Anxiety

What is anxiety?

Anxiety is the body’s natural response to stress or perceived threat. It can sharpen your attention before an exam or help you react quickly to danger. For most people, anxious feelings come and go with the situation.

An anxiety disorder is different. The worry or fear is more intense or longer-lasting than the situation seems to call for, is hard to control, and gets in the way of everyday life. Anxiety disorders are among the most common mental health conditions worldwide, and they are highly treatable.

Symptoms

Anxiety affects thoughts, emotions, the body and behavior. Common symptoms can include:

• Persistent worry that is difficult to switch off
• Feeling restless, keyed up or on edge
• Trouble concentrating, or your mind “going blank”
• Irritability
• Muscle tension, headaches or stomach upset
• A racing heart, sweating, trembling or shortness of breath
• Difficulty falling or staying asleep
• Avoiding situations that trigger anxious feelings

These symptoms can occur with anxiety disorders, but they can also have other causes. Only a qualified healthcare professional can provide a diagnosis.

Types

Clinicians recognize several types of anxiety disorders. They share excessive fear or worry but differ in what triggers it:

• Generalized anxiety disorder (GAD): ongoing worry about many everyday things — health, work, family, money — on most days for at least six months.
• Panic disorder: repeated, unexpected panic attacks and ongoing worry about having more.
• Social anxiety disorder: intense fear of being judged, embarrassed or scrutinized in social or performance situations.
• Specific phobias: strong fear of a particular object or situation, such as flying, heights or needles.
• Agoraphobia: fear of situations where escape might feel difficult, such as crowds or public transport.
• Separation anxiety disorder: excessive fear of being apart from people you are attached to. It is often discussed in children but can occur in adults.

Related conditions such as obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) also involve anxiety but are classified separately.

Causes

There is no single cause of anxiety disorders. Research suggests they develop from a combination of factors:

• Biology: differences in how the brain processes threat and regulates emotion.
• Genetics: anxiety disorders tend to run in families, suggesting an inherited component.
• Life experiences: stressful or traumatic events, especially in childhood, are associated with higher risk.
• Health factors: some medical conditions, medications and substances can cause or worsen anxiety symptoms.

Risk factors

Factors associated with a higher chance of developing an anxiety disorder include:

• A family history of anxiety or other mental health conditions
• Shyness or behavioral inhibition in childhood
• Exposure to stressful or negative life events
• Some physical health conditions, such as thyroid problems or heart arrhythmias
• Use of caffeine, alcohol or other substances, or withdrawal from them

Having a risk factor does not mean you will develop an anxiety disorder, and many people with anxiety have none of these factors.

Diagnosis

A primary care doctor or mental health professional can assess anxiety. An evaluation usually includes:

• A conversation about your symptoms, how long they have lasted and how they affect your life
• Questionnaires that help measure the type and severity of anxiety
• A physical exam or tests, when needed, to rule out other causes

Diagnosis is based on established clinical criteria. Online self-assessments can help you reflect on your symptoms, but they cannot diagnose an anxiety disorder.

Treatment

Anxiety disorders are usually treated with psychotherapy, medication, or both. The right approach depends on the type of anxiety, its severity, your preferences and your health history.

Clinical guidelines generally recommend starting with lower-intensity options — such as guided self-help based on CBT — for milder symptoms, and moving to individual therapy or medication when symptoms are more severe or don’t improve.

Therapy

Cognitive behavioral therapy (CBT) has the strongest evidence for most anxiety disorders. CBT helps you notice anxious thinking patterns, test them against reality and gradually face feared situations. Exposure therapy, a form of CBT, is particularly effective for phobias, panic disorder and social anxiety.

Other approaches — including acceptance and commitment therapy (ACT) and applied relaxation — also have research support. Many people now access therapy online, which research suggests can be effective for many people with mild to moderate anxiety.

Medications

Several types of medication can help reduce anxiety symptoms. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line options for many anxiety disorders. Other medications may be used in specific situations.

Medication decisions should always be made with a prescriber who knows your full health history. Learn more about anti-anxiety medications and antidepressants.

Self-care

Self-care does not replace professional treatment, but these habits can support recovery and help manage everyday anxiety:

• Move your body. Regular physical activity is associated with lower anxiety.
• Protect your sleep. Poor sleep and anxiety feed each other. See our guide to sleep and mental health.
• Limit caffeine and alcohol, both of which can worsen anxiety symptoms.
• Practice slow breathing or grounding when anxiety rises. Our guide on calming an overwhelmed mind walks through simple techniques.
• Stay connected. Talking with people you trust can make anxiety feel more manageable.