Anxiety is a feeling of nervousness, unease, or worry that typically occurs in the absence of an imminent threat. It differs from fear, which is the body’s natural response to immediate danger.
Anxiety is part of the body's natural reaction to stress, so it can be helpful at times, making you more alert and ready for action.
Anxiety disorders and normal feelings of anxiousness are two different things. Many of us get anxious when faced with particular situations we find stressful, but if those feelings don’t subside, the anxiety could be more chronic. When feelings of fear or nervousness become excessive, difficult to control, or interfere with daily life, an anxiety disorder may be present. Anxiety disorders are among the most common mental disorders in the United States.
It’s common to think about anxiety in a way that may hinder our ability to overcome it. “The biggest misconception about anxiety is that it’s to be feared and avoided at all costs,” says Noah Clyman, a licensed clinical social worker and the director of NYC Cognitive Therapy, a private psychotherapy practice in New York City.
“I teach my clients that negative emotions, such as sadness, anger, and fear, are important to our survival, and emotional discomfort is a very normal, universal human experience,” he says.
Your heart beats fast, and your breathing speeds up. Your chest may feel tight, and you might start to sweat. If you’ve ever felt it, you know that anxiety is just as much a physical state as a mental state. That's because there's a very strong biological chain reaction that occurs when we encounter a stressful event or begin to worry about potential stressors or dangers in the future. Other physical symptoms include headaches and insomnia. Psychological symptoms may include feeling restless or tense, having a feeling of dread, or experiencing ruminative or obsessive thoughts.
Some of the most common symptoms of anxiety disorders include:
- Feelings of apprehension
- Anticipating the worst
- Tremors or twitches
When Should I Seek Treatment?
When the symptoms of anxiety and the associated behaviors are having a detrimental impact on your life and day-to-day functioning, it's important to get help.
Suma Chand, PhD, the director of the cognitive behavioral therapy program in the department of psychiatry and behavioral neuroscience at St. Louis University School of Medicine in Missouri, says a person who has panic disorder is “very avoidant of many situations that could trigger [their] panic symptoms” and the panic disorder is impacting their ability to go to work regularly, go shopping, attend church, and the like. The ability to function while in these situations is negatively impacted as well. If you’re avoiding situations that trigger your anxiety or you experience tremendous discomfort and can't function effectively when you're in those situations, it’s necessary to seek treatment.
Researchers think that various factors may contribute to anxiety. The more risk factors an individual has, the greater the likelihood that they’ll develop an anxiety disorder, notes Dr. Chand.
- Family history Having a family member with anxiety increases the likelihood of developing an anxiety disorder. Although this may suggest genetic transmission, Chand explains that “there is also the possibility of learning anxious responses from family members with anxiety.”
- Temperaments of behavioral inhibition, negative affectivity, and anxiety sensitivity Starting in infancy, according to Chand, people with a temperament of behavioral inhibition have heightened reactions to new and different situations and stimuli. This causes them to withdraw from new or unfamiliar social situations as they grow older. Negative affectivity is the tendency to experience negative emotions, while anxiety sensitivity means you’re disposed to believe that symptoms of anxiety are harmful.
- Traumatic events Children who have endured abuse (physical, emotional, or sexual) or other traumatic experiences tend to develop anxiety disorders. Adults exposed to traumatic experiences can also develop anxiety.
- Stress can be associated with the development of anxiety, whether it’s a major stressor such as a serious illness or the ongoing stress caused by work issues, financial and family conflicts, and chronic health problems. According to the National Institute of Mental Health, thyroid problems or heart arrhythmias can produce or aggravate anxiety symptoms.
- Drug or alcohol use, misuse, or withdrawal can cause anxiety.
- Brain structure Changes in the areas that regulate stress and anxiety may contribute to the disorder.
“There is a genetic component to anxiety disorders, no doubt,” says Chand. “This tends to make the individual vulnerable to developing an anxiety disorder, rather than cause them to directly inherit one,” she says. Environmental factors, she adds, interact with genetic predispositions to trigger the onset of anxiety disorders. A study published in August 2017 in the journal Emotion may offer clues as to how both genes and environment combine to make anxiety take root.
When researchers from Pennsylvania State University in State College and Rutgers University in Newark, New Jersey, showed babies pictures of angry, happy, and neutral faces, they found that the infants of anxious mothers took longer to look away from the angry faces, which meant that the infants had a tendency to focus more on potential threat.
An author of the study, Koraly Perez-Edgar, PhD, a professor of psychology at the Pennsylvania State University in University Park, says that this focus on threat may be one way that anxiety begins to take hold.
“Individuals who attend to aspects of the environment that they consider threatening can potentially create a cycle that strengthens biases toward threat, as well as toward the view that the environment is threatening, which can then lead to social withdrawal and anxiety,” she says.
“People can learn to be anxious in various situations,” says Jonathan Abramowitz, PhD, a professor of clinical psychology at the University of North Carolina in Chapel Hill and the founding editor of the Journal of Obsessive-Compulsive and Related Disorders.
“This can occur through experiences in which anxiety or fear becomes associated with a specific stimulus or a stressful or traumatic event, by learning about something fearful, and through vicarious conditioning,” he says.
Vicarious conditioning, says Dr. Abramowitz, occurs when you watch someone else experience a stressful and traumatic event — like food poisoning or being bitten by a dog — and come to see certain situations as dangerous.
When you visit your healthcare provider, you can expect that your doctor or nurse will ask you about your symptoms, perform a physical exam, and order lab tests to rule out other health problems. If tests don't reveal any other conditions, your doctor will likely refer you to a psychiatrist or psychologist to make a diagnosis.
A mental health professional will identify the specific type of anxiety disorder that's causing your symptoms. They’ll also look for any other mental health conditions that you may be experiencing, including depression.
The Different Types of Anxiety Disorders
What Is Agoraphobia?
Agoraphobia is often comorbid with panic disorder — meaning people often suffer from both conditions at the same time. It's an intense fear of not being able to escape whatever place you’re in, and can often lead to an avoidance of leaving the house. People with agoraphobia can fear situations where this anxiety might flare up, and typically don’t feel comfortable or safe in public, crowded places.
What Are Some Other Phobia-Related Disorders?
According to the American Psychiatric Association, phobias are a type of anxiety disorder. A specific phobia is an “excessive and persistent fear of a specific object, situation, or activity that is generally not harmful.” Examples include fear of flying, fear of germs, emetophobia (fear of vomiting) and arachnophobia (fear of spiders). People with specific phobias understand that their fear may be irrational, but they can't control their reaction, and their desire to avoid triggers interferes with their daily routines. Even simply thinking about the situation or thing associated with the phobia can cause anxiety.
Specific phobias, notes the Anxiety and Depression Association of America (ADAA), can develop in childhood, but the onset can also be sudden, sometimes the result of a traumatic event or experience.
What Is Generalized Anxiety Disorder (GAD)?
Generalized anxiety disorder is a condition in which your worries overwhelm you to the point where your daily routine seems difficult to carry out, and you have been worrying this way for at least six months. You may feel on edge and have difficulty focusing on tasks. There may be a tendency to fear and expect the worst; some call this catastrophic thinking. You may know that your worries are perhaps irrational, but you still go on feeling them.
What Is Panic Disorder?
Everyone has probably experienced panic, or something like it, at least once in their lifetime: on a disturbingly turbulent airplane, or before giving an important presentation, or after realizing you hit reply all when you really, really should not have. We all know the paralyzed feeling and the heightened physical sensations. But panic attacks and panic disorder take a different shape. Panic attacks have many physical symptoms and tend to peak around 10 minutes, and may last for 30. Panic disorder is diagnosed by the frequency of these attacks, and the presence of a fear of having them.
What Is Social Anxiety Disorder?
Many of us may know what it feels like to be nervous before a party, or when meeting new people or making an important phone call. Those with social anxiety disorder have very intense versions of those fears — intense fears of being judged by others that cause them to avoid those kinds of situations. For most people, fears of social situations usually subside once the intimidating event has been faced. But in social anxiety disorder, these feelings are persistent and usually last for at least six months.
It is possible to get rid of anxiety with therapy or medication, or through a combination of therapy and medication. It may also take changing your mind a bit about the power your mind has over you.
According to Clyman, “You might start to consider your emotions as changing experiences that are always fluctuating. When we feel distressed, it can seem like the distress is going to go on and on forever until we emotionally combust. But instead, emotions act more like a wave, at times increasing and becoming more intense. But inevitably they'll reach a plateau, subsiding and finally passing.”
Anxiety disorders are treated through medication and therapy. You might feel embarrassed talking about the things you are feeling and thinking, but talking about it, say experts, is the best treatment.
A particular form of therapy is considered most effective: cognitive behavioral therapy, or CBT for short, which offers patients strategies to help change the negative thought patterns that have reinforced their anxiety.
What Are the Most Common Types of Treatment for Anxiety?
There’s no one-size-fits-all approach in treating anxiety, but the most common methods are a combination of medication and psychotherapy (talk therapy).
There are dozens of drugs that can be prescribed to treat anxiety. Since each person responds to medication differently, there’s no one drug that works perfectly for everyone. You may have to work a little with a psychiatrist to find the right medication, or the right combination of medicines, that’s most beneficial to you. The drugs that are used to treat anxiety over a long period of time are antidepressants, which affect serotonin, norepinephrine, and other neurotransmitters in the brain.
What Are Some Anxiety-Relieving Techniques?
What Are Some Anxiety-Relieving Techniques?
In addition to medication and therapy, exercise can be helpful. Aerobic exercise “has been found to improve mood and anxiety by releasing endorphins and neurotransmitters such as dopamine and serotonin,” says Chand, adding that “regular moderate exercise also helps with sleep, which in turn has a beneficial impact on anxiety.”
Research suggests that yoga, meditation, and acupuncture may also reduce anxiety symptoms by reducing stress. Anecdotal evidence, notes Chand, indicates that massage therapy may be helpful in improving a sense of overall well-being.
More scientific evidence is needed to support treating anxiety disorders with aromatherapy and essential plant oils, such as lavender, but some people find they have a calming effect. Chand points out that certain scents work better for some people than others, so it’s good to try a variety.
Prevention of Anxiety
There’s no way to know when or if someone will develop an anxiety disorder. But if you’re prone to being anxious, there are steps you can take that may help keep it in check. Seek treatment early, because anxiety can be harder to treat the longer you wait. Staying active and exercising regularly is important, as is avoiding drugs and alcohol, which can increase anxiety, and limiting your caffeine intake.
According to Chand, here are some important ways to prevent the development of an anxiety disorder:
- Build a repertoire of stress management strategies, such as: break tasks down into manageable steps, plan and schedule tasks and activities in a flexible manner, and delegate and share responsibilities instead of taking on everything yourself. Routinely incorporate meditation and relaxation practices into your life to keep stress at bay.
- Good relationships and a social support system act as a protective force. Build interpersonal and communication skills to reduce stress associated with social interactions, which can sometimes be challenging.
- Create a healthy lifestyle with good sleep hygiene, healthy nutrition, regular exercise, and self-care.
- Develop coping skills geared toward facing rather than avoiding stressful problems. Use of problem-solving coping skills has been found to be helpful in reducing stress and anxiety.
- A more optimistic outlook can be achieved consciously by recognizing skewed negative thinking and establishing a more balanced perspective. The earlier this is done, the more likely it will help with prevention of anxiety disorders.
Good mental health education is also vital, says Chand. “While several steps can be taken to prevent mental health problems, people often feel helpless when they’re not armed with information. Mental health education paves the way for a society that is more mentally healthy. Early mental health education starting in schools would be ideal,” she says, adding that the initiation of such programs has yielded positive results.
Can My Diet Affect Anxiety?
Dietary changes are no substitute for treatment, but what you eat can indeed have an effect on your anxiety levels.
Foods rich in complex carbohydrates, such as whole grains, are thought to boost serotonin levels in the brain. Starting your day with protein at breakfast could also be beneficial, keeping you fuller longer and steadying your blood sugar level — which may help you feel calmer.
Limit or avoid caffeine and alcohol, as they can worsen feelings of anxiety.
Complications of Prolonged Anxiety
Anxiety disorders can negatively affect both your physical and mental health, causing new concerns or exacerbating existing ones. As noted above, anxiety can lead to depression. It can also worsen insomnia, digestive troubles, headaches, and chronic pain. The emotional toll of excessive worrying and fear can contribute to substance misuse, increasing social isolation, and problems functioning at work. Suicidal thoughts are another complication of severe anxiety.
Untreated anxiety is also linked to gastrointestinal disorders, chronic respiratory disorders, and heart disease. Anxiety can make these conditions more difficult to treat, thereby worsening outcomes.
Research and Statistics: How Many People Have Anxiety Disorders and When Do Symptoms Tend to Start?
Many people first develop symptoms of an anxiety disorder during childhood. Some anxiety disorders, such as specific phobias and social anxiety disorder, are more likely to develop in childhood or the teenage years, while others, such as generalized anxiety disorder, are more likely to start in young adulthood.
According to the World Health Organization, an estimated 4.4 percent of the world’s population suffers from anxiety disorders.
The National Institute of Mental Health reports that 19 percent of American adults are affected by an anxiety disorder each year.
A review of 48 studies published in June 2016 in the journal Brain and Behavior noted that anxiety was more prevalent in women, in people under 35, and in those who live in North America or Western European countries.
The review, conducted by researchers at Cambridge University in England, also found that people with chronic health conditions were more likely to experience anxiety. According to the review, almost 11 percent of people with heart disease in Western countries reported having generalized anxiety disorder (GAD). In addition, 32 percent of those with multiple sclerosis had some kind of anxiety disorder.
Are Anxiety Disorders More Common in Women?
Women are more than twice as likely as men to be diagnosed with an anxiety disorder. It’s not clear why this is the case, but researchers have theorized that it may be due to a combination of social and biological factors. Scientists are still investigating the complex role that sex plays in brain chemistry, but some research suggests that in women, the amygdala, which is the part of the brain responsible for processing potential threats, may be more sensitive to negative stimuli and may hold on to the memory of it longer.
Other research suggests that the hormone progesterone may act as a trigger for this response.
But some think that nature is less of an influence than nurture. Women, the theory goes, tend to be socialized in a way that gives them permission to openly discuss emotion. So women may feel more comfortable admitting to feelings than men, who tend to be socialized to keep their feelings to themselves. Women may therefore get diagnosed with anxiety disorders more often than men.
Other research suggests that social structures that contribute to inequality, such as lower wages, may play a part. In a study published in January 2016 in the journal Social Science and Medicine, Columbia epidemiologists reviewed data on wages and mood disorders, and noted that, at least in their data set, when a woman’s pay rose higher than a man’s, the odds of her having both generalized anxiety disorder and major depression decreased.
What is known for sure, says Beth Salcedo, MD, the medical director of the Ross Center for Anxiety & Related Disorders and a past board president of the ADAA, “is that more often than not, women definitely experience an uptick in anxiety before menstruation, around perimenopause, and after giving birth.”
How Common Are Anxiety Disorders in Children and Teens?
Kids and teens often experience anxious feelings and worries, but when this apprehensiveness becomes so overwhelming or persistent that it interferes with daily functioning, they may have an anxiety disorder. Anxiety disorders are the most common childhood mental health problem, affecting up to 1 in 10 children and teens, according to Boston Children’s Hospital.
Generalized anxiety disorder in children and teens may manifest as excessive worry about performance in school or sports, or catastrophic events such as natural disasters. But, as Stanford Children’s Health points out, children, unlike adults, may not understand that their anxiety is more extreme than any given situation typically warrants.
In addition to the specific types of anxiety disorders mentioned above, separation anxiety disorder can affect children. While young children frequently experience separation anxiety when they’re not in the same room as their parents, older kids who have intense fear when they’re apart from their caregivers may have separation anxiety disorder. According to the ADAA, this disorder affects 4 percent of children, and is most common in children ages seven to nine.
Data suggests that anxiety disorders may be underdiagnosed in Black patients. A study published in January 2019 in the journal Society & Mental Health examined the gap between prevalence of reported anxiety symptoms and diagnosis rates. Researchers found that Native American, white, and Hispanic/Latino Americans were more likely than Black respondents to receive an anxiety disorder diagnosis.
The National Alliance on Mental Illness (NAMI) notes that for Black Americans, barriers to care for mental health conditions include socioeconomic disparities, stigma within the community, and bias on the part of healthcare providers. NAMI also reports that Asian American and Pacific Islanders have the lowest help-seeking rate of any racial or ethnic group in the United States — with just over 23 percent of adults receiving treatment for mental health. Language barriers, cultural stigma around mental health, the "model minority" stereotype, and lack of insurance may all be contributing to treatment delays and disparities in AAPI populations, according to NAMI.
Anxiety often coexists with other chronic health conditions, including:
Depression and How It Relates to Anxiety
Depression and anxiety are different mood disorders, but it’s very common for someone with an anxiety disorder to suffer from depression, too. (This doesn't necessarily mean you have bipolar disorder.)
About half of all people diagnosed with depression also have an anxiety disorder, according to the ADAA.
Anxiety may trigger depression, or depression may trigger anxiety. Anxiety disorders may be a predictor of a major depressive episode, say researchers, and those who suffer from both anxiety and depression tend to have more severe symptoms, and earlier onset of symptoms of both.
In a large Danish study published in June 2015 in the journal Lancet Psychiatry, which followed participants for nearly 20 years, researchers confirmed that having severe anxiety or several anxiety disorders is linked to recurrent depressive episodes.
If you have both anxiety and depression, you may experience the following symptoms:
- Decreased energy and increased fatigue
- Difficulty concentrating
Obsessive-Compulsive Disorder and Anxiety
While obsessive-compulsive disorder is not officially classified by the American Psychological Association as an anxiety disorder, it shares many traits with common anxiety disorders, such as generalized anxiety disorder. In both conditions, you may know that your thoughts are irrational, but you feel unable to stop thinking them. Often, but not always, these thoughts may concern cleanliness, sex, or religion.
In obsessive-compulsive disorder, you may also think you need to carry out certain actions in order to relieve anxiety. For instance, you might not be able to leave the house without locking all the doors and checking all the appliances — twice. And the compulsion to carry out those actions may make it difficult to get through your day.
A good number of organizations and websites offer help and a wealth of information to support people with anxiety disorders. Personal help, including where and how you can find a therapist, is also available. These resources can make dealing with anxiety feel much less overwhelming.
Trusted Organizations for Essential Anxiety Information
Founded in 1979, this organization raises awareness and offers support and education on mental health disorders such as anxiety, and provides information on how to cope with these disorders. You can access free crisis support via the NAMI HelpLine and find help through the site’s online discussion groups, which have threads dedicated to dealing with various aspects of anxiety.
Through this organization, you can find free online support groups, podcasts, videos, Twitter chats, and recorded webinars dedicated to the topic of anxiety.
This respected organization of psychiatrists provides information for patients and loved ones looking for guidance on living with anxiety. You can also search for a psychiatrist through the site.
At the website for the federal government’s mental health organization, you can find current statistics and other information on anxiety and other mental disorders. The site can also help you find ongoing studies to participate in.
Sites to Make You Feel Like You’re Not the Only One
People of Color and Mental Illness Photo Project
Launched in 2014 by the Latina feminist mental health activist Dior Vargas in response to the lack of nonwhite media representations of mental illness, this is a living online self-portrait gallery dedicated to eradicating shame, stigma, and stereotypes. Those living with depression, anxiety, and other mood disorders submit photos of themselves holding signs describing their illness. It’s uplifting, moving, and funny.
The Mighty has 2 million registered users posting stories, videos, essays, and more in an effort to share raw and honest accounts of what it’s like to struggle with anxiety, depression, and other health issues. Healthcare professionals also chime in from time to time to lessen the stigma and show support. In addition, the site offers Facebook-like communities that are centered on more than 6,000 topics, ranging from sticking with self-care to living with a rare disease.
Best Books on Living and Dealing With Anxiety
In this book, Stossel, the editor of The Atlantic, draws on his personal experience with anxiety while digging into history, philosophy, and science to chronicle the ways in which we’ve attempted to deal with the condition.
A science and health reporter, Petersen herself has experienced anxiety, and she digs into the reasons it tends to affect women more than men, interviews experts in the field, and surveys current research and treatments along with her own family history.
An author and journalist, Smith deploys a sense of humor to deal with his monkey mind — a Buddhist term describing the often restless, cluttered state of the mind — in this very funny New York Times bestselling memoir.
Wilson, an Australian journalist, is no stranger to the beast that is anxiety. She interviews a range of authorities (including the actual, literal, honest-to-God Dalai Lama) around the world in this book, which is a mix of memoir, journalism, and self-help, with practical and compassionate advice for conquering said beast.
Most Anxiety-Free Online Therapy Search Experience
This site’s aesthetics make this online experience feel as calming as its name suggests. With Zencare, you can review videos of therapists and then schedule a free 10-minute phone call with them via the site to see if you’re a good match. (Providers are vetted to make sure they’re licensed by the state they work in and certified by the American Board of Psychiatry and Neurology.) You can also find information on different therapy groups, including for survivors of childhood sexual abuse and those recovering from substance abuse, in your area. The downside is that the only areas currently covered are New York, Rhode Island, Boston, Chicago, Connecticut, New Jersey, and Seattle.
Favorite (Soothingly Wise) Podcast
The multimedia publishing company Sounds True, which began in 1985 as a radio program, aims to inspire spiritual understanding and transformation. While the free podcast offered up by the Sounds True team doesn't address anxiety and other mood disorders head on, the interviews with various authors, thinkers, therapists, and scholars is a compassionate, thoughtful companion to anyone struggling with what it means to be human, and as such, imperfect.