Michelle Janssen was eventually diagnosed with generalised anxiety disorder. Photo / news.com.au
In her teenage years, Michelle Janssen was regarded as a perfectionist who overthought things and probably just needed to relax.
By the time she reached early adulthood, things were rapidly unravelling and she was forced to schedule regular "cry breaks" at work in order to get through a day.
The now 31-year-old was eventually diagnosed with generalised anxiety disorder, one of the most common mental illnesses, but followed the same path as millions of others.
"It took me so long to access help, like a couple of years, because I didn't understand what was happening to me," Janssen told news.com.au.
"I'd worry about the future, that I wasn't doing enough to succeed in life, that I wasn't enough as a person. I could exist day to day in the workplace and then these thoughts would pop into my head. I'd need to pop off to the toilet for a cry break.
"Those obsessive, racing thoughts about all kinds of catastrophes would manifest physically with extreme nervousness, and a tightening in my chest. The combination of those mental and physical symptoms was terrifying."
In a given year, some 2.5 million Australians battle a type of anxiety disorder, which is now the most common mental illness in Australia and the top condition that prompts people to visit a GP.
In their lifetimes, a staggering one-in-five people in the country will experience anxiety in a way that has a disruptive impact on relationships or work.
And yet, the huge inroads made in raising awareness and reducing stigma about mental health have overlooked anxiety, focusing almost exclusively on depression and suicide prevention.
"The discussion for more than a decade now has been about depression, which was obviously important," clinical psychologist and Curtin University academic Peter McEvoy said.
"But it's only relatively recently that the conversation has shifted to include anxiety conditions, and we've still got a long way to go. People with anxiety don't know what it is, those without don't understand what it means."
Telling someone you were struggling with depression was likely to elicit a more understanding and sympathetic response than revealing you were battling anxiety, McEvoy said.
"If you haven't experienced it, I think it's difficult to understand how debilitating in a clinical sense anxiety can be," he said.
Part of the problem is anxiety describes a number of different conditions that differ in expression and severity.
Caroline Hunt, the head of clinical psychology at the University of Sydney, said one of the most frequently experienced was generalised anxiety disorder, which causes extreme worry.
"The content of the worry isn't that unusual," Hunt said.
"People will worry about their work, their family, competence, health — a whole range of things. What makes it different is the degree to which they worry and how it interferes with their lives."
Social anxiety describes someone's fear that others have negative opinions of them, which can make typical interactions with people difficult.
"Another common one is panic disorder where people will, for a range of reasons, have quite a rapid onset of extreme panic — the heart racing, shaking, sweating.
"It's often called 'the fear of fear' and so people start to change their life and avoid things. They're worried about having an attack while driving a car or being out and about, away from home, for example."
There are other types of anxiety, like phobias, health anxiety, post-traumatic stress disorder and obsessive-compulsive disorder.
The latest Housing Income and Labour Dynamics (HILDA) Survey, which tracks the lives and wellbeing of 17,500 Australians, found diagnoses of anxiety conditions had risen sharply over the past eight years.
Despite more people seeking treatment, it still takes an incredibly long time for those battling anxiety to visit a healthcare professional.
General practitioner Jeannie Yoo, a medical adviser at NPS MedicineWise, said people with an anxiety disorder waited an average 8.2 years to seek treatment.
"Once they do, it can be a great relief for them to understand that the way they feel is due to a treatable condition, and that this condition is not uncommon," Yoo said.
"It is important for people to remember that there are effective treatments for anxiety. Seeking help from your doctor is an important first step in feeling better."
Hunt said those with generalised anxiety disorder often thought they were sensitive or a natural worrier.
"Large surveys have shown that what tends to bring people to treatment is not so much the anxiety itself, but when it co-occurs with depression. Then they recognise something is wrong and they go to their doctor," she said.
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"It's mostly a recognition issue. It's why mental health literacy is important — when people understand disorders and that they can be treated."
The HILDA survey found increases in rates of anxiety across all age groups over the past eight years, but it was especially pronounced among young people.
Private health insurer Medibank, which regularly surveys Australians for its Better Health Index, found a marked increase in those aged 18 to 29 who reported having an anxiety disorder.
In March 2018, it observed a 27 per cent year-on-year increase, with one-in-four respondents saying they had anxiety.
Medibank chief health officer Linda Swan said rapidly changing lifestyle factors, including technology, could be contributing to higher rates of anxiety conditions.
"Today's young adults are among the first to grow up with technology playing the ever-present role it now does — giving way to new and flexible ways of working, as seen in the rise of the freelancer economy," Swan said.
"While this brings with it countless new opportunities, it also means today's young people are required to be far more adaptable and accept a less regimented way of living.
"We know that a lack of routine can heighten stress and symptoms of mental health issues, and this could be playing a role in the trends indicated in this index.
"Disconnecting for a while and practising mindfulness techniques such as meditation could help, however if you're battling with your mental health, remember that your GP is always there for you."
More research is needed to determine the role the modern world plays in anxiety rates, especially among younger people, she said.
Janssen was in her mid-20s when the symptoms she'd battled for years but misunderstood collided with some stressful life events.
"I wasn't coping at work, I went through a relationship break-up, my dad became quite sick — it was stress that anyone would struggle with, but I didn't have any mental resilience," she said.
Feeling lost, she started to see a psychologist and was struck by how effective it was to "talk through things I'd avoided" and commit to a process of learning coping strategies.
It's not just young people who are struggling though, with anxiety an issue across boundaries of age, race, gender, socio-economic background and location.
"You'll find anxiety in boardrooms, workshops, offices, schoolrooms … in the city, in the suburbs and in the regions," McEvoy said.
Although, anxiety tends to emerge in early adolescence with an onset in most people by their mid-20s, he said.
"The longer it's untreated, the more long-term suffering we see."
Mental health researcher Anthony Jorm from the University of Melbourne said higher rates of anxiety diagnoses didn't necessarily mean more people were anxious.
It could be that people were more willingly reaching out for help and that methods used to determine mental health issues had improved, Jorm said.
"The real concern is why we're not seeing any benefit from these large increases in diagnosis and treatment," Jorm said.
"In theory, our mental health should be improving. There are two likely reasons for the lack of progress: the treatments are often not up to standard and we have neglected prevention."
The frustration is that anxiety is highly treatable in most cases, with a range of options on offer from e-health services to evidence-based cognitive behavioural therapy and medication.
McEvoy said great progress had been made in improving access to services, but it was crucial people got the right care.
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If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE:
• LIFELINE: 0800 543 354 (0800 LIFELINE) or free text 4357 (HELP) (available 24/7)
• SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• YOUTHLINE: 0800 376 633
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757 or TEXT 4202
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