ConditionMental health & sleep
Anxiety Disorders
Anxiety disorders are mental health conditions in which worry, fear or nervousness is excessive, persistent and interferes with daily life. They include generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, agoraphobia and separation anxiety. Together they are the most common mental health conditions, affecting about 1 in 5 US adults in a given year. They are highly treatable with cognitive behavioral therapy, medicines such as SSRIs, or both.
Also called: Anxiety, generalized anxiety disorder (GAD), anxiety neurosis, chronic anxiety
At a glance
- What they are
- Conditions with excessive, persistent fear or worry and avoidance that disrupt work, relationships or daily life.
- Main types
- Generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, agoraphobia, separation anxiety disorder, selective mutism.
- Common symptoms
- Worry, restlessness, tension, poor sleep, racing heart, breathlessness, stomach upset, avoidance.
- Causes
- A mix of genes, brain chemistry, temperament, stress and trauma, health conditions and substances.
- Treatment
- Cognitive behavioral therapy, SSRIs or SNRIs, lifestyle changes. Most people improve significantly.
When to get help
Call 911 or go to the ER
- Thoughts of suicide or self-harm: call or text 988 (US), or call 911 or your local emergency number
- Chest pain, fainting or severe breathlessness, especially for the first time or with heart risk factors
- Severe agitation, confusion or hallucinations
See a doctor within a day or two
- Panic attacks happening frequently or worsening quickly
- Anxiety so severe you cannot leave home, work or care for yourself or your children
- Using alcohol, cannabis or sedatives to cope, or withdrawal symptoms when stopping them
- New severe anxiety during pregnancy or after birth
Book a routine appointment
- Worry most days for weeks to months that is hard to control
- Avoiding places, people or situations because of fear
- Physical symptoms such as poor sleep, tension, stomach problems or a racing heart with no clear cause
- Anxiety in a child that stops them going to school or sleeping alone
Usually safe to manage at home
- Short-lived nervousness before an exam, interview or event that passes afterward
What anxiety disorders are
Anxiety is a normal reaction that helps you prepare for challenges and avoid danger. It becomes a disorder when it is out of proportion to the situation, lasts a long time (usually 6 months or more for most types), is hard to control and causes significant distress or problems in daily life.
Anxiety disorders are more common in women than men, often begin in childhood, adolescence or early adulthood, and frequently occur alongside depression, substance use and other anxiety disorders.
Types of anxiety disorders
| Disorder | Core feature | Typical signs |
|---|---|---|
| Generalized anxiety disorder (GAD) | Persistent, hard-to-control worry about many everyday things | Restlessness, fatigue, poor concentration, irritability, muscle tension, poor sleep, for 6 months or more |
| Panic disorder | Recurrent unexpected panic attacks and fear of further attacks | Sudden surges of fear with pounding heart, breathlessness, dizziness, fear of dying |
| Social anxiety disorder | Fear of being judged or embarrassed | Avoiding speaking, eating in public, parties, phone calls |
| Specific phobias | Intense fear of a particular object or situation | Heights, flying, animals, needles, blood |
| Agoraphobia | Fear of situations where escape or help may be hard | Avoiding crowds, public transport, open or enclosed spaces, leaving home |
| Separation anxiety disorder | Excessive fear of being apart from attachment figures | Children refusing school, adults fearing harm to loved ones |
| Selective mutism | Consistently not speaking in certain settings | A child who talks at home but not at school |
Related conditions that used to be classed as anxiety disorders include obsessive-compulsive disorder, post-traumatic stress disorder and illness anxiety disorder.
Symptoms
Emotional and thinking symptoms
- Persistent worry or dread
- Feeling on edge, restless or keyed up
- Difficulty concentrating, mind going blank
- Irritability
- Anticipating the worst
- Avoiding situations that trigger anxiety
Physical symptoms
- Racing or pounding heart (palpitations)
- Breathlessness or feeling of choking
- Muscle tension, headaches, jaw clenching
- Sweating, trembling, hot flashes or chills
- Stomach upset, nausea, diarrhea, irritable bowel symptoms
- Fatigue
- Trouble falling or staying asleep (insomnia)
- Dizziness and tingling, often from overbreathing
In children and teenagers
Children may complain of stomachaches or headaches, cling to parents, have tantrums, refuse school, struggle to sleep alone or seek constant reassurance. Teenagers may withdraw socially or avoid school.
Causes and risk factors
No single cause explains anxiety disorders. Contributing factors include:
- Genetics: anxiety disorders run in families. Heritability is estimated around 30 to 50 percent
- Brain circuits: overactivity of the amygdala and fear circuits, and imbalances in neurotransmitters such as serotonin, norepinephrine and GABA
- Temperament: shyness or behavioral inhibition in childhood
- Life experiences: childhood adversity, trauma, ongoing stress, bereavement, financial or relationship problems
- Health conditions: hyperthyroidism, heart rhythm disorders, asthma and COPD, chronic pain, irritable bowel syndrome
- Substances: caffeine, nicotine, alcohol, cannabis, stimulants, and withdrawal from alcohol, benzodiazepines or opioids
- Medicines: steroids, some asthma and decongestant medicines, thyroid hormone excess
Diagnosis
There is no blood test for anxiety. A primary care doctor, psychiatrist or psychologist will ask about symptoms, how long they have lasted, triggers, avoidance, impact on life, substance use, sleep and mood. Standard questionnaires such as the GAD-7 help measure severity. The US Preventive Services Task Force recommends screening adults under 65 for anxiety, including during pregnancy and after birth.
Doctors may order tests to rule out physical causes, such as thyroid function, blood glucose, a blood count and an ECG when palpitations or chest symptoms are prominent.
Treatment
Psychological therapy
- Cognitive behavioral therapy (CBT): the most researched treatment. It teaches you to recognize anxious thinking patterns, test them against reality and gradually face feared situations (exposure). Typical courses last 12 to 20 sessions. Guided self-help and digital CBT programs are effective for milder anxiety.
- Acceptance and commitment therapy, applied relaxation and mindfulness-based approaches also help many people.
Medicines
- SSRIs (such as sertraline, escitalopram) and SNRIs (such as venlafaxine, duloxetine) are first-line medicines. They take 2 to 6 weeks to work and are usually continued for at least 6 to 12 months after improvement.
- Buspirone for generalized anxiety.
- Pregabalin is used in some countries for GAD.
- Benzodiazepines can relieve severe anxiety quickly but carry risks of dependence, sedation and falls, so they are generally limited to short-term use.
- Beta-blockers such as propranolol can reduce physical symptoms for performance anxiety.
Combining therapy and medication often works best for moderate to severe anxiety.
Self-help and lifestyle
- Regular aerobic exercise, which reduces anxiety symptoms
- Cutting back on caffeine and alcohol
- Regular sleep schedule
- Slow breathing and progressive muscle relaxation
- Staying connected with others and not avoiding feared situations
- Limiting reassurance-seeking and internet symptom searching
Complications
Without treatment, anxiety disorders can lead to depression, alcohol or drug misuse, social isolation, problems at school or work, poor sleep, worse physical health and, in some people, suicidal thoughts.
Outlook
Most people with anxiety disorders improve substantially with treatment, and many become symptom-free. Anxiety can return during stressful periods, but skills learned in therapy help manage relapses. Early treatment in childhood and adolescence improves long-term outcomes.
Frequently asked questions
What are the main types of anxiety disorders?
The main types are generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, agoraphobia, separation anxiety disorder and selective mutism. Obsessive-compulsive disorder and PTSD are closely related but are now classified separately.
What causes anxiety disorders?
Anxiety disorders result from a combination of genetic vulnerability, brain chemistry, temperament, life stress and trauma. Medical conditions such as an overactive thyroid, and substances such as caffeine, alcohol and stimulants, can cause or worsen anxiety.
What is the best treatment for anxiety?
Cognitive behavioral therapy and SSRI or SNRI medicines are the best-supported treatments. Many people do well with therapy alone, while others benefit from combining therapy and medication. Exercise, good sleep and reducing caffeine and alcohol also help.
Can anxiety disorders be cured?
Many people recover fully or have only occasional mild symptoms after treatment. Anxiety can come back during stressful times, but the skills learned in therapy and, if needed, restarting medication usually bring it back under control.
How do I know if my anxiety is a disorder?
Anxiety may be a disorder if it is excessive for the situation, lasts weeks to months, is hard to control and interferes with your work, studies, relationships or sleep. A doctor or mental health professional can assess it, often using a short questionnaire.
Can anxiety cause physical symptoms?
Yes. Anxiety commonly causes a racing heart, breathlessness, chest tightness, sweating, shaking, headaches, muscle tension, stomach upset and fatigue. Because these overlap with medical conditions, new physical symptoms should be checked by a doctor.
Sources
This guide was written from current patient and clinical guidance, including:
- National Institute of Mental Health: Anxiety disorders
- American Psychiatric Association: What are anxiety disorders? (DSM-5-TR)
- NICE: Generalised anxiety disorder and panic disorder in adults (CG113)
- US Preventive Services Task Force: Screening for anxiety disorders in adults
- Anxiety and Depression Association of America: Facts and statistics