What Is Anxiety? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Anxiety is a feeling of nervousness, unease, or worry that typically occurs in the absence of an imminent threat. It differs from fear, which is the body’s natural response to immediate danger.
Anxiety is part of the body’s natural reaction to stress, so it can be helpful at times, making you more alert and ready for action.
Anxiety disorders and normal feelings of anxiousness are two different things. Many of us get anxious when faced with particular situations we find stressful, but if those feelings don’t subside, the anxiety could be more chronic. When feelings of fear or nervousness become excessive or difficult to control, or interfere with daily life, an anxiety disorder may be present. Anxiety disorders are among the most common psychiatric conditions in the United States.
It’s common to think about anxiety in a way that may hinder our ability to overcome it. “The biggest misconception about anxiety is that it’s to be feared and avoided at all costs,” says Noah Clyman, the director of NYC Cognitive Therapy, a private psychotherapy practice in New York City.
“I teach my clients that negative emotions, such as sadness, anger, and fear, are important to our survival, and emotional discomfort is a very normal, universal human experience,” he says.
Your heart beats fast, and your breathing speeds up. Your chest may feel tight, and you might start to sweat. If you’ve ever felt it, you know that anxiety is just as much a physical state as a mental state. That’s because there’s a very strong biological chain reaction that occurs when we encounter a stressful event or begin to worry about potential stressors or dangers in the future. Other physical symptoms include headaches and insomnia. Psychological symptoms may include feeling restless or tense, having a feeling of dread, or experiencing ruminative or obsessive thoughts.
Some of the most common symptoms of anxiety disorders include:
When the symptoms of anxiety and the associated behaviors are having a detrimental impact on your well-being and day-to-day functioning, it’s important to get help.
Suma Chand, PhD, the director of the cognitive behavioral therapy program at St. Louis University School of Medicine in Missouri, says a person who has panic disorder is “very avoidant of many situations that could trigger [their] panic symptoms,” and the panic disorder is likely impacting their ability to go to work regularly, go shopping, attend church, and the like. The ability to function while in these situations is negatively impacted as well. If you’re avoiding situations that trigger your anxiety, or you experience tremendous discomfort and can’t function effectively when you’re in those situations, it’s probably a good time to seek treatment.
Researchers think that various factors may contribute to anxiety. The more risk factors an individual has, the greater the likelihood that they’ll develop an anxiety disorder, notes Dr. Chand.
An author of the study, Koraly Perez-Edgar, PhD, a professor of psychology at the Pennsylvania State University in University Park, says that this focus on threat may be one way that anxiety begins to take hold.
“Individuals who attend to aspects of the environment that they consider threatening can potentially create a cycle that strengthens biases toward threat, as well as toward the view that the environment is threatening, which can then lead to social withdrawal and anxiety,” she says.
“People can learn to be anxious in various situations,” says Jonathan Abramowitz, PhD, a professor of psychology at the University of North Carolina in Chapel Hill.
“This can occur through experiences in which anxiety or fear becomes associated with a specific stimulus or a stressful or traumatic event, by learning about something fearful, and through vicarious conditioning,” he says.
Vicarious conditioning, says Dr. Abramowitz, occurs when you watch someone else experience a stressful and traumatic event — like food poisoning or being bitten by a dog — and come to see certain situations as dangerous.
Learn More About Causes of Anxiety Disorders: Common Risk Factors, Genetics, and More
When you visit your healthcare provider, you can expect that your doctor or nurse will ask you about your symptoms, perform a physical exam, and order lab tests to rule out other health problems. If tests don’t reveal any other conditions, your doctor will likely refer you to a psychiatrist or psychologist to make a diagnosis.
A mental health professional will identify the specific type of anxiety disorder that’s causing your symptoms. They’ll also look for any other mental health conditions that you may be experiencing, including depression.
Agoraphobia is often comorbid with panic disorder — meaning people often suffer from both conditions at the same time. It’s an intense fear of not being able to escape whatever place you’re in if you were to have a panic attack or an embarrassing experience such as incontinence, and it can often lead to an avoidance of leaving the house. People with agoraphobia can fear situations where this anxiety might flare up and typically don’t feel comfortable or safe in public, crowded places.
Generalized anxiety disorder is a condition in which your worries about a wide range of things overwhelm you to the point where your daily routine may be difficult to carry out, and you have been worrying this way for at least six months. You may feel on edge and have difficulty focusing on tasks. There may be a tendency to fear and expect the worst; some call this catastrophic thinking. You may know that your worries are perhaps irrational, but you continue to worry.
Learn More About Generalized Anxiety Disorder
Everyone has probably experienced a feeling of panic, or something like it, at least once in their lifetime: on a disturbingly turbulent airplane, or before giving an important presentation, or after realizing you hit reply all when you really, really should not have. We all know the paralyzed feeling and the heightened physical sensations. But panic attacks and panic disorder take a different shape. Panic attacks have many physical symptoms and tend to peak around 10 minutes and may last for 30 or more. Panic disorder is diagnosed by having recurrent, unexpected panic frequency of these attacks, along with unhelpful changes in behavior and/or the fear of having them.
Learn More About Panic Disorder
Many of us may know what it feels like to be nervous before a party or when meeting new people or making an important phone call. Those with social anxiety disorder have very intense versions of those fears — intense fears of being judged by others that trigger intense distress and may cause them to avoid those kinds of situations. For most people, fears of social situations usually subside once the intimidating event has been faced. But in social anxiety disorder, these feelings are more pervasive and usually last for at least six months.
It is possible to manage anxiety with therapy or medication, or through a combination of therapy and medication. It may also be helpful to reexamine your relationship with your anxiety.
According to Clyman, “You might start to consider your emotions as changing experiences that are always fluctuating. When we feel distressed, it can seem like the distress is going to go on and on forever until we emotionally combust. But instead, emotions act more like a wave, at times increasing and becoming more intense. Inevitably, they’ll reach a plateau, subsiding and finally passing.”
Anxiety disorders are treated through medication and therapy. You might feel embarrassed talking about the things you are feeling and thinking, but talking about it, say experts, is the best treatment.
A particular form of therapy has the most research support: cognitive behavioral therapy, or CBT for short, which offers patients strategies to help change the negative thought patterns that have reinforced their anxiety.
The types of medication most frequently used to treat depression are the drugs that also work best for anxiety disorders. Anti-anxiety medications are also used.
There’s no one-size-fits-all approach in treating anxiety, but the most common methods are a combination of medication and psychotherapy (talk therapy).
Medication Options
There are dozens of drugs that can be prescribed to treat anxiety. Since each person responds to medication differently, there’s no one drug that works perfectly for everyone. You may have to work with a psychiatrist to find the medication, or the combination of medicines, that’s most beneficial to you. The drugs that are used to treat anxiety over a long period of time are antidepressants, which affect serotonin, norepinephrine, and other neurotransmitters in the brain.
In addition to medication and therapy, exercise can be helpful. Aerobic exercise “has been found to improve mood and anxiety by releasing endorphins and neurotransmitters such as dopamine and serotonin,” says Chand, adding that “regular moderate exercise also helps with sleep, which in turn has a beneficial impact on anxiety.”
Research suggests that yoga, meditation, and acupuncture may also reduce anxiety symptoms by reducing stress. Anecdotal evidence, notes Chand, indicates that massage therapy may be helpful in improving a sense of overall well-being.
More scientific evidence is needed to support treating anxiety disorders with aromatherapy and essential plant oils, such as lavender, but some people find they have a calming effect. Chand points out that certain scents work better for some people than others, so it’s good to try a variety.
Learn More About Treatment for Anxiety: Medication, Therapy, and Complementary Techniques
According to Chand, here are some important ways to prevent the development of an anxiety disorder:
Good mental health education is also vital, says Chand. “While several steps can be taken to prevent mental health problems, people often feel helpless when they’re not armed with information. Mental health education paves the way for a society that is more mentally healthy. Early mental health education starting in schools would be ideal,” she says, adding that the initiation of such programs has yielded positive results.
Dietary changes are no substitute for treatment, but what you eat can indeed have an effect on your anxiety levels.
Limit or avoid caffeine and alcohol, as they can worsen feelings of anxiety.
Many people first develop symptoms of an anxiety disorder during childhood. Some anxiety disorders, such as specific phobias and social anxiety disorder, are more likely to develop in childhood or the teenage years, while others, such as generalized anxiety disorder, are more likely to start in young adulthood.
What is known for sure, says Beth Salcedo, MD, a past board president of the Anxiety and Depression Association of American (ADAA), “is that more often than not, women definitely experience an uptick in anxiety before menstruation, around perimenopause, and after giving birth.”
Anxiety often coexists with other chronic health conditions, including:
Depression and anxiety are different disorders, but it’s very common for someone with an anxiety disorder to suffer from depression, too.
If you have both anxiety and depression, you may experience the following symptoms:
While obsessive-compulsive disorder is no longer officially classified by the American Psychological Association as an anxiety disorder, it shares many traits with common anxiety disorders, such as generalized anxiety disorder. In both conditions, you may know that your thoughts are irrational, but you feel unable to stop thinking them. Often, but not always, these thoughts may concern cleanliness, sex, religion, or a fear of causing harm.
With obsessive-compulsive disorder, you may also think you need to carry out certain actions in order to relieve anxiety or prevent something bad from happening. For instance, you might not be able to leave the house without locking all the doors and checking all the appliances — multiple times. And the compulsion to carry out those actions may make it difficult to get through your day.
Anxiety is often a natural stress response that keeps you alert and ready to respond, but when these feelings become excessive or interfere with your daily life, you might have an anxiety disorder like panic disorder, social anxiety disorder, generalized anxiety disorder, or agoraphobia. Common symptoms include a rapid heartbeat and breathing, chest tightness, sweating, tremors, nausea, diarrhea, and frequent urination, as well as feelings of irritability, apprehension, dread, and obsession.
Anxiety disorders may develop due to stress, brain structure, alcohol and drug use, trauma, and family history. Reaching out for support when anxiety symptoms start to disrupt your day can help you manage symptoms effectively, and treatment might include talk therapy, medications, and learning self-management methods that include exercise, meditation, and yoga.
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