Anxiety and cumulative trauma

Firstly it may be worth defining what anxiety is. I think it is a mental and physical process. For me it is a combination of worry or frustration and physical tension. Physical tension can manifest itself in a whole range of ways from hyperventilation to literally just the sensation of tighter muscles. Worry and frustration can cause these sensations but equally the physical sensations can cause further worry and frustration e.g. I find that tension affects my voice and makes me stammer more, and because I become frustrated and worried about this I become more tense.  So anxiety is not just a mental state, it is also a physical state and most probably a kind of vicious circle, a process that I will explain shortly.

Anxiety as an emotion.

Since anxiety is an emotion it can be understood in the same way as other emotions. Emotions can be triggered by various thoughts or experiences. Anxiety can also be understood as something that is triggered. Everybody has their own triggers for anxiety. So to reduce anxiety you need to know what your triggers are and then reduce your responses to those triggers. Easier said than done.

What makes up the mental symptoms of anxiety?

– Anticipation. In my case I sometimes anticipate the physical symptoms which can become a self-fulfilling prophecy.

– A sense of lack of control.

– A loss of confidence in one’s thoughts and one’s mind which can cause or exacerbate a more pervasive lack of self esteem

Anxiety as a physical state

What makes up the physical symptoms of anxiety?

– Disrupted breathing. In my case I think that the sequence of events is worry first followed by a feeling of tightening in my chest which if frequent enough leads to hyperventilation. The hyperventilation in turn leads to further symptoms. I think that the hyperventilation is caused by the restriction of my breathing that follows on from the frequent episodes of chest tightening. I think that like many people who suffer with anxiety the frequent periods of bronchitis that I experienced as a young child may have made me prone to this disrupted breathing pattern when I am under stress.

– physical tension that is to say tightening of the muscles. In my case this physical tension particularly affects my voice and makes me prone to stammering which leads to more frustration and tension.

What causes an anxiety disorder?

For some people there are 3 main factors: an underlying predisposition caused by cumulative trauma normally in childhood which through a triggering stress event later in life and risk factors cause phobophobia, the fear of fear. This causes a vicious circle in many ways, but particularly phobophobia itself causes further trauma.

  • Cumulative trauma

Long term cumulative trauma;

The kind of anxiety that I am focusing on is trauma based anxiety where there is a long term cumulative process of repeated exposure to worry and stress without sufficient recovery time. As well as the obvious physical, sexual and psychological abuse and neglect risk factors there may be other risk factors such as internal personality stresses that include traits such as perfectionism or requiring an unrealistic level of certainty and external social stresses or conditions such as bipolar disorder, migraine, autism, personality disorder. These risk factors interact to create the stress load that can lead to anxiety if one develops phobophobia.

Shorter term cumulative trauma

– There is an immediate short-term process involved in anxiety. I think that this is a cumulative process, just like the physical overuse injuries. Repeated episodes of worrying and tension cause an escalation of anxiety. Anxiety is associated with stress and anxiety itself is stressful, so the vicious circle of anxiety could also be understood as a vicious circle of stress.

Lack of recovery time

As with physical overuse injuries, if you do not have enough recovery time built into your life then anxiety can take root. For example when my anxiety problem was starting I was experiencing stress at school and also at home so there was no real opportunity for me to have any recovery time. Recovery time is time when you are not experiencing stress, so the goal to aim is to have at least part of each day and each week when you are not experiencing stress. I appreciate that this can be difficult because it is very easy for stress to rear its head but only when you are at work or school that but you are at home too. It is about finding ways to manage stress when it is not possible to avoid stress.

  • Learning

– Anxiety is a learnt process because there must be an evolutionary advantage in remembering situations that cause fear and distress.

– I have observed a self-fulfilling prophecy with worry about the physical symptoms. I think that this is connected to mental imagery where I imagine the physical symptoms and this process of imagination brings on the physical symptoms. This is similar to rehearsing something such as playing a golf shot in one’s mind before playing it on the golf course in order to get the stroke right.

Breaking this down: anxiety involves….

1) Stress leading to physical symptoms

2) Worry and frustration about these physical symptoms that causes more stress and therefore more physical symptoms.

3) A learned response whereby the physical anxiety symptoms appear more easily and rapidly under the influence of certain triggers for stress or other cues.

4) Once the pattern is established an increased vulnerability to anxiety is created because anxiety itself increases the sufferer’s general level of stress.

5) Eventually once you have learnt how unpleasant the experience of anxiety is you automatically start to fear anxiety itself and you have thus stepped onto the treadmill of the ‘fear of fear’, otherwise known as ‘phobophobia’.


Anxiety may be caused by cumulative psychological trauma. The cumulative psychological trauma happens in childhood but the trigger for the anxiety disorder might not happen until the individual is in their teens or twenties. The anxiety disorder is triggered by a series of stresses which leads to a self-perpetuating condition because of Phobophobia, the fear of fear.