Anxiety

What is anxiety?

Anxiety is both an emotion and a physical state. When you’re anxious, you may feel nervous, worried, tense, panicked, or frightened. Your body reacts too, your heart rate and breathing may speed up, you may feel sick, your hands could shake or tremble.

What makes you feel anxious will be unique to you. But some common sources of anxiety include exams, job interviews, giving a presentation in front of an audience, or meeting new people.

Anxiety can feel intense, but it’s a natural condition. It’s your body’s reaction to stress. Anxiety prepares you; it causes a rush of adrenalin, it makes you more alert, it heightens your responses. For most people, a short spike of anxiety can improve their performance in a stressful situation. 

What is an anxiety disorder?

In most cases, anxiety is temporary, and it doesn’t have any lasting effect on your life. But if your anxiety becomes frequent, particularly intense, or long lasting, it can cross a line from being helpful anxiety into an anxiety disorder.

Anxiety disorders, often just called anxiety for short, are a group of mental disorders. They cause you to feel significant feelings of anxiety and fear. This anxiety may last for days to weeks to months, and it can be so overwhelming it can cause anxiety attacks. 

Whereas occasional anxiety can be a useful response to stress, the level of anxiety you experience with anxiety disorders can be debilitating. It can stop you doing everyday things you enjoy, can make you isolate yourself, stop you meeting the responsibilities of your life, and make you feel like a different person.

Anxiety disorders are felt differently by different people, but typically you’ll be diagnosed with an anxiety disorder if your anxiety:

1. Feels out of proportion for the situation that is causing it
2. Stops you from living your normal life

Anxiety disorders are the most common type of mental disorder in the US. It’s estimated that over 40 million adults in the United States are affected each year, over 18% of the population. Although anxiety disorders are common, only around a third of people who have them seek treatment. 

Types of anxiety disorders

There are different types of anxiety disorder. They’re categorized depending on what causes your anxiety and how strongly it’s felt. You can have more than one anxiety disorder. 

These are the most widely recognized anxiety disorders:

• Generalized anxiety disorder. Your anxiety is long-lasting and/or arises frequently and disrupts your daily life. It can make you feel tense, anxious, restless, on edge, and easily tired. You may have problems concentrating and sleeping. Your anxiety is usually triggered by everyday events and worries, like your job, your relationships, your health, and minor matters like chores. Your anxiety feels disproportionate to what’s causing it. 

• Social anxiety phobia (social phobia). Your anxiety is brought on by a fear of being judged, embarrassed, humiliated, or rejected by other people. It can make you scared to interact with other people and avoid social situations. Common circumstances that trigger social anxiety are public speaking and meeting new people for the first time.

• Agoraphobia. Your anxiety is brought on by being in situations where you feel you can’t escape or that escape would be embarrassing. This fear is often out of proportion to the situation, like a fear of not being able to step out of a line. Other situations that may trigger agoraphobia can include being on public transport, being in a crowd, or being in an enclosed space or an open area. Agoraphobia can make you avoid the situations that cause it. In severe cases, you may feel unable to leave your home. 

• Separation anxiety disorder. Your anxiety is caused by separation from a person, place, or object that makes you feel safe and secure. It can make you too scared to leave the person, place, or object, and can make you worry excessively about the idea of separation. You normally won’t experience any actual adverse consequences from separation and your anxiety feels disproportionate.

• Specific phobias. You’re scared of a specific object, person, place, or activity. Often the source of your fear isn’t dangerous, or is low risk, and you know your fear is excessive, but you can’t overcome it. Examples include phobias of flying, spiders, injections, or of being hit by lightning.

• Panic disorder. Your anxiety can become so intense it can overwhelm you and cause an anxiety attack, also called a panic attack. Anxiety attacks can feel so intense you may think you’re having a heart attack or feel like you’re dying. They can give you heart palpitations, chest pain, and make it hard to breathe, as well as make you feel dizzy and disorientated, and like you’re losing control. Anxiety attacks may be brought on by other anxiety disorders.

Anxiety in children

Anxiety is a common and natural emotion in children. Usually anxiety in children is short-lived and can be assuaged by parents and caregivers. As children age, they develop ways to cope with and lessen anxiety. 

But in some instances, anxiety can become persistent and hard to cope with, and can develop into an anxiety disorder. Examples can include separation anxiety from parents or a favorite toy, phobias of school, or social anxiety around unfamiliar people.

Look out for the following symptoms of childhood anxiety:

• Irritability
• Jitteriness
• Excessive fear
• Emotional outbursts
• Muteness 
• Problems sleeping

Talk to your doctor if you think your child has an anxiety disorder.

Anxiety in teens

Teenage years can be filled with sources of anxiety. These can include study and high school pressures, changing social expectations, changes in life stages, and changes in their bodies and their thoughts and behaviors. Some of these may cause excessive anxiety that can become an anxiety disorder.

An anxiety disorder in a teenager may cause:

• Nervous behaviors 
• Shyness
• A lack of interest in social events
• Poor school performance
• Alcohol and substance abuse
• Depression

If you think your teenager has an anxiety disorder, encourage them to see a medical professional.

Anxiety symptoms

People can experience anxiety disorders in different ways, and the symptoms you may have can be different from someone else’s. The following symptoms are common:

• Restlessness
• Feeling tense or on edge
• Feelings of worry that are hard to control
• Feeling panicked and scared
• Feeling overwhelmed and out of control
• Wanting to stay at home or away from stressful places or people
• Irritability 
• Getting tired easily
• Difficulties concentrating
• Problems falling and staying asleep (insomnia)
• Stomach problems
• A rapid heart rate
• Breathing quickly, including hyperventilating 
• Difficulties breathing
• Sweating excessively
• Trembling and shaking
• Anxiety attacks (panic attacks)

What is an anxiety attack?

Anxiety attacks, also called panic attacks, are moments of extreme anxiety that can overwhelm you.

They may come on suddenly, they may build-up slowly, but they tend to be short-lasting, usually affecting you for less than 10 minutes. People experience anxiety attacks differently, however. For some people they may last seconds, for others up to an hour and even longer. 

Anxiety attacks can be debilitating, they can be so intense they can be mistaken for heart attacks. 

Anxiety attack symptoms

People experience anxiety attacks differently, but common symptoms include:

• A rapid heart rate
• Heart palpitations 
• Chest pain
• Shortness of breath
• Feelings of choking
• Nausea
• Chills and hot flashes
• Shaking and trembling
• Disorientation
• Dizziness
• Confusion
• Feelings of losing consciousness
• Feelings of being out of control
• Fear of dying

When to see a doctor?

If you feel like you’re worrying too much, you are finding things difficult to control, and your anxiety is affecting your life, you may have an anxiety disorder. If this is the case, if you have any reason to think you have an anxiety disorder, speak to a medical professional right away. 

Your doctor can make a professional diagnosis, or they can refer you to a professional who can. Anxiety is a serious condition that can make it hard to live your life. The sooner you get a diagnosis, the faster you can begin treatment. 

What causes anxiety disorders?

What causes regular, every-day anxiety to escalate into an anxiety disorder isn’t fully understood. There’s no simple explanation of the causes of anxiety disorders, but it’s thought they can be triggered by a range of factors, and that these can vary by person. They can include:

• Your genetics – you may inherit certain genes that make you more vulnerable to developing an anxiety disorder
• Stress in your life – constant background stress, sudden stressful events, or a combination of these, may trigger you to develop an anxiety disorder 
• Other mental health disorders – anxiety may be brought on or triggered by another mental disorder, like depression
• Disease and treatments – some diseases are thought to be involved in bringing on anxiety disorders, particularly long-lasting (chronic diseases). Some medications are associated with causing anxiety too, like antidepressants
• Brain chemistry – changes in brain chemistry, like levels of neurotransmitters that regulate brain function, may be involved
• Use of recreational drugs – alcohol abuse, and using cannabis and other recreational drugs may contribute to anxiety disorders

Risk factors for anxiety

The following anxiety disorder risk factors may increase your chances of developing an anxiety disorder:

• Having family members who’ve had an anxiety disorder – you may inherit genes from your family that make you more likely to develop an anxiety disorder
• Being a woman – women are more likely to develop anxiety disorders than men
• Certain personality traits, like being prone to worry and panic, fixating on details, and not having good coping strategies
• Having another mental health disorder, like depression
• Having an absent parent (missing or rarely there) during your childhood 
• Childhood trauma or witnessing traumatic events
• Experiencing a lot of stressful events in a short period of time, or constant stress, such as from a demanding job or ongoing financial worries
• Experiencing one, extremely stressful event
• Stress caused by a chronic illness, like a heart condition or diabetes
• Drug or alcohol abuse

Anxiety complications

Having an anxiety disorder can increase your risk of developing other physical or mental conditions. It can also potentially aggravate existing conditions, including:

• Depression
• Social isolation
• Problems meeting school, work, or family responsibilities 
• Insomnia (problems falling or staying asleep)
• Severe headaches and chronic pain
• Digestion and bowel problems, including irritable bowel syndrome
• Substance abuse, like alcohol and prescription and illegal drugs
• Self-harm
• Suicide

Depression and anxiety

Anxiety disorders and depression are separate mental health disorders, but they can occur together, and they are related. If you have an anxiety disorder, you may have depression too, and if you have depression, you may have an anxiety disorder. Anxiety can be a symptom of depression too, whilst depression may be brought on by an anxiety disorder. 

When you’re diagnosed for anxiety, you’ll likely be diagnosed for depression too. The good news is both conditions can be treated using similar approaches, including counseling, lifestyle changes, and medication.

Stress and anxiety

Stress is caused by demands being placed on your body and mind. In today’s world this stress is usually mental, and can be caused by workplace demands, financial worries, relationship and family issues, and the demands of balancing a busy life. 

Stress is at the heart of anxiety. Anxiety is a reaction to stress, either stress happening at the time or the worry of future stress. And like anxiety, stress isn’t always bad. Stress can give you the motivation to get something done, to complete a task, or to overcome a challenge.

But like anxiety, too much stress can be debilitating. It can cause an anxiety disorder, and it can lead to other mental and physical health complications too.

Anxiety diagnosis

If you think you have an anxiety order, you need to get yourself diagnosed. Diagnosis is the first step towards treatment.

Start by seeing your doctor. They may diagnose you themselves, or they can refer you to a mental health professional who can. Your doctor can also check your health to see if any of your symptoms are caused by another condition.

Usually a mental health professional, like a psychologist, physiatrist, or psychotherapist, will diagnose your condition. There’s no standard test for how to diagnose anxiety, it’ll usually be done by talking to you. You’ll likely go through a psychological evaluation that will involve talking about your thoughts, your symptoms, what brings your anxiety on, and more. 

The mental health professional may also compare your symptoms against those published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. They may also use an anxiety test, where they score your symptoms against a list, although there’s no standard test for anxiety evaluation. 

How to treat anxiety

There’s no standard approach for treating anxiety. But the two most common treatments for anxiety disorders are psychotherapy and medication. You may find one is more effective for you than the other, but many people find they work best in combination. 

Natural remedies and lifestyle changes can also be complementary treatments that may help.

Therapy for anxiety

Therapy goes under a range of different names, from anxiety counseling, psychotherapy for anxiety, talking therapy, counselling, to psychoanalysis. There are a wide range of different schools and approaches too, but one of the most effective and commonly used for anxiety disorders is cognitive behavioral therapy.

Cognitive behavioral therapy (CBT) focuses on understanding your thought processes and patterns of behavior around your anxiety. Often you may not be consciously aware of these, and you may be required to keep a journal or have homework assignments to help with this. You then work with the therapist to change your thoughts and behaviors in a productive way that helps you manage your anxiety.

CBT is a collaborative approach between you and your therapist. Your therapist gives you the benefit of their expertise, but they empower you to take control of your disorder. Everyone reacts differently to CBT, but many people see benefits after 12 to 16 weeks.

Anxiety medication

Anti-anxiety medications can help relieve the symptoms of your anxiety and can be an effective way to manage your condition. They make symptoms easier to live with and may even banish them entirely. 

The following types of medication may be used to treat your anxiety disorder:

• Pregabalin, sold under the brand name Lyrica, is a prescription medication used to treat generalized anxiety disorder. It’s a central nervous system depressant that lowers and calms your brain activity. It comes as either a capsule or liquid that you swallow.

• Buspirone is a prescription anti-anxiety medication. It works by changing levels of neurotransmitters in your brain. These are chemicals naturally produced by your body that regulate your brain function. Buspirone increases levels of the neurotransmitters dopamine and norepinephrine and lowers levels of serotonin. It comes as an oral pill. 

• SSRI and SNRI antidepressants. Although usually called antidepressants, a lot of these medications are also used to treat other mental disorders, like anxiety disorder. Like buspirone, they work by changing levels of neurotransmitters in your brain to influence your brain function. SSRI medications are selective serotonin reuptake inhibitors that increase levels of serotonin. SNRI medications are serotonin–norepinephrine reuptake inhibitors that increase levels of both serotonin and norepinephrine. You take them as an oral pill. Examples include:
• Prozac (SSRI)
• Zoloft (SSRI)
• Paxil (SSRI)
• Cymbalta (SNRI)
• Fetzima (SNRI)

• Sedatives. These are only used in certain, limited situations to calm you or to make you fall asleep. They’re not intended to be used long term; sedatives are used for short term relief of extreme symptoms.

Natural remedies for anxiety

Some people find natural remedies and natural supplements for anxiety can help them manage their anxiety disorder.

Supplements and natural remedies often aren’t medically proven to be effective, so they should be used alongside other treatments, rather than replacing them. They also don’t go through the same rigorous FDA evaluation as medical drugs, so you should use them with caution. Make sure you talk to a medical professional about any natural remedies or supplements you plan to take, as they can interact with other medications, like antidepressants. 

Popular natural remedies for anxiety disorders include:

• Vitamins A, B, C, D, and E
• Magnesium
• Fish oils (omega-3 fatty acids)
• Gamma-aminobutyric acid (GAMMA) – this is an amino acid that also functions as a neurotransmitter in your brain
• L-theanine, an amino acid found in green tea
• Herbal supplements like ashwagandha, bacopa, chamomile, kava kav, lavender, lemon balm, passionflower, rhodiola, St. John’s wort, and valerian

Anxiety self-help and lifestyle changes

You can make changes to your life that can help with your anxiety disorder. In addition to your other treatments, you might like to try the following anxiety self-treatments:

• Exercise. Physical activity can be a great stress reliever and regular exercise can improve both your physical and mental health.

• Eat a healthy diet. Eating healthily may help with your anxiety and will help with your general health. Aim for a diet high in fruits, vegetables, slow-burning carbs, healthy fats, and lean meats, and low in processed food, saturated fat, and sugar. 

• Get enough sleep. Not sleeping enough can harm your physical and mental health and may exacerbate your anxiety disorder. Try to follow good sleep hygiene, including having a set bedtime routine and regular sleeping and waking hours.

• Quit smoking and cut back on the coffee. Nicotine and caffeine can make anxiety worse for some people.

• Quit alcohol and recreational drugs. Alcohol and many drugs can impact your mental health and anxiety disorder.

• Reduce stress and relax. Finding pastimes and other ways to have fun that help you relax can be beneficial. Self-care is important for your mental health and can give you a break from your anxiety. What this looks like will vary by person, it could be yoga, meditating, reading, art, cooking, whatever self-care for anxiety works for you.

Anxiety support

You don’t have to deal with your anxiety disorder alone. In addition to speaking to your doctor and a medical health professional, you have other options for support.

A good place to start is the Anxiety and Depression Association of America (ADAA). It’s a nonprofit organization dedicated to the prevention, treatment, and cure of anxiety and other mental health disorders. You will find a wealth of material with advice, articles, blogs, videos; and also lists of local support groups for people with anxiety disorders.

You can also get support by talking with trained professionals for free either with a voice call or via text. You can try: 

• The Samaritans: an organization that provides someone to talk to and emotional support. You can call or text them 24 hours a day, 7 days a week on (877) 870-4673

• Crisis Text Line helps put you in touch with trained counsellors. You text CONNECT to 741741, then a trained, live counselor talks to you via text messages.

• The National Suicide Prevention Lifeline : You can call or text them 24 hours a day, 7 days a week on 1-800-273-8255

• Lifeline Chat: Part of the National Suicide Prevention Lifeline, you can chat online to someone 24 hours a day, 7 days a week.