Anxiety disorder is a common long-term condition in which feelings of unease, worry or fear become so persistent and overwhelming that they disrupt your daily life, often making normal activities seem impossible.
What is an anxiety disorder?
For most people, anxiety is an occasional feeling of mild unease or worry about future events. It’s normal to feel anxious about things like exams, job interviews, a first date, public speaking, moving house and so forth. Most people know what they are anxious about and why – and their anxiety passes when its cause is over.
But with an anxiety disorder worries may be almost constant - you may be plagued with feelings of anxiety even if there’s no identifiable cause. Intense anxiety may come up suddenly, often for no clear reason or because of unrealistic fears about something that is unlikely to ever happen. The anxiety may seem impossible to control.
“Sometimes it is difficult to maintain relationships or a general social life. There are many challenges; I try my best to make it through each situation. Being social can actually help alleviate anxiety.”response in HealthUnlocked anxiety survey, 2018
Such anxiety is a key feature of several conditions, the most common being Generalized Anxiety Disorder (GAD) – it’s often referred to simply as “having anxiety”.
Alongside the feelings and thoughts, there are physical symptoms that can, in turn, make the anxiety still worse. An anxiety disorder can affect everything from personal relationships and work to social activities and home life.
The Anxiety and Depression Association of America (ADAA) estimates that 40 million American adults are affected to some degree by anxiety disorders — roughly 18 percent of the population. Of those, almost 6.8 million have GAD. In the UK, the NHS says around 5% of adults have GAD – about 3.2 million people.
What happens when we are anxious?
Normal anxiety is part of the mechanism that triggers our ‘fight or flight’ response to protect us from danger. When we feel threatened, our bodies release the hormones adrenaline (epinephrine) and cortisol. These hormones make us temporarily more alert and physically able. They make our hearts beat faster, speed up breathing, release extra energy into the bloodstream and let blood flow more easily into muscles so we are primed for action.
Someone with an anxiety disorder gets the ‘fight or flight’ response in relation to a range of triggers or situations that are not actually life-threatening or dangerous but still make them feel threatened in some way.
“Appropriate anxiety in the face of danger can be life-saving but how do we know what is 'appropriate'? Fight, flight, freeze reactions are instinctive; they aren't the result of conscious thought,”says psychotherapist Sue Cowan-Jenssen.
Symptoms of anxiety
Anxiety has physical as well as psychological effects. There are many possible symptoms, though you are unlikely to have them all and some people have different symptoms at different times.
Common physical symptoms of anxiety include:
Increased heart rate and/or palpitations
Pins and needles, or tingling sensations, in the hands and feet
Shallow, short breathing (hyperventilating)
Tightness in the chest
Feeling dizzy, faint or nauseous
Changes in appetite, sleeping patterns and/or sex drive
Headaches and tension around the eyes and jaw
Dryness of the mouth
Common psychological symptoms include:
Feeling detached from the environment and other people
Worries about death or major illness
Feeling a sense of dread or severe apprehension
Feeling observed or judged by others
Feeling the need to flee from a situation
Feeling extremely on edge and hypersensitive
Persistent feelings of anxiety can prompt the onset of other mental health issues, such as depression. People often have both GAD and depression.
While Generalized Anxiety Disorder may be experienced as tension, physical discomfort and intrusive thoughts, intense anxiety can trigger a panic attack.
Panic attacks usually come on quickly, peak, and pass within 10-15 minutes. This, however, can feel like a lifetime for the person having the attack. Panic attacks cause no physical harm, but the emotional and psychological distress caused may persist for a long time after the event. During a panic attack an individual may:
Feel convinced they are going to die
Feel as though they have lost all control
Feel detached from their environment and undergo an ‘out-of-body’ experience
Feel as though they cannot breathe or are having a heart attack
Anyone can have a panic attack, but if you have them repeatedly, worry constantly about having one and change your day-to-day activities to try to avoid having one, then you might have panic disorder, another anxiety disorder often associated with GAD.
“There is so much help out there and you are not alone. Don't be afraid or ashamed to ask for help”response in HealthUnlocked anxiety survey, 2018
Diagnosis of anxiety
As anxiety is a normal human emotion, it can be difficult to know at what point it becomes a mental health issue. GAD can be difficult for doctors to diagnose and is sometimes hard to distinguish from other mental health issues, such as depression.
If your anxiety is stopping you living your life fully, or preventing you from completing daily tasks, you should talk to your GP. You should also talk to your GP if you have had a panic attack.
If some or all the following statements are true for you, consider seeing your GP:
I am always worried about my job/health/relationship
When I am worried, I find it extremely difficult to take my mind off it
I often feel physical symptoms when I am worried or anxious, such as nausea or shortness of breath
I expect the worst possible outcome to most situations
I have had a panic attack
Beyond Generalized Anxiety Disorder, there are other conditions that are characterized by anxiety. These include:
Obsessive Compulsive Disorder (OCD) – in which people have intrusive and repetitive thoughts, and repetitive behaviours and impulses
Body Dysmorphic Disorder (BDD) – which produces intrusive and distressing anxiety related to the body or a particular body part
Phobias – which bring severe anxiety over particular triggers or situations, for example, fear of snakes or fear of open spaces
Causes of anxiety
As is the case with most mental health conditions, it is generally difficult to pinpoint a single cause for anxiety disorders. Anxiety is thought to be caused by a combination of the following factors:
If someone experiences a traumatic event, such as an accident, assault or abuse, the feelings of anxiety this provokes may be hard to overcome. This anxiety is generally considered a symptom of Post-Traumatic Stress Disorder (PTSD).
The long-term stress that can be caused by significant life events, such as divorce, bereavement, personal illness or illness of a loved one, can cause long-lasting feelings of anxiety.
Evidence suggests that there is potentially a genetic element to developing an anxiety disorder. It is, however, unclear whether this is linked to specific genes, or whether it is the result of the growing up with a parent with an anxiety disorder and the impact this might have on a child’s development. If you have a close relative with GAD, your risk of developing it is about five times higher than the general population.
Natural anxiety can develop into an anxiety disorder. An individual may, for example, after experiencing a bout of anxiety-related physical issues such as nausea or chest pain, become convinced that they are not well. This might develop into health anxiety and can, in turn, develop into generalized anxiety disorder.
“Try to stay positive even when you feel everything is not looking too good! It will change!”response in HealthUnlocked anxiety survey, 2018
One of the most challenging things about overcoming anxiety is that it is somewhat self-fulfilling. When we experience anxiety, we view the world and other people more negatively. We become hypersensitive to what we see as negative speech and facial expressions. These negative views give us more to worry about and so reinforce our anxiety.
Living with other mental health issues, such as depression or bipolar disorder, can also cause anxiety. Many individuals with depression also experience panic attacks.
Treatment of anxiety
If you have GAD, your GP might recommend a talking therapy. Cognitive Behavioural Therapy (CBT) is an evidence-based treatment for anxiety disorders. CBT focuses on changing the unhelpful patterns of thinking that characterise anxiety. Many people with anxiety tend to do what is called ‘catastrophizing’ – where the mind will present the worst possible outcome to a situation and will struggle to let it go. A course of CBT can equip you to manage and overcome this kind of thinking.
Other forms of talking therapy, such as psychodynamic psychotherapy or EMDR (Eye Movement Desensitisation and Reprocessing) may also be considered valuable treatments for anxiety that is rooted in past trauma or relationship issues.
Mindfulness – recommended by the UK National Institute for Health and Care Excellence (NICE) as a treatment for depression – has also been shown to help some people with GAD. By focusing attention on the present moment, you can develop more control over your thinking. While the goal of mindfulness and meditation is not to immediately eliminate feelings or thoughts of anxiety, it can support you in developing a level of healthy detachment from your thoughts. Much mindfulness meditation is rooted in breathing exercises.
In some cases, you may be offered medication for anxiety, usually anti-depressants. You should discuss the benefits and potential side effects of taking anti-depressants with your doctor.
Living with anxiety
Often, we avoid situations that make us anxious. By ensuring that we don’t have to face a situation that causes anxiety, we get immediate relief. This is, however, only a short-term solution, and can make the situation more difficult in the future. By repeatedly avoiding situations that cause anxiety, we may compound the belief that we are unable to cope with those situations.
The problem is that no-one can avoid everything that causes anxiety. Attempting to do so continually will either result in a lifestyle that is seriously limited and potentially isolated, or will fail, in which case when a stressful situation does arise, it may seem completely overwhelming. It can be immensely helpful to learn about what triggers your anxiety and practise challenging your patterns of thinking.
If you have an anxiety disorder, or even if you would simply like to manage feelings of anxiety that occur infrequently, there are various things you can do.
In a 2018 survey among HealthUnlocked users with anxiety disorders, almost two-thirds used breathing techniques to control their anxiety – you can read about breathing to relax on the NHS website. About 40% of those in the survey found meditation helpful, and about half said walking, exercise or listening to music helped them.
Being careful about what you consume is also important. Alcohol and drugs can make anxiety much more difficult to cope with, as can the caffeine in coffee. Ensuring you eat a balanced diet, take exercise and sleep well can go a long way to keeping anxiety under control.
“Life has been a struggle at times and just getting through the days has been extremely difficult. My family and friends have been very supportive which helps tremendously”response in HealthUnlocked anxiety survey, 2018
Talking to those close to you about your anxiety can make life more manageable. Your friends, family or partner will be able to help you more effectively if they are aware of the triggers for your anxiety. It can also be a huge relief to be open about your difficulties; you are not alone in struggling with anxiety.
Support and apps
Anxiety is a common mental health issue and sharing your experience with others who understand what you are going through can be a huge relief.
Joining an online community, such as the Living with Anxiety forum at HealthUnlocked, lets you see what others are discussing, ask questions and chat with people in similar situations to yourself.
There are also face-to-face local support groups, where you can meet others coping with similar problems. Your doctor may be able to suggest a local group, or you can search online.
- In the US, the Anxiety and Depression Association of America lists support groups throughout the country and provides links to find more through other sites.
- In the UK, you can find local support groups through Anxiety UK. The charity also runs an information line: 08444 775 774, (Monday-Friday 9.30-5.30).
- MIND also has a directory of peer-to-peer support groups for people with mental health issues.
If you are looking for a UK therapist to help with anxiety, you can search the welldoing.org website for a therapist with CBT training who specialises in anxiety.
There are many free and low-cost apps to help you manage your anxiety. You can find them by searching for ‘anxiety’ in your device’s app store.