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Anxiety Disorders

Overview

Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. You may avoid places or situations to prevent these feelings. Symptoms may start during childhood or the teen years and continue into adulthood.

Examples of anxiety disorders include generalized anxiety disorder, social anxiety disorder (social phobia), specific phobias and separation anxiety disorder. You can have more than one anxiety disorder. Sometimes anxiety results from a medical condition that needs treatment.

Whatever form of anxiety you have, treatment can help.

How common are anxiety disorders?

Anxiety disorders are some of the most common mental health conditions:

Specific phobias affect up to 12% of the U.S. population.

Social anxiety disorder affects about 7% of the U.S. population.

Generalized anxiety disorder affects about 3% of the U.S. population.

Agoraphobia affects up to 1.7% of the U.S. population.

Separation anxiety disorder affects about 4% of children, 1.6% of adolescents and up to 1.9% of adults.

Selective mutism is the least common anxiety disorder. It affects between 0.47% and 0.76% of the U.S. population.

Symptoms

Common anxiety signs and symptoms include:

Psychological symptoms may include:

Feeling panic, fear, dread and uneasiness.

Feeling on edge or irritable.

Uncontrollable, obsessive thoughts.

Difficulty concentrating.

Physical symptoms may include:

Restlessness.

Heart palpitations.

Shortness of breath.

Muscle tension.

Cold or sweaty hands.

Dry mouth.

Nausea.

Numbness or tingling in your hands or feet.

Difficulty falling asleep or staying asleep (insomnia).

It’s important to talk to your healthcare provider or a mental health professional if you frequently experience these symptoms.

Several types of anxiety disorders exist:

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.

Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events — even ordinary, routine issues. The worry is out of proportion to the actual circumstance, is difficult to control and affects how you feel physically. It often occurs along with other anxiety disorders or depression.

Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). These panic attacks may lead to worrying about them happening again or avoiding situations in which they've occurred.

Post-traumatic stress disorder (PTSD). A traumatic event triggers this type of anxiety. You may experience panic attacks or more general symptoms like sleep problems, muscle tension or constant worry. These attacks associated with PTSD can come up out of nowhere, even when the cause is unidentified, but they’re often rooted in a past traumatic experience.

Selective mutism is a consistent failure of children to speak in certain situations, such as school, even when they can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.

Separation anxiety disorder is a childhood disorder characterized by anxiety that's excessive for the child's developmental level and related to separation from parents or others who have parental roles.

Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.

Specific phobias are characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.

Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that are a direct result of misusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.

Other specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don't meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.

When to see a doctor

See your doctor if:

You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your life

Your fear, worry or anxiety is upsetting to you and difficult to control

You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety

You think your anxiety could be linked to a physical health problem

You have suicidal thoughts or behaviors — if this is the case, seek emergency treatment immediately

Your worries may not go away on their own, and they may get worse over time if you don't seek help. See your doctor or a mental health provider before your anxiety gets worse. It's easier to treat if you get help early.

Causes

The causes of anxiety disorders aren't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety. Inherited traits also can be a factor.

Medical causes

For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem.

Examples of medical problems that can be linked to anxiety include:

Heart disease

Chemical imbalances

Diabetes

Brain changes

Thyroid problems, such as hyperthyroidism

Genetics

Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma

Environmental factors

Drug misuse or withdrawal

Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications

Chronic pain or irritable bowel syndrome

Rare tumors that produce certain fight-or-flight hormones

Sometimes anxiety can be a side effect of certain medications.

It's possible that your anxiety may be due to an underlying medical condition if:

You don't have any blood relatives (such as a parent or sibling) with an anxiety disorder

You didn't have an anxiety disorder as a child

You don't avoid certain things or situations because of anxiety

You have a sudden occurrence of anxiety that seems unrelated to life events and you didn't have a previous history of anxiety

Risk factors

These factors may increase your risk of developing an anxiety disorder:

Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.

Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.

Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family, work stress or ongoing worry about finances.

Personality. People with certain personality types are more prone to anxiety disorders than others are.

Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder.

Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.

Drugs or alcohol. Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.

Complications

Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical conditions, such as:

Depression (which often occurs with an anxiety disorder) or other mental health disorders

Substance misuse

Trouble sleeping (insomnia)

Digestive or bowel problems

Headaches and chronic pain

Social isolation

Problems functioning at school or work

Poor quality of life

Suicide

Prevention

Currently, there’s no known way to prevent anxiety disorders. But you can lessen many of the related issues with treatment. Seeking help as soon as symptoms appear can help decrease the disruption to your life.

Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.

Stay active. Participate in activities that you enjoy and that make you feel good about yourself. Enjoy social interaction and caring relationships, which can lessen your worries.

Avoid alcohol or drug use. Alcohol and drug use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a support group to help you.

Diagnosis

If you or your child are experiencing symptoms of an anxiety disorder, see a healthcare provider. They’ll start with a medical evaluation. They’ll do a physical exam and ask about your medical history, any medications you’re taking and if any of your family members have been diagnosed with an anxiety disorder.

There aren’t any blood tests or imaging scans that can diagnose anxiety disorders. But your provider may run some of these tests to rule out physical conditions that may be causing your symptoms, like hyperthyroidism, for example. If there isn’t an underlying physical cause, your provider may refer you to a mental health professional.

A mental health professional, such as a psychologist or psychiatrist, will do an interview or survey, asking questions about your symptoms, sleeping habits and other behaviors. They use criteria in the American Psychiatric Association’s DSM-5 to make diagnoses of anxiety disorders.

To help diagnose an anxiety disorder, your mental health provider may:

Give you a psychological evaluation. This involves discussing your thoughts, feelings and behavior to help pinpoint a diagnosis and check for related complications. Anxiety disorders often occur along with other mental health problems — such as depression or substance misuse — which can make diagnosis more challenging.

Compare your symptoms to the criteria in the DSM-5. Many doctors use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose an anxiety disorder.

Treatment

The two main treatments for anxiety disorders are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

Psychotherapy

“Psychotherapy,” also called talk therapy, is a term for a variety of treatment techniques that aim to help you identify and change unhealthy emotions, thoughts and behaviors. A mental health provider talks through strategies to help you better understand and manage an anxiety disorder. Approaches include:

Cognitive behavioral therapy (CBT): This is the most common type of psychotherapy to help manage anxiety disorders. CBT for anxiety teaches you to recognize and identify thought patterns and behaviors that lead to troublesome feelings. You then work on changing the thoughts and your reactions to triggering situations.

Exposure therapy: This is a type of therapy in which a mental health provider creates a safe environment to expose you to your fears. Fears may be things, situations and/or activities. Exposure therapy helps show you that you’re capable of confronting your fears. You’ll learn to attach new, more realistic beliefs to the things you’re afraid of. You’ll become more comfortable with the experience of fear.

Medications

Two types of medication may help manage your symptoms:

Daily. You can take some medications regularly to prevent anxiety as a whole.

As-needed. You can take medications only when an episode occurs to lessen how your body reacts to specific moments that trigger your anxiety. This is perhaps most helpful when providing clarity to a specific situation or managing physical symptoms of anxiety like muscle tension, nausea and stomach ache in the moment they happen.

Several types of medications are used to help relieve symptoms, depending on the type of anxiety disorder you have and whether you also have other mental or physical health issues.

For example:

Antidepressants: While they mainly treat depression, these medications can also help with anxiety disorders. They adjust how your brain uses certain chemicals to improve mood and reduce stress. Antidepressants may take some time to work, so try to be patient. SSRIs and SNRIs are the go-to types of antidepressants for anxiety. Tricyclic antidepressants are another option, but they cause more side effects.

Benzodiazepines: This class of medications may decrease your anxiety, panic and worry. They work quickly, but you can build up a tolerance to them. They also have addiction potential, so you have to take them cautiously. Your healthcare provider may prescribe a benzodiazepine for the short term, then taper you off. Benzodiazepines that can help treat anxiety disorders include alprazolam, clonazepam, diazepam and lorazepam.

Beta-blockers: These medications can help reduce some of the physical symptoms of anxiety disorders, like rapid heartbeat, shaking and trembling. They don’t treat the psychological aspects of anxiety disorders.

Your healthcare provider will work with you to find the right medication combination and dosage. Don’t change the dose or stop taking medications without talking to your provider first. They’ll monitor you to make sure the medicines are working without causing negative side effects.

Lifestyle and home remedies

While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here's what you can do:

Keep physically active. Develop a routine so that you're physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities.

Avoid alcohol and recreational drugs. These substances can cause or worsen anxiety. If you can't quit on your own, see your doctor or find a support group to help you.

Quit smoking and cut back or quit drinking caffeinated beverages. Both nicotine and caffeine can worsen anxiety.

Use stress management and relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.

Make sleep a priority. Do what you can to make sure you're getting enough sleep to feel rested. If you aren't sleeping well, see your doctor.

Eat healthy. Healthy eating — such as focusing on vegetables, fruits, whole grains and fish — may be linked to reduced anxiety, but more research is needed.

Alternative medicine

Several herbal remedies have been studied as a treatment for anxiety, but more research is needed to understand the risks and benefits. Herbal and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are. You can't always be certain of what you're getting and whether it's safe. Some of these supplements can interfere with prescription medications or cause dangerous interactions.

Before taking herbal remedies or dietary supplements, talk to your doctor to make sure they're safe for you and won't interact with any medications you take.

Coping and support

To cope with an anxiety disorder, here's what you can do:

Learn about your disorder. Talk to your doctor or mental health provider. Find out what might be causing your specific condition and what treatments might be best for you. Involve your family and friends and ask for their support.

Stick to your treatment plan. Take medications as directed. Keep therapy appointments and complete any assignments your therapist may give you. Consistency can make a big difference, especially when it comes to taking your medication.

Take action. Learn what triggers your anxiety or causes you stress. Practice the strategies you developed with your mental health provider so you're ready to deal with anxious feelings in these situations.

Keep a journal. Keeping track of your personal life can help you and your mental health provider identify what's causing you stress and what seems to help you feel better.

Join an anxiety support group. Remember that you aren't alone. Support groups offer compassion, understanding and shared experiences. The National Alliance on Mental Illness and the Anxiety and Depression Association of America provide information on finding support.

Learn time management techniques. You can reduce anxiety by learning how to carefully manage your time and energy.

Socialize. Don't let worries isolate you from loved ones or activities.

Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.

Preparing for your appointment

You may start by seeing your primary care provider. He or she may refer you to a mental health professional.

What you can do

Before your appointment, make a list of:

Your anxiety symptoms. Note when they occur, whether anything seems to make them better or worse, and how much they affect your day-to-day activities and interactions.

What causes you stress. Include any major life changes or stressful events you've dealt with recently. Also note any traumatic experiences you've had in the past or as a child.

Any family history of mental health problems. Note if your parents, grandparents, siblings or children have struggled with any mental health problems.

Any other health problems you have. Include both physical conditions and mental health issues.

All medications you're taking. Include any medications, vitamins, herbs or other supplements, and the doses.

Questions to ask your doctor to make the most of your appointment.

Some basic questions to ask your doctor include:

What's the most likely cause of my anxiety?

Are there other possible situations, psychological issues or physical health problems that could be causing or worsening my anxiety?

Do I need any tests?

Should I see a psychiatrist, psychologist or other mental health provider?

What type of therapy might help me?

Would medication help? If so, is there a generic alternative to the medicine you're prescribing?

In addition to treatment, are there any steps I can take at home that might help?

Do you have any educational materials that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you several questions, such as:

What are your symptoms, and how severe are they? How do they impact your ability to function?

Have you ever had a panic attack?

Do you avoid certain things or situations because they make you anxious?

Have your feelings of anxiety been occasional or continuous?

When did you first begin noticing your feelings of anxiety?

Does anything in particular seem to trigger your anxiety or make it worse?

What, if anything, seems to improve your feelings of anxiety?

What traumatic experiences have you had recently or in the past?

What, if any, physical or mental health conditions do you have?

Do you take any prescription drugs?

Do you regularly drink alcohol or use recreational drugs?

Do you have any blood relatives who have anxiety or other mental health conditions, such as depression?

Preparing and anticipating questions will help you make the most of your time.

Living with Anxiety

How can I take care of myself if I have an anxiety disorder?

Aside from seeking professional medical help and treatment, certain strategies can help you manage an anxiety disorder and make treatment more effective. They include:

Stress management: Chronic or intense stress worsens anxiety disorders. Explore stress management techniques, like meditation, breathing exercises, mindfulness and regular exercise.

Support groups: Participating in a support group for people with anxiety — in-person or online — can provide opportunities to relate to others, share experiences and learn different coping strategies.

Education: Learning more about your condition and educating loved ones can help you and them better understand the condition and offer support.

Limiting or avoiding caffeine: Caffeine can make the physical symptoms of anxiety worse. Talk to your healthcare provider if you’re concerned about your level of caffeine consumption.

Related Support Group Web Sites

National Institutes of Mental Health (NIMH)

Anxiety Disorders Association of America

Center for the Study of Traumatic Stress

Gateway to Posttraumatic Stress Disorder Information

Helpful Apps

Calm (Apple) | (Android)

Worry Time (Apple)

Breathe (Apple Watch)

Triangle of Life (iPhone) | (iPad)

When should I see my healthcare provider?

Your healthcare provider is your partner in your care. If you feel like treatment for an anxiety disorder isn’t working or have questions about your medication, contact your provider. Together, you can figure out how to best move forward.

One Final Note..

You don’t need to live with constant worry and fear. If you notice symptoms of an anxiety disorder, talk to a healthcare provider. It’s best to get diagnosed and treated as soon as possible. Doing so can limit the problems that anxiety disorders can cause. Often, a combination of medications and counseling for anxiety can help you feel your best.

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