Anxiety

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Introduction

What is anxiety?

Anxiety is a feeling of worry, fear or trepidation. It is normal to worry about things that affect everyday life. As part of your body’s natural defense system, healthy anxiety can help protect you by causing you to respond quickly to a dangerous situation, such as avoiding a car accident, or by helping you focus under stressful situations when you need to succeed, such as passing an exam. Mild, moderate or occasional, short-term severe anxiety is a normal reaction to stressors in daily life.

Anxiety can help people to recognize and more effectively deal with stressful situations, such as starting a new job or meeting a deadline at work. Anxiety may also occur when there isn’t a clear physical threat, such as when a child is afraid of a monster in the closet.

Feelings of anxiety can range from mild uneasiness to full-blown panic attack. Anxiety becomes a problem when the levels of anxiety are so extreme, recurring or continuous that they interfere with one’s ability to function effectively in everyday life. This level of anxiety may be caused by or can develop into an anxiety disorder.

Common anxiety disorders include:

  • Agoraphobia is characterized by anxiety that occurs when a person is in open spaces or public places.

  • Generalized anxiety disorder manifests as excessive worry and anxiety that is out of proportion to the actual situation.

  • Obsessive-compulsive disorder is a disorder in which people try to reduce their anxieties through excessive ritual and repeated behaviors.

  • Panic disorder is marked by an extreme and crippling sense of anxiety and panic.

  • Posttraumatic stress disorder occurs after a traumatizing event and is characterized by flashbacks of the terrifying event.

  • Social anxiety disorder is a persistent fear of public social situations.

The good news is that anxiety is treatable. With help, you can develop skills to help you cope with anxiety or overcome fears.  Certain activities can help reduce stress and relieve tension so that you can feel more relaxed. Medications can treat severe and chronic anxiety or anxiety disorders.

Anxiety disorders often occur along with depression or bipolar disorder, two potentially serious mental health conditions. In some cases, these disorders can be severe enough that a person can become suicidal or a danger to himself or herself or others. Seek immediate medical care (call 911) if you, or someone you are with or know, are thinking or talking about wanting to hurt or kill oneself or another person.

Symptoms

What are the symptoms of anxiety?

A key characteristic of an anxiety disorder is that anxiety becomes so extreme that instead of helping a person to deal with stress, it negatively impacts the ability to cope and function in everyday life.

For example, driving slowly and cautiously on a snowy day is a normal reaction to the stress of icy road conditions. On the other hand, being so anxious about snow that a person is unable to come out of the house on a snowy day is an excessive reaction that will negatively impact a person’s life.

The symptoms of anxiety and anxiety disorders can manifest in one’s mood, behavior, thoughts and emotions. Physical symptoms can occur as well. Typical symptoms of anxiety and anxiety disorders include:

Causes

What causes anxiety?

The sensation of anxiety is the result of the body’s reaction to stress, called the fright, fight or flight response. This natural defense reaction developed in early human evolution as a means to increase alertness and readiness to react to dangerous stressors, such as the threat of a man-eating predator.

When confronted with a stressor, your body reacts by releasing the chemical epinephrine, also known as adrenaline. Epinephrine produces effects that make your body better able to physically “fight or take flight” from a stressor. Effects include increased alertness and more rapid breathing and heart rate. These effects prepare the muscles with extra oxygen and energy they will need to work hard.

In the modern world, people most often experience stressors that cannot be addressed effectively by fighting or running away. However, epinephrine still circulates through the body in response to modern stressors, such as losing a job, balancing finances on a tight budget, cramming for a test, going through a divorce, or being late for an important appointment. This excessive circulating epinephrine results in symptoms that can manifest in one’s mood, behavior, thoughts and emotions. Physical symptoms also occur and do not let up until your body believes it is safe again.

Anxiety disorders are generally caused by underlying anxiety that is recurring or continuous or is at an extreme level that interferes with the ability to function effectively in everyday life. High levels of anxiety can also be caused by certain untreated underlying medical conditions, such as hyperthyroidism (overactive thyroid) and hypoxia (lack of oxygen reaching body tissues).

What are the risk factors for anxiety?

A number of factors are thought to increase your chances of having an anxiety disorder or are associated with anxiety. Risk factors include:

Reducing your risk for anxiety

Not all people who are at risk will develop an anxiety disorder, but you may be able to reduce your risk of anxiety by:

  • Getting enough sleep, rest and relaxation

  • Not drinking alcohol or limiting alcohol intake to one drink per day for women and two drinks per day for men

  • Not smoking or using recreational drugs

  • Participating in a regular exercise program

  • Reducing excessive stress

  • Reducing or eliminating caffeine

  • Regularly participating in leisure activities or other activities you enjoy

  • Seeking regular medical care and following your treatment plan for short-term and chronic illnesses

Treatments

How is anxiety treated?

The overall treatment goal for people living with excessive anxiety or anxiety disorders is to feel better and live normal, functional and productive lives. The first step to addressing excessive anxiety or an anxiety disorder is to diagnose and treat any underlying medical conditions, such as hyperthyroidism or hypoxia, which can cause anxiety.

There are many ways to reduce, even eliminate, the symptoms of anxiety. The most effective strategy is to address anxiety in a variety of ways. Taking inventory of stressors and developing strategies to cope with or eliminate them is an important approach.

For example, you can increase activities that help you relax or reduce anxiety, such as taking a quiet walk, getting a massage or spa treatment, or watching the game with buddies. The most important thing is to recognize what helps you to reduce anxiety and to ensure that you incorporate it regularly into your life.

Treatment of anxiety or anxiety disorders may include:

  • Complementary or alternative treatments, such as acupuncture, massage therapy, tai chi, and yoga may help to reduce stress, produce a calm state, clear the mind of anxiety-producing thoughts, and improve overall well-being. Complementary treatments are not meant to substitute for full medical care.

  • Regular exercise may allow the muscles to use and “work off” the body’s buildup of stress-induced epinephrine, which can produce symptoms of anxiety, such as irritability and muscle tension.

  • Psychotherapy (talk therapy) is when a psychotherapist builds a relationship with a client, establishes trust, and helps the client address anxiety through such techniques as communication and behavior therapy. These techniques can help you to recognize and work through situations and thought patterns that trigger anxiety, and can teach you more effective patterns of thinking, behaving and coping.

  • Regular follow-up care is very important to help monitor your treatment and progress and to promptly address any problems, medication side effects, or complications.

Medications used to treat anxiety and anxiety disorders

Medications may be used in combination with other treatments to treat anxiety and anxiety disorders. Commonly prescribed medications include:

  • SSRIs, selective serotonin reuptake inhibitors, such as Prozac, Paxil and Zoloft

  • SNRIs, serotonin and norepinephrine reuptake inhibitors, such as Effexor

  • Benzodiazepines, such as Ativan and Xanax

  • Tricyclic antidepressants, such as Tofranil

What are the possible complications of anxiety?

Complications of anxiety or an anxiety disorder can be serious and even become life threatening in some cases. You can minimize the risk of serious complications of anxiety or an anxiety disorder by following the treatment plan you and your health care professional design specifically for you.

Complications of anxiety include:

  • Decreased ability to function in work, school or daily life

  • Decreased sexual desire

  • Depression

  • Disability

  • Migraine headaches, backaches and other chronic pain

  • Poor quality of life

  • Sleep disturbances

  • Suicidal thoughts or actions

  • Worsening of symptoms of chronic diseases

Seek immediate medical care (call 911) if you, or someone you are with or know, are thinking or talking about wanting to hurt or kill oneself or another person.  

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 12
  1. Anxiety Disorders. National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml.
  2. Understanding Anxiety. Anxiety Disorders Association of America. http://www.adaa.org/understanding-anxiety.
  3. Kahan S, Miller R, Smith EG (Eds.). In A Page Signs & Symptoms, 2d ed. Philadelphia: Lippincott, Williams & Williams, 2009.
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