When people experience anxiety, they also often have physical symptoms, including shortness of breath, dizziness, sweating, rapid heartbeat, and/or tremor.
Anxiety disorders often substantially change people's daily behavior, including leading them to avoid certain things and situations.
These disorders are diagnosed using standard medical criteria.
Medications, psychotherapy, or both can substantially help most people with anxiety disorders.
Anxiety is a normal response to a threat or to psychologic stress. Normal anxiety has its root in fear and serves an important survival function. When someone is faced with a dangerous situation, anxiety triggers the fight-or-flight response. With this response, a variety of physical changes, such as increased blood flow to the heart and muscles, provide the body with the necessary energy and strength to deal with life-threatening situations, such as running from an aggressive animal or fighting off an attacker. Anxiety can help a person adapt to more ordinary stressors by motivating them to prepare, practice, and rehearse. It can even prompt a person to approach potentially dangerous situations with an appropriate amount of caution.
However, anxiety is considered a disorder when it
Occurs at inappropriate times
Is so intense and long-lasting that it interferes with a person's normal activities (that is to say, it leads to maladaptive behavior)
Anxiety disorders are more common than any other category of mental health disorder and affect about one third of adults in the United States at some point during their lifetime. Significant anxiety can persist for years and begin to feel normal to the person with the anxiety. For this and other reasons, anxiety disorders are often not diagnosed or treated. They can also be associated with suicidal thoughts and suicide attempts Suicidal Behavior Suicide is death caused by an act of self-harm that is intended to be lethal. Suicidal behavior includes completed suicide, attempted suicide, and suicidal ideation (thoughts and ideas). Suicide... read more .
There are many anxiety disorders:
Specific phobia Specific Phobias Specific phobias involve persistent, unrealistic, intense anxiety about and fear of specific situations, circumstances, or objects. The anxiety caused by a phobic disorder can interfere with... read more (animal, natural environment, blood-injection-injury, situational, other situations)
Substance-induced/medication-induced anxiety disorder
Anxiety due to another medical condition
Other specified anxiety disorder (applies when a person has significant symptoms but does not meet the criteria for any specific anxiety disorder)
Most of these disorders develop in adulthood, but separation anxiety and selective mutism usually start during childhood. Doctors also evaluate people who present with severe anxiety for substance-induced/medication-induced anxiety disorder and anxiety due to another medical condition.
Other disorders that often present with prominent anxiety include acute stress disorder Acute Stress Disorder Acute stress disorder is an intense, unpleasant, and dysfunctional reaction beginning shortly after an overwhelming traumatic event and lasting less than a month. If symptoms persist longer... read more , adjustment disorders Adjustment Disorders Adjustment disorders involve emotional and/or behavioral symptoms in response to an identifiable stressor. (See also Overview of Trauma- and Stressor-Related Disorders.) Adjustment disorders... read more , and posttraumatic stress disorder (PTSD) Posttraumatic Stress Disorder (PTSD) Posttraumatic stress disorder (PTSD) involves intense, unpleasant, and dysfunctional reactions after an overwhelming traumatic event. Events that threaten death or serious injury can cause intense... read more . These disorders are brought on by traumatic or stressful experiences (see Overview of Trauma- and Stressor-Related Disorders Overview of Trauma- and Stressor-Related Disorders Trauma- and stressor-related disorders result from exposure to a traumatic or stressful event. Specific disorders include posttraumatic stress disorder (PTSD), acute stress disorder, and adjustment... read more ).
Anxiety disorders tend to occur with other medical and mental health conditions:
Mental health disorders: Depression Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more , bipolar disorder, Bipolar Disorder In bipolar disorder (formerly called manic-depressive disorder), episodes of depression alternate with episodes of mania (or a less severe form of mania called hypomania). Mania is characterized... read more substance use disorders Substance Use Disorders Substance use disorders generally involve behavior patterns in which people continue to use a substance (for example, a recreational drug) despite having problems caused by its use. The substances... read more , personality disorders Overview of Personality Disorders Personality disorders are mental health conditions that involve long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or... read more , and other anxiety disorders Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of mental health conditions, including generalized anxiety disorder... read more ,
Medical disorders: Coronary artery disease Overview of Coronary Artery Disease (CAD) Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary... read more , asthma Asthma Asthma is a condition in which the airways narrow—usually reversibly—in response to certain stimuli. Coughing, wheezing, and shortness of breath that occur in response to specific triggers are... read more , migraines Migraines A migraine headache is typically a pulsating or throbbing pain that ranges from moderate to severe. It can affect one or both sides of the head. It is often worsened by physical activity, light... read more , and arthritis Joint Disorders
How Anxiety Affects Performance
The effects of anxiety on performance can be shown on a curve. As the level of anxiety increases, performance efficiency increases proportionately, but only up to a point. As anxiety increases further, performance efficiency decreases. Before the peak of the curve, anxiety is considered adaptive because it helps people prepare for a crisis and improve their functioning. Beyond the peak of the curve, anxiety is considered maladaptive because it produces distress and impairs functioning.
Causes of Anxiety Disorders
The causes of anxiety disorders are not fully known, but the following may be involved:
Environment (such as experiencing a traumatic event or stress)
Genetic factors (including a family history of an anxiety disorder)
A physical condition (for example, an overactive thyroid gland, heart failure)
Medications, illicit drugs, or other substances (for example, caffeine, corticosteroids, cocaine)
An anxiety disorder can be triggered by environmental stresses, such as the breakup of a significant relationship or exposure to a life-threatening disaster. However, many people develop an anxiety disorder in the absence of an identifiable trigger.
When a person responds strongly to stressors or a person is overwhelmed by events, an anxiety disorder can arise. For example, some people find speaking before a group exhilarating. But others dread it, becoming anxious with symptoms such as sweating, fear, a rapid heart rate, and tremor. Such people may avoid speaking even in a small group.
Anxiety tends to run in families. Doctors think some of this tendency may be inherited, but some is probably learned by living with anxious people.
Did You Know...
Anxiety caused by a medical condition or medication
Anxiety can be caused by a medical disorder or the use or discontinuation (withdrawal) of a medication. Medical disorders that can cause anxiety include the following:
Heart disorders, such as heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more and abnormal heart rhythms Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more (arrhythmias)
Hormonal (endocrine) disorders, such as an overactive adrenal gland (hyperadrenocorticism Cushing Syndrome In Cushing syndrome, the level of corticosteroids is excessive, usually due to taking corticosteroid drugs or overproduction by the adrenal glands. Cushing syndrome usually results from taking... read more ) or overactive thyroid gland (hyperthyroidism Hyperthyroidism Hyperthyroidism is overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions. Graves disease is the most common cause of hyperthyroidism... read more ) or a hormone-secreting tumor called a pheochromocytoma Pheochromocytoma A pheochromocytoma is a tumor that usually originates from the adrenal glands’ chromaffin cells, causing overproduction of catecholamines, powerful hormones that induce high blood pressure and... read more
Lung (respiratory) disorders, such as asthma Asthma Asthma is a condition in which the airways narrow—usually reversibly—in response to certain stimuli. Coughing, wheezing, and shortness of breath that occur in response to specific triggers are... read more , chronic obstructive pulmonary disease Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease is persistent narrowing (blocking, or obstruction) of the airways occurring with emphysema, chronic obstructive bronchitis, or both disorders. Cigarette... read more (COPD), and sleep apnea Sleep Apnea Sleep apnea is a serious disorder in which breathing repeatedly stops long enough to disrupt sleep and often temporarily decrease the amount of oxygen and increase the amount of carbon dioxide... read more
It is normal for people to have some level of anxiety when they have a medical condition that they fear will make them ill or even cause death. There is no right answer about how much anxiety is reasonable or excessive for any individual person or disease. However, if it causes distress or interferes with daily functioning, the person may have an anxiety disorder that needs treatment.
Even fever can cause anxiety.
Drugs, medications, or other substances that can trigger anxiety include the following:
Many prescription medications, such as corticosteroids
Some over-the-counter medications, such an antihistamines and decongestants
Some over-the-counter weight-loss products, such as those containing the herbal product guarana, caffeine, or both
Withdrawal from alcohol Detoxification and rehabilitation Alcohol (ethanol) is a depressant (it slows down brain and nervous system functioning). Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma,... read more or sedatives Detoxification and rehabilitation Antianxiety and sedative medications are prescription drugs used to relieve anxiety and/or help with sleep, but their use can result in dependency and a substance use disorder. Using prescription... read more , such as benzodiazepines (used to treat anxiety disorders; see the appropriate entry in the table ), can cause anxiety and other symptoms, such as insomnia Insomnia and Excessive Daytime Sleepiness (EDS) The most commonly reported sleep-related problems are insomnia and excessive daytime sleepiness. Insomnia is difficulty falling asleep or staying asleep, waking up early, or a disturbance in... read more and restlessness.
Many people developed anxiety and trauma- and stressor-related disorders during the COVID-19 pandemic, and some people continue to have anxiety associated with the pandemic or a COVID-19 infection. Factors that caused fear and anxiety or made it worse include risk of illness or death, symptoms such as shortness of breath, treatment with corticosteroids, illness or death of a loved one, the need for preventive measures (masks, hand washing, lockdowns), and many other personal or social factors (such as major changes in daily routines, social isolation, or changes in school, work, family, or community). In addition, some experts think that COVID-19 infection induces a host immune response that leads to neuropsychiatric symptoms (for example, anxiety, mood changes, neuromuscular dysfunction). These neuropsychiatric reactions may be acute or part of a syndrome known as long COVID.
Anxiety may also occur in people with a life-threatening condition as a result of fear of death, pain, and difficulty breathing (see Symptoms During a Fatal Illness: Depression and Anxiety Depression and Anxiety Many fatal illnesses cause similar symptoms, including pain, shortness of breath, digestive problems, incontinence, skin breakdown, and fatigue. Depression and anxiety, confusion and unconsciousness... read more ).
Symptoms of Anxiety Disorders
Anxiety can arise suddenly, as in panic, or gradually over minutes, hours, or days. Anxiety can last for any length of time, from a few seconds to years. It ranges in intensity from barely noticeable qualms to a full-blown panic attack Panic Attacks and Panic Disorder A panic attack is a brief period of extreme distress, anxiety, or fear that begins suddenly and is accompanied by physical and/or emotional symptoms. Panic disorder involves recurrent panic... read more , which may cause shortness of breath, dizziness, an increased heart rate, and trembling (tremor).
Anxiety disorders can induce many physical symptoms, including
Nausea, vomiting, diarrhea
Shortness of breath, choking
Dizziness, faintness, sweats, hot and cold flashes
Palpitations, accelerated heart rate
Muscle tension, chest pain or tightness
It can be useful for the person to keep a detailed panic or worry diary to write down descriptions of symptoms and what factors were associated with them (day, time, any known causes of the anxiety). Remembering the details to report to the doctor after the fact can be difficult. The most successful treatment strategies often depend on addressing the specific details.
Anxiety disorders can be so distressing and interfere so much with a person's life that they can lead to depression Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more . People who have an anxiety disorder (except for certain very specific phobias Specific Phobias Specific phobias involve persistent, unrealistic, intense anxiety about and fear of specific situations, circumstances, or objects. The anxiety caused by a phobic disorder can interfere with... read more , such as fear of spiders) are at least twice as likely to have depression as those without an anxiety disorder. Sometimes people have depression first and then develop an anxiety disorder later. People may try to treat their anxiety by drinking alcohol or using drugs and develop a substance use disorder Substance Use Disorders Substance use disorders generally involve behavior patterns in which people continue to use a substance (for example, a recreational drug) despite having problems caused by its use. The substances... read more as a result.
Diagnosis of Anxiety Disorders
A doctor's evaluation, based on standard psychiatric diagnostic criteria
Deciding when anxiety is severe enough to be considered a disorder can be complicated. People's ability to tolerate anxiety varies, and determining what constitutes abnormal anxiety can be difficult. Doctors usually use the following specific established criteria:
Anxiety is very distressing.
Anxiety interferes with functioning.
Anxiety is long-lasting or keeps coming back.
Doctors look for other disorders that may be causing anxiety, such as depression Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more or a sleep disturbance Overview of Sleep Sleep is necessary for survival and good health, but why sleep is needed and exactly how it benefits people are not fully understood. One of sleep's benefits is its restorative effect on people's... read more . Doctors also ask whether relatives have had similar symptoms, because anxiety disorders tend to run in families.
Doctors also do a physical examination. Blood and other tests may be done to check for other medical disorders that can cause anxiety.
Treatment of Anxiety Disorders
Treatment of the cause, if a medical condition is found
Accurate diagnosis is important because treatment varies depending on the anxiety disorder. Additionally, anxiety disorders must be distinguished from anxiety that occurs in many other mental health disorders, which involve different treatment approaches.
If the cause of anxiety is another medical disorder or a medication, doctors aim to correct the cause. Anxiety should subside after the physical disorder is treated or the medication has been stopped long enough for any withdrawal symptoms to subside. If anxiety remains, antianxiety medications or psychotherapy (such as behavioral therapy) is used.
Many people with anxiety disorders self-medicate with substances such as alcohol, marijuana, and benzodiazepines (antianxiety medications). Not only might they be embarrassed to admit this to their doctor, but they may also be unwilling to give up these substances until their doctor comes up with a viable alternative. Self-medicating in this way is dangerous and can lead to a vicious circle of rebounding anxiety after use, followed by an urgent need to self-medicate again and again.
If an anxiety disorder is diagnosed, medications or psychotherapy Psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more (such as behavioral therapy Behavioral therapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more ), alone or in combination, can significantly relieve the distress and dysfunction for most people. Different types of psychotherapies may be used, such as cognitive behavioral therapy, mindfulness-based stress reduction, hypnosis, and supportive psychotherapy.
Benzodiazepines (such as diazepam) are commonly prescribed. For many people, antidepressants, Drug Therapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more such as selective serotonin reuptake inhibitors (SSRIs), work as well for anxiety disorders as they do for depression.
All anxiety disorders can occur along with other mental health conditions. Doctors need to treat all conditions related to the anxiety. For example, anxiety disorders often occur along with an alcohol use disorder Alcohol Use Alcohol (ethanol) is a depressant (it slows down brain and nervous system functioning). Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma,... read more . Treating the alcohol use disorder without treating the anxiety is unlikely to be effective since the person may be using alcohol to decrease the anxiety. On the other hand, treating the anxiety without addressing the alcohol disorder may be unsuccessful because daily changes in the amount of alcohol in the blood can cause levels of anxiety to fluctuate.
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
National Institute of Mental Health, Anxiety Disorders: General information on many aspects of all the anxiety disorders, including crisis lines and educational programs
Drugs Mentioned In This Article
|Generic Name||Select Brand Names|
|Cafcit, NoDoz, Stay Awake, Vivarin|
|Diastat, Dizac, Valium, VALTOCO|