Anxiety Disorders

Overview

Feeling anxious is a normal part of life. Many people worry about things such as health, money, school, work, or family. But anxiety disorders involve more than occasional worry or fear. For people with these disorders, anxiety does not go away, is felt in many situations, and can get worse over time.

Signs and Symptoms

Common symptoms of anxiety disorders include excessive worry, uneasiness, muscle tension, headaches, stomachaches, or body pain, sweaty palms, increased heart rate or respiratory rate, high blood pressure, and loss of sleep.

There are several types of anxiety disorders, each with their own symptoms.

Generalized Anxiety Disorder

People with generalized anxiety disorder may:

• Worry excessively about everyday things
• Have trouble controlling their worries or feelings of nervousness
• Feel irritable or "on edge" frequently
• Feel restless or have trouble relaxing
• Have a hard time concentrating
• Have trouble falling asleep or staying asleep, or feel fatigued
• Experience muscle tension

Panic Disorder

Physical symptoms during a panic attack may include pounding or racing heart, sweating, chills, trembling, difficulty breathing, dizziness or lightheadedness, tingly or numb hands, chest pain, and stomach pain or nausea. A panic attack usually peaks within minutes, although some symptoms or associated distress may last longer.

People with panic disorder may have:

• Unexpected and repeated panic attacks of overwhelming anxiety and fear
• A fear of losing control
• A fear of death or impending doom during a panic attack
• An intense worry about when the next panic attack will happen
• A fear or avoidance of places where panic attacks have occurred in the past

Social Anxiety Disorder

When having to perform in front of or be around others, people with social anxiety disorder may:

• Blush, sweat, or tremble
• Have nausea or stomachache
• Have a rapid heart rate
• Feel their "mind going blank"
• Find it difficult to make eye contact or talk to people in social situations
• Feel self-consciousness or fear that people will judge them negatively
• Avoid places where there are other people
• Expect the worst possible consequences from a negative social situation

Specific Phobia

People with a specific phobia may:

• Have disproportionate or excessive fear or anxiety about a specific object or situation
• Take active steps to avoid the feared object or situation
• Experience immediate, intense anxiety upon encountering the feared object or situation
• If unavoidable, endure the feared object or situation with intense fear or anxiety

Related Health Effects

Some people with anxiety disorders have other mental and physical health disorders or conditions, including depression, other anxiety disorders, post-traumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), chronic pain syndromes, cardiovascular problems, or suicidal thoughts or behaviors. Anxiety disorders are also common in people with alcohol and substance use disorders. The presence of multiple disorders can make treatment more complex.

Causes and Risk Factors

Anxiety disorders may run in families, but the exact cause of the disorders is unknown. Research suggests that anxiety disorders result from a mix of genetics, brain chemistry, biology, and environment. Researchers have found that external causes, such as experiencing a traumatic event or being in a stressful environment, may make someone more likely to develop generalized anxiety disorder.

Research shows that genetic and environmental factors play a role in developing a specific phobia. Some risk factors may include:

• Exposure to a traumatic event involving a specific object or situation
• Feeling distressed or nervous in new situations in childhood
• A history of anxiety or other mental disorders in biological relatives

Prevention Guidance

There is no single way to prevent anxiety disorders, but researchers have found that certain healthy habits, such as exercising regularly and getting enough sleep, can help reduce anxiety symptoms when paired with standard care.

Diagnosis

If you think you are experiencing symptoms of an anxiety disorder, talk to a healthcare provider, such as a primary care doctor, psychiatrist, psychologist, or clinical social worker. During the visit, the provider may ask when your symptoms began, how long they have lasted, how often they occur, and how they affect your life. After discussing your history, the provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms.

Treatment and Management

Treatment for anxiety disorders typically involves psychotherapy, medicine, or both. A mental health professional or healthcare provider can help you determine the right treatment plan based on your needs, preferences, and medical situation. Learn about how to talk with a doctor or healthcare practitioner about mental health.

The relaxation response is a healthy habit that may help to manage anxiety symptoms, and it can be triggered through techniques that often combine breathing deeply with focusing attention on pleasant thoughts and images. Relaxation response techniques include:

• Progressive muscle relaxation: Tightening individual muscles in the body and then releasing the tension, starting with the toes and working up to the face
• Meditation: Likely involve being in a quiet location, being physically comfortable, focusing attention on breathing or a specific word or object, and having an open attitude
• Guided imagery: Relaxing and visualizing the details of a calm, peaceful setting
• Deep breathing: Taking in a slow, deep breath, letting the stomach or chest expand, then exhaling slowly

Psychotherapy

Psychotherapy, also called talk therapy or counseling, can be effective when delivered in person or virtually via telehealth. Cognitive behavioral therapy is a type of psychotherapy that is often used to treat anxiety disorders.

Cognitive behavioral therapy helps people become aware of automatic ways of thinking that are inaccurate or harmful, question those thoughts, understand how the thoughts affect their emotions and behavior, and change self-defeating behavior patterns to feel less anxious and worried. Exposure therapy is a type of cognitive behavioral therapy that focuses on confronting the fears and beliefs associated with anxiety disorder symptoms. This can help people engage in activities they have been avoiding.

Another type of psychotherapy is acceptance and commitment therapy, which encourages nonjudgmental acceptance of thoughts and feelings. This therapy uses strategies such as mindfulness and goal setting to allow a person to continue to engage in meaningful, values-based activities even when they feel anxiety.

Medicine

Healthcare providers may prescribe medicine to treat anxiety disorders. There are different options for medicines, including the following:

The selective serotonin reuptake inhibitor (SSRI) class of antidepressants are often used to treat depression, but they can help treat the symptoms of anxiety disorders such as panic disorder and social anxiety disorder. It may take several weeks for them to start working. These medicines may cause side effects, such as headaches, nausea, or difficulty sleeping, which are usually not severe. Starting at a low dose and increasing it slowly over time can help minimize side effects.

Benzodiazepines are used sparingly and temporarily in the treatment of anxiety disorders, only in specific circumstances when there is a need to rapidly decrease anxiety symptoms. Some people build up a tolerance to them and need higher doses to get the same effect. Some people even become dependent on them, so they are generally used only for brief periods of time. If benzodiazepines have been prescribed, doctors may suggest that a patient taper their use slowly to reduce the likelihood of withdrawal symptoms or renewed anxiety symptoms.

Beta-blockers may be prescribed off-label to treat short-term anxiety symptoms, even though the medicine is not approved for that specific purpose. For instance, people with a specific phobia or social anxiety disorder often experience intense physical symptoms, such as rapid heart rate, sweating, and tremors in feared situations. Beta-blockers can help manage these symptoms. Beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen the symptoms of both conditions.

The anxiolytic buspirone is a different type of anti-anxiety medicine that can be used to treat anxiety over longer periods. Buspirone must be taken every day for 3-4 weeks to reach its full effect, so it is not effective for rapidly decreasing anxiety.

Complementary Health Approaches

Some complementary approaches have been studied and shown to be helpful for treating and managing anxiety disorders.

• Mindfulness-based practices may be as effective as or more effective than some established treatments for reducing anxiety, though more research is still needed.
• Relaxation techniques may reduce anxiety in people with chronic medical problems and those having medical procedures, but cognitive behavioral therapy may be more helpful to treat anxiety disorders.
• Music can help reduce anxiety in people undergoing medical treatment.

If you are considering a complementary health practice, ask a trusted source, such as your healthcare provider, to recommend a practitioner. Keep in mind that "natural" does not always mean safe. Learn more about talking with your doctor about complementary health approaches.

Living With Anxiety

Learning what causes or triggers your stress and what coping techniques work for you can help reduce your anxiety and improve your daily life.

Here are some activities to try when you feel overwhelmed:

• Keep a journal.
• Download an app that provides relaxation exercises, such as deep breathing or visualization, or tips to practice mindfulness.
• Exercise and eat healthy, regular meals.
• Stick to a sleep routine and make sure you are getting enough sleep.
• Avoid drinking excess caffeine such as soft drinks or coffee.
• Identify and challenge your negative and unhelpful thoughts.
• Reach out to friends or family members who help you cope in positive ways.

If you are struggling to cope or if the symptoms of your stress or anxiety will not go away, talk to a healthcare provider, such as a primary care doctor, psychiatrist, psychologist, or clinical social worker.

Tips For Support

• Educate yourself. Research the signs and symptoms, learn about treatment options, and keep up to date with current research.
• Communicate. Have an honest conversation about how you are feeling with someone you trust.
• Practice compassion. Be kind and patient with yourself and others. Acknowledge progress, no matter how small, and recognize that managing anxiety may involve setbacks along the way.

Support Groups

Some people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Support groups are available both in person and online. Any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a healthcare provider.

Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Search for clinical trials on anxiety disorders at ClinicalTrials.gov.

Find Treatment

If you have concerns about your mental health, talk to a primary care provider. They can refer you to a qualified mental health professional such as a psychologist, psychiatrist, or clinical social worker who can help you figure out the next steps.

Learn how to find support and locate mental health services in your area on the Substance Abuse and Mental Health Services Administration website.

Community Support

Additional resources are available to learn more about anxiety disorders:

• The National Alliance on Mental Illness (NAMI) offers support groups and family education programs for people with an anxiety disorder and their loved ones. The NAMI HelpLine can connect you with the NAMI office in your state and help you find programs close to home.
• Mental Health America is a leading nonprofit dedicated to the promotion of mental health, well-being, and condition prevention. They provide resources for understanding your mental health, helping loved ones, or accessing information for personal, academic, or professional purposes.
• The Anxiety and Depression Association of America (ADAA) provides information about anxiety, depression, and related disorders, including research advances and evidence-based clinical practices, to healthcare professionals and the public.

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.  

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

NIH conducts research to identify environmental and genetic factors that contribute to different types of anxiety disorders, and to explore the co-occurrence of anxiety disorders with other mental and behavioral disorders, such as depression and eating disorders. Research also is looking at how major events like pregnancy, trauma, or illness affect rates and symptoms of anxiety disorders.

NIH also supports studies of different treatment approaches for people with anxiety disorders.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.