Most of us have experienced anxiety or will at some point in the future. It’s normal to feel worried from time to time. Everyday stressors — such as finances, health and relationships — are common triggers for anxiety. In most cases, anxiety is temporary and manageable.
However, for many people, anxiety may escalate in intensity or progress to a chronic mental health condition, such as generalized anxiety disorder (GAD), in which anxiety symptoms last for months or longer. These chronic conditions are typically much more disruptive to daily life and may need careful management in collaboration with your health care providers.
According to the National Institute of Mental Health (NIMH), anxiety disorders will affect an estimated 31% of adults in the United States at least once in their lives. Anxiety symptoms of any degree may negatively impact your life and shouldn’t be ignored. If you’re able to recognize the effects, there is a wide range of tools you may use to help ease them.
Here, we’ll cover what anxiety is, its causes and risk factors, its symptoms, and the most common anxiety disorders.
What is anxiety?
Anxiety is best described as a feeling similar to fear or worry in response to a perceived future threat that may or may not be real or rational. It varies in intensity between individuals and over time. It’s often triggered by external causes that may have uncertain effects, such as a serious health issue or upcoming exam.
Anxiety is distinct from the simple emotions of fear or worry because it’s unusually intense, accompanied by heightened stress and arises in response to an abstract future threat — real or imagined — rather than a clear and direct threat.
Sometimes, anxiety has no obvious cause or occurs much more often than it should. This may be a sign that you have an anxiety disorder or that you might develop one if the problem isn’t addressed.
When the anxiety is constant or severe enough to make your daily life more difficult, the anxiety may have developed into a defined anxiety disorder.
Anxiety causes and risk factors
As noted above, anxiety may be triggered by a wide range of common, everyday problems. Anxiety tends to appear before the triggering event occurs, when its outcome is still uncertain. However, not every stressful (or potentially stressful) event will trigger anxiety, or it won’t do so consistently, even when it has before.
There are many factors that may cause you to start experiencing anxiety or worsen the anxiety you already have. These include, but are not limited to:
Anxiety typically causes a mix of emotional, behavioral and physical symptoms, and these may contribute to or worsen one another. For example, a pounding heart may cause a person to feel intense fear about having a heart attack, even if this physical experience is temporary and not indicative of a health problem.
The type and intensity of these symptoms is variable and depends on the person, the situation and whether and which type of anxiety disorder is present. According to NIMH, the most common symptoms include:
- Nervousness
- Irritability
- A rapid heart rate
- Intense worry or fear
- Panic
- Avoidance of places, people, objects, behaviors or situations that have caused anxiety in the past or that you fear will cause anxiety
- Difficulty concentrating
- Sleep problems
- Unexplained aches and pains that may affect any part of your body — common areas include the head, chest and stomach
- A feeling of impending doom
- Trembling
- Numbness or tingling
- Sweating that is abnormal for the situation
There are treatments for anxiety. Your health care provider may use a combination of medications and counseling or other behavioral interventions. The treatment(s) selected will depend on, among other factors:
- Your diagnosis
- What you’ve tried before
- The severity of your symptoms
- Your preferences
- Your treatment goals
If your health care provider determines that your anxiety is likely caused by another condition, treatment for that condition should improve the anxiety symptoms.
For anxiety unrelated to other conditions, NIMH notes that these anxiety medications may be offered:
- Selective serotonin reuptake inhibitors (SSRIs). These are used to treat depression, anxiety or a combination of both depression and anxiety.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). These are similar to SSRIs, and they’re most often used to treat GAD.
- Benzodiazepines. These are used for short-term, occasional and severe symptoms only, as there is a high risk of dependence and also tolerance (where one needs to have an increased amount over time to have the same effect).
- Beta blockers. These are used off-label to help with the physical symptoms of anxiety, such as a rapid pulse, sweating and jitteriness.
Non-drug anxiety treatments
Some non-drug treatments available for a wide range of anxiety disorders include:
- Cognitive behavioral therapy (CBT)
- Acceptance and commitment therapy (ACT)
- Psychodynamic therapy
- Exposure therapy (for phobias)
- Hypnosis
- Biofeedback
- Mindfulness-based stress reduction (MBSR) techniques, which may include meditation, deep breathing, guided visualization, tai chi or yoga
- Art or music therapy
- Exercise
Anxiety disorders take many different forms. A person with one anxiety disorder may also have others at the same time. In general, women are more likely than men to experience any kind of anxiety disorder.
Below are the diagnostic categories outlined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
Generalized anxiety disorder (GAD)
GAD is a chronic condition marked by persistent, low to moderate anxiety that’s typically nonspecific (i.e., not confined to a limited number of specific situations).
According to the American Psychiatric Association (APA), GAD affects an estimated 2% of adults in the United States. It may last months or years, and people with GAD tend to be aware that they worry too much or out of proportion to the perceived threat(s).
The most common treatment for GAD is a combination of psychotherapy and medication.
Panic disorder
Panic disorder is a condition in which a person has multiple panic attacks.
The APA notes that it affects an estimated 2% to 3% of adults in the United States.
These are generally short-term episodes in which a person feels extremely fearful and may have physical symptoms, including:
- Shaking
- Dizziness
- Chills
- Muscle pain
- Shortness of breath
Psychotherapy is the first-line treatment for panic disorder, as it may help a person recognize and manage their symptoms in order to help prevent future panic attacks. Medications — such as SSRIs, benzodiazepines or beta blockers — may be introduced if therapy doesn’t offer enough relief.
Social anxiety disorder is a situational condition in which a person’s anxiety is largely triggered by social situations, such as meeting new people, social gatherings or public speaking.
According to the APA, in the United States, social anxiety disorder affects an estimated 7% of adults.
The most common treatment is specialized CBT, alongside exposure therapy, psychotherapy and SSRIs.
Specific phobias
A specific phobia is a lasting and intense fear of a generally harmless object, situation or activity that can’t be easily overcome, even if the person experiencing it knows that their reaction is excessive.
The APA notes that between 8% and 12% of adults in the United States are estimated to have a specific phobia. The reaction is typically very stressful and will often cause the person to go to great lengths to avoid situations where it will be triggered.
Common phobias include:
- Heights (acrophobia)
- Spiders (arachnophobia)
- Cramped spaces (claustrophobia)
Treatment for phobias is variable, but the most common include:
- ACT
- Psychotherapy
- CBT
- Exposure therapy
Agoraphobia
Agoraphobia is a severe and disproportionate fear of leaving one’s home or other safe place, especially to enter crowds or confined spaces such as elevators and movie theaters.
According to the APA, in the United States, it affects an estimated 1% to 3% of adults.
Though it’s related to other phobias, agoraphobia is distinct and disruptive enough to have its own category. It’s usually treated with CBT and, in some cases, medications such as antidepressants.
Selective mutism
Selective mutism is a rare anxiety disorder in which a person (usually a child) stops speaking entirely in certain situations when they will speak normally in others.
According to the American Speech-Language-Hearing Association (ASHA), it’s difficult to find accurate incidence numbers for selective mutism, but some studies estimate that the disorder affects between 0.2% and 1.6% of children. It almost always starts in childhood, and it may continue into adulthood in some cases.
Many children simply outgrow selective mutism. For those who don’t, CBT is a common treatment, and SSRIs have also shown some success.
Substance/medication-induced anxiety disorder
Substance/medication-induced anxiety disorder is anxiety that has a clear and specific cause: a drug (either regulated or illicit) or alcohol. Side effects, effects of illicit use or misuse and withdrawal may all trigger this kind of anxiety. Often, the anxiety will fade with the effects of the substance or withdrawal.
Anxiety disorder due to another medical condition
Anxiety disorder due to another medical condition is when the anxiety symptoms are secondary to another (typically physical) health condition. In many cases, the anxiety will resolve when the underlying health condition is successfully managed.
References:
National Institute of Mental Health (NIMH): Anxiety Disorders.
National Institute of Mental Health (NIMH): Any Anxiety Disorder.
American Psychiatric Association (APA): What Are Anxiety Disorders?
American Psychological Association (APA): Anxiety.
StatPearls: Anxiety.
U.S. National Library of Medicine MedlinePlus: Anxiety.
Temple Health: How to Cope with COPD and Anxiety.
Middle East Current Psychiatry: Depression and Anxiety Among Hyperthyroid Female Patients and Impact of Treatment.
Focus: Anxiety Disorders and General Medical Conditions.
Dialogues in Clinical Neuroscience: Treatment of Anxiety Disorders.
Frontiers in Psychology: The Effectiveness of Art Therapy for Anxiety in Adult Women.
JMIR Mental Health: Biofeedback-Based Connected Mental Health Interventions for Anxiety.
American Speech-Language-Hearing Association (ASHA): Selective Mutism.
European Child & Adolescent Psychiatry: Treatment of Selective Mutism.
