Anxiety Overview

Anxiety is a natural emotion. However, it can also cause physical symptoms, such as shaking and sweating. Anxiety disorders can affect daily life and can improve with treatment.

Anxiety disorders form a category of mental health diagnoses that lead to excessive nervousness, fear, apprehension, and worry.

What is Anxiety?

According to the Anxiety and Depression Association of America (ADAA), around 40 million people in the United States have an anxiety disorder. It is the most common group of mental illnesses in the country. However, only 36.9% of people with an anxiety disorder receive treatment.

The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.”

Knowing the difference between typical feelings of anxiety and an anxiety disorder requiring medical attention can help a person identify and treat the condition.

Anxiety and Anxiety Disorders

Anxiety is a complex response to real or perceived threats. It can involve cognitive, physical, and behavioral changes.

Real or perceived danger causes a  rush of adrenaline, a hormone and chemical messenger in the brain, which in turn triggers these anxiety reactions in a process called the fight-or-flight response. Some people may experience this response in difficult social situations or around important events or decisions.

The duration or severity of feelings of anxiety can sometimes be out of proportion to the original trigger or stressor. Physical symptoms, such as increased blood pressure and nausea, may also develop. These responses move beyond anxiety into an anxiety disorder.

Once anxiety reaches the stage of a disorder, it can interfere with daily function.

Symptoms

There are several different anxiety disorders, which can present with different symptoms. Typical symptoms of anxious feelings include the following:

  • Difficulty concentrating
  • Increased Irritability
  • Restlessness
  • Sleep difficulties
  • Uncontrollable feelings of worry

While many people will occasionally experience these symptoms in daily life, people with general anxiety disorder (GAD) will experience them at persistent or extreme levels.

Types of Anxiety

The Diagnostic and Statistical Manual of Mental Health Disorders, classifies anxiety disorders into several main types.

In previous editions of the DSM-5-TR, anxiety disorders included obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PSTD), as well as acute stress disorder. However, the manual no longer groups these mental health difficulties under anxiety.

Anxiety disorders include the following:

GAD

This chronic disorder involves excessive, long lasting anxiety and worries about nonspecific life events, objects, and situations. GAD is the most common anxiety disorder, and people with it are not always able to identify the cause of their anxiety.

Panic Disorder

Brief or sudden attacks of intense terror and apprehension characterize panic disorder. These attacks can lead to shaking, confusion, dizziness, nausea, and breathing difficulties. Panic attacks tend to occur and escalate rapidly.

Panic disorders usually occur after frightening experiences or prolonged stress but may also occur without a trigger.

Specific Phobia

This is a fear and avoidance of a particular object or situation. Phobias are not like other anxiety disorders, as they relate to a specific cause.

A person with a phobia might acknowledge fear as illogical or extreme but remain unable to control feelings of anxiety around the trigger. Triggers for a phobia range from situations and animals to everyday objects.

Agoraphobia

This is a fear and avoidance of places, events, or situations from which it may be difficult to escape or where help would not be available in emergencies.

People often misunderstand this condition as a phobia of open spaces and the outdoors. A person with agoraphobia may fear leaving home or using elevators and public transport.

Selective Mutism

Some children experience this form of anxiety, in which they cannot speak in certain places or contexts, even though they may have excellent verbal communication skills around familiar people.

Social Anxiety Disorder

This is a fear of adverse judgment from others in social situations or of public embarrassment. Social anxiety disorder includes a range of feelings, such as stage fright, a fear of intimacy, and anxiety around humiliation and rejection.

Separation Anxiety Disorder

High anxiety levels after separation from a person or place that provides feelings of security or safety characterize separation anxiety disorder. Separation anxiety is most common in young children but can affect people of all ages.

Causes of Anxiety

The causes of anxiety disorders are complicated. Many might occur at once, some may lead to others, and some might not lead to an anxiety disorder unless another is present.

Possible causes include:

  • Environmental stressors, such as relationship problems or family issues
  • Genetics
  • Medical factors, such as disease symptoms or the effects of a medication
  • Substance withdrawal

Treatment of Anxiety

Treatment often consists of psychotherapy, behavioral therapy, and medication.

Sometimes, alcohol dependence, depression, or other underlying conditions require treatment before treating an anxiety disorder can take place.

Self-Treatment

Sometimes, a person can treat an anxiety disorder at home without clinical supervision. However, this may not be effective for severe or long-term anxiety disorders.

There are several exercises and actions to help a person cope with milder, more focused, or shorter-term anxiety disorders, including:

  • Stress management
  • Maintaining support networks
  • Physical exercise 
  • Relaxation techniques

Counseling

A standard way of treating anxiety is psychological counseling. This can include cognitive behavioral therapy (CBT), psychotherapy, or a combination of therapies.

CBT is a type of psychotherapy that aims to recognize and change harmful thought patterns that form the foundation of anxious and troublesome feelings.

Medications

A person can support anxiety management with several types of medication.

Medicines that might control some physical and mental symptoms include antidepressants, benzodiazepines, and tricyclic antidepressants.

  • Benzodiazepines: A doctor may prescribe these for certain people with anxiety, but they can cause addiction. Diazepam, or Valium, is a common benzodiazepine.
  • Antidepressants: These commonly help with anxiety, even though they also target depression. 
  • Tricyclic antidepressants: These are an older class of drugs that benefit most anxiety disorders other than obsessive-compulsive disorder (OCD). Imipramine and clomipramine are two examples of tricyclics.

Additional drugs a person might use to treat anxiety include:

  • Beta-blockers
  • Monoamine oxidase inhibitors (MAOIs) 
  • Buspirone


Prevention of Anxiety

There are ways to reduce the risk of anxiety disorders. Remember that anxious feelings are a natural factor of daily life, and experiencing them does not always indicate the presence of a mental health disorder.

People may benefit from the following:

  • Avoiding alcohol and drugs
  • Reducing caffeine intake
  • Checking with a health professional before using over-the-counter or herbal remedies
  • Eating balanced diet
  • Maintaining a regular sleep pattern
  • Regular exercise 

Summary

Anxiety is not a medical condition but a natural emotion that is vital for survival when an individual faces danger.

An anxiety disorder develops when this reaction becomes exaggerated or out-of-proportion to the trigger that causes it. There are several types of anxiety disorders, including panic disorder, phobias, and social anxiety.

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