What You Need To Know to Write Anxiety in Fiction

Anxiety disorders are as varied as they are common. Working as a counselor in a school, this is one I see quite often and no two people present their anxiety the same. Recent Canadian statistics show that anxiety effects up to 5% of the population. It's frequency, however, is a drawback when it leads to complacency. People sometimes throw out the term to mean fear, or worry, or a general discomfort.

Anxiety is much more than that.

If you're interested in writing a believable character who suffers from an anxiety disorder, chances are a significant portion of your readers will have first hand experience with this diagnosis. You're going to want to know some facts on what is and is not an anxiety disorder, then determine how those symptoms might present themselves in every day ways.

Criteria & Symptoms:

Just as the term anxiety is used so broadly, the diagnosis of anxiety disorders is a very broad area. There are several types of anxiety disorders, such as generalized anxiety disorder, panic disorder, specific phobias, social anxiety disorder and separation anxiety disorder. For the purposes of this article, I'll be using the criteria for general anxiety disorder (GAD) as my example.

The six criteria mental health professionals use to determine a diagnosis of GAD, as outlined in the DSM-V are [source]:

1. Excessive worry about a number of events or activities, occurring more days than not for the past 6 months.

2. Difficulty controlling the worry

3. Three of the following six symptoms experienced (more often than not in the past 6 months):

   1. Restlessness

   2. Easily fatigued

   3. Difficulty concentrating

   4. Irritability

   5. Muscle tension

   6. Sleep disturbance

   7. Clinically significant distress or impairment experienced at home, work, school etc., caused by these symptoms

   8. Not attributed to a drug, medication or other medical condition

   9. The disturbance is not better explained by another medical condition

If you didn't believe me when I said anxiety disorders are a very broad category, that last criteria should make it clear that even mental health professionals have a built in grey area when it comes to diagnosing anxiety.

What else should be clear is that the symptoms that need to be evident must be prevalent in nature. GAD, as well as all the other anxiety disorders, must have a significant, daily impact on a persons life.

Examples:

At this point, you may be thinking: So how, as an author, do I portray a character with a disorder so varied? Luckily, in this case you can use the flexibility of the diagnosis to your advantage. After all, fiction is so much more forgiving than real life in many ways and this is one of them. Now that you know the basics of what needs to be in place to warrant a diagnosis, all that's left is setting your character up with the quirks of their disorder.

For example, say you choose for your character to experience their GAD through excessive worry about school performance. It's easy to see how this preoccupation and worry could easily start to effect their concentration in other areas of their life. While at their part time job? On the bus ride home, maybe? Thinking about what happened earlier in the day while washing dishes later that evening? Could your character start feeling tension in their muscles as their excessive anxiety takes hold? How's their sleep, now that he's all tense and anxious? If this starts happening over an extended period of time then, my fine author friend, your character has the makings of an anxiety disorder.

Basically it's this: give your character a real, believable worry- one that might cause you or I some stress- and magnify it so the stress and worry starts to permeate other parts of the characters life. These symptoms can be played with and set up in a way that moves your character arc and plot forward and create interesting conflict in your story.

A cautionary note: a huge pet peeve I have is when terms like "anxiety" and "depression" are thrown around as synonyms for "sad" or "shy" or whatever else. These are real diagnoses and with symptoms that impact peoples lives in a significant way. If you choose to write about a character who suffers from GAD or any other anxiety disorder, please do so with respect to that, not just as an excuse to allow your character to act a certain way.

I’ve included the sources for information used in this article and have updated my Resources page with links to some sites that talk more about anxiety. This is by no means a substitute for professional advice or clinical assessment.

If anyone is interested in learning more about a different type of anxiety disorder, leave a comment below and I'll do my best to address the unique criteria for that disorder.

Is anyone writing a character right now that has GAD? I'd love to hear what kinds of things cause them anxiety and how it impacts their story! Leave me a comment below.

-Everly