Experiencing occasional feelings of nervousness, worry, or fear is normal, especially when they arise in response to stressful, unfamiliar, or challenging situations. However, frequent, regular, intense, and lasting (almost daily for 6 months) feelings of nervousness can signal an underlying anxiety disorder, especially when they interrupt a person’s ability to function normally.
One in three adults in America will struggle with an anxiety disorder at some point in their lives, making it the most common type of mental illness. Left untreated, anxiety disorders often worsen but with treatment, symptoms can be improved and sometimes even resolved. The most effective treatment for anxiety disorders is a type of counselling called Cognitive Behavioral Therapy (or CBT), but other types of counseling, medication, or a combination of the two are also commonly used.
What Is Anxiety?
Anxiety describes the emotion of fear, which occurs on a spectrum that ranges from mildly nervous or worried to the extremes of feeling completely panicked. Anxiety can be normal when it is situational, meaning it occurs in response to a specific situation and goes away on its own when the situation is resolved.
Most symptoms of anxiety are a direct result of a normal chain reaction called the “fight or flight” response that involves the brain, nervous system, and body.3 A part of the brain called the amygdala is largely responsible for beginning this chain reaction, acting as a threat detector that cues the nervous system to activate. Once activated, the nervous system releases stress hormones and adrenaline into the bloodstream, causing physiological changes like increased heart rate, respiration, heightened awareness and a surge of energy.1,2
When Is Anxiety a Mental Health Problem?
Fear is not a “rational” emotion, so even normal anxiety sometimes seems like an overreaction, but frequent anxiety that is excessive or unexplainable is abnormal. The symptoms of anxiety disorders vary depending on the type, but experiencing worried, catastrophic or racing thoughts are common, and increased irritability, restlessness, and nervous energy are as well. Many people experience physical symptoms when they become anxious including increases in their heart rate, blood pressure and respiration.1
How Common Are Anxiety Disorders?
According to the latest report from the Anxiety and Depression Association of America (ADAA), anxiety disorders are the most common psychiatric conditions impacting about 19 % of the U.S. adult population in any given year.7
In 2020, Mental Health America (MHA) examined the effects of the COVID-19 pandemic on mental health in the U.S. The findings revealed an astonishing increase in screened cases of anxiety, peaking in severity in September 2020 and continuing to grow and remain high since the start of the pandemic.8
Types of Anxiety Disorders
Anxiety disorders describe a category of mental health conditions that share common symptoms, but have different patterns of onset, duration, and frequency. Many anxiety disorders are distinguished by the specific events and circumstances that trigger the symptoms or “false alarms” described above.
Some of the more common types of anxiety disorders include:4
- Generalized anxiety disorder (GAD): Symptoms of anxiety triggered by a wide range of circumstances, or sometimes for unknown reasons.
- Social anxiety disorder: Symptoms of anxiety which occur in specific social interactions or settings where a person is afraid of being judged or rejected.
- Specific phobias: Intense symptoms of anxiety triggered by a specific thing (i.e. fear of spiders), situations (i.e. heights), or activities (i.e. public speaking).
- Panic disorder: An anxiety disorder characterized by panic attacks and intense fear about the possibility of future attacks.
- Anxiety disorders related to an underlying health issue or are related to the effects of a prescribed or illicit substance
- Separation Anxiety which primarily affects children (but can happen in adults) and is characterized by extreme anxiety when separated from loved ones (usually caregivers)
- Unspecified Anxiety Disorders which includes some symptoms of anxiety that do not match other known anxiety disorders but do cause significant distress or impairment.
- Obsessive compulsive disorder (OCD): Not technically an anxiety disorder, but characterized by high levels of anxiety, intrusive thoughts, and ritualistic behavior
- Post-traumatic stress disorder (PTSD): Not an anxiety disorder, but involves symptoms of anxiety, avoidance, mood problems, and recurrent memories following a traumatic experience
Anxiety Symptoms & Signs
Depending on the specific disorder a person has, their symptoms can vary.4 Each disorder has a detailed list of symptoms that licensed health and mental health professionals reference to determine a diagnosis. Because anxiety is a common feature of all of the conditions listed above, there are some similarities in the symptoms that people with these conditions may experience.
Some of the more common symptoms of anxiety that people with these conditions report include:4
- Feeling tense, irritable or on-edge
- Racing or worried thoughts
- Trouble focusing or concentrating
- Changes in eating or sleeping patterns
- Restlessness and trouble sitting still
- Avoidance of feared situations
- Sweating, shaking or other unusual sensations in the body
- Feeling disconnected, “zoned out” or dissociated
- Panic attacks which can include extreme fear, racing heart, or trouble breathing
Anxiety Attack Symptoms
Symptoms of anxiety can be mild, moderate or severe. When anxiety becomes severe, it can culminate in an anxiety attack (also called a panic attack). An anxiety attack can occur to anyone in a highly stressful situation but is more likely to happen to people with an anxiety disorder or other pre-existing condition. Anxiety attacks tend to come on suddenly and include highly intense symptoms of anxiety that are primarily physiological in nature.
A person who experiences four or more of the following symptoms may be experiencing an anxiety attack:4
- Heart palpitations
- Shaking or trembling
- Feeling hot or cold (hot flashes or chills)
- Feelings of choking
- Feeling smothered or short of breath
- Chest pain or discomfort
- Nausea, stomach pain or GI distress
- Feeling dizzy, lightheaded or unsteady
- Feeling afraid of dying
- Feeling afraid of losing control or “going crazy”
- Numbness or tingling sensations
- Derealization (not feeling in touch with reality) or depersonalization (not feeling attached to yourself)
Anxiety attacks are sudden, intense and frightening. People who experience them often mistake them for a heart attack or other medical emergency. Despite their intensity, anxiety attacks are not dangerous or life-threatening, and are common in people who struggle with anxiety.
What Causes Anxiety?
There isn’t one specific cause for developing an anxiety disorder. Experts believe that the interaction of genetic vulnerability with stressful life events can trigger an anxiety condition. A person can also experience anxiety from having an underlying medical condition, taking certain medications, or a combination of any of these factors.9
In some cases, an anxiety disorder can be caused by another underlying medical condition. In fact, there are certain medical conditions known to produce anxiety symptoms, such as hyperthyroidism, cardiovascular disease, asthma, encephalitis, and more. By the same token, having a chronic illness can cause stress related to the implications of the medical issue thus triggering anxiety. Additionally, anxiety can be a common symptom in other mental disorders like depression or bipolar disorder.4
Evidence suggests that unhealthy environments, stressful life events (death of a loved one, divorce, financial issues etc.), growing up in an unsafe environment, and experiencing childhood abuse are strongly linked to anxiety disorders. These conditions amplify the likelihood of developing anxiety, and the risks can be even higher for those with a genetic predisposition.10
As with other mental health conditions, anxiety disorders typically have a genetic component. This means that having a family member with anxiety, or any other psychological disorder, can predispose you to developing an anxiety disorder—especially if other risk factors are involved.10
Some people can experience nervousness, anxiety, panic symptoms as a side effect from taking certain medications. If the person already has anxiety, these medications can make their symptoms worse. Medications that can provoke anxiety symptoms include pain relievers, anticonvulsants, oral contraceptives, antidepressants, and some over-the-counter medicines. It’s always a good idea to check with your doctor or pharmacist and read medication labels to learn if your prescriptions can cause anxiety. 4
Who Is at Greatest Risk for Anxiety Disorders?
There are certain populations that are vulnerable and/or life circumstances that increase the chances for developing an anxiety disorder. These include:6
- Adolescents between 13 and 18 years old
- People with a history of or an existing of mental illness, especially depression
- People with substance use/alcohol problems
- Individuals with certain personality traits
- Those with history of childhood trauma, particularly sexual abuse
- Having a family history of mental illness
- Certain stressful life events: Financial worries, work stress, having a chronic illness, death of a loved one, etc.
Getting an Anxiety Diagnosis
In order to be diagnosed with any anxiety disorder or related condition, a person must also be negatively impacted or impaired by their anxiety. Impairments can show up in almost any area of a person’s life, and are important indicators licensed professionals use to determine whether a person has a diagnosis.
Some examples of ways people may be impaired or negatively impacted by their anxiety include:2,4
- Mental health: Fear-based thoughts cause the person to be frequently stressed, anxious, irritable or moody or keeps them from experiencing positive emotions
- Sleep: Anxiety keeps a person from being able to sleep (i.e. racing thoughts at night) or wakes them up (i.e. nightmares in PTSD)
- Physical health: Anxiety causes a person to experience migraines, GI problems, high blood pressure or other stress-related illnesses or medical problems (*people with these symptoms should always consult with their doctor to rule out a medical cause).
- Relationships: Anxiety causes a person to be more irritable, on-edge, and to lash out at co-workers, family members or friends or to isolate themselves
- Work: Anxiety makes it difficult for a person to stay focused and complete their work or distracts them, causing more errors or mistakes
- Routine: Irrational fears keep a person from following their normal routine (i.e. not driving anywhere for fear of getting in an accident)
Who Can Diagnose Anxiety Disorders?
If you suspect that you may have an anxiety disorder, talking to your primary physician may be a good place to start. Your doctor can evaluate if your anxiety is related to a medical condition or something else that needs to be addressed. You can also reach out to a mental health practitioner like a psychiatrist, psychologist, or other mental health expert who can conduct a comprehensive assessment to derive a diagnosis and provide treatment as well. However, it’s important to rule out medical-related issues first.
Treatment for Anxiety Disorders
Anxiety disorders can cause people a great deal of distress and can get in the way of living a full and productive life. Luckily, anxiety disorders are highly treatable.5 Treatment for anxiety disorders can include therapy, medication, and even lifestyle changes that can help reduce symptoms.
Therapy for Anxiety Disorders
Therapy for anxiety is a frontline treatment, and can be highly effective at helping people learn skills and strategies to manage and reduce symptoms. Usually, therapy is offered by a licensed counselor or social worker for about an hour a week, although that can vary based on a person’s needs. Over time and as people’s symptoms improve, they often come less frequently and eventually complete treatment.
Medication Options for Anxiety Disorders
At times, medication for anxiety may be recommended as a part of treatment. Medications can be prescribed by a medical doctor, psychiatrist, nurse practitioner, or physician’s assistant, but usually not by a therapist or social worker. The three most commonly prescribed types of medication for anxiety disorders are Antidepressants, Beta blockers and Benzodiazepines, but other medications are also sometimes prescribed. Speak with your doctor about how anxiety medication can affect you and the timeline for when you’ll see results to determine whether it’s the right option for you.
There is vast evidence indicating that support groups can have a positive impact on mental health. By providing moral support and a feeling of social connection, these peer-led groups can help to reduce symptoms of psychological conditions, including anxiety.11 Consider joining an online or in-person self-help group to help you feel less alone, decrease your stress, and improve your symptoms of anxiety. Moreover, these groups can also offer a validating place to process difficult emotions with other people who are struggling with similar issues. You can begin your search by contacting organizations like Anxiety.org or the Anxiety and Depression Association of America.
When to Go to the Emergency Room for Anxiety
Many times, people end up in the emergency room thinking that they’re having a heart attack when in reality they’re having a panic attack. Either way, it’s better to be safe than sorry—if you’re experiencing any concerning physical issues, go to the doctor, urgent care, or emergency room.
Other factors that may indicate you need medical attention include feeling depressed, misuse of alcohol or drugs, and any other emotional/mental health issues along with your anxiety. If suicidal thoughts and/or behaviors arise seek immediate emergency care. Recognizing anxiety symptoms and the associated negative implications is key, because anxiety can worsen over time when left untreated.12
How to Get Treatment for Anxiety
If you have health insurance, the best place to find a therapist is often to go through your insurance plan to find an in-network provider. You can usually do so by calling the number on the back of your insurance card or by using the insurance company’s website to locate local in-network providers.
For those without insurance or who prefer to pay out-of-pocket, it might make more sense to use a therapist directory where you can browse profiles of local therapists. Online therapist directories usually have advanced search filters that allow you to narrow down to providers who are within a certain mile radius of you, who have afterhours availability or those who have specialized experience in anxiety.
Lifestyle Changes to Help With Anxiety Disorders
In addition to formal treatment options like therapy and medication, there are also certain lifestyle changes and natural remedies that help with anxiety. Certain activities and routine adjustments can help to reduce stress and control symptoms. Because anxiety has a neurochemical basis, many of the suggested lifestyle changes are ones that work to rebalance these chemicals.
Some lifestyle changes that may help manage anxiety include:
- Mindfulness and meditation practices can promote relaxation, decrease stress, and distance people from anxious thoughts
- An active lifestyle that includes regular exercise helps to balance neurochemicals and stress hormones linked to anxiety
- A consistent sleep routine that includes 7-8 hours per night helps reduce stress, improve focus and performance, and prevent health and mental health issues
- Cutting back on caffeine can also make a difference for those suffering with anxiety disorders, as caffeine’s stimulating properties can induce anxiety
- Regularly spending time with friends or family is an essential part of wellness, decreasing risk and severity for both physical and mental health issues
- Enjoying offline time is another lifestyle change that can help reduce anxiety, as some people might find that work emails, social media, or other notifications cause stress and anxiety
- Introducing positive thoughts can help to build new thinking habits that counteract stress and anxiety
- Practicing self-compassion through kind self-talk and consistent self-care activities has shown to be helpful in reducing a range of mental health issues, including anxiety
- Learning more about anxiety online or from a professional can be helpful in understanding signs and symptoms, helping people feel more in control of their symptoms
- Finding supportive people to talk to about anxiety (friends, a therapist, or a support group) can also help people have an outlet and feel less alone in their experience
What Anxiety Looks Like
People of all ages can, and do, experience anxiety, but the signs of anxiety can vary depending on a person’s age. In children and teens, anxiety can surface behaviorally or can mimic other types of mental or physical illnesses.
What Anxiety Can Look Like in Children
Younger children can’t always describe their emotions, so physical symptoms of anxiety are common. These can include complaints of stomach and headaches or chest pains. Anxious children may also act out, throwing tantrums or displaying a lot of defiant behavior. Avoidant behavior is also common in children with anxiety, who may start avoiding certain activities, places, or things that trigger their anxiety.
What Anxiety Can Look Like in Teens
In teens, anxiety can also show up behaviorally. Anxious teens may seem moody and get into more confrontations with teachers and parents or they may begin socially isolating themselves. Parents of anxious children and teens may notice that their grades are dropping or hear from teachers that their child is less focused in class. Changes in sleep and eating patterns may also indicate an underlying anxiety disorder.
What Anxiety Looks Like in Adults
Not all adults will experience anxiety in the same way, and anxiety is often overlooked or attributed to other factors. Some people experience more physical symptoms like a racing heart, upset stomach, muscle tension, and migraines, while others struggle with overthinking or worrying too much. Many adults will confuse their anxiety as “stress,” not recognizing how consistent, frequent, or severe their symptoms have become.
Anxiety in Older Adults
Anxiety in older adults often goes undetected. Sometimes it can be masked or overridden by more pressing physical ailments, and other times seniors will deny feeling anxious to avoid loved ones from becoming overly concerned or burdened. In some cases, anxiety in older adults surfaces as increased concerns about safety, security, health, or even the larger society. Other times, it becomes apparent when a person changes their routine, and uses avoidance coping to stay away from certain situations, or becomes overly concerned with precautionary measures that seem excessive.
Here are some key statistics on anxiety:6
- Anxiety disorders impact 40 million adults in America each year
- 31.9% of teens between the ages of 13-18 are affected by an anxiety disorder
- Within their lifetime, 31.1% of adults (or about one in every three people) in America will struggle with an anxiety disorder
- Only 36.9% of people struggling with an anxiety disorder will get treatment
Anxiety vs. Stress vs. Depression
Much overlap exists between anxiety, stress, and depression, but they are distinctly different experiences that can occur independently or together. Anxiety is the frequent experience of excessive nervousness or worry. People can experience high levels of anxiety in response to small triggers and even during times when there is no identifiable trigger. Stress differs from anxiety, in that it occurs in response to specific triggers that are typically identifiable. During times of high stress, people with any mental health disorder, including anxiety, are at higher risk of developing symptoms.
Depression is the second most common mental health condition affecting American adults and is characterized by persistent feelings of sadness and a loss of energy, motivation or interest. People who experience depression often have depressive episodes lasting weeks or longer. Many people who experience depression also experience anxiety, and there is a high rate of comorbidity between the two disorders. While symptoms of anxiety and depression can happen at the same time, they can also occur independently, even in those diagnosed with both disorders.
Anxiety Tests & Self-Assessments
While people cannot self-diagnose an anxiety disorder, doing some additional research can be helpful to some in identifying signs or symptoms. This should not be a substitute for professional help or a clinical diagnosis, but may be useful for those looking for more information.
Mental Health America provides a screening tool for anxiety (also available in Spanish) that can help you assess whether it might be time to seek out professional help. While this screening tool can be helpful resources in identifying warning signs, they are not reliable tools for diagnosing an anxiety disorder.
Final Thoughts on Anxiety Disorders
If you or someone you care about is concerned about a potential anxiety disorder, seeking professional treatment is highly recommended. Counselors, social workers, psychologists, and other licensed professionals can verify a diagnosis and help people explore options to treat and manage their condition.
For Further Reading
- Anxiety and Depression Association of America: Learn more about anxiety disorders and the difference between normal anxiety and an anxiety disorder
- National Alliance on Mental Illness: Find an anxiety support group
- Online therapist directory: Sort therapists by specialty, cost, and availability. Watch the therapists’ intro videos and see articles they’ve written. When you’ve found a good match, book an online therapy appointment with them directly.