Anxiety

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Anxiety

Anxiety is what someone feels when they are worried, tense, or afraid. It can be mild or severe. People experience anxiety as thoughts, feelings, and physical sensations.¹

If you are struggling with anxiety, speak to a health care professional who will be able to provide any help and support you may need.

Read on to find out more about what anxiety is, the symptoms, and how it can be managed and treated.

What is anxiety?

Anxiety is the body’s natural response to a potentially dangerous or challenging situation. It is a feeling of unease, worry, fear or dread about what is going to happen. It is entirely normal to feel anxious from time to time, and it can even be beneficial. Anxiety can help us prepare for specific situations, making sure we pay attention and stay alert to any dangers.²

However, some people find it hard to control their anxiety. High levels of anxiety maintained over a long time that impact normal, day-to-day activities could mean someone has an anxiety disorder.³

What are the main types of anxiety?

Everyone experiences anxiety in different ways. However, anxiety disorders are different from normal feelings of nervousness and stress and involve excessive anxiety or fear.¹

The most frequently diagnosed anxiety disorders include generalised anxiety disorder, panic disorder, phobias, and social anxiety disorder (social phobia) and post-traumatic stress disorder (PTSD).³

Generalised anxiety disorder: A chronic (long-term) condition that causes people to have regular feelings of anxiety about a wide range of issues or situations in their everyday lives. Its psychological and physical symptoms vary from person to person, but may include worry, trouble concentrating or sleeping, dizziness, and heart palpitations.³
Panic disorder: Sudden and repeated attacks of intense fear that can last for several minutes or longer. Sometimes these attacks happen for no apparent reason. A person having a panic attack experiences a rush of mental and physical symptoms.⁴ They may feel as though they are losing control, having a heart attack, or even dying.¹
Phobias: An overwhelming, extreme fear of an object, animal, place, situation, or feeling. Phobias can be categorised as specific or complex. A specific phobia is a fear of a particular object, animal, or activity, such as a fear of spiders (arachnophobia). A complex phobia is anxiety about a specific situation or circumstance, such as agoraphobia (fear of open spaces or being unable to escape).⁵
Social anxiety disorder (social phobia): A fear or dread of social situations. It is much more than a feeling of apprehension about a social event; it involves excessive worry about everyday social activities, such as meeting people, starting conversations, speaking on the phone, going shopping, or working.⁶
Post-traumatic stress disorder (PTSD): Someone with PTSD has experienced a very stressful, frightening, or distressing event. The condition often involves nightmares and ‘flashbacks’ in which the person relives the traumatic event. People with PTSD often have feelings of guilt, isolation, and irritability.⁷

Some people with anxiety disorders are affected by more than one anxiety or psychiatric disorder at a time (known as ‘comorbidity’). For example, generalised anxiety disorder can be associated with other psychiatric conditions including depression or major depressive disorder (MDD), bipolar disorder (BD), and substance use disorder (SUD).⁸

How many people have anxiety?

Statistics show that anxiety disorders are prevalent across the globe. The World Health Organization estimates that around 284 million people (3.8% of the world’s population) have experienced an anxiety disorder. About 63% (179 million) are female, compared with 105 million males.⁹

According to the Institute for Health Metrics and Evaluation (IHME), more than one in six people (nearly 84 million people) across the EU had a mental health problem in 2016. Across EU countries, the most common mental disorder is anxiety disorder, with an estimated 25 million people (equating to 5.4% of the population) living with anxiety disorders.¹⁰

Symptoms

Everyone experiences anxiety differently. The physical and mental effects can vary from one person to the next.

What are the symptoms of anxiety?

The body reacts to anxiety in a particular way, releasing stress hormones such as adrenaline and cortisol. These hormones put someone experiencing anxiety into a high-alert state in which they look for potential threats and activate their fight-or-flight responses¹. As a result, some common symptoms of anxiety include^1,11:

Mental effects:

Feeling tense, nervous, and restless
Having a feeling of dread or panic, or a sense of being in danger
Feeling constantly ‘on edge’
Feeling out of control
Having difficulty focusing or thinking clearly
Feeling disconnected, or worrying about being out of touch with reality
Being irritable

Physical effects:

A fast, thumping, irregular heartbeat (palpitations)
Rapid breathing
Shortness of breath
Dizziness or light-headedness
Dry mouth
Sweating or hot flushes
Churning feeling in the stomach, or nausea
Stomach ache
Trembling or shaking
Needing the toilet frequently
Inability to sit still
Headaches
Muscular aches and pains or tension in the muscles
Pins and needles
Problems sleeping (insomnia)

What are the early signs of anxiety?

The early signs of anxiety are sometimes not obvious and often develop slowly over time. The symptoms vary from person to person. One of the most common early signs of anxiety is excessive worrying about everyday situations. Symptoms sometimes start in childhood or the teenage years and continue into adulthood.¹²

Causes, risk factors and life expectancy

Many different situations or experiences can bring on anxiety. Sometimes it can be challenging to know what is causing the anxiety, and this can result in further stress or upset.

What causes anxiety?

Difficult or traumatic events experienced in the past – during childhood, adolescence, or adulthood – often trigger anxiety problems. Some common examples that can result in anxiety issues include¹:

Physical or emotional abuse
Neglect
Losing a loved one (bereavement)
Being bullied or socially excluded

Current issues or life problems can also trigger anxiety, such as:

Pressures at work
Working long hours
Money issues
Relationship problems
Exhaustion
Feeling lonely or isolated
Losing a loved one (bereavement)
Dealing with a severe illness or injury¹²
Being bullied, harassed, or abused
Experiencing other mental health problems, such as depression

Sometimes people have underlying medical issues that can affect their anxiety levels. Examples of medical conditions that are linked to anxiety include¹²:

Heart disease
Diabetes
Irritable bowel syndrome
Thyroid problems
Respiratory conditions such as chronic obstructive pulmonary disease (COPD)

Certain drugs can also trigger anxiety, including psychiatric medications, some medicines used to treat certain physical health conditions, and recreational drugs and alcohol.¹²

Is anxiety hereditary?

Research shows that having a close family member with anxiety issues can increase the chances of someone experiencing problems with anxiety themselves. More research is needed to understand whether genetic factors contribute to someone developing anxiety, or whether some people are more susceptible to developing anxiety because of behaviour they learned from parents and relatives while growing up.¹

Who gets anxiety?

Anyone can get anxiety, although recent research found that women are almost twice as likely to be affected by anxiety as men. Additionally, people under the age of 35 are disproportionately affected by anxiety disorders.¹³

How long can you live with anxiety?

Anxiety is not a life-threatening condition. However, research published in The British Journal of Psychiatry shows that anxiety disorders can significantly increase the risk of death. Comorbidity (when two disorders are experienced at the same time) of anxiety disorders and depression plays a key part in the increased mortality risk.¹⁴

Diagnosis

Anxiety is not a simple diagnosis; it can sometimes be difficult for doctors to diagnose whether a person has an anxiety disorder or another mental health condition, such as depression.¹⁵

How is anxiety diagnosed?¹⁵

To diagnose anxiety accurately, a doctor needs to rule out certain physical illnesses that may be causing the symptoms. They may ask questions about:

Any physical or psychological symptoms
How long the symptoms have been an issue
Any significant worries, fears, or issues
The individual’s personal life

It can be difficult to talk to a doctor about emotions, feelings, and personal issues. Still, the doctor must understand the symptoms and circumstances to make an accurate diagnosis. To help with the diagnosis, the doctor may also make a physical examination and do some blood tests to rule out conditions such as anaemia (iron deficiency) or an overactive thyroid.

Test to diagnose anxiety

There are no laboratory tests to diagnose anxiety. If a doctor cannot find any medical reason for certain physical and mental symptoms, they may make a referral to a mental health specialist, such as a psychiatrist or psychologist.

A mental health specialist will ask further questions about symptoms, feelings and emotions, and make a clinical assessment using questionnaires to gauge anxiety levels. Some examples of anxiety assessment questionnaires include the Hamilton anxiety rating scale (HAM-A)¹⁶, or the Beck Anxiety Inventory (BAI)¹⁷, which measures the severity of anxiety in adults and adolescents.

Treatment and medication

Treatment and medication for anxiety can relieve the symptoms and make the condition easier to live with.

How is anxiety treated?

Several therapies and medications can be helpful for anxiety. People with anxiety may benefit most from a combination of therapy and medication to control their symptoms.

Medication

Doctors use a range of medications to help people manage their anxiety symptoms. However, medication should not be the only treatment option offered. Instead, doctors often need to work with individuals to find the right medication, dosage, and therapy that works best. Some medications are only used on a short-term basis, while others can be prescribed for more extended periods. Depending on the person’s symptoms, medication may treat the physical symptoms of anxiety and the psychological effects. Some of the most commonly prescribed medications to treat anxiety include:

Anti-depressants: In most cases, an anti-depressant will be the first medication offered. The main types that may be prescribed for an anxiety disorder are:
- Selective serotonin reuptake inhibitors (SSRIs): These drugs work by increasing the level of a chemical called serotonin in the brain. Serotonin plays a vital role in the brain, boosting feelings of wellbeing and happiness, and aiding sleep. SSRIs can be taken on a long-term basis, but it can take a few weeks for them to start working.¹⁸
- Serotonin and noradrenaline reuptake inhibitors (SNRIs): This type of medication works in a similar way to SSRIs, by increasing the levels of serotonin in the brain, but they also effect levels of another chemical called noradrenaline.¹⁹
Anti-seizure drugs: Certain anti-seizure medications (also known as anti-convulsant drugs) used to treat epilepsy can also be an effective anxiety treatment. Pregabalin is an epilepsy drug which may be offered if SSRIs and SNRIs aren’t suitable.¹⁹ It works by lowering the chemicals in the brain which make people feel anxious.²⁰
Benzodiazepines: Sometimes benzodiazepines, a type of sedative, are used as a short-term treatment during a severe period of severe anxiety, sometimes alongside other medication.¹⁹

Therapy

Several psychological therapies (psychotherapy) can be useful in treating anxiety, including:

Guided self-help: A doctor or mental health specialist may suggest trying a guided self-help course to manage anxiety levels and teach coping techniques to deal with anxiety daily. This may involve going through a workbook or an online course with a therapist’s support.
Cognitive behavioural therapy (CBT): This form of therapy helps someone question their anxious thoughts or negative feelings. It can help improve focus and concentration and reduce the need to avoid doing things that cause anxiety. CBT usually involves meeting with a specially trained and accredited therapist every week for several months.
Applied relaxation: This approach involves a trained therapist teaching someone how to relax their muscles and to practise this during situations that make them feel anxious.

Intervention

It is vital that anyone whose anxiety is affecting their daily life gets medical advice early to prevent their condition from worsening.

People with a suspected anxiety disorder should be offered psychological intervention as a first line treatment.²¹

A qualified mental health professional who knows how to treat anxiety effectively will help individuals learn critical coping strategies to deal with their anxiety disorder.

Diet

People with anxiety should try to eat a regular, healthy, well-balanced diet. It is also vital to eat regularly and avoid skipping meals, which may result in the blood sugar dropping, making people feel ‘jittery’ or on edge and worsening the underlying anxiety.²²

Eating foods rich in complex carbohydrates, such as whole grains – for example, oatmeal, quinoa, and wholegrain bread and cereals – is thought to increase the amount of serotonin in the brain, which has a calming effect.²³

Alcohol and caffeine should be limited or avoided. Both can make people feel on edge or nervous and can interfere with sleep patterns.²³

Exercice

Exercise can be very beneficial for people with anxiety. It produces chemicals in the brain known as endorphins that act as natural painkillers and improve the ability to sleep, which reduces feelings of stress and anxiety. Scientists have found that regular exercise can decrease tension levels, elevate and stabilise mood, improve sleep, and improve self-esteem. Just five minutes of aerobic exercise can begin to produce anti-anxiety effects.²⁴ Any physical exercise can help reduce anxiety, but researchers say aerobic exercise that gets the heart rate up is the most beneficial. Some aerobic exercises that can help manage anxiety are²⁵:

Swimming
Cycling
Running or jogging
Brisk walking
Tennis
Dancing

Even short bursts of exercise (just 10–15 minutes) can improve fitness levels and mood.

Prevention

There is no way to accurately predict what will cause someone to develop problems with anxiety. However, steps can be taken to reduce the impact of related symptoms¹²:

Seek help early: Anxiety can be harder to treat if it is left too long.
Live a healthy lifestyle: Exercise can help boost mental health and relieve feelings of anxiety.
Try to be as active as possible: Taking part in activities and hobbies can improve feelings of self-worth and take the mind off worries. Social interaction can prevent feelings of isolation.
Avoid alcohol and drug use: Alcohol and drug use can cause anxiety or make existing anxiety worse.

Scientific studies

Research is continuing into anxiety, the potential risks for developing anxiety disorders, and effective treatment options. There have been significant advances in understanding the parts of the brain involved with experiencing fear and anxiety. For example, scientists have found that the amygdala region of the brain appears to be involved processing information about fear and danger. People with anxiety disorders seem to have a more reactive amygdala.²⁶

Another critical study has looked at how a receptor involved in the brain’s reward system may be a target for treating anhedonia (lack of pleasure), a symptom of several anxiety disorders. This research has significant implications for the development of medications to target specific areas of the brain and will hopefully lead to more informative clinical trials in the future.²⁷

One area of research that has seen significant progress is the role that genetics play in anxiety. Current research is looking at how genes and environments might work together to contribute to the development of anxiety disorders.²⁸ For example, a child with a genetic predisposition to being shy and sensitive might become a target for bullies. In turn, being bullied (an environmental factor) might increase their anxiety levels.

Research is continuing into treatment options for anxiety. The current medications available to help people suffering from anxiety disorders have not changed significantly over the past 50 years²⁹. They are not effective for all patients, and some are known to have potential side effects and safety concerns (for example, a risk of abuse and dependency). Scientists are now working to develop new medicines that could replace current anti-anxiety drugs, and there are currently 12 new medications that are being trialled in anxiety patients.²⁹

There is optimism in the scientific community that more advances are on the horizon. The future treatment for people suffering from anxiety will look very different from today’s care.

Referenced sources

Mind. Anxiety and panic attacks. Updated February, 2021. Accessed October 7, 2021
Mental Health Foundation. Anxiety. Updated July, 2021. Accessed October 11, 2021.
NHS. Overview. Generalised anxiety disorders in adults. Updated December, 2018. Accessed February 5, 2021.
NHS. Panic Disorder. Updated July, 2020. Accessed October 7, 2021.
NHS. Phobias. Updated October, 2018. Accessed October 7, 2021.
NHS. Social Anxiety. Updated March, 2020. Accessed October 7, 2021.
NHS. Overview. Post-traumatic stress disorder. Updated September, 2018. Accessed October 7, 2021.
Simon, N.M. Generalized anxiety disorder and psychiatric comorbidities such as depression, bipolar disorder, and substance abuse. Journal of Clinical Psychiatry. 2009; 70(2), pp.10-14.
Ritchie H, Roser M. Mental health. Our World in Data. Published 2018. Accessed February 2021.
OECD/European Union. Health at a Glance: Europe 2018: State of Health in the EU Cycle. OECD Publishing, Paris/European Union, Brussels. 2018. Accessed February 2021. doi:10.1787/health_glance_eur-2018-en
NHS. Symptoms. Generalised anxiety disorder in adults. Updated December, 2018. Accessed October 7, 2021.
Mayo Clinic. Symptoms and Causes. Anxiety disorders. Accessed October 7, 2021.
Remes, O., Brayne, C., Van Der Linde, R. and Lafortune, L.A systematic review of reviews on the prevalence of anxiety disorders in adult populations. Brain and behavior. 2016; 6(7), p.e00497.
Meier SM, Matthiesen M, Mors O, Mortensen PB, Laursen TM, Penninx BW. Increased mortality among people with anxiety disorders: total population study. Br J Psychiatry. 2016;209(3):216-21.
NHS. Diagnosis. Generalised anxiety disorder in adults. Updated December, 2018. Accessed October 7, 2021.
Hamilton, M. Hamilton anxiety scale. Group, 1(4). 1959; pp.10-1037.
Beck, A.T., Epstein, N., Brown, G., & Steer, R.A. An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology. 1988; 56, 893-897.
NHS. Overview. Selective serotonin reuptake inhibitors. Updated October, 2018. Accessed October 7, 2021.
NHS. Treatment. Generalised anxiety disorder in adults. Updated December, 2018. Accessed October 7, 2021.
NHS. Pregabalin. Updated November, 2018. Accessed October 11, 2021.
NICE. Offer of psychological interventions for anxiety disorders. Published February, 2014. Accessed October 7, 2021.
Naidoo U. Harvard Health Publishing. Nutritional strategies to ease anxiety. Published April 13, 2016. Accessed February 2021. https://www.health.harvard.edu/blog/nutritional-strategies-to-ease-anxiety-201604139441
Mayo Clinic. Coping with anxiety: can diet make a difference? Updated May, 2017. Accessed October 7, 2021.
Anxiety and Depression Association of America. Exercise for stress and anxiety. Accessed February 2021.
Everyday Health. How exercise eases anxiety. Published June 2009. Accessed February 2021.
National Collaborating Centre for Mental Health UK, 2011. Generalised anxiety disorder in adults: management in primary, secondary and community care. British Psychological Society.
Krystal AD, Pizzagalli DA, Smoski M, et al. A randomized proof-of-mechanism trial applying the ‘fast-fail’ approach to evaluating κ-opioid antagonism as a treatment for anhedonia. Nat Med. 2020;26(5):760-768.
Craske MG, Stein MB, Eley TC, et al. Anxiety disorders [published correction appears in Nat Rev Dis Primers. 2017 Dec 14;3:17100]. Nat Rev Dis Primers. 2017;3:17024.
Sartori, S.B. and Singewald, N. Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders. Pharmacology & therapeutics. 2019; 204, p.107402.

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Anxiety

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Related articles

IN THIS SECTION

What is anxiety?

What are the main types of anxiety?

How many people have anxiety?

Symptoms

What are the symptoms of anxiety?

What are the early signs of anxiety?

Causes, risk factors and life expectancy

What causes anxiety?

Is anxiety hereditary?

Who gets anxiety?

How long can you live with anxiety?

Diagnosis

How is anxiety diagnosed?15

Test to diagnose anxiety

Treatment and medication

How is anxiety treated?

Medication

Therapy

Intervention

Diet

Exercice

Prevention

Scientific studies

Referenced sources

Related articles

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How is anxiety diagnosed?¹⁵