Middle years

Anxiety disorders

The middle years start off as being a time of higher anxiety and as you age anxiety often starts to decrease. Around the age of 35, 27% of women have an anxiety disorder and this drops to around 16% by the time a woman reaches 64. However, lack of support, a poor lifestyle, your changing body and changing relationships with friends, family and partners could make the journey through midlife that much harder! It’s a time when lots of things catch up with you like past traumas and losses; particularly if you haven’t dealt with them before now. Past episodes of anxiety and depression put you more at risk at this time also. Often midlife is a time when your usual ways of coping don’t seem to work as well anymore. Add to this recipe some stress, a little worry and apprehension and you can find yourself completely overwhelmed!

Is this you?

LEARN Consider the different stories and pictures below, listen to a podcast or watch a video.

THINK Then, to understand more about what causes anxiety you can explore the different social, psychological and physical things that can increase anxiety. In this section you will find questions to ask yourself about each cause to see if it affects you.

DO Once you have explored the causes of anxiety then it is time to do something. Go to the ‘Toolkit’ to find a range of different tools to help yourself try and reduce anxiety.

View the causes of Anxiety Disorders for Middle years

Do you relate to these?

someecards.com - I'm usually about Live, Laugh, Love, and Dance but today its more like, Raise, Aim, Fire, and Reload...

“It was one of those days when I was thinking too much, too fast. Only it was more like the thoughts had a mind of their own and going all by themselves at a hundred miles a second, and I was just sitting back, feeling the growing paranoia inside of me.”
Sasha Mizaree

I don’t know where it came from. It just hit me and all those feelings of panic - I just started remembering. I haven’t thought about that time for so long. I had just got on with life and pushed it down. Now…I can’t breathe, I can’t work, I can’t eat, I can’t sleep and my heart goes a million miles an hour.  I have to do something, but I don’t know what. I don’t want to remember. I don’t want to revisit that fear, but I think I might have to.

I just want to scream I can’t do this anymore.

“She had a strange feeling in the pit of her stomach, like when you're swimming and you want to put your feet down on something solid, but the water's deeper than you think and there's nothing there.”
Julie Gregson

Causes of anxiety disorders for Middle years

What happens

Some personalities are more prone to anxiety - you might be a perfectionist, yet midlife is a time when your inner perfectionist may be challenged. You can have a lot of changes and demands going on such as responding to aging parents and growing teenagers or changing work roles. It can feel like your ability to complete tasks and get things done to any standard has completely disappeared. You might be very rigid in your thinking and find uncertainty difficult to cope with or tolerate. The hormonal changes of menopause are often unpredictable and may well increase your sense of things being out of control which can increase your anxiety.

Questions to ask yourself

Is it in my make up to be anxious?

How much do I like things to be perfect?

How much do I over think things?

How much do I over analyse my every thought?

Do I find uncertainty difficult to cope with?

Do I get anxious that I am losing control because of changes that are happening in my life?

What happens

If you have had a diagnosis of anxiety or depression before in your life you are more at risk of having a further episode.

Questions to ask yourself

Have I been diagnosed with either anxiety or depression before in my life?

What happens

Having a negative attitude to aging and menopause can make you fearful and excessively concerned about the future.

Questions to ask yourself

How negative do I feel about getting older and menopause?

What happens

Having low confidence in who you are, and not valuing yourself can result in increased anxiety. Sometimes you focus on all the things you can’t do. If you focus on your failures and doubt your abilities, this can create high levels of anxiety. Having a fear of failure is paralysing and can overwhelm you. Instead of facing your fears you are more likely to avoid them.

Questions to ask yourself

How much do I value myself?

How much do I believe I am a valuable person?

How much do I focus on the things I don’t do well?

Do I avoid things if I think I will fail?

What happens

With menopause, your body shape will change and fat starts to move up from your hips to around your stomach.  With aging, your metabolism starts to slow and you can find yourself putting on weight more easily. Two thirds of all women are dissatisfied with their body and would like to make changes. However if you are so focused on your shape and weight that you do things that can harm your health you are vulnerable to an anxiety disorder. If you are obsessed about your appearance and believe that thin and beautiful equal happiness and success you can find this preoccupation severely affects your daily life.

Questions to ask yourself

How anxious am I about how my body looks?

How anxious am I about changes to my body with menopause and aging?

How much does the anxiety I feel about how my body looks, affect my daily life?

How fixated am I about my weight? For example, do I:

  • Starve myself
  • Severely restrict the foods I eat
  • Binge on food
  • Purge after eating my food?
What happens

Distressing and faulty thinking such as:

  • Catastrophising - thinking the worst possible thing will happen
  • Jumping to conclusions - thinking you can predict the future (and it is bad) create a negative cycle.

Distressing thoughts cause physical symptoms such as a racing heart, feeling sick causing you to want to run away. Your self-talk remains negative - “I am hopeless” and the whole cycle starts again. If you find it hard to challenge your thoughts or if you avoid situations that cause anxiety you don’t get the benefit of facing your fear and working through the anxiety – this can lead to anxiety disorders.

Questions to ask yourself

Think of a recent time when you felt anxiety and ask yourself – in what ways were my thoughts unhelpful or faulty?

For example, do I:

  • Jump to the wrong conclusions about what people are thinking about me?
  • Think something really bad is about to happen?

What is the evidence to support my thoughts?

What is the worst thing that could happen? How likely is this?

What happens

At midlife you can find the ways you used to cope when things get difficult don’t work as well anymore. Perhaps you used to just push through your feelings, or perhaps you increased your activity or went and had coffee with friends. If your ways of coping aren’t working as well and your anxieties are increasing you need to understand what is happening and what may be different in your life to cause this.

Questions to ask yourself

Do the ways I usually cope still work?

What has changed in my life that I no longer can rely on the ways I used to cope?

Do I need to change the ways I cope when I am anxious?

Do I need new ways of managing my anxieties and the hassles of life?

What happens

Physical, emotional, mental and sexual abuse can significantly affect your mental and emotional health. Ever having felt neglected, threatened or that you may be harmed in some way increases the risk of you experiencing an anxiety disorder. With maltreatment you learn you can’t trust that people will do the right thing by you – even sometimes those you thought loved and cared about you. With abuse you may lose the idea that everything in your world will be okay in the future and you may no longer feel safe.

Questions to ask yourself

Have I felt:

  • neglected
  • threatened
  • that I might be harmed at any time during my life?

Has abuse put me more at risk of anxiety?

How much can I trust others?

How safe do I feel?

What happens

Having roles that give you meaning and a sense of purpose are important to your mental and emotional health. You might be a best friend, a mother, grandmother, artist, volunteer… there are many roles you may have. Sometimes these roles are given to you and at other times you choose the roles you have. If you feel good about your roles, feel a sense of purpose and that you have a place in this world you are more likely to have the confidence to deal with your anxiety.

Questions to ask yourself

What roles do I have?

How anxious am I about the roles I have?

Social causes →
What happens

Problems with your family can include lots of things as midlife is a time of great change. You may have problems with your parents, or you have lost a parent, or both parents. Perhaps your relationship with a brother or sister is distressing. You might be anxious about your children, their safety, or their happiness or their future, or they are teenagers and your relationship is strained. Perhaps you don’t have children and midlife is a reminder you won’t have your own children. Midlife can be a time of reassessment of your relationship with your partner - some women may question whether they want to be with their current partner for the next 30-40 years? Being in an unhappy relationship can increase anxiety levels significantly, or you may be anxious you are alone and not in a relationship.

Questions to ask yourself

Are there family problems that cause me to be anxious?

Have there been changes to my family that I am anxious about? If so, what are they?

How anxious am I about the relationship with my children (if relevant)?

How anxious am I about not having children (if relevant)?

Am I anxious I am not in a happy relationship?

What happens

Friends can accept you for all that you are and sometimes they can reject you. This happens at every age and stage of your life. Midlife can be a busy time and perhaps you are distressed you are not able to see your friends as much as you would like, or their lives are changing and you are anxious about them also. Having friends in your life when you are going through so many changes is important to your emotional health particularly if you have an anxiety disorder.

Questions to ask yourself

Do I feel accepted by my friends?

Who accepts or does not accept me?

How anxious am I that my relationship with friends is changing?

What happens

Having people to talk to when you need support is one of the most important ways to feel good about yourself. This might be friends, family, people in groups you belong to, or the people you mix with where you work. As you move through midlife some of your supports can change, perhaps because your circumstances have changed, you have moved, changed jobs, your children are at different schools, or perhaps through illness. Losing reliable support networks can negatively impact on your mental and emotional health. You may get fearful about who is there to support you if you need.

Questions to ask yourself

Do I have good friends, family or people I trust who can be there for me?

Who can I turn to if I need support or someone to talk to?

Have people who I turn to for support moved on, or are no longer there for me?

What happens

How much anxiety you feel about money will depend on your financial situation. At midlife there can be a lot of expenses and at the same time you are being told you need to save for your future, or if you are near retirement, the end of your working life. Money can be a lifelong issue but at midlife you can be highly anxious about covering your present expenses and distressed about providing for the future.

Questions to ask yourself

How anxious am I about money?

How anxious am I about being able to afford today’s living costs?

How anxious am I about providing money for my future living costs?

What happens

All the changes that can occur at midlife can be very frightening, particularly if you are someone who finds change unsettling. If these changes affect your daily living this can be a sign of an anxiety disorder.

Life events can be distressing at this time also such as serious illness or the death of someone you love.

Questions to ask yourself

How do I feel about change?

Have I experienced any distressing or difficult events recently? If so, what are they?

What happens

Being placed in a situation where you experience fear of actual harm or death, helplessness or horror can cause a type of anxiety called Post Traumatic Stress Disorder (PTSD). Sometimes the anxieties from a past event come up again when you are in midlife. You can find yourself reliving the anxiety, possibly having distressing memories. Why the anxiety returns at midlife is hard to know. It may be that at the time of the traumatic event you just got on with life and kept busy and distracted. With all the other changes that are happening to you at midlife, perhaps you are more sensitive to stress now and your body remembers the trauma again now. It is like a double dose of stress and can feel incredibly overwhelming.

Questions to ask yourself

Are my anxious feelings and thoughts associated with an event that happened in the past?

Could I have PTSD? (get information on PTSD here)

Community causes →
What happens

The community in which you live is important to your mental health. Feeling safe, that there are places to go, ways to get there and things to do can help you to feel connected to your community and that you belong somewhere. If you move to a new community you may be anxious about finding your way around, and finding the same type of services you are used to. If you have an anxiety disorder feeling disconnected can add to your anxiety.

Questions to ask yourself

How do I feel about the community where I live?

How connected do I feel and do I feel that I belong in my community?

What services are available to me in the community where I live?

What happens

Feeling safe is a basic human right. As you get older you can feel more vulnerable and less safe. This might be physically, such as feeling more vulnerable to a physical attack, or that you might fall more easily and hurt yourself – or it can be emotionally, where you feel more vulnerable to being exploited or financially cheated.

Questions to ask yourself

How safe do I feel in my community?

How anxious am I about being physically attacked?

How anxious am I about falling over?

How anxious am I about being cheated financially or exploited?

What happens

Work can provide a source of anxiety such as:

  • how wafe and secure you feel in your job
  • how flexible your workplace is so you can meet other commitments
  • how demanding your job is of your time and energy
  • how much the politics and gossiping of a workplace affects you
Questions to ask yourself

How anxious am I about my work?

How secure do I feel in my job?

Do I feel exhausted by my job?

How supportive are my boss and work place?

Physical causes →
What happens

There is debate about whether anxiety is inherited. If you have a family member who has experienced an anxiety disorder this doesn’t mean you will get anxiety, but certain genes along with things that happen in your life may mix together to increase your vulnerability to anxiety.

Questions to ask yourself

Do I have someone in my family who has, or has had an anxiety disorder?

In addition to other causes of anxiety, does a family history add to my risk of anxiety?

What happens

Illness can both cause and increase anxiety in a number of ways:

  • As you age, anxiety about your health can increase.
  • Suffering from an illness, particularly if it is serious, increases anxiety.
  • Some illnesses such as arthritis, Polycystic Ovary Syndrome (PCOS) and diabetes appear to significantly increase the risk you may suffer an anxiety disorder.
Questions to ask yourself

How anxious am I about getting sick in the future?

How anxious am I about my illness? (if relevant)

Do I have an illness already that increases my risk of an anxiety disorder?

What happens

Midlife is a time when your hormones start to change and you become menopausal. The stages of menopause you are most likely to encounter at midlife are:

  • Perimenopause - when hormone changes start to happen, you can start to feel hot and your periods may be irregular and or heavy
  • Menopause – when it has been 12 months since your final menstrual period
  • Postmenopause – when you no longer have a period, but you can still have symptoms of hot flushes and a dry vagina

While menopause does not cause an anxiety disorder, the hormonal changes can mean you feel tired, sad, irritable and anxious at times. If you already have an anxiety disorder, menopause can make your symptoms worse.

Questions to ask yourself

Am I starting to go through menopause?

Do I have any symptoms of menopause such as:

  • Hot flushes?
  • Night sweats?
  • Dry vagina?
  • Moodiness?

How anxious am I at different times in my cycle? (if relevant)

Am I more anxious since I started to have changes associated with menopause?

What happens

Excessive drinking (defined as more than two standard drinks on any day and with no alcohol free days in a week) can:

  • make you focus more on your anxiety
  • be a sign you are trying to cover up or numb your feelings of anxiety.
Questions to ask yourself

How much am I drinking?

How anxious am I about how much I am drinking?

What happens

Side effects from some medications including medications for blood pressure, asthma and steroids, such as cortisone, can cause you to have anxious thoughts and feelings.

Questions to ask yourself

Am I taking any medications that could be causing anxiety symptoms?

What happens

Lack of quality sleep can make you tired and this affects your ability to think clearly. Quality sleep can be difficult to achieve as you grow older and is almost impossible when you are having night sweats with menopause. This can really impact on your ability to cope with the daily hassles of life and if you already have an anxiety disorder this can add to your symptoms.

Questions to ask yourself

How much sleep do I get per night?

Is it hard to go to sleep or do I wake in the night and find it hard to go back to sleep?

Do I feel rested?

Are night sweats affecting my sleep?

Is my anxiety disorder worse when I have poor sleep?

What happens

An unhealthy diet made up of high fat and sugary food affects your mood and can make you more prone to anxious feelings. Skipping meals or eating only one large meal a day doesn’t help your mood either. On top of this, if you are also not exercising enough, you have another reason why you may be feeling anxious.

Questions to ask yourself

Do I generally eat a range of healthy foods?

Do I exercise at least 3-4 times per week for more than 30 minutes?

How much do my current anxiety symptoms affect my diet and stop me eating healthy foods?

How much do my current anxiety symptoms stop me from exercising?

Created on 18/08/2013 | Updated on 10/12/2015
References for this page

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Jean Hailes is Australia’s leading and most trusted women’s health organisation. We believe in physical and emotional health and wellbeing in all its dimensions for all women in Australia throughout their lives.

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