Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).
These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. Symptoms may start during childhood or the teen years and continue into adulthood.
Examples of anxiety disorders include social anxiety disorder (social phobia), specific phobias and separation anxiety disorder. A person can have more than one anxiety disorder.
Sometimes anxiety results from a medical condition that needs treatment. Whatever form of anxiety you have, treatment can help.
Common anxiety signs and symptoms include:
- Feeling nervous
- Feeling powerless
- Having a sense of impending danger, panic or doom
- Having an increased heart rate
- Breathing rapidly (hyperventilation)
- Feeling weak or tired
- Trouble concentrating or thinking about anything other than the present worry
Several types of anxiety disorders exist:
- Separation anxiety disorder is a childhood disorder characterized by anxiety that is excessive for the developmental level and related to separation from parents or others who have parental roles.
- Selective mutism is a consistent failure to speak in certain situations, such as school, even when you can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.
- Specific phobias are characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.
- Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.
- Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, heart palpitations or chest pain.
- Agoraphobia is anxiety about, and often avoidance of, places or situations where you might feel trapped or helpless if you start to feel panicky or experience embarrassing symptoms, such as losing control.
- Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events — even ordinary, routine issues. The worry is usually out of proportion to the actual circumstance, is difficult to control and interferes with your ability to focus on current tasks. It often occurs along with other anxiety disorders or depression.
- Substance-induced anxiety disorder is characterized by prominent symptoms of anxiety or panic that are a direct result of abusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.
- Anxiety disorder due to a medical condition includes prominent symptoms of anxiety or panic that are directly caused by a physical health problem.
- Specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don't meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.
When to see a doctor
See your doctor if:
- You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your life
- Your fear, worry or anxiety is upsetting to you
- You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety
- You think your anxiety could be linked to a physical health problem
- You have suicidal thoughts or behaviors — seek emergency treatment immediately
Your worries may not go away on their own, and they may actually get worse over time if you don't seek help. See your doctor or a mental health provider before your anxiety gets worse. It may be easier to treat if you get help early.
As with many mental health conditions, the exact cause of anxiety disorders isn't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to becoming anxious. Inherited traits also can be a factor.
For some people, anxiety is linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order lab tests and other tests to look for signs of a problem.
Examples of medical problems that can be linked to anxiety include:
- Heart disease
- Thyroid problems, such as hypothyroidism or hyperthyroidism
- Drug abuse or withdrawal
- Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications
- Irritable bowel syndrome
- Rare tumors that produce certain "fight-or-flight" hormones
- Premenstrual syndrome
Sometimes anxiety can be a side effect of certain medications.
It's more likely that your anxiety may be due to an underlying medical condition if:
- You don't have any blood relatives (such as a parent or sibling) with an anxiety disorder
- You didn't have an anxiety disorder as a child
- You don't avoid certain things or situations because of anxiety
- You have a sudden occurrence of anxiety that seems unrelated to life events and you didn't have a previous history of anxiety
These factors may increase your risk of developing an anxiety disorder:
- Being female. Women are more likely than men to be diagnosed with an anxiety disorder.
- Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.
- Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.
- Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family or ongoing worry about finances.
- Personality. People with certain personality types are more prone to anxiety disorders than are others.
- Other mental health disorders. People with other mental health disorders, such as depression, often experience anxiety disorder as well.
- Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.
- Drugs or alcohol. Drug or alcohol use or abuse or withdrawal can cause or worsen anxiety.
Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical health conditions, such as:
- Depression (which often occurs with anxiety disorder)
- Substance abuse
- Trouble sleeping (insomnia)
- Digestive or bowel problems
- Poor quality of life
You may start by seeing your primary care doctor to find out if your anxiety could be related to your physical health. Your doctor can check for signs of an underlying condition that may need treatment.
However, you may need to see a specialist if you have severe anxiety. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. A psychologist and certain other mental health providers can diagnose anxiety and provide counseling (psychotherapy).
What you can do
Prepare and take this information with you:
- A list of your anxiety symptoms. Note when they occur, whether anything seems to make them better or worse, and how much they affect your day-to-day activities and interactions.
- What causes you stress. Include any major life changes or stressful events you've dealt with recently. Also note any traumatic experiences you've had in the past or as a child.
- Any other health problems you have. Include both physical conditions and mental health issues.
- A list of all medications you're taking. Include any medications, vitamins, herbs or other supplements and the dosages.
Prepare a list of questions ahead of time to make the most of your appointment. For anxiety, some basic questions to ask your doctor include:
- What's the most likely cause of my anxiety?
- Are there other possible situations, psychological issues or physical health problems that could be causing or worsening my anxiety?
- Do I need medical tests or other tests?
- Are there any restrictions or steps I need to follow?
- Should I see a psychiatrist, psychologist or other mental health provider?
- What type of therapy might help me?
- Would medication help? If so, is there a generic alternative to the medicine you're prescribing?
- Do you have any printed material that I can have? What websites do you recommend?
Don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor will likely do a physical exam and ask you several questions, such as:
- What are your symptoms, and how severe are they?
- Have you ever had a panic attack?
- Do you avoid certain things or situations because they make you anxious?
- Have your feelings of anxiety been occasional or continuous?
- When did you first begin noticing your feelings of anxiety?
- Does anything in particular seem to trigger your anxiety or make it worse?
- What, if anything, seems to improve your feelings of anxiety?
- What traumatic experiences have you had recently or in the past?
- What, if any, physical or mental health conditions do you have?
- Do you take any prescription drugs?
- Do you regularly drink alcohol or use illegal drugs?
- Do you have any blood relatives with anxiety or other mental health conditions, such as depression?
To help diagnose an anxiety disorder and rule out other conditions, your doctor or mental health provider may have you fill out a psychological questionnaire. Your doctor will probably do a physical exam to look for signs that your anxiety might be linked to a medical condition.
To be diagnosed with an anxiety disorder, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Symptoms and diagnostic criteria differ for each type of anxiety disorder. However, they all share the features of excessive fear and problems with functioning as a result. Anxiety disorders often occur along with other mental health problems — such as depression or substance abuse — which can make diagnosis and treatment more challenging.
Tests and diagnosis at Mayo Clinic: Children and teens
Mayo Clinic's Pediatric Anxiety Disorders Clinic includes a comprehensive, one-day assessment clinic for children and teens with heightened anxiety, fears, nervousness and worry. Health care professionals thoroughly evaluate your child, providing diagnosis and treatment recommendations in a timely manner. During the evaluation, the care team conducts an interview that focuses on identifying anxious thoughts, physical sensations and behaviors.
In cases where anxiety is caused by or occurs with a medical illness, a doctor also performs a physical exam during the initial evaluation. A child and adolescent psychologist and a psychiatrist who specialize in anxiety disorders staff the clinic. This staffing allows for an integrated medical and psychological understanding of your child's symptoms.
The two main treatments for anxiety disorders are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.
Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.
Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build upon your initial success.
Several types of medications are used to treat anxiety disorders, including those below. Talk with your doctor about benefits, risks and possible side effects.
- Antidepressants. These medications influence the activity of brain chemicals (neurotransmitters) thought to play a role in anxiety disorders. Examples of antidepressants used to treat anxiety disorders include fluoxetine (Prozac, Sarafem), imipramine (Tofranil), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and venlafaxine (Effexor XR). Citalopram (Celexa) and escitalopram (Lexapro) also can be effective, but dosages of 40 milligrams (mg) a day of citalopram or 20 mg a day of escitalopram warrant discussion of risks versus benefits. Your doctor also may recommend other antidepressants.
- Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.
- Benzodiazepines. In limited circumstances, your doctor may prescribe one of these sedatives for relief of anxiety symptoms. Examples include alprazolam (Niravam, Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren't a good choice if you've had problems with alcohol or drug abuse.
While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here's what you can do:
- Keep physically active. Develop a routine so that you're physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities.
- Avoid alcohol and other sedatives. These substances can worsen anxiety.
- Quit smoking and cut back or quit drinking coffee. Both nicotine and caffeine can worsen anxiety.
- Use relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.
- Make sleep a priority. Do what you can to make sure you're getting enough sleep to feel rested. If you aren't sleeping well, see your doctor.
- Eat healthy. Healthy eating — such as focusing on vegetables, fruits, whole grains and fish — may be linked to reduced anxiety, but more research is needed.
Several herbal remedies have been studied as a treatment for anxiety, such as kava, valerian and passionflower, but more research is needed to understand the risks and benefits. Here's what researchers know — and don't know:
- Kava. Kava appeared to be a promising treatment for anxiety, but reports of serious liver damage — even with short-term use — caused several European countries and Canada to pull it off the market. The Food and Drug Administration has issued warnings but not banned sales in the United States. Avoid using kava until more rigorous safety studies are done, especially if you have liver problems or take medications that affect your liver.
- Valerian. In some studies, people who used valerian reported less anxiety and stress, but in other studies, people reported no benefit. Discuss valerian with your doctor before trying it. Some people who have used high doses or used it long term may have increased their risk of liver damage, although it's not clear if valerian caused the damage. When it's time to stop using valerian, it must be tapered down to prevent withdrawal symptoms.
- Passionflower. A few small clinical trials suggest that passionflower might help with anxiety. In many commercial products, passionflower is combined with other herbs, making it difficult to distinguish the unique qualities of each herb. Passionflower is generally considered safe when taken as directed, but some studies found it can cause drowsiness, dizziness and confusion.
- Theanine. This amino acid is found in green tea and may be found in some supplements. Preliminary evidence shows that theanine may make some people feel calmer, but there is no evidence that it helps treat anxiety.
Before taking herbal remedies or supplements, talk to your doctor to make sure they're safe for you and won't interact with any medications you take.
To cope with anxiety disorder, here's what you can do:
- Learn about your disorder. Talk to your doctor or mental health provider. Find out what might be causing your specific condition and what treatments might be best for you.
- Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Consistency can make a big difference, especially when it comes to taking your medication.
- Take action. Work with your mental health provider to figure out what's making you anxious and what steps you can take to address it.
- Involve your family. As with any illness, asking your partner or family members for help is an important part of coping.
- Join an anxiety support group. Remember that you aren't alone. Support groups offer compassion, understanding and shared experiences. The National Alliance on Mental Illness and the Anxiety and Depression Association of America provide information on finding support.
- Socialize. Don't let worries isolate you from loved ones or activities. Social interaction and caring relationships can lessen your worries.
- Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.
- Let it go. Try not to dwell on past concerns. Change what you can and let the rest take its course.
There's no way to predict for certain what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you're anxious:
- Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
- Keep a journal. Keeping track of your personal life can help you and your mental health provider identify what's causing you stress and what seems to help you feel better.
- Stay active. Continue to participate in activities that you enjoy and that make you feel good about yourself. Avoiding activities because you're nervous can make anxiety worse.
- Learn time management techniques. You can reduce anxiety by learning how to carefully manage your time and energy.
- Avoid unhealthy alcohol or drug use. Alcohol and drug use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a support group to help you.
Aug. 15, 2014
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