Let's Talk About Anxiety
Ready to live with more peace and less worry? Understanding the causes, symptoms, and treatment of anxiety is the first step.by Sunny Sea Gold Health Writer
When’s the last time you lay awake in bed, willing your spinning thoughts to quiet down? Or the last time you felt your heart race so hard you thought your chest might burst? If this happens to you often, you’ve come to the right place.*
Our Pro Panel
Our experts have all the details you need to understand the causes, symptoms, and treatments for anxiety disorders.
Eric Rafla-Yuan, M.D.
Clinical Professor in the Department of Psychiatry
University of California San Diego
San Diego, CA
Andrew Pleener, M.D.
Integrative Psychiatrist, and Founder and Director; Founder
#SameHere Psych Alliance; Regional Psychiatry
Jennifer L. Payne, M.D.
Director of the Women's Mood Disorders Center and Associate Professor of Psychiatry
Johns Hopkins School of Medicine
First, see a doctor if feelings of fear, dread, and worry interfere with your daily life—anxiety disorders are very real medical conditions with treatments that work. Many people with anxiety benefit from psychotherapy and medication. Healthy lifestyle behaviors such as a good diet and regular exercise can help maintain brain health in general, but anxiety disorders often require more treatment.
Most experts say that anxiety is rooted in a combination of factors, including genetics, differences in brain chemistry and personality, and sometimes traumatic experiences such as divorce, assault, major accidents or other traumas.
Anxiety feels different for different people, but one common thread is a sense of fear and foreboding that you can’t talk yourself out of. Many people also experience physical symptoms of anxiety such as muscle tension, headaches, nausea, shakiness, dizziness, or tingling and numbness in fingers and toes.
Encourage them to connect with a doctor or mental health professional, and tell them they’re not alone. Remind them that there is no shame in having an anxiety disorder. They are very real medical conditions that literally millions of people around the world suffer from.
*Anxiety is a daily reality for millions of people—who feel just like you do right now. Here, we share the reality of coping with anxiety, as well as expert advice from top doctors, the most successful treatments, and body-calming lifestyle changes. With the right treatment, our experts say people can bring your anxiety down to a level that is manageable, perhaps even helpful (yes, you read that right), rather than painful and disabling.
What Is Anxiety, Really?
Anxiety can show up in your body as a racing heartbeat, or in your mind as racing thoughts that are hard to quiet. It can make it tough to fall asleep at night, or give you a sick stomach when you wake up in the morning. Feeling anxious is a normal part of being human—and we can feel “anxious” about things that are good or bad. (Ever felt a little anxious or nervous while packing up for a much-anticipated trip? Or before meeting up with a date?)
“Anxiety” is, in fact, a useful, basic human response that is partially responsible for the survival of our species! A natural vigilance against potential danger keeps us from falling off a cliff or being bitten by an aggressive animal. It’s also a useful motivator that helps give us energy and alertness during work or school deadlines, sporting events, and other stressful moments that require vigilant awareness and stamina.
Feeling some worry, nervousness, and anxiety is especially normal when there are major changes or challenges going on in your life like starting a new job, entering a relationship, or moving homes. And some people tend to be a little more prone to anxiety than others. Because the unknown can mean potential danger, anxious brains sometimes interpret anything “new” as dangerous.
The thing is, these feelings typically fade once a problem is solved or a stressful moment passes. In other words, typical, everyday anxiety, even for those who experience it more often than average, is uncomfortable but temporary.
For people suffering from anxiety disorders, however, that’s not the case. For these folks, some form of nervousness, agitation, or fear is persistent—at times overwhelming—and can greatly interfere with their daily lives.
Anxiety disorders can happen to anyone, at any age. They are the most common mental health issue in the United States. An estimated 19% of Americans have an anxiety disorder, and about 7% of kids. Most of the time, anxiety disorder symptoms start to appear before you hit age 21. There are many conditions that fall under this umbrella:
Generalized Anxiety Disorder
People with generalized anxiety disorder (GAD)—the most common anxiety disorder—feel “excessively” anxious or worried most days, for a period of six months or more. These worries make handling and succeeding in relationships, friendships, school, or work harder, and can sometimes cause people to withdraw from socialization and normal everyday tasks. Nearly 7 million American adults have GAD; and women are nearly twice as likely to be diagnosed with it than men.
Generalized anxiety disorder is the most common type of anxiety issue, but there are many other conditions, including:
Panic Disorder and Panic Attacks
A panic attack is an episode of extreme fear that strikes very suddenly and ramps up quickly. Panic attacks often cause feelings of “doom,” shaking or shivering, sweating, racing heartbeat or palpitations, and a feeling of being out of control. The attacks can come on without notice, or be kicked off by something a person is already afraid of. Those with panic disorders have recurring attacks, and can spend a lot of time worrying about when the next one will hit. An estimated 2% to 3% of the United States population reports having panic disorder each year.
Social Anxiety Disorder
Most of us feel nervous about meeting new people or speaking in public. But folks with social anxiety disorder experience intense worry about public or social situations—or workplace or school interactions—and sometimes avoid them altogether out of fear.
A phobia is a severe and often overwhelming fear of or aversion to a thing or situation that is generally thought to be pretty safe or neutral by other folks. Phobias last for a long time, and can cause very intense reactions such as nausea, dizziness, fainting, sweating, and rapid heartbeat. Some common phobias are fear of heights, flying, blood, or animals like snakes or spiders. Agoraphobia creates powerful fear around things like crowds, standing in line with others, leaving the house, or being on a bus, train, or other public transportation.
Separation Anxiety Disorder
This is most often seen in children, but teens and adults can suffer from separation anxiety disorder, too. People with this condition have intense fear around being away from their loved ones and worry that something terrible will happen to their family or friend while they’re apart. Separation anxiety can also cause nightmares and physical symptoms like headaches and stomach pain.
People with selective mutism seem unable to speak in some public situations such as at work or school—even though they talk plenty when they’re at home or with people they know and feel comfortable with.
Other Specified or Unspecified Anxiety Disorder
Significant and disruptive disorders and phobias that don’t fit neatly into any of the other diagnoses are often grouped under these terms.
What Causes Anxiety?
As is the case with many medical issues involving the brain and nervous system, doctors don’t know exactly what causes anxiety. Rather than one root cause, it’s probably a combination of many things, including genetics, brain chemistry, and past traumatic experiences.
Anxiety disorders are known to run in families, just like other medical conditions such as diabetes, depression, and autoimmune disorders. Studies suggest that about 33% of a person’s risk of developing generalized anxiety disorder is predicted by their genes.
Neurotransmitter chemicals in the brain such as dopamine and serotonin are important in regulating mood. Imbalances or disruptions in these and other neurotransmitters is associated with anxiety and depression.
Intensely negative or traumatic experiences like assault, divorce, and other situations can trigger anxiety disorders.
Personality and Parental Modeling
People who are naturally cautious or shy seem to have a higher risk of anxiety disorders, as do folks who grew up with a parent with anxious tendencies.
What Are the Symptoms of Anxiety?
Because everyone experiences anxiety sometimes, it can be tough to know if what you’re going through is an anxiety disorder. Plus, symptoms of specific disorders can be different from each other. But one common thread that runs through all anxiety disorders is a persistent feeling of worry or fear in situations that may not typically be perceived as very threatening by other folks. Some other common emotional or psychological symptoms to look out for:
Feelings of restlessness
Being ever-watchful of danger
Feelings of dread or impending doom
Anxiety also causes many physical symptoms, a fact that surprises many people. Some of the physical symptoms are so intense that people may undergo lots of medical testing only to find that their physical symptoms go away once they’re treated for anxiety. Some of the physical symptoms of anxiety include:
Trouble falling or staying asleep
Racing heartbeat or palpitations
Shaking or twitching
Numbness or tingling, often in the hands, feet, head, neck, or face
Shortness of breath
How Do Doctors Diagnose Anxiety?
You may worry that a medical doctor will tell you that your feelings of fear and dread are “all in your head.” But if anxiety is getting in the way of your relationships with friends or family, or interfering with your ability to go to work, eat or sleep normally, it’s time to make an appointment.
General practitioners see anxiety disorders in their medical practices every single day—after all, more than 40 million Americans suffer from them. And if your particular provider doesn’t seem to be taking your symptoms seriously, don’t hesitate to get a second opinion or ask for a referral to a psychiatrist for further evaluation. Your wellness is worth it!
When you get to your appointment, here are the three main steps your doctor will likely take to officially diagnose you with an anxiety disorder:
Your doctor will want to rule out other conditions such as heart problems, and may even order a simple test to check levels of thyroid hormone and other substances in your blood. She’ll also want a complete list of all medications or supplements you take on a regular basis, since side effects of some medications and supplements can mimic the symptoms of anxiety, or cause actual anxiety as a side effect.
Because anxiety disorders tend to run in families, your doctor will want to know about mental health conditions in close relatives such as parents, siblings, and grandparents.
Your doctor will ask for a detailed description of the frequency and severity of your symptoms. She may also give you a formal or informal screening questionnaire for anxiety that includes questions about specific anxiety symptoms and how they affect your life. If the doctor suspects an anxiety disorder, they may discuss treatments such as medication and psychotherapy or refer you to a psychologist or psychiatrist for additional care.
What Are the Best Treatments for Anxiety?
People with anxiety disorders often use a combination of psychotherapy and medication to help alleviate symptoms. There are complementary medicine approaches that may help, too.
Research has shown certain types of talk therapy to be very effective at helping people with anxiety disorders feel better, including:
Cognitive-behavioral therapy (CBT)
Dialectical-behavioral therapy (DBT)
Acceptance and commitment therapy (ACT)
Process-based therapy (PBT)
These types of therapy offer specific tools, such as worksheets, mental tools, and deep breathing, that address the underlying causes of anxiety and teach people how to cope.
Although medications can’t cure anxiety, they can help reduce or control symptoms. Some of the most common ones prescribed for anxiety disorders include:
Antidepressants: Despite the name, antidepressants can also be very helpful in treating anxiety by helping your brain utilize mood-stabilizing chemicals better. Selective serotonin reuptake inhibitors (SSRIs) such as Zoloft (sertraline) and Paxil (paroxetine), and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine) and Effexor (venlafaxine), are often used to treat anxiety.
Anxiolytics: These anti-anxiety medications target certain brain chemicals in order to calm the brain and reduce agitation and excitability. They’re often taken on a daily basis, but sometimes they are prescribed to be taken only in moments of extreme anxiety. Some of the most common ones are:
Beta-blockers: These blood-pressure lowering drugs target racing heartbeat, shaking, and trembling, and can be used to help keep physical symptoms of anxiety under control.
CBD for Anxiety, and Other Supplements: CBD oil, also known as cannabidiol, is a non-intoxicating extract of the cannabis (or marijuana) plant that is also sometimes used to help with symptoms of anxiety. There isn’t enough evidence on safety and efficacy of CBD for doctors to routinely recommend it to their anxiety patients—and some people find that cannabis products make their symptoms worse. But if you do decide to try CBD, be sure to get it from a reliable manufacturer, since, like all supplements, CBD isn’t regulated by the FDA. Some doctors also support the use of the amino acid L-Theanine as an anxiolytic as well as a sleep aid.
Where Can I Find Anxiety-Related Communities?
Anxiety can make you want to pull away and isolate yourself. But the thing is, opening up to and being with people who get it, helps way more than Netflix and a warm blanket. Along with therapy and medication, finding supportive people—and connecting with them online and in real life—is a key part of taking care of yourself. Here's where to start.
Top Anxiety Support Groups and Nonprofits
Anxiety Sisters. A nonprofit formed by two women with anxiety disorders, Anxiety Sisters offers peer support, e-courses, and a well-loved podcast to help women with anxiety feel less alone and learn new ways to get the treatment and support they need.
National Alliance on Mental Illness (NAMI). Connect with other anxiety sufferers on the NAMI online message boards and via a NAMI Connection weekly or monthly recovery group near you. The NAMI Peer-to-Peer session also offers eight free sessions for adults with specific mental health conditions.
Anxiety and Depression Association of America (ADAA). This nonprofit offers new research, monthly webinars from mental health experts, educational infographics and stats, and a Find-a-Therapist database you can search by disorder. The ADAA is dedicated to the prevention, treatment, and cure of anxiety, depression, OCD, PTSD, and co-occurring disorders. There’s also (free) support available on the ADAA Online Peer-to-Peer Support Group or support group iOS app for iPhone.
GAD and Panic Disorder Information: National Alliance on Mental Illness. (2018). “Anxiety Disorders.” nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
Panic Disorder Statistics: Anxiety and Depression Association of America. (Accessed 2020.) “Panic Disorder.” adaa.org/understanding-anxiety/panic-disorder
Anxiety Statistics: National Alliance on Mental Illness. (2017). “Anxiety Disorders.” nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders
Causes of Anxiety Disorders: Boston Children's Hospital. (Accessed 2020). “Generalized Anxiety Disorder (GAD) Symptoms & Causes.” childrenshospital.org/conditions-and-treatments/conditions/g/generalized-anxiety-disorder-gad/symptoms-and-causes
Symptom Information: Mayo Clinic. (2020). “Anxiety Disorders.” mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
Diagnostic Information: NYU Langone Medical Center. (2020). “Diagnosing Anxiety Disorders in Adults.” nyulangone.org/conditions/anxiety-disorders-in-adults/diagnosis
Psychotherapy Information: National Institute of Mental Health. (2018). “Anxiety Disorders.” nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145338
Medications for Anxiety: Mayo Clinic. (2019). “Selective Serotonin Reuptake Inhibitors.” mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825