Onika L. Dainty

When Worry Doesn’t Stop: Let's Talk about Generalized Anxiety Disorder and Its Overlap with Bipolar Disorder - Part 1 of 5

Anxiety: The Worry That Lingers

I remember the exact moment anxiety entered my life. It was brought on by abject terror.

As a child, I had anxious moments when the anxiety-driven voices in my mind became so loud that I would have to shake my head a few times to quiet the noise. It felt normal, even manageable, until one spring afternoon outside my sixth-grade classroom when anxiety attacked me out of the blue.

To my recollection, here’s what happened.

The Day the River Threatened to Pull Me Under

It was the final few months of grade six, and everything seemed normal. We had just finished recess, and the playground was its usual discord of harshness, where bullies moved from group to group unleashing their cruel brand of humour on any kid who would listen, and especially on any kid they knew it would affect.

There was one boy in particular they reserved the worst of their venom for. That day, the boy, whom we can call Christopher, simply couldn’t take it. He let out a giant scream that echoed across the playground. Every kid stopped and turned to see where it was coming from.

It was coming from Christopher.

It’s still unclear how I got involved, but knowing me, I was always a champion of the underdog and went to his defence. I had a fixer personality even when I was young. Christopher did not seem to want me to fix things. I remember the angry look directed at me before he stomped off inside the school.

That afternoon, as I walked to my backpack cubby to get my notebook, I found a threatening letter instead. It read, “This will be you in five days,” with a disturbing drawing meant to frighten me.

That was the moment my mind began to race with thoughts of danger and death. My breathing became shallow, my vision blurred, and I collapsed on the hallway floor with the letter in my hand as my world fell off its axis and spun out of control. I remember my fingers going numb and taking on a distorted shape that can only be explained by the lack of oxygen moving through my body. My lungs felt as if they had stopped working, constricted in my chest, until eventually I could feel only the last shallow breaths I took before I fainted.

That is how my teachers and classmates found me. The ambulance and police were called once they realized what had put me in that condition. My vitals were checked, and I was given oxygen, although I still felt like I couldn’t breathe. My parents were called to take me home for the day to rest after my traumatic ordeal. It was promised to my family that the police would investigate and “get to the bottom of this.”

For the next two days, I stayed home from school. When I got home, my mother put me straight to bed, and that was when the anxiety and fear entered my sleep. I tried to rest but got very few hours, waking from nightmares of red walls and ropes tangling around me, squeezing the air out of me. My anxiety manifested as screams in the middle of the night. Screams that took my breath away. My stomach refused to hold down any meal, no matter how small. My head throbbed with agony, like a hammer beating against my brain, repeating the same rhythm over and over: “three more days until you die.”

My parents, being strict about school attendance, refused to let me stay home for the entire five days. So, on day four, I returned to school. I couldn’t concentrate. I sat at my desk in a state of hypervigilance. Sounds were too loud, lights were too bright, and my thoughts continued to spin out of control.

By day five, what I believed would be the final day of my life, I was a ball of anxious energy, no longer my cheerful, outgoing self. On that day, however, it was discovered by police and staff, after comparing handwriting samples from each student, that the culprit was Christopher. My parents were called in and told that he had behavioural problems at other schools and would be expelled as punishment for what he had done.

The punishment for me would be the beginning of a mental health condition I did not yet understand. I had no name for it, but I would experience it daily, living from anxiety attack to anxiety attack.

This blog is a reflection on my lived experience with anxiety. I will discuss living with both Bipolar disorder and Generalized Anxiety Disorder, also known as GAD, the challenges I have faced while trying to balance co-occurring disorders, and how changing my mindset helped me create a space where anxiety could exist.

This is the worry that lingers.

Some worry does not end. Instead, it loops, deepens, and stays.

When Anxiety Persists: A Bipolar Woman’s Reflection

After that incident, I started calling anxiety “the voices.” Throughout my adolescence, I would worry about anything and everything. I created scenarios in my head of negative events that were not actually happening and might never happen, but to my fragile mind, each scenario held some truth.

From the day I found that letter in my backpack, I lived in fear that something just as terrible would happen to me again. The sad part was that even my 11-year-old self knew it would be a hard road between me and regaining my peace of mind.

What I know now, that I did not know then, was that I would experience a series of life-changing events until one day I found myself in a child psychologist’s office being diagnosed with depression and a mild anxiety disorder. Mild anxiety would later develop into Generalized Anxiety Disorder as I got older and continued to struggle with processing painful experiences in a healthy way.

There is a difference between everyday concern and persistent anxiety. Persistent anxiety does not simply affect your thoughts. It also affects your perception of the world, your self-perception, your self-esteem, and your self-worth. Anxiety can even shape your behaviour.

It is not just persistent. Sometimes the worry that comes with anxiety is all-consuming.

Anxiety during a Bipolar manic episode is something I can only describe as loud and chaotic. Because one of the symptoms of mania is disorganized thinking, anxiety in mania can take on a disorganized, even paranoid form. In my experience, when Bipolar disorder occurs alongside anxiety, it can feel as if the extreme worry itself triggers hypomania, the precursor to mania.

When your body is in a constant state of fight, flight, or freeze because anxious thoughts persist day after day, your mind starts to break down. If you live with another mental health condition like Bipolar disorder, that internal pressure can increase the risk of a serious mood episode.

What Generalized Anxiety Disorder Feels Like: A Lived Experience Perspective

I moved to Toronto, Ontario at 33 years old to start working in the event management industry. I was fresh out of school when I was hired by a boutique events company where the staff consisted of myself, my boss, and another woman.

At first, things went well. I was securing big accounts, much to the excitement of my boss. Then one day, there was a notable shift between myself and my co-worker. She seemed to begin a passive-aggressive campaign to undermine my work and shake my confidence. She told me that if I did not find a way to bring in more clients, my boss would be forced to fire me.

That was the moment my anxious mind took control of my rational brain.

When you have Generalized Anxiety Disorder, unless you are experiencing visible physical symptoms or an anxiety attack, people cannot see the internal war you are fighting with your own thoughts. The moment I perceived that I could be terminated, I believed I was already terminated. The worry became persistent, excessive, and all-consuming.

I couldn’t eat or sleep because I was constantly thinking about being fired. Questions raced through my head one after another:

“When am I going to get fired?”

“What is my boss going to say to me?”

“How much time do I have left?”

“Should I start looking for another job?”

“Should I quit before he has a chance to fire me?”

“Should I just work harder to get the big accounts?”

“If I get the big accounts, will he still fire me?”

“Fired, fired, fired. You are going to get fired.”

With every thought came another and another. The thoughts, or voices, invaded my mind at work, and my performance declined. I started taking two and three days off so I could try to catch up on the sleep I was lacking, but also so I could isolate myself, untangle the anxious thoughts in my mind, and come up with a plan to keep my job.

I could not see how illogical I was being. Based on one person’s thoughtless comment, I was spiralling out of control.

I began to see danger around every corner, as if the world was not meant for me, as if I was not enough. There was nowhere I felt safe or secure, not at home and not at work. I eventually did get fired from that job, but I cannot blame my co-worker. She planted the seed, and I watered it with anxiety until the thoughts overwhelmed me.

Anxiety can feel like your mind is always preparing for something that has not happened. When something does happen, like me getting fired, anxiety can become deliberate, telling you your thoughts were right and that you have every reason to constantly worry.

Bipolar Disorder and Anxiety: When They Overlap

Trigger Warning: The below section discusses suicidal thoughts in a non-graphic way.

When you have a co-occurring condition like Bipolar 1 disorder and Generalized Anxiety Disorder, the emotional complexity can present as constant mental confusion and chaos. When you are in crisis, it is hard to tell where your thoughts end and anxiety begins.

During my depressive cycles, anxiety and the intrusive thoughts that come with it have sometimes deepened my distress and contributed to dangerous thoughts about my own life. For me, those moments often begin through the lens of anxious thinking, negative self-perception, diminished self-worth, and lowered self-esteem.

When depression shifts into hypomania, mania, or psychosis, my anxiety moves into that same realm of dysregulation and can take on a voice of illogical fear, paranoia, and emotional instability.

Anxiety has always felt different depending on my internal state. During remission or baseline periods, I have a firmer grip on my thoughts, and I can recognize more clearly when anxiety is trying to overtake me. I use tools like breathing exercises, meditation, and positive self-talk to calm the waves of anxiety that pass through me, attempting to pull me under into a dark place where my life has no value beyond what my anxiety dictates.

During episodes, however, it has always been difficult to distinguish mood shifts from anxiety symptoms. It becomes a constant question: which came first, the shifts or the symptoms?

When I reflect on my past experiences with Bipolar 1 disorder and GAD, I come to the conclusion that although Bipolar 1 disorder is my primary condition, Generalized Anxiety Disorder often acts as a trigger and causes my moods to shift.

For example, although I experience anxiety throughout the day, at night the voices often become louder and more persistent, disrupting my sleep. When I have insomnia for days at a time, when my thoughts will not quiet and prescribed medication does not have the desired effect, lack of sleep can lead to elevated mood and eventually mania.

Anxiety does not always stand alone. It often moves through mood states differently.

Living With Both: Emotional Weight and Exhaustion

There is an emotional fatigue that happens when living with overlapping mental health conditions, especially when each has its own dialogue inside your head. You become constantly alert, fearing relapse and living with uncertainty.

My past experiences with both conditions often creep into my present-day anxieties, especially when my mood shifts from elevated to low, or from low to elevated. The emotional weight and exhaustion of living with both Bipolar disorder and Generalized Anxiety Disorder can be overwhelming at times.

Then I remind myself that my mood disorder and GAD are both part of the lived experience that has shaped who I am today, both good and bad. Managing more than one internal experience can make even calm moments complex, but the calm moments, though rare, do exist.

At present, I practice self-awareness. When possible, I do not allow the voices inside my head to lead me. Instead, I show myself compassionate grace and remember that with inner strength and time, the voices can move from a loud roar to a dull silence.

I still hear and feel my anxiety when it creeps in, but with the self-care tools I have acquired, the emotional weight and exhaustion of living with anxiety has become less and less. It is not about ignoring my inner dialogue. It is about making space for it inside my head, a space where I can choose to listen to the anxious roar or turn it down to a dull silence I have learned to live beside.

Final Thoughts

Finding a Name for the Worry, Reclaiming Peace

Many years ago, the writer inside me decided to take control of the narratives in my head, the voices in my mind that I called anxiety. I realized one day, as I listened to the worry, that it often came in the form of a storyline. There would be one worrisome thought, and then that thought would build upon itself, creating a full story of anxiety.

Calling my worry one of the storylines in my head helped me untangle whether it was fiction or non-fiction, real or imagined. Although this has never been the solution to my anxiety, it was definitely a turning point in how I experienced it.

This new awareness created a space of understanding rather than a resolution to my condition. It allowed me to reflect on my ongoing relationship with anxiety.

Understanding anxiety does not end it, but it can change how you carry it.

To my readers: Have you ever experienced worry that felt constant or hard to quiet, and what helped you begin to recognize it for what it was?

The Page Became My Place of Survival

After nearly 20 years of navigating the highs and lows of Bipolar I disorder, I thought I understood the facets, complexities, and myriad shades of my illness. Then a new diagnosis, schizoaffective disorder, bipolar type with borderline traits, seemed to erase everything I believed I had learned. Over the past year, putting pen to paper has helped me live inside the latest version of my story. It has taught me how to love, learn, and accept myself as I rewrite a past I no longer recognize, a present where I am still searching for where I belong, and a future full of unknown possibilities.

This is not just a story of medical labels. It is a lived, raw, year-long journey of unraveling, discovery, grief, and creative survival. There were times when reflecting on the new diagnosis left me paralyzed by self-doubt, self-loathing, and defeat. There were other moments when I had to be radically honest with myself and ask: What does re-diagnosis change? In between those moments, I shed tears of grief over a lost identity, felt guilt over mislabelled lived experiences I had shared with the world, and struggled with disbelief over how broken I felt existing in a broken system. I had once believed I was thriving, yet suddenly found myself barely surviving.

This blog shares how one year of journaling, storytelling, and reflection helped me move through the chaos of re-diagnosis and into deeper self-awareness. I hope my journey through madness encourages you to reflect on your own experience of diagnosis or re-diagnosis so you can move from chaos to calm and continue your journey toward healing, recovery, and wellness, no matter the missteps or barriers that try to defeat you.

Bipolar I Disorder: Twenty Years in a Frame That Almost Fit

At 17 years old, I was assessed by a child psychologist. After that assessment, I was told I was experiencing generalized anxiety disorder and depression. No one told me that my journey through madness had begun that afternoon in a Scarborough hospital, in the office of “Dr. Glass,” the name I gave him because of his cold and clinical demeanor.

No one mentioned that anxiety and depression can sometimes be precursors to bipolar disorder, or that for many women, onset may happen in their mid-20s, often shaped by stress, trauma, and other precipitating factors. So at 17, I walked out of Dr. Glass’s office with my first mental health diagnosis, completely unaware that my mental health journey was beginning. I did not know there would likely be other diagnoses, misdiagnoses, and eventually re-diagnosis on my path toward wellness, emotional stability, and better health.

When I received my former and longest-standing diagnosis of Bipolar I disorder, I was 24 years old, just out of university, experiencing my first psychotic episode, my first hospitalization, and my first real initiation into the world of psychotic and mood-related disorders. The severity of my manic psychosis led clinicians to conclude that I was on the schizophrenia spectrum and other psychotic disorders, while also meeting nearly all the criteria for a manic episode, which formed the basis of a Bipolar I diagnosis.

So after the second mental health assessment of my life, I was placed in a frame, like a picture on a wall, with very few medical professionals noticing that the bipolar frame around the landscape of my mental health was off, crooked, leaning slightly the wrong way. It took 20 years of manic-psychotic episodes, hospitalizations, assessments, and reassessments for the mental health system to realize I had been misdiagnosed with bipolar disorder. The frame almost fit, but it did not capture the complex landscape of my mind or the combination of mental illnesses I exhibited both in and out of psychosis.

It was not until my most recent assessment at Ontario Shores Centre for Mental Health Sciences, where I was observed in one of their Complex General Psychiatry units, that psychiatrists realized my condition was not a simple one. Though I am still considered to be on the spectrum, the symptoms they observed, including auditory hallucinations, delusions, paranoia, and disorganized speech, did not fully align with the Bipolar I diagnosis I had carried for two decades. Instead, the new frame was called schizoaffective disorder, bipolar type with borderline personality disorder traits.

I would not learn about my re-diagnosis until a year after my discharge from Ontario Shores, but in truth, the discovery brought relief because in my heart the Bipolar I diagnosis felt true, until it did not. It was like being handed a giant blank canvas, with my new diagnosis as the uncomfortable centrepiece surrounded by empty space. With the support of my medical team, my personal support system, psychoeducation, psychotherapy, and my own willingness to keep moving forward, I began letting go of the old frame and working with a new canvas. I was able to reshape my mental health identity, create a more complete picture, and release a former bipolar disorder diagnosis that had almost, but not quite, explained everything in my symptom profile. Now it was time to move forward with a diagnosis that fit my experiences, both past and present, and changed the mental health landscape through which I viewed myself and my future.

Schizoaffective Disorder: The Diagnosis That Changed Everything and Nothing

What Is Schizoaffective Disorder?

Schizoaffective disorder is a chronic mental health condition that combines symptoms of schizophrenia, such as hallucinations, delusions, or disorganized speech, with a major mood disorder, either depression or bipolar disorder. It involves both psychosis and severe mood symptoms, and it typically requires a combination of medication and psychotherapy for long-term management.

There are two main types of schizoaffective disorder. Bipolar type includes episodes of mania and sometimes depression. Depressive type includes only major depressive episodes. One of the key features that distinguishes schizoaffective disorder from other psychotic disorders is that psychotic symptoms must be present for at least two weeks without prominent mood symptoms.

Unlike bipolar disorder, schizoaffective disorder often involves persistent psychosis or delusions outside of mood episodes, which can lead to significant functional impairment. There is no known cure, but the condition can be managed through medication, including antipsychotics and mood stabilizers, as well as psychotherapy and ongoing support.

A Newly Diagnosed Woman’s Reflection: The Emotional Impact of Schizoaffective Disorder

Going from bipolar to schizoaffective in what felt like mere seconds, the day I discovered the new diagnosis while reading my social worker’s assessment notes from February 4, 2024 in my medical records, was more than a shock. It was life-shattering. I went from being a 42-year-old woman with a 20-year history of Bipolar I disorder to someone recently re-diagnosed with schizoaffective disorder, bipolar type with borderline traits.

As I read the notes and tried to interpret their meaning, I could feel my mind pressing against my skull, my ears ringing, and my palms turning clammy with sweat. It was as if my world stood still, yet the ground beneath my feet had become unstable. With every word, my mind screamed in disbelief as the sound of my tears filled the still silence of my living room. For the first time since my mental health journey began, I felt truly alone.

Shame, confusion, betrayal, and fear washed over me like summer rain. But there was something else hidden in the recesses of my mind, fighting to come through, an emotion demanding acknowledgement through the shock and grief: reluctant relief. For 20 years, I had lived in a space of the unknown. Unknown symptoms that did not fit the bipolar profile. Chaotic psychotic episodes experienced without any real explanation. A diagnosis psychiatrists believed was the key to treatment and management. And beneath it all, the constant questions: What is wrong with me? Why does a diagnosis I have carried for two decades feel wrong with every episode I have? The answer, painfully, was because it was.

When I was 24 years old, a doctor labelled me based on one episode and a handful of DSM criteria, and ever since that day I was never entirely comfortable in my bipolar identity. I simply did my best to make it work. Relief quickly turned into grief over losing an old narrative, and anxiety over embracing a new one. I had fully embraced bipolar disorder, but could I now embrace schizoaffective disorder, especially when it came with equally complex elements of bipolar type and borderline traits? Could I begin a new journey of self-discovery, a new journey toward women’s mental health, healing, and recovery, and leave the baggage of old labels behind? Only time, along with self-compassion, self-love, and deep self-reflection, could begin to answer the many questions that came with my new diagnosis.

Writing: My Mirror, My Map, and My Medicine

After discovering my misdiagnosis and new diagnosis of schizoaffective disorder, I felt lost, so I did the only thing I knew how to do to find my way again: I began to write. I had been writing through mental illness, through all the ups and downs and every moment in between, from the very beginning of my journey. I have journals and hand-crafted notebooks, some gifts from people who love and understand my struggle, others just loose-leaf pages requested behind the walls of psychiatric units and filled with psychosis-driven thoughts. Writing daily became a ritual, one that has always helped me find my way back to myself and back to sanity. Journaling for mental health clarity has always brought me comfort in the chaotic world psychosis creates around me.

When I journal through the various stages of illness, depression, hypomania, mania, and psychosis, it becomes a record of my mental growth and progress. When I finally reach the light at the end of an often very dark tunnel, I have the opportunity to look back and reflect on the different voices that come through me as I move from illness back to baseline and wellness. The patterns in my language, the themes and tones of my daily writing, even my penmanship, all serve as indicators of my thought process and illness progression in ways therapy simply cannot always catch in a one-hour daily or weekly session.

There is therapeutic value in storytelling, even when it is done in madness, while healing from symptoms that make you lose yourself. When I write, no matter the stage, I have always been able to find my way back to baseline, back to wellness, and back to me. Writing has become my map, my mirror, and a form of medicine. It has supported my resilience, strengthened my self-awareness, and given me a structure and routine to return to when everything else feels uncertain.

Final Thoughts

One Year Later: What I Know Now That I Didn’t Then

Living with schizoaffective disorder has been an education. My new diagnosis has presented many challenges, especially the resistance I still feel when I share it with others. I still have a habit of cutting myself off before I speak of the type and the traits because I am still discovering what they mean within my symptom profile. What I have accepted is that schizoaffective disorder is not just a label. It is an invitation to see myself and reflect on my experiences more fully. Though I felt broken a year ago when I discovered my re-diagnosis, today I feel more honest and more authentic in my experiences and in my journey through madness toward wellness. My mental health recovery has been shaped in large part by writing, which has taught me that I do not need to be “stable” to be whole.

Reflecting through writing has strengthened my resilience, self-compassion, self-acceptance, self-love, and ultimately my self-awareness. This past year was not just about surviving a re-diagnosis. It was about reclaiming my voice, one word at a time. Writing did not cure me. It witnessed me. And sometimes that is what healing looks like.

To my readers, take this question with you on your own journey toward healing and women’s wellness, as I have carried it with me over the past year and beyond:

What if madness isn’t the end, but the beginning in disguise?

I Thought It Was Just Stress, Until the Voices Stayed