The Diagnostic and Statistical Manual of Mental Disorders (DSM)1 is the handbook used by healthcare professionals as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria.

*

The strangers on the city sidewalk flow assertively by me — an interweaving stream of faces that do not make eye contact. I am swept along by their collective current. For a moment, I imagine I am floating, carried forward upon their wake. I am the fallen leaf in the river, bobbing merrily along until I reach my final resting spot. This is oddly comforting. I am invisible.

Then their tide forces me to cross a large sewer grate. Or is it a subway vent? It spans most of the sidewalk, easily ten feet wide, its metal rungs moving and rattling just enough under my feet to trigger the image of one of the grill pieces shifting. It will fall off its supports and send you down into the dark unknown below. Blackness and stank water await. My intellect knows this is an irrational thought, but my heart’s imagination does not and begins to race. I quicken my step, eager to get off the grate. Once back on solid pavement, I take a deep breath — I feel dizzy. Do not pass out and make a spectacle of yourself! I am fine. I am not crazy.

General Anxiety Disorder – Symptoms & Criteria for Anxiety

(3) At least four symptoms out of the following list of items must be present, of which at    least one from items (I) to (IV).

(I) Autonomic arousal symptom

  (a) Palpitations or pounding heart, or accelerated heart rate.

(II) Symptoms concerning chest and abdomen

  (e) Difficulty breathing.

(III) Symptoms concerning brain and mind:

  (k) Fear of losing control, going crazy, or passing out.

I enter the office tower, pulling my phone out as the door swings shut behind me to check the time. Just enough for a quick bathroom break before my committee meeting. Upon entering the washroom, I can hear a woman throwing up in the second stall. At nine am, here? I hold my breath until I reach the farthest stall. Not drunk, sick. Could be contagious. People your age die from the flu all the time. 

(III) Symptoms concerning brain and mind:

  (l) Fear of dying.

I hear her stall door swing open, then the tap running. I wait inside my stall until she leaves. When I exit, I lay a paper towel on the counter before placing my bag on top. I wash my hands carefully. Too many people do not wash their hands. My face looks waxy and tired, so I freshen my makeup. Once done, I pack everything in my bag, zip it shut, and wipe the counter with the towel. I start walking toward the exit.

You left something behind. You should check the counter. Do not go back, do not turn around!  Struggling with my inner voice is impossible — I have to check. I walk back past the dryers until I can see the counter.

Nothing there.

*

At the end of my meeting, the committee Chair praises me for the pitch. He stands too close to me while he is talking, however. I can feel my left hand starting to shake, so I grasp it with my other hand. Steady.

“That one was a real walk in the park. Thanks again, Sandra, for all your work on this. I can always count on your research to find their secret weakness.” He smiles, electrified our charity will receive an influx of much-needed funding. I cannot respond, so I look away. Breathe.

“They were thrilled,” he adds. “I predict a big donation.” I can feel his concern. Without making eye contact, I nod. I start moving papers around, pretending to pack up my notes. My mouth is too dry. Where is your water bottle? It is empty. I drank it during the meeting.

(I) Autonomic arousal symptoms:

  (c) Trembling or shaking.

  (d) Dry mouth (not due to medication or dehydration).

I manage to look at him. He frowns. “Good job, Sandra. Really.” He pauses. “The other potential donor we spoke about contacted me yesterday. Having lunch with him today. I would invite you to join us, but maybe you should take the rest of the day off? You look tired. I’ll send you his profile on Monday and we can strategize.”

Oh no. I’ve done something wrong. Why doesn’t he want me to come to the lunch meeting? No matter what he says, you know he’s thinking something else. I suddenly feel nauseous. Could you do more to help? Have you let him down somehow? Maybe I’ve already caught something from the vomiting washroom woman. No. He likes my work. I am a talented researcher. I can read between the lines. I see things other people do not. I am a busy, successful person who kindly gives her time. He doesn’t want me off the committee. What if he thinks you’re too quiet? Too outspoken? Does he think you’re trying to replace him as Chair?

(1) Excessive anxiety and worry (apprehensive expectation), occurring more days than not, about a number of events or activities

(2) The individual finds it difficult to control their worry.

(3) At least four symptoms out of the following list of items must be present, of which at least one from items (I) to (IV).

(II) Symptoms concerning chest and abdomen

  (h) Nausea or abdominal distress

   (e.g., churning in the stomach).

“Sure. Thanks, Steve. Let’s talk Monday.”

*

When I get home that evening, I curl up in my favorite armchair with my advanced Sudoku book — the effort to hold all those numbers in my head is calming. Clears my mind of all else within minutes.

Did you close the garage door? Is it wide open, inviting theft? No, I pushed the automatic garage door button. It is closed. I take the bookmark out of my Sudoku and pick up my pen. Only amateurs use a pencil. Wouldn’t hurt to check. You will feel better. I get up, then walk quickly downstairs — as if my paranoia will go unnoticed if I am fast enough. I live alone, but still — I notice.

(1) Excessive anxiety and worry (apprehensive expectation), occurring more days than not,

about a number of events or activities

(2) The individual finds it difficult to control their worry.

The garage is dark, its door closed. I close the access door and turn the lock. Two steps out of the mudroom, I cannot resist returning to pull on the door handle. Only once I feel the reassuring rattle of the deadbolt between me and the outside do I head back upstairs.

*

I set two alarms each night — one on my cell and another on an old-fashioned battery clock I’ve had since college. Just in case one fails. I have an abhorrence for lateness. As I turn off the bedside lamp, I cannot remember if I locked the front door. No, of course, it’s bolted — I came in through the garage. Wait, when was the last time you checked? Maybe you should check it. It is not safe to sleep with the door unlocked. Remember when the neighbour’s home was broken into last year? My mind is blank. I cannot recall the last time I used the front door. It is locked. I always lock it. I should stay in bed — I’m bundled in already. For a moment, I successfully resist the urge to go downstairs. Then there is an unexpected bang outside, causing me to sit up. I suddenly feel out of breath.

(IV) Other Non-Specific Symptoms:

  (s) Exaggerated response to minor surprises or to being startled.

  (t) Difficulty in concentrating or mind going blank because of worrying or anxiety         

  (v) Difficulty getting to sleep because of worrying.

(V) Symptoms of tension:

  (p) Restlessness and inability to relax

  (q) Feeling keyed up, or on edge, or of mental tension.

It is my neighbour’s husband, returning home late again. He tries to slip in quietly, but, more often than not, fails to navigate the trash bins in the alleyway. Still, I cannot fall asleep. You should check the door. Safety first! I slip out of bed in the dark, then glide down the stairs, my heart pounding.

(I)Autonomic arousal symptoms

  (1) Palpitations or pounding heart, or accelerated heart rate.

​

It is locked. I feel much better.

*

The next morning, I arrive at the clinic fifteen minutes before my appointment. The office has just opened; the secretary is on the phone and doesn’t look up when I enter. I glance at the shiny plaque on the office door:

            Dr. S. Hawking, M.D. 

            PsyD, LGPC, MBBS.

            Licensed Psychiatrist.

I always thought it pretentious when people list their degrees after their names — trying to prove their worth. I can’t understand why it is not sufficient to state “Licensed Psychiatrist.” That title was hard enough for new patients to face all on its own without credential letters added, asserting their authority. Standard signage for such practices, however, or so I’ve been told. Recognizing the secretary is too busy to take notice of me, I turn the knob and enter the office, closing the door gently behind me so as not to disturb her call. Immediately, I feel restless. I have never been good at waiting. What to do until she arrives?

Placing my purse behind the largest chair, I flop down into its curved leather. I tell myself to remember to sit up straighter when she comes; best to make a good first impression. In the meantime, I can enjoy the way the chair seems to wrap itself around me. Like a cocoon. The swivel of its base sets me on edge a bit, however. I prefer to be more grounded. I uncross my legs, then plant both feet firmly on the floor. That is much better. I glance up at the clock. Five minutes to nine. Was she going to be late? Surprising. I see the blank notepad and pen the secretary has placed on the coffee table. I pick it up. It is thick, the hefty kind that I like.

The office door opens. A tall, thin woman enters the room. Her hair is pulled back too tightly in a strange high ponytail that defies its grey cast. She sits down across from me. I sit up straight, placing the notebook gently on my lap after quickly jotting a note about her promptness.

“Cathy. Nice to meet you. Please, call me Sandra. Why don’t you tell me why you’re here? Start anywhere you like. I’m here to help.”

[1]* regarding DSM quotes throughout the piece. All indented text is taken from DSM, Symptoms and Criteria for Anxiety, as sourced from:

 American Psychiatric Association,

 www.psychiatry.org/psychiatrists/practice/dsm/feedback-and-questions/frequently-asked-questions, and the DSM section for diagnosis of General Anxiety Disorder.