Anxiety: Symptoms, Causes and Treatment

Anxiety is the most common mental health issue people face. About one in three Americans will develop an anxiety disorder in the lifetime.[1] Anxiety is another word for worry. It is the body’s mental and physical response to imagined threats that may occur. It differs from fear, which is the body’s response to real and present threats. Some anxiety is helpful and keeps us alive. But too much can interfere with your life.

Table of Contents

1. Symptoms of Anxiety
2. Anxiety Disorders
3. Anxiety Tests
4. Causes of Anxiety
5. Anxiety Treatment

Seven Symptoms of Anxiety

Anxiety is a physical, emotional, and psychological response:

• Chest: Chest tightness, difficulty breathing
• Heart: Racing heart, skipped beats, palpitations
• GI: Nausea, vomiting, diarrhea, stomach aches
• Muscles: Muscle tension, twitches, tremors, shakes, muscle aches
• Skin: Sweating, tingling
• Sleep: Insomnia, difficulty falling asleep or staying asleep
• Cognitive: Restlessness, poor concentration, poor memory, irritability

Fight-or-Flight Response and Anxiety Symptoms

When you are anxious, your body goes into fight or flight mode and releases adrenaline. Even though the threat is imagined, your primitive brain behaves as if you are under a real threat. It gets ready to fight or run.

Too much adrenaline explains all the physical, emotional, and cognitive symptoms of anxiety. Adrenaline causes your heart to pump faster, so that you have more energy to fight. But this also makes you prone to skipped beats and arrhythmias. You begin to sweat so that you can stay cool when you run. You automatically start breathing from your chest instead of from your diaphragm so that you can take in more oxygen. But breathing from your chest is harder when you're at rest, so you feel as if you're choking or being smothered.

Blood is drained away from your nonessential organs like your gastrointestinal tract, which makes you feel nauseous. Your brain becomes hyperactive so that you can detect threats quickly. But it's harder to think clearly.

Anxiety Disorders

If your anxiety is severe enough it may escalate to the level of an anxiety disorder. Here are some of the signs of an anxiety disorder.

• Are you tense or worried much of the time?
• Does your anxiety interfere with your work, school, social or family life?
• Do you avoid everyday situations or activities because they cause anxiety?
• Have your symptoms lasted for at least a few months?
• Are your symptoms getting worse?

There are seven major anxiety disorders recognized in the DSM-5.[2] It is possible to have more than one.

Social anxiety disorder

You have an intense fear of being criticized, judged, rejected, embarrassed, or offending others. Performance anxiety or stage fright are the most common types of social anxiety. You prefer to avoid social situations such as public speaking, eating in public, being assertive at work, or making small talk. (Learn more about social anxiety disorder.)

Generalized anxiety disorder (GAD)

You excessively worry about many things most of the time. You worry that something bad is going to happen. You feel restless, irritable, exhausted, and may have trouble concentrating and/or sleeping. (Learn more about generalized anxiety disorder.)

Panic disorder

A panic attack is an episode of intense fear or impending doom that happens suddenly and without warning. You may feel dizzy, sweaty, have a pounding heart, and feel like you can’t breathe. A panic disorder is recurrent panic attacks or a persistent fear of having another attack. (Learn more about panic disorder.)

Agoraphobia

You are anxious about being in places or situations in which escape might be difficult or embarrassing. Common examples are fear of using public transit, being in open spaces, being outside alone, being in enclosed spaces, standing in line, or being in a crowd. (Learn more about agoraphobia.)

Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder has two parts: obsessions are intrusive and recurrent thoughts; compulsions are rituals or behavior that you have a strong urge to repeat, which bring temporary emotional relief. You can have one or the other or both. For example, a fear of germs may lead you to frequently wash your hands, or a fear of overlooking something may lead you to repeatedly checking things. (Learn more about obsessive-compulsive disorder.)

Specific phobias

You have an overwhelming fear of an object or situation that is out of proportion to the actual danger posed, and you go to great lengths to avoid the object or situation. Examples of specific phobias are fear of animals such as snakes or spiders, fear of flying, fear of heights, or fear of seeing blood. (Learn more about specific phobias.)

Post-traumatic stress disorder (PTSD)

PTSD can happen after you have experienced a traumatic event such as war, disaster, accident, or an assault. After the event, you may repeatedly relive the trauma with upsetting dreams or flashbacks and try to avoid situations or things related to the event. (Learn more about post-traumatic stress disorder.)

Labelling Anxiety Disorders

What are the advantages and disadvantages of labelling anxiety as a “disorder”? The advantages are that you can finally give your symptoms a name, which may help you feel like you’re not alone. It may also encourage you to seek treatment, and may help you get insurance coverage, disability support or job protection.

The disadvantages are that it “medicalizes” your symptoms, which may make you feel like you’re somehow broken even though anxiety is common. It may encourage you to only look for medical solutions without working on the underlying issues that may have caused your anxiety. You must decide which approach to take.

Anxiety Tests

The following tests are considered the most reliable for diagnosing anxiety disorders:

• Generalized Anxiety Disorder Screening Test – GAD7 (pdf)
• Obsessive Compulsive Disorder Screening Test – Yale-Brown-YBOCS (pdf)
• Post-Traumatic Stress Disorder-PTSD Screening Test – PC-PTSD-5 (pdf)

Currently there are no self- screening tests for panic disorder, agoraphobia, or specific phobias, perhaps because these are relatively easier to identify. However, there are clinician-administered tests for all anxiety disorders that are used to monitor therapeutic progress once a diagnosis has been made.

How Common Are Anxiety Disorders?

The prevalence of anxiety disorders varies greatly across developed nations. In decreasing prevalence, 30% of Americans, 25% of French people, 15% of Germans, 11% of Italians, 10% of Spanish people, and 7% of Japanese, will develop some kind of anxiety disorder during their lifetime.[3]

Causes of Anxiety

Before looking at the treatment of social anxiety disorder, it helps to understand the causes because that can help guide you to the appropriate treatment.

External Factors

Socioeconomic factors can increase your risk of anxiety, including, living alone, low level of education, and unemployment.[4]

The era you were born in can increase your risk of anxiety. Two large studies have shown that recent generations are more anxious than previous generations.[5]

The increase in anxiety has been so dramatic that the average American child in the 1980s is more anxious than children who received psychiatric care in the 1950s. Studies suggest that a decrease in social connectedness and an increase in possible threats may be responsible for the rise in anxiety.[5][
Here are some external factors that can lead to stress:

• work stress
• isolation, not having a support network
• harassment, bullying
• unemployment
• financial stress
• family and relationship problems
• illness, declining health
• trauma, abuse
• death, loss of a loved one

Coping Skills

External factors affect your life to some degree, but how you interpret external factors also plays a role. Suppose you make a mistake at work. Your level of anxiety depends on how you interpret that mistake. If you think that you have to be perfect, you will interpret that mistake as a major failure. You may even take it as proof that you are a failure.

Suppose there is a big social event and you have not been invited yet? If you worry too much about what people think about you, you may interpret this as meaning that people don't like you. You may look for evidence that confirms people don’t like you. You may even conclude that you’re not invited because you are flawed or unlikeable.

Four Common Types of Negative Thinking:

The main underlying cause of anxiety is negative thinking. These are the four main types:

All-or-Nothing Thinking: “I have to do things perfectly, anything less is a failure.” This is the most common type of negative thinking. How does it lead to anxiety? If you think that everything has to be perfect, you don’t give yourself permission to relax or let down your guard. You’re always worried about disappointing others or yourself.

Focusing on the Negatives: “Nothing goes my way. It feels like one disappointment after another. Everybody has it easier than me.” A variation is being overly judgmental: “The world is falling apart. I don’t like what I see around me.” This can lead to anxiety because you’re always waiting to be let down.

Negative Self-Labeling: “I’m a failure. If people knew the real me, they wouldn’t like me. I am flawed.” This leads to anxiety because you’re worried that people will discover the real you. Some people compensate by putting on an overly brave front.

Catastrophizing: “If something is going to happen, it’ll probably be the worst-case scenario.” This leads to anxiety because you see the world as a threatening and unpredictable place. This makes you withdraw and restrict your interactions with the world. You may even restrict them to the point of being reluctant to go outside.

Anxiety-Avoidance Cycle

Negative thinking is sometimes based on turning uncomfortable feelings into facts. “I feel bad, so it must be bad.” Once something is thought of as an uncomfortable fact, people either try to avoid the situation or try to escape the feeling.

Trying to avoid anxiety creates a cycle that causes more anxiety. When you try to avoid anxiety-provoking situations, you are subconsciously saying that you can’t handle life on life’s terms. You’re telling yourself that you’re not capable. This makes you more anxious, because you believe that you can’t succeed.

Like so many unhealthy coping strategies, avoiding uncomfortable feelings has the exact opposite effect of what you hoped for. Cognitive therapy helps you change how you handle uncomfortable feelings, and find healthier alternatives, which helps reduce your anxiety.

Substance Abuse

Almost all substance of abuse can cause anxiety. This can happen in two ways:

• Drugs and alcohol abuse can trigger anxiety during withdrawal. While some drugs and alcohol temporarily reduce anxiety, they usually increase anxiety within a few hours after using due to withdrawal.
• Most drugs and alcohol eventually lead to anxiety if used long-term. Even drugs that are initially relaxing such as tranquilizers, sleeping pills, alcohol, and marijuana eventually increase your overall anxiety after prolonged use.[6, 7, 8]
• (Learn more about addiction and recovery at the companion website www.AddictionsAndRecovery.org.)

Caffeine and Nicotine

If you suffer from an anxiety disorder, the simplest thing you can do to reduce your anxiety is quit smoking tobacco and drinking caffeine. It has been proven that smoking tobacco increases anxiety and the risk of developing an anxiety disorder.[9] It’s ironic of course, because smokers usually try to relax by smoking.

It has also been proven that even moderate amounts of caffeine can increase adrenaline and cortisol levels and increase the risk of anxiety. What’s worse is that regular use of caffeine does not increase your tolerance to these negative effects. If you keep drinking coffee hoping that you’ll become immune to the effects, your anxiety will simply increase.[10]

Mental Health Conditions

Anxiety is a common symptom of mental health conditions especially depression.[11]

• 72 percent of individuals with anxiety will also have depression.
• 48 percent of individuals with depression will also have anxiety.
• Anxiety begins before or concurrently with depression in 37 percent of people.
• Depression begins before or concurrently with anxiety in 32 percent of people.

Medical Causes

In order to be diagnosed as an anxiety disorder, your symptoms should have no known medical cause. A number of medical conditions can cause anxiety. These include an overactive thyroid, hypoglycemia, mitral valve prolapse, anemia, asthma, COPD, inflammatory bowel disease, Parkinson's disease, and dementia among others. Your physician may perform certain tests to rule out these conditions. But it is important to remember that anxiety is more often due to negative thinking or substance abuse than any medical condition.

Chronic Pain

Chronic pain is a well-known trigger for anxiety and depression. One study showed that 50 percent of patients with chronic pain also suffered from an anxiety disorder.[12] Factors that increased the risk of developing anxiety or depression were, a higher number of pain locations, joint pain, pain lasting more than three months, daily use of pain medication, and a higher level of pain.[13]

Genetics

Much scientific research has been done to understand the connection between genes and brain function. A study of more than 5,000 twin pairs from the Virginia Adult Twin Study has shown that genetics explains about one third of the chance of developing generalized anxiety disorder.[14, 15]

The main contributing factors to anxiety are lifestyle and psychological factors, not genetics. The danger in focusing too much on genetics is that it takes the focus off other factors that you have control over.

How can genetics increase the likelihood of developing anxiety? A study of 500 individuals showed that those with the “short” form of the SERT (serotonin transfer) gene produced less serotonin and had an increased chance of developing anxiety. Individuals with the “long” form of the gene produced more serotonin and were less likely to develop anxiety, despite experiencing similar childhood and adult stresses.[16]

A meta-analysis of 26 studies including over 5,000 individuals confirmed that there is a strong association between variation in the SERT (serotonin transfer) gene and an increased chance of developing anxiety.[17]

These results have been taken a step further. When studied with an MRI, individuals with the “short” form the SERT gene had greater brain activity in the amygdala, the part of the brain that is responsible for processing emotions, especially fear.[18] In other words, genes can affect neurotransmitters, which can affect brain activity, which can affect mood and behavior.

Anxiety Treatment

The treatment for all anxiety disorders is similar. The three main treatments are cognitive behavioral therapy, mindfulness-meditation, and anti-anxiety medications.

Five Things You Can Do About Your Anxiety

• Avoid smoking, alcohol, and caffeine, which can cause anxiety symptoms.
• Review your over-the counter medications such as diet pills and cold medications that can contain stimulants, which may trigger anxiety.
• Learn relaxation and stress-management techniques and make them part of your life. Develop healthy coping skills.
• Rule out any medical causes for your symptoms.
• Ask for help. Talk with a health professional about your anxiety. Review your thought patterns, and identify any negative thinking that can contribute to your anxiety.

Cognitive Behavioral Therapy (CBT) for Anxiety

If you can change your thinking you can change your life. The basic idea behind cognitive behavioral therapy (CBT) is that your own thinking is the biggest preventable cause of your anxiety.

Cognitive behavioral therapy helps you change your inner dialogue. It helps you identify the negative thinking that contributes to your anxiety, and helps you learn healthier ways of thinking, behaving, and reacting to situations. Numerous studies have shown that cognitive behavioral therapy is effective for treating all forms of anxiety.[19]

Here are some other benefits of cognitive behavioral therapy:

• MRI studies have shown that the benefits of cognitive behavioral therapy are not just temporary. Cognitive therapy changes brain pathways and results in a more permanent change in thinking and behavior. Your brain begins to reflect your new way of thinking.[20, 21]
• Research has shown that cognitive behavioral therapy is more effective than other forms of therapy for treating anxiety and depression.[22]
• Cognitive behavioral therapy is effective when provided in a primary care setting.[23]
• A review of recent variants of cognitive behavioral therapy including mindfulness-based cognitive therapy and acceptance and commitment therapy has shown that they are no more or less effective than CBT, and that they work through the same underlying mechanisms.[24]

Stress Management, Meditation, and Mindfulness for Anxiety

The goal of stress management is to reduce your internal stress by changing the way you respond to external stress. External stress is what happens to you. Internal stress is what you feel. The two are connected by how you think. Negative thinking turns external stress into internal stress.

Meditation and mindfulness are being used in medicine. The evidence is overwhelming that these methods are effective in treating anxiety disorders.[25, 26] There are a number of techniques to choose from. All variations of meditation are effective. Which one works for you is largely a matter of personal choice. Start slowly with ten minutes a day, and see how you will reduce your anxiety and change your life. (Learn more about meditation and mindfulness.)

Building Emotional Resilience against Anxiety and Depression

Resilience is your ability to recover and bounce back from life’s challenges. This is key to overcoming anxiety because if you do not respond well to adversity you will be more fearful of life. Cognitive behavioral therapy and stress management are both helpful in developing resilience.

An important characteristic of resilience is a positive view of yourself and your abilities. This is sometimes called self-efficacy. If you feel that you are able to handle life’s challenges, you are less likely to be anxious.

High resilience predicts fewer mental health problems. Greater resilience scores have been shown to predict a lower risk of depression, stress, and anxiety disorders.[27]

Anti-Anxiety Medication

Medication cannot cure an anxiety disorder, but it can relieve the symptoms. Research has shown that a combination of psychotherapy and medication can be more effective than either one alone.

Anxiety and depression often go together. Antidepressants are sometimes helpful in treating anxiety symptoms and anxiety disorders.

Tranquilizers and sleeping pills (benzodiazepines) are sometimes used for the short-term treatment of anxiety. But long-term use can lead to dependence and addiction.

Consequences of Chronic Anxiety Symptoms

Chronic anxiety is exhausting. If you do not treat your anxiety, your stress will eventually overcome your mental capacity to cope with stress. You will feel burnt out and exhausted.

Chronic low-grade anxiety is usually the worst, because it's the kind of anxiety you push to the back of your mind and try to ignore. When the symptoms of chronic anxiety finally emerge, you have little reserve left. Relationship issues, work stress, and chronic illness take a toll that can leave you depleted if you don’t take care of yourself.

Chronic Anxiety Physical Symptoms

• Headaches, teeth grinding, TMJ pain
• Neck pain, shoulder pain, and back pain from muscle tension
• High blood pressure and cardiac arrhythmias
• Abdominal pain, bloating, discomfort, stomach ulcers, irritable bowel syndrome
• Skin rashes, eczema, psoriasis
• Chest pain. Anxiety can cause chest pain because the muscles between your ribs tighten and go into spasm. But there are also potentially serious causes of chest pain. Always consult a doctor.

Chronic Anxiety Emotional Symptoms

• Panic attacks
• Exhaustion, burnout
• Depression
• Poor concentration
• Irritability, poor sleep
• Loss of enjoyment, feeling hopeless, overwhelmed or pessimistic
• Substance abuse

Anxiety is treatable. The most important step you can take is reaching out and asking for help. You can change your life.

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