult to have insight that there is a problem. Many people will move through life and not realize why their heart is racing when they hear the same song that played during a car accident they survived, or why they feel uncomfortable around their mom after she gets home from work and starts to drink.
Our culture is maturing, but it is still an act of bravery to say when something is emotionally difficult, even in the privacy of a doctor's or therapist’s office. It can be hard to talk about these symptoms, and many people, young and old, will feel shame that they cannot “just brush it off” or “stop worrying about it” like they were encouraged by well-intending friends or family. When asked about a history of anxiety, some individuals will downplay how severe their anxiety symptoms are due to stigma, referring to it with euphemisms of “stress” or just being “tired.”
The Benefits of Stress
When experienced in moderate amounts, short-term anxiety can enhance our focus and motivation, prompting us to prepare and perform better in various situations, such as exams, job interviews, or public speaking. When stress rises, and later falls, we are able to adapt and then return to a state of peace. Feeling safe and calm, this type of stress can be beneficial to our resiliency and immune system, providing a trigger for growth and a sense of accomplishment for completing the assignment, setting a new personal record, asking out our crush, or shutting down a bully.
Anxiety As a Guide
Anxiety, often perceived as a negative emotion, can actually function as a valuable guide in our lives. It acts as an internal alarm system, alerting us to potential threats or challenges that require our attention. It can encourage us to reflect on our priorities and make necessary adjustments to our lifestyle or environment to reduce stress. With practice, and if we are open to it, anxiety can serve us as an instrument, like wisdom and intuition, helping us realize what we need or how we feel.
Modern life is full of pressure to be and do things that may not be in line with what we truly want for ourselves. By acknowledging and understanding our anxiety, we can use it as a tool for personal growth and self-improvement, ultimately leading to a more balanced and fulfilling life. This work can be challenging and a great reason to start psychotherapy.
Etiology: What Causes Anxiety?
Social Factors
The mental health field continues to research this important topic and has discovered a bi-directional and complex relationship with social factors such as childhood trauma, isolation, limited coping skills learned during childhood, economic pressure, cultural expectations regarding gender and sexual orientation, and, of course, access to supports and resources.
Unstable Blood Sugar
Consuming processed foods and a diet high in sugar (above 25-30 grams per day) can cause spikes and crashes in blood sugar levels, which can affect mood and energy levels. Additionally, consuming large amounts of sugar can lead to the release of stress hormones like cortisol, which can exacerbate feelings of anxiety.
Hormones
Genetics, nutritional patterns, inflammation, infections, and toxins can disrupt the production and metabolism of estrogens and androgens for all humans. Men with low testosterone will often feel irritable and worried. Women can be thrown into anxious episodes, causing or exacerbating symptoms of premenstrual syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD), perimenopause, and postpartum anxiety.
Inadequate Nutrition
Our bodies were designed to consume whole foods, rich in nutrients, free of toxins or additives, and rich in healthy fats. All ingredients necessary for the production of hormones and neurotransmitters that support sleep, mood, stable energy, and feelings associated with resiliency. Eating patterns that are low in nutritional value, contain novel chemicals, and are sources of inflammation, like sugar and conventional wheat treated with herbicides, negatively impact us in two critical ways. First, the body does not receive the necessary nutrients to build neurotransmitters, like serotonin and GABA, both important for how we experience anxiety.
Any nutrients on hand will go to manage the most important functions, like the critical work of creating cellular energy, thermoregulation, maintaining blood pressure, et cetera. The second problem is that a processed-food diet contains chemicals and toxins that create inflammation, disrupt digestion, and destabilize blood sugar. This process increases cortisol, resulting in worsened symptoms of anxiety and may be ignored as a source of medical and mental health problems.
Caffeine: Liquid Motivation or Generator of Anxiety
Coffee is a source of magnesium and antioxidants, and many teas are sought after for their polyphenols (sources of antioxidants and anti-inflammatory compounds). Popular and ubiquitous, but not all of us feel good after a cup of coffee or caffeinated tea. Caffeine raises cortisol and can leave many individuals feeling anxious without knowing why. Genetics and nutritional factors impacting metabolism can create susceptibility to feeling jittery, stressed, and slow breakdown of the chemical, leading to poor sleep.
Diagnostic Tests for Anxiety
What Tests Would a Conventional Psychiatrist Order for Anxiety?
All providers will discuss the patient’s concerns, typically during an assessment or evaluation. They will want to learn what is bringing the patient in for treatment or the chief complaint(s), in the patient’s own words, and how these problems are impacting the patient. There are several scales used to evaluate anxiety, including the Hamilton Anxiety Rating Scale (HAM-A), Beck Anxiety Inventory (BAI), or the GAD-7 (Generalized Anxiety Disorder 7-item). These forms help communicate the frequency, severity, and impact anxiety has on the patient and their life.
Labs are recommended as it is possible for certain medical conditions to be misdiagnosed as anxiety if there is not an adequate medical workup. Hyperthyroidism, Irritable Bowel Disease, Lyme Disease, Peri-Menopause, and Endometriosis are a few health problems that can masquerade as an anxiety disorder, complicating treatment. Standard lab studies (phlebotomy) should be done to determine if common health issues are causing or exacerbating anxiety, including TSH, free T4, free T3, reverse T3, TPO, complete blood count, comprehensive metabolic panel, vitamin B12, and a urine drug screen.
What Tests Would an Integrative Psychiatrist Order for Anxiety?
An integrative practitioner combines conventional medicine with complementary, evidence-based care to offer holistic treatment that focuses on what the client can do to heal themselves and less on the use of pharmaceutical medications. In addition to a thorough psychiatric evaluation, including the labs already listed, an integrative provider may also recommend testing magnesium, vitamin D, ferritin, the markers of Celiac disease, MTHFR gene mutations, and continuous glucose monitoring. Depending on the signs and symptoms, a sleep study may also be recommended.
Integrative Lab Testing
Additional labs can help determine the best treatment for anxiety. Magnesium plays a critical role in many bodily functions and is necessary to produce GABA and regulate cortisol, both of which are important in managing anxiety. Research has found that low vitamin D levels are associated with anxiety. The mechanism of action is still being evaluated, but it has been established that vitamin D is required for serotonin synthesis and mood regulation. Ferritin is the body’s storage of iron, and at low levels, an individual may struggle with sleep, anxiety, and depression as iron is a rate-limiting step in the production of many neurotransmitters.
Studies have shown that clients with Celiac disease suffer higher rates of anxiety compared to the general population, and only 50% of those with Celiac disease will have gastrointestinal symptoms, which leads to low diagnosis rates and delayed treatment. Lastly, mutations in the MTHFR genes can limit the body’s ability to process folate and produce neurotransmitters. These mutations are very common and can be easily treated with methylated B vitamins.
Continue Glucose Monitoring
Continuous glucose monitoring (CGM) can be a valuable tool in evaluating anxiety, particularly in understanding the relationship between blood sugar levels and anxiety symptoms. CGM devices provide real-time data on glucose fluctuations, allowing for the identification of patterns that may correlate with anxiety episodes. For instance, through the actions of insulin and cortisol in attempting to stabilize blood sugar, sudden drops or spikes in blood sugar can trigger physiological responses that mimic or exacerbate anxiety, such as increased heart rate, sweating, and feelings of panic.
By monitoring these changes, healthcare providers can gain insights into how blood sugar variability impacts mental health. This information can be used to tailor dietary and lifestyle interventions to stabilize glucose levels and reduce anxiety symptoms. Additionally, CGM can help in identifying specific times of day or situations that are more likely to provoke anxiety, enabling more targeted and effective management strategies. Integrating CGM into the assessment of anxiety offers a holistic approach that can improve both physiological and psychological wellness.
Sleep Studies
Sleep disturbances are commonly associated with anxiety disorders, and understanding the quality and patterns of a patient's sleep can provide valuable insights into their mental health. A sleep study monitors various physiological parameters during sleep, such as brain activity, eye movements, heart rate, and breathing patterns. This comprehensive data can help identify specific sleep disorders, such as insomnia, sleep apnea, or restless leg syndrome, which may be contributing to or exacerbating anxiety symptoms. Common symptoms of snoring, significant fatigue, morning headaches, frequent waking in the middle of the night, poor concentration, brain fog, gasping or choking during sleep, falling asleep during work or class, or pauses in breathing while asleep may warrant a sleep study.
How Does a Functional Psychiatry Provider Evaluate Anxiety?
Although training and specialization are specific and unique to each provider, a Functional Psychiatry provider is interested in helping their client heal the problems that are causing their anxiety. To that end, they would likely also recommend that testing evaluate not only hormones but hormone metabolism, the adrenals, the gut microbiome, and organic acid testing. Depending on signs and symptoms, testing for toxins, non-celiac gluten sensitivity, and Pyrrole Disorder may be recommended.
Hormone Metabolism
Our hormones are much like canaries in the coal mines; when nutrition is high, stress is low, and toxins and infections are absent, our hormones sing along and help us feel a harmonious balance. But when infections are present, processed foods are frequent, and stress is high, our hormones can torture us. These hormones - cortisol, estrogen, progesterone, and testosterone – all play crucial roles in regulating our moods and stress responses.
Problems in the production or metabolism of estrogen, testosterone, and progesterone can result in concerns such as low testosterone, PMS, PMDD, postpartum anxiety, perimenopause, and other conditions. By evaluating hormone levels and their metabolism, a functional provider can identify specific hormonal imbalances and the driving forces that may be contributing to a client’s anxiety. As limitations in nutrition, gastrointestinal infections, genetics, toxins, and other sources of inflammation can interfere with the balance of hormones and lead to anxiety, its often necessary to also test the gut microbiome and the organic acids. This information can guide personalized treatment plans, including hormone therapy, lifestyle modifications, and dietary interventions, to help manage anxiety more effectively.
Why a Stool Test Can Help Cure Your Anxiety
The gut microbiome, which consists of trillions of microorganisms living in the digestive tract, has been shown to influence anxiety, mood, brain function, and behavior. Research has found that imbalances in gut bacteria can lead to increased inflammation and altered neurotransmitter production, such as types of GABA and serotonin, both of which are linked to anxiety. Low levels of beneficial bacteria, like Lactobacillus and Bacteroides, are correlated with lowered resilience and higher rates of anxiety. Infections like Candida albicans (yeast), Helicobacter pylori, and Streptococcus (which causes PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)), and other infections, are associated with worse anxiety.
These infections can also drive hormonal dysregulation, inflammation, and nutrient deficiencies, which is why it is common for a functional provider to request testing more than simply a stool test when evaluating for anxiety. Specialized stool tests can help identify inflammation, infections, pathogens, and communicate what is needed to re-establish balance to the gut microbiome to help treat anxiety in a way that is much more durable and curative than a selective serotonin inhibitor (SSRI), like Zoloft or Lexapro.
Organic Acid Testing
Organic acids are byproducts of metabolism and can indicate how well the body is functioning at a cellular level. Imbalances in organic acids can reveal issues such as nutrient deficiencies, detoxification problems, limitations with neurotransmitter production, mitochondrial retraction, and dysbiosis (an imbalance in gut bacteria), all of which can contribute to anxiety. For instance, certain organic acid metabolites can indicate deficiencies in B vitamins or specific co-factors, which are crucial for neurotransmitter production and mood regulation.
The catecholamines will be represented by the urinary metabolites homovanillic acid and vanillylmandelic acid, which can signal to the provider the need for certain precursors to improve focus and anxiety. Additionally, elevated levels of specific markers can indicate oxidative stress and mitochondrial dysfunction, both of which are linked to anxiety. By analyzing organic acids, healthcare professionals can identify underlying biochemical imbalances and tailor treatments to address these issues, ultimately helping to alleviate anxiety symptoms and improve overall mental well-being, often from the source. This comprehensive approach underscores the importance of considering biochemical individuality in mental health care and how functional psychiatric treatment can durably improve someone’s mental health and reduce the need for psychiatric medication in the long run.
What I Recommend If You Have Anxiety
After working with clients of all ages for the past two and a half decades, I disagree with the notion that anxiety is a mental health condition wherein the patient’s symptoms are “out of proportion to the circumstances.” As a Nurse Practitioner, I believe that we as healthcare providers often fail to identify all of the stressors acting on the client, like problems in hormone metabolism, poor sleep, toxins, inflammation, and subtle social stressors that may be downplayed by the patient’s loved ones, and possibly the patient as well. If a patient of mine is anxious, I want to identify the cause and help heal the source.
I would love for us all to exist in low-stress environments, free of toxins, where we eat nutrient-dense foods most of the time, feel loved and supported by great friends and good family, and for our stress to be occasional and beneficial to our resilience and growth. While that would be lovely, the reality is that life is hard and anxiety is very common.
When I work with a client suffering from anxiety, I listen for the hidden clues that indicate what might be applying pressure to this individual. By implementing the analyses noted above, from conventional to holistic, we can tease apart what may be rightfully making the client uncomfortable and what may be interfering with their resiliency. Through this work, we can combine psychotherapy, medicine, natural treatments, and lifestyle interventions to help de-load the drivers of anxiety, have fewer worried thoughts, better sleep, more confidence, fewer nightmares, and finally, less anxiety.
To learn more about my practice, fees, and policies, and to schedule a phone consultation at Mountain Psychiatry, please start here.
Find Root-Cause Support for Anxiety with Psychiatric Treatment in Richmond, VA
If anxiety has taken a toll on your focus, sleep, or sense of calm, you deserve care that looks deeper. At Mountain Psychiatry, we offer a thoughtful blend of conventional, integrative, and functional approaches to address the root causes of your symptoms. Reach out today to begin compassionate psychiatric treatment in Richmond, VA that supports your whole well-being. Follow these three simple steps to get started:
Review fees and clinic policies
Schedule a phone consultation to explore whether psychiatric treatment is the right fit for you.
Begin meeting with NP Lis Collins for your psychiatric evaluation
Start healing with a personalized approach that addresses the root causes of anxiety for lasting well-being.
Additional Services Offered at Mountain Psychiatry
Mountain Psychiatry delivers comprehensive psychiatric care along with focused support for individuals facing challenges like trauma and PTSD, treatment-resistant depression, ADHD, sleep issues, substance use recovery, benzodiazepine tapering, and gender-affirming care. Although based in Richmond, Virginia, I also provide secure telehealth services to clients throughout Virginia, Colorado, and California — ensuring personalized, compassionate care is within reach wherever you are.