Malory Gorraiz has struggled with anxiety since she could remember.

At age 12, she felt easily confused by things and isolated in her feelings. When you constantly have thoughts going through your head, you don’t know what’s me, what are these thoughts.

“I was always lost and trying to figure life out,” the Duluth woman said.

Anxiety is a cluster of physiological and cognitive manifestations, said Paul Goossens, licensed psychologist at Harbor City Psychological Associates in Duluth.

Cognitive symptoms are incessant worry and ruminative thinking, trouble concentrating, a sense of impending danger, restlessness. Physiologically, it shows up as shortness of breath, increased heart rate, sweating, fatigue.

From the perspective of evolution, anxiety can help us detect and avoid danger, such as having a heightened awareness of our surroundings while walking home at night. Sometimes, anxiety propels us to take positive actions, such as studying for a test we’re worried about.

About 18-20% of the population might have anxiety at some time in life, and it affects people at all different stages — on the first day of school, during a job interview.

“Not all anxiety is bad; some of it protects us. At times, it can get in our way,” said David Plude, licensed psychologist at Arrowhead Psychological Clinic in Duluth.

Worry crosses into diagnosable anxiety or an anxiety disorder if it’s causing avoidance or real debilitating fear, a hyper focus on a negative life event, or if it’s affecting home or work life.

When we come into contact with a real or perceived danger, the amygdala in our brains prompts a release of hormones, increasing heart rate and tensing muscles, preparing the body for fight or flight. This happens before the cerebral cortex, in charge of decision-making, can react, according to a Harvard Health Publishing article.

“When we’re anxious or overly fearful, the rational part of the brain kind of goes offline,” Goossens said.

The brain can misinterpret or over-exaggerate threats as if somebody were attacking us, but often the perceived threat is to our ego, or psychological self, Goossens said. For people with anxiety disorders, the amygdala may overreact to non-threatening situations, prompting emergency stress responses in the brain. Anxiety then can attach to memories and situations unrelated to actual danger.

According to the U.S. Department of Health and Human Services, the five major types of anxiety disorders are: generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD) and social phobia.

“Not all anxiety is bad; some of it protects us. At times, it can get in our way.”

Generalized anxiety is becoming more common, and the sometimes polarizing effects of social media contribute to social anxiety for children and adults, said Shelley Plude, licensed and clinical social worker at Arrowhead Psychological.

She sees at least 25% of her clients are dealing with higher levels of anxiety. And for kids, anxiety can manifest in different ways.

In younger children, it often shows up physically as aches in the stomach, head or body; also as sleepless nights, incessant crying or refusal to get out of the car for school.

Fear of rejection is common. And test anxiety, forgetting what they studied during an exam, often crops up in middle school, she said.

Anxiety can cause forgetfulness or difficulty concentrating. There’s less frontal cortex function, less logical reasoning, so we may not be encoding memory effectively, Goossens said. But functions like planning remain uninterrupted, according to the National Library of Medicine National Institutes of Health.

In teens, anxiety can look like increased agitation, restlessness, volatility and frustration. “A lot of their physical energy is being tapped by this anxiety, and they’re not as resilient in managing day-to-day things, so they might be more reactive,” Goossens said.

A good sign is if kids or teens are starting to avoid things their peers are doing.

Avoidance is a common coping mechanism for stress. Whereas positive reinforcement rewards, negative reinforcement takes the pain away through avoidance, and it’s very powerful, said David Plude.

A child avoids a fear of sharks when she reads a book at the beach instead of swimming. The anxiety goes away, but she’s restricted herself a bit. Or a man could be less vulnerable and more guarded in a relationship if he has experienced infidelity.

“The sad part is you don’t have as fulfilling of relationships," Plude said. “Life starts to contract a little bit when you’re making rules about what you can and can’t do.”

And this can manifest further into skipping class, commitments or even social events.

When life gets smaller due to anxiety and avoidance, depressive symptoms can rise. Where anxiety is more fear-based and racing thoughts, depression, in its more severe forms is irritability, low energy and lethargy.

Spotting these responses can lead to conversation in children or adults. Goossens encouraged asking about stress and trying to open a dialogue.

For kids, “the key thing for caregivers, mentors, teachers, coaches, and certainly as therapists, (is) to not ignore the behaviors, but to be more curious about what’s driving the behavior. That takes more effort; that takes engagement,” he said.

Allow the person to ask for help and talk about help that’s out there such as counselors, therapists, social workers.

Anxiety is an indicator that there’s distress, and we can use it as a motivator to prompt internal reflection and engage in problem-solving and resolutions, Goossens said.

Other solutions are to stop what you’re doing to focus on calm, centered breathing. Try temporarily turning off social media and reducing technology if it’s adding to mental chatter. There are also workbooks, meditation, exercise and cognitive behavioral therapy.

It’s a “broad umbrella,” and specific strategies aren’t going to work for everyone, but self-calming, managing irrational beliefs can help, Goossens said.

If symptoms are really significant, medication is an option, the Pludes said.

“It’s really about quality of life,” said Shelley Plude.

If anxiety or depression symptoms last longer than six months and are interfering with work or school, there are actions to discuss with a physician; and a combination of medication and counseling is usually the most effective, she said.

After decades of anxiety, Malory Gorraiz had her first panic attack about two years ago.

“All of a sudden, shoulder pain, tingling feet and hands. I started seeing black spots, so that made me think I was going to pass out,” she said.

After that, Gorraiz, 32, started regular therapy, and she changed her diet. Today, she tries to address her symptoms right away.

One telltale sign is when she’s not "present."

“I call it ‘getting stuck in my head,’" she said. "I get irritated easily at noises. It’s overwhelming.”

She meditates, she prays, she focuses on her surroundings — what she can see, smell, hear. She also exercises, dances, jumps on a trampoline. “That immediately helps,” she said.

Because mental health and anxiety run in her family, Gorraiz wants to pass on healthy coping tools to her children.

Different approaches suit her kids — deep breathing and sensory tools like a weighted blanket or essential oils work for some and not for others.

“I don't know if they listen or not, but I want them to know those tools are theirs,” she said.

We live in a highly arousing, high-stimulus world, and giving ourselves time to step away and recharge our batteries is really important. Find things that nourish the soul, nourish the psyche, nourish the spirit, Goossens said.

David Plude said he has felt stress studying for his licensure test or proposing to his wife. Shelley Plude said she experienced anxiety when they brought their first daughter home.

Talking about it normalizes it, so reach out to friends and family, he said. “Don’t be ashamed that you’re having the experience.”

5 types of anxiety disorders

Generalized anxiety disorder (GAD): exaggerated and continuous worry, chronic anxiety when there is little to no threat. It can be restlessness, edginess, fatigue, constant worry.

Obsessive-compulsive disorder (OCD): repetitive behaviors and recurrent thoughts that lead to rituals or actions to prevent or banish thoughts, control outcomes and ease anxiety.

Panic disorder: episodes of extreme fear that manifest physically with symptoms such as shortness of breath, chest pain, heart palpitations, dizziness. It’s common for people to mistake panic attacks for heart attacks.

Post-traumatic stress disorder (PTSD): can be the result of a terrifying event where drastic physical harm occurred or was threatened, symptoms include flashbacks, nightmares and uncontrollable thoughts about the event

Social phobia (or social anxiety disorder): extreme self-consciousness or overwhelming anxiety of rejection or scrutiny from others in regular social scenarios or online.

Source: U.S. Department of Health and Human Services

NAMI Minnesota is a nonprofit aimed at supporting and helping people with mental illness and their families.

What: NAMI Minnesota support group for people with anxiety disorders

When: Starting Oct. 2 — 6:30-8 p.m., first and third Wednesday of the month

Where: Central Hillside Community Center, 12 E. 4th St.

Cost: Free

More info: Call 218-349-0358, email; or contact NAMI Minnesota at 651-645-2948.

NAMI launches anxiety support group

A new anxiety support group is slated for the Twin Ports.

The National Alliance on Mental Illness (NAMI) of Duluth is launching a free Open Door Anxiety and Panic support group from 6:30-8 p.m. the first and third Wednesday of the month starting Oct. 2 at the Central Hillside Community Center.

The group will introduce strategies and coping skills for those living with generalized anxiety, panic, OCD and PTSD, said Morgan Caldwell, peer programming coordinator for NAMI Minnesota.

Caldwell said a support group doesn’t replace care, but it can be a beneficial bonus to overall treatment. “Going to therapy and going to a doctor, that is really important. What’s different about our support group is that it’s peer-based. … Everybody in that room lives with anxiety.

“It’s the most common mental illness, and it’s treatable. There’s hope.”