Anxiety Disorder
Anxiety disorders are the world’s most common mental health conditions, affecting millions of people. While everyone experiences worry from time to time, anxiety disorders involve intense, excessive fear that interferes with daily life—but effective treatments are available.
Table of contents
- What is Anxiety Disorder?
- Types of Anxiety Disorders
- Signs and Symptoms
- What Causes Anxiety Disorders?
- Who Is at Risk?
- How Anxiety Disorders Are Diagnosed
- Treatment Options
- Managing Anxiety in Daily Life
What is Anxiety Disorder?
An anxiety disorder is a type of mental health condition that causes intense fear, dread, and worry that goes beyond normal nervousness[3]. Everyone feels anxious sometimes—before a job interview, taking a test, or making an important decision. This type of anxiety is normal and can even be helpful, as it helps us notice dangerous situations and stay safe[3].
However, people with anxiety disorders experience worry and fear that is both intense and excessive. These feelings are typically accompanied by physical tension and other symptoms that are difficult to control, cause significant distress, and can last a long time if untreated[4]. The anxiety interferes with daily activities such as job performance, schoolwork, and relationships[5].
Anxiety disorders are the world’s most common mental health conditions. In 2021, approximately 359 million people worldwide had an anxiety disorder, making them the most prevalent of all mental disorders[4]. An estimated 4.4% of the global population currently experiences an anxiety disorder[4]. In the United States, nearly one-third of people will experience an anxiety disorder at some point in their lifetime[6].
The good news is that anxiety disorders are highly treatable. With appropriate treatment—including medication, therapy, or both—people with anxiety disorders can manage their symptoms and lead happy, successful lives[3].
Types of Anxiety Disorders
There are several different types of anxiety disorders, each with its own characteristics[3]:
Generalized anxiety disorder (GAD) causes persistent and excessive worry about everyday issues such as health, money, work, and family. People with GAD worry about ordinary concerns almost every day for at least six months[3]. They find it difficult to control their worry and may feel overwhelmed[3].
Panic disorder involves multiple unexpected panic attacks—sudden, repeated periods of intense fear when there is no real danger. These attacks come on quickly and can last several minutes or more[5]. A main feature is that the attacks usually happen without warning[3].
Social anxiety disorder (formerly called social phobia) happens when someone experiences intense and ongoing fear of being judged negatively or watched by others[3]. This fear occurs in social situations and can severely disrupt a person’s life.
Specific phobias involve an intense fear of something that causes anxiety so severe it consistently disrupts daily life. There are hundreds of different types of phobias, ranging from fear of spiders to fear of flying[3].
Agoraphobia causes an intense fear of becoming overwhelmed or unable to escape or get help. People with this condition often avoid new places and unfamiliar situations, like large open areas, enclosed spaces, crowds, and places outside their homes[3].
Separation anxiety disorder happens when someone feels excessive anxiety when separated from a loved one, such as a primary caregiver. While this is a normal stage of development in babies and toddlers, separation anxiety disorder can affect children and adults[3].
Selective mutism is a condition where someone doesn’t talk in certain situations because of fear or anxiety. It usually affects young children but can also affect adolescents and adults[3].
Signs and Symptoms
Anxiety disorders can cause many different symptoms that affect how a person feels physically, mentally, and how they behave[2].
Physical symptoms may include a faster, irregular, or more noticeable heartbeat; feeling lightheaded and dizzy; headaches; chest pains; sweating; breathing rapidly or feeling short of breath; trembling or shaking; feeling hot; and feeling weak or tired[2]. People may also experience loss of appetite, upset stomach, or other digestive problems[2].
Mental and emotional symptoms include feeling nervous, restless, or tense; having a sense of impending danger, panic, or doom; worrying about the past or future; being unable to relax; feeling tearful; having trouble concentrating or thinking about anything other than the present worry; and having difficulty controlling worry[2]. People may also fear the worst happening and have intrusive thoughts[2].
Behavioral changes can include not being able to enjoy leisure time, difficulty looking after oneself, struggling to form or maintain relationships, feeling worried about trying new things, avoiding places and situations that trigger anxiety, and engaging in compulsive behavior such as constantly checking things[2]. Many people also have trouble sleeping[2].
A panic attack is a sudden episode of intense anxiety and fear. During a panic attack, a person may experience a racing heartbeat, feeling faint or dizzy, feeling like they’re losing control, sweating and trembling, shortness of breath or very quick breathing, tingling in the fingers or lips, and feeling sick[2]. A panic attack usually lasts 5 to 30 minutes. While frightening, panic attacks are not dangerous and should not cause harm[14].
What Causes Anxiety Disorders?
The exact cause of anxiety disorders is unknown. However, several factors appear to play a role[5].
There is a biological component to anxiety. Neurotransmitters are chemicals in the brain that send messages about how we’re supposed to feel. If they aren’t sending the right messages at the right time, people may be more likely to experience anxiety[6].
Research has shown that both genetic and environmental factors can contribute to a higher risk of developing an anxiety disorder[6]. Some risk factors include exposure to stressful events in early childhood or adulthood, family history of anxiety or other mental health conditions, and unpredictable bouts of shyness in childhood[6].
Some physical health conditions can also worsen anxiety symptoms. Heart arrhythmia, caffeine intake, thyroid problems, or medication side effects can create or increase the severity of anxiety symptoms[5, 6].
Who Is at Risk?
Children, adolescents, and adults can all experience anxiety disorders[3]. Symptoms often begin during childhood or adolescence[4], though anxiety disorders can appear at any time in life[6].
Women are about twice as likely as men to have an anxiety disorder[3]. The risk factors for different types of anxiety disorders can vary, but general risk factors include certain personality traits such as being shy or withdrawn when in new situations or meeting new people, traumatic events in early childhood or adulthood, family history of anxiety or other mental health conditions, and some physical health conditions[5].
Anxiety disorders increase the risk for depression and substance use disorders, as well as the risk of suicidal thoughts and behaviors[4].
How Anxiety Disorders Are Diagnosed
A person may start by seeing their primary care provider to find out if anxiety could be related to their physical health. The provider can check for signs of an underlying medical condition that may need treatment[8].
If there is no other health problem causing the symptoms, the person may need to see a mental health professional. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. A psychologist and certain other mental health professionals can also diagnose anxiety and provide counseling[8].
To help diagnose an anxiety disorder, the mental health provider may discuss thoughts, feelings, and behaviors when the person feels anxious, and ask about other mental health problems such as depression or alcohol or drug misuse, which can happen along with anxiety[8]. The provider will get a psychological evaluation to understand the person’s symptoms and medical history[5].
Validated screening tools can help with diagnosis and assessment. For example, the GAD-7 is a tool used to screen for generalized anxiety disorder[11].
Treatment Options
The main treatments for anxiety disorders are psychotherapy (talk therapy), medications, or both[8]. Most people benefit from a combination of the two[8]. Treatment usually consists of a combination of these approaches[13].
Psychotherapy involves working with a therapist to reduce anxiety symptoms. Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders[8]. Generally a short-term treatment, CBT focuses on teaching specific skills to improve symptoms and gradually return to activities the person has avoided because of anxiety[8]. CBT includes exposure therapy, in which a person gradually encounters the object or situation that causes fear[8]. Psychotherapy can be as effective as medication for anxiety disorders[10].
Medications used to treat anxiety disorders include antidepressants and anti-anxiety medications. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are recommended as first-line medications[10, 11]. These medications have a safer side effect profile and are more easily adjusted to effective doses without excessive side effects[13].
Benzodiazepines are not recommended for first-line therapy or long-term use because of adverse reactions, risk of dependence, and higher mortality[10, 11]. They are not more effective than antidepressants for anxiety disorders[10].
After achieving treatment response, antidepressants should be continued for at least six to 12 months to decrease the rate of relapse[10, 11]. It may take some trial and error to discover which treatments work best for each individual[8].
Although highly effective treatments for anxiety disorders exist, only about 1 in 4 people in need receive any treatment[4]. Barriers to care include lack of awareness that this is a treatable health condition, lack of investment in mental health services, lack of trained healthcare providers, and social stigma[4].
Managing Anxiety in Daily Life
There are several self-help strategies that can help manage anxiety symptoms[12].
Learning about anxiety is central to recovery. Understanding how anxiety works, including the body’s “fight-or-flight” response, is an important way to promote control over symptoms[12].
Mindfulness guides people to bring their attention back to the present moment and unhook from thoughts that may be unhelpful. Many resources are available to support developing a mindfulness practice[12].
Relaxation techniques can help release muscle tension. These include progressive muscle relaxation, abdominal breathing, and isometric relaxation exercises[12]. Using calming breathing exercises can be particularly helpful[14].
Physical activity reduces symptoms of anxiety[11, 17]. Daily exercise alone can help manage anxiety because the body may produce more serotonin and endorphins, which can have a positive effect on mood and the ability to manage stress[17]. Activities such as running, walking, swimming, and yoga can help with relaxation[14]. Consider scheduling 30 minutes or more of exercise at least three to five days a week[17].
Good nutrition can improve overall well-being. Eating balanced meals throughout the day that include protein, complex carbohydrates like oatmeal and whole grains, plus fruits and vegetables is important[17]. Having a healthy diet with regular meals helps keep energy levels stable[14].
Prioritizing sleep is essential because sleep is interconnected with mental health. A lack of sleep can make anxiety worse. Adults should get seven to nine hours of sleep each night. A consistent sleep routine—going to bed and waking up at the same time every day—can help[17].
Limiting alcohol is important because alcohol can affect sleep and may make anxiety symptoms worse the next day[17]. If taking antidepressant medication, mixing alcohol may worsen symptoms and cause unwanted side effects[17].
People should try talking about their feelings to a friend, family member, health professional, or counselor[14]. It’s also important not to avoid situations that make them anxious, but instead to slowly build up time spent in worrying situations to gradually reduce anxiety[14].
Setting small, achievable targets rather than trying to do everything at once, and focusing time and energy on things that can be controlled, can help reduce feelings of being overwhelmed[14].
