Studying with an anxiety disorder: “During lectures I have the feeling that all eyes are on me”

Studying with an anxiety disorder: “During lectures I have the feeling that all eyes are on me”

Mentally, going to lectures or seminars takes a lot more energy than I ever expected before I went to university,” says Lara (23), Master’s student at Tilburg University. “Even when I don’t have to talk in class, I often come home tired and stressed.” Lara suffers from an anxiety disorder that complicates her student life. She’s not the only one: in most lecture halls there’s at least one student with an anxiety disorder. How do these students experience university?

Image Zep de Bruyn

Many people in the Netherlands suffer from an anxiety disorder. According to the population survey Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, see text box), which offers the most recent figures, it concerns more than one million Dutch people. It affects many students; young people are vulnerable. Between the ages of 15 and 29, the number of disorders increases significantly. Not until then do the numbers gradually decrease.

“Anxiety disorders often manifest themselves around puberty and adolescence. This is partly due to the fact that in this period you become more independent and your responsibilities increase,” says Laura Kunst, PhD candidate in Medical and Clinical Psychology at Tilburg University, who is involved in (the treatment of) anxiety disorders in her research.

“Anxiety disorders are caused by a combination of biological, social, and psychological factors. If you are vulnerable to anxiety disorders, you are often still somewhat ‘protected’ by your parents in your childhood. From adolescence and adulthood, your body undergoes changes, you can increasingly experience stressful life events, and you have to be more self-reliant.”

Anxiety disorders in the Netherlands

In 2011, it is estimated that nearly 1.1 million people aged 18 to 65 had an anxiety disorder, 655,100 of whom were women and 413,600 men. This is shown by the NEMESIS-2 population survey. It amounts to 125 out of 1,000 women and 78 out of 1,000 men. The number of people with an anxiety disorder differs per age category and is highest among young people.

The difference in the number of cases between the age categories 15–19 years and 20–24 years is the largest: the number increases from 28.5 to 51.6 per 1,000 women and from 11.5 to 22.1 per 1,000 men. The number reaches its peak in the 25–29 age group with 55.6 per 1,000 women and 26.9 per 1,000 men, after which the numbers decrease very gradually.

As the figures show, more women than men have an anxiety disorder. There is no simple explanation for this. “This gender difference also stems from a combination of factors. It is not purely due to hormones, for example. The social position of men and women probably also plays a role,” says Kunst.

Types of anxiety disorders

Someone who knows no fear can get into big trouble because he or she can take life-threatening risks. Fear has a function and is crucial in life. But when a person is overwhelmed by fear when it is not necessary and is hindered in daily life, there is an anxiety disorder.

According to NEMESIS-2, the most common anxiety disorder is singular phobia (fear of a specific object, person, animal, or situation), followed by social anxiety disorder (fear of social situations and reactions or criticism from others), generalized anxiety disorder (constant fear or nervousness, also known as worry disorder), panic disorder (having panic attacks and fear of these attacks), and agoraphobia (fear of being in crowded, public places).

Although a distinction is made between different anxiety disorders, people often experience the same anxiety symptoms, such as palpitations, restlessness, and sleep and concentration problems. Moreover, anxiety disorders often occur jointly. For example, a person with a panic disorder can develop agoraphobia when he or she has had a panic attack in a supermarket.

About half of the people with an anxiety disorder have another anxiety disorder at the same time, says Kunst. And that’s often not the only thing: about 80% of them also experience depression at some point in their lives. “There seems to be an underlying vulnerability factor for the development of anxiety and mood disorders.”

“Which elements are most important is still unclear,” says Kunst. “Examples are a trauma at a young age, neuroticism, a negative self-image, difficulty feeling and indicating your needs, introversion, and a tendency to avoid and worry instead of being assertive and solving problems.”

Fear in university and universities of applied sciences

“I get anxious from lecture halls and waiting in front of them before the lecture starts. Even when I enter the building, I have to get myself together in the toilet before I can enter the lecture hall,” says Roos (20), student at HAS University of Applied Sciences. “Being present at a lecture is also very tiring. It costs me a lot of energy, which makes it hard for me to concentrate”.

Every week, Roos gets intensive therapy sessions, but it is not yet completely clear to her therapist what kind of anxiety disorder she has, despite the fact that she has been fighting it since she was twelve years old. “My therapist is sure that I have a post-traumatic stress disorder with an associated panic disorder.” One time, Roos had a panic attack during class, in which she fainted several times and was eventually taken to the emergency room.

“Panic attacks are very suffocating. I feel like I can’t get out of it and that makes me desperate. In addition, the attacks cost so much energy that the only thing I can do afterwards is sleep. It often makes me feel lonely, because I don’t want to talk about it and because not everyone has sympathy for the situation,” says Roos.

When Roos feels too much stress or pressure in a certain situation, she tends to flee. “This sometimes makes it difficult to work with fellow students and often stands in the way of learning,” she says. In addition, her anxiety disorder causes her energy to be consumed and enables her to concentrate on her schoolwork for only fifteen minutes at most.

Image Zep de Bruyn

TiU Master’s student Lara was diagnosed with a social and generalized anxiety disorder at the age of eighteen. She often feels anxious at university, especially when she feels she has to perform at a social or academic level in a group. “During a lecture, I often feel that all eyes are on me and that everyone expects something from me. When I have to open my mouth, my heart is racing and I can barely hear myself speak,” she explains.

Lara calls an anxiety attack a “short circuit”: “It’s a chaotic storm in my head that won’t calm down, so I can’t concentrate on anything anymore. It feels as if I have no control over myself, my own thoughts. The only thing I can think is that people criticize me or that I do something wrong. Preferably, I want to flee the lecture hall as soon as possible. When I come home I have a headache and often the only thing I can do is sleep.”

When I have to open my mouth, my heart is racing and I can barely hear myself speak.


Both Lara and Roos indicate that they are highly sensitive and that their fears partly come from their pasts. “My father became very ill when I turned twelve, and after that, there was a lot of fighting in the house. I was also mentally and physically abused by my ex-boyfriend,” says Roos.

Emily (23), an international Master’s student at Tilburg University, who was diagnosed with a generalized anxiety disorder at the beginning of this year, says that her anxiety disorder stems from her being bullied in the past. “I also always feel I have to excel in the things I’m good at,” she adds.

Much to her relief, Emily says that her anxiety disorder causes few problems at university. Time management is the most important thing for her to keep a grip on the situation: “I don’t like large group meetings or crowds. That’s why I sometimes try to be on campus 45 minutes before lectures starts. This gives me plenty of time to go to the toilet, find a place or eat a snack. It is terrifying to enter a lecture hall full of people”.

In addition, Emily sees her therapist from time to time and gets weekly challenges or activities through a website created for people who have mental health problems. “The activities range from talking to a friend about how I feel to doing something in a social situation that I wouldn’t normally do because it makes me anxious.”

The beauty of fear

Saskia Kalb (54) has had a panic disorder since adolescence, which has affected her during her student life. After studying business economics in Maastricht, she studied to become a chartered accountant in Tilburg in the early 90s. Because of a stressful period, her panic disorder was at its most severe at that time.

“It wasn’t great, to put it mildly,” begins Kalb. “Experiencing a panic attack is hell on earth, a nightmare from which you can’t wake up because you’re already awake. It is as if the light goes out, or everything is darker outside you, but especially inside you. Your thoughts are dark; you can only think in doomsday scenarios, that you are going crazy or dying. Your heart is racing, the adrenaline rushes through your veins, you freeze, get extremely cold, then hot again, start to tremble, and, in an extreme case, you end up in the emergency room or you faint from misery.”

Last year, Kalb published De schoonheid van angst (The beauty of fear), a personal investigation into the characteristics and workings of anxiety. “My anxiety disorder didn’t make studying more fun or easier. During lectures, I always looked for a place close to the door, to be able to get out, should an attack occur. I did this mainly because I was ashamed and because I hoped that no one would see that I was fleeing.”

A panic attack is hell on earth, a nightmare from which you can’t wake up. You think you’re going crazy, or that you’re dying

Author Saskia Kalb

“Nobody knew I had an anxiety disorder, not even my parents and brother, who also studied in Tilburg.” Kalb fought not only with her anxiety disorder but especially with her shame. As a result, she often felt lonely and had few contacts with other students.

Although Kalb eventually learned to deal with her fear, that struggle lasted much longer than necessary because she did not get the right help or had knowledge. With her book, she hopes to help other people with an anxiety disorder and to create understanding for anxious fellow human beings. For her book, she has taken teachings on fear and its alleviation from biology, philosophy, psychiatry, organizational science, sociology, and from Buddhism and Kabbalah.

In her book, she emphasizes that there are also positive sides to having an anxious character. “The book is not called De schoonheid van angst for nothing,” says Kalb. “An anxious nature often correlates with a relatively high IQ and especially a high EQ, a high problem-solving ability, and a good eye for detecting and monitoring risks.”

“Moreover, anxious people often have an altruistic nature,” she says. “As one of my favorite writers, Hermann Hesse, put it so beautifully: ‘Fearful people are the strongest in character and the richest in gifts’.”

Taboo and help from the university

With De schoonheid van angst, Kalb tries to take anxiety disorders out of the taboo sphere. Roos, Lara, and Emily also have trouble talking to others about their anxiety disorders. “People often don’t take mental health problems seriously, so I keep it to myself,” says Emily. “When you explain why you have certain feelings, people think you’re overthinking or playing the victim. The latter especially bothers me because someone with a real disorder would never play the victim.”

Nevertheless, PhD researcher Laura Kunst advises students to talk about their fears with others. “Discussing them can provide relief and support. Usually, people won’t suddenly consider you weird or stupid—on the contrary. It often turns out that your introverted side is exactly what people appreciate in you: that you are someone who listens well, feels what the other person needs, and can empathize with the other person because you know what it’s like to feel anxious and insecure.”

Talking about your fears can provide relief and support

TiU PhD researcher Laura Kunst

“Once, during a presentation, I was open about finding it difficult and scary to approach unfamiliar people—something I had to do for that course,” says Lara. “Nobody was surprised, and I remember one student smiling at me. It sounds very simple, yet it was very liberating. I would like to see more space being created at the university and attention being paid to the experiences and feelings of students.”

Image Zep de Bruyn

Students with mental health problems can usually report to student psychologists at the university. Of all the registrations at Tilburg University in 2019, 27% were for stress, 13% for anxiety, and 10% for depression. “However, when registering, we often see an interconnectedness of multiple mood experiences within the cluster uncertainty, anxiety, depression, and stress,” says Jos Haarbosch, student psychologist at Tilburg University.

“If the request for help and complaint fall within the expertise and working method of the student psychologists, a counseling cycle of an average of three meetings can be started, or sometimes students can participate in a workshop or training,” Haarbosch explains.

“If the problems have been going on for a long time, if they are seriously impeding, and not directly linked to this stage of life or to the studies, the student will be referred to the family physician and to where the necessary help can best be given,” says the student psychologist. “For example, there are people in mental health care teams who specialize in effective and targeted help with anxiety complaints.”

In this way, the student psychologists try to keep a clear separation between the primary care that can be offered within the university and the more intensive, longer-term specialized help and help for which a person is admitted to an institution with specialized colleagues.

We have the feeling that mental health is not taken seriously at university


However, according to Emily, students’ mental health is not a priority at the university. “People I know and myself prefer to seek help in the city center. We feel that mental health is not taken seriously at the university,” she says. There are few visible points of reference for mental health on campus and the student candidates from the Schools who want to improve visibility fail miserably.”

Author Saskia Kalb would like to see much more help for students and staff with mental health problems at universities and schools. And that starts with creating more knowledge and understanding. “Give students, in their first year, an introduction about mental disorders in general, let experience experts have their say, make it clear that it’s very common, so you don’t have to be ashamed.”

“Make sure,” she continues, “there is a point of contact where they can reach current or former students who have had an anxiety disorder, depression, obsessive-compulsive or other disorder and know their way around. Give them a say in how best to avoid stress at university and school. Maybe a think tank is an idea, in which ideas can be put forward for improvement.”

Laura Kunst also thinks that the openness about psychological complaints and the visibility of help points at the university can be improved. “But the responsibility for treatment lies somewhere else: if students want more extensive treatment, they eventually have to take the step themselves to go to the family physician for a referral to a treatment center.”

The real names of Lara and Emily are known to the editors.

Translated by Language Center, Riet Bettonviel

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