Anxiety is a normal reaction to stress that everyone experiences from time to time. However, for some people anxiety can become excessive, persistent, and disabling. This intense, out-of-proportion anxiety is a hallmark symptom of several different anxiety disorders.
What is anxiety?
Anxiety is characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure. People with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. These thoughts are called anxiety cognitions. Anxiety is considered to be problematic and classified as a disorder when it interferes with daily activities, relationships, productivity, and overall quality of life.
Mild anxiety can actually be helpful at times, spurring one into action or helping them focus on a task. But severe or ongoing anxiety that negatively impacts lives is considered an anxiety disorder.
What are the main types of anxiety disorders?
There are several recognized types of anxiety disorders, each with different characteristics:
- Generalized anxiety disorder (GAD) – Excessive anxiety or worry occurring most days for at least 6 months. Difficulty controlling the anxiety.
- Social anxiety disorder – Intense fear of social situations due to concern over embarrassment or humiliation.
- Panic disorder – Recurring, unexpected panic attacks followed by concern about having more attacks.
- Obsessive compulsive disorder (OCD) – Repeated obsessions or compulsions that are time-consuming and interfere with daily activities.
- Post-traumatic stress disorder (PTSD) – Anxiety related to a traumatic event that involved death, violence, or severe injury.
- Phobias – Persistent, excessive, and unrealistic fear response to specific objects or situations.
What causes anxiety disorders?
The exact causes of anxiety disorders are not fully known, but likely involve a complex combination of factors:
- Genetics – Anxiety disorders tend to run in families.
- Brain chemistry – Imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine can contribute to anxiety disorders.
- Environmental factors – Stressful or traumatic experiences, especially in childhood, may lead to anxiety disorders.
- Medical factors – Chronic medical conditions, medication side effects, and substance use can produce anxiety symptoms.
- Personality traits – People who lack resilience and emotional stability tend to be more prone to anxiety.
What are the symptoms of intense anxiety?
All types of anxiety share both psychological and physical symptoms. Common symptoms of intense anxiety include:
- Excessive worry about daily situations or events
- Racing thoughts or constant feeling that your mind is overstimulated
- Feeling restless, keyed up, or on edge
- Fatigue or irritability
- Muscle tension
- Difficulty concentrating
- Sleep disturbances
- Palpitations, rapid heart rate
- Sweating, tremors
- Shortness of breath, dizziness
- Nausea, upset stomach
The intensity of anxiety symptoms can range from manageable to completely debilitating depending on the individual and type of anxiety disorder. Symptoms are considered intense when they significantly disrupt normal functioning.
How is intense anxiety diagnosed?
If intense anxiety is suspected, the first step is a complete medical exam by a doctor to check for any underlying physical illnesses or substance use problems contributing to anxiety symptoms. Providing the doctor with a thorough history of symptoms can help them distinguish between everyday anxiety and an anxiety disorder.
To be diagnosed with a specific type of anxiety disorder, symptoms must persist for at least 6 months. The doctor will ask about the situations where anxiety occurs and severity of symptoms. Psychological testing may be done to help confirm the diagnosis.
When does anxiety become a disorder?
Anxiety transitions from normal to disordered when it:
- Is more severe, persistent, and intense than warranted
- Interferes with daily responsibilities and activities
- Cannot be easily controlled
- Leads to avoidance of situations that trigger anxiety
- Causes significant distress and impairment
Seeing a mental health professional is recommended if anxiety symptoms are hard to control, last 6 months or longer, or negatively impact quality of life.
What are the main anxiety disorders?
Some examples of specific anxiety disorders causing intense anxiety include:
Generalized Anxiety Disorder (GAD)
- Excessive anxiety or worry about everyday situations for at least 6 months
- Hard to control feelings of nervousness or being on edge
- Physical symptoms like muscle tension, fatigue, irritability
- Difficulty concentrating, insomnia, restlessness
Social Anxiety Disorder
- Intense fear of social situations due to fear of embarrassment
- Avoidance of social events, public speaking, interacting with strangers
- Worrying for days or weeks before an anticipated social situation
- Racing heart, upset stomach, shaking, sweating when in social settings
Panic Disorder
- Recurrent unexpected panic attacks with intense fear and physical symptoms
- Feelings of impending doom, loss of control, “going crazy”
- At least one month worrying about more attacks or changing behavior due to attacks
Obsessive Compulsive Disorder (OCD)
- Intrusive, unwanted thoughts, images, or urges that cause anxiety (obsessions)
- Repetitive behaviors done to reduce anxiety (compulsions)
- Obsessions and compulsions take up significant time, over 1 hour per day
- Examples include excessive hand washing, counting, checking
Post-Traumatic Stress Disorder (PTSD)
- Develops after exposure to a traumatic event involving potential death, violence, or serious injury
- Re-experiencing the trauma through intrusive memories, nightmares, or flashbacks
- Heightened arousal, reckless behavior, irritability, difficulty concentrating
- Avoidance of traumatic reminders, feeling emotionally numb
Phobias
- Persistent, irrational fear of a specific object, situation, or activity
- Immediate intense anxiety response when exposed to the phobia stimulus
- Recognition that fear is excessive but unable to control it
- Avoidance of phobic situation, leading to interference in functioning
What is the treatment for intense anxiety?
Effective treatment options are available to help reduce symptoms of intense anxiety from anxiety disorders:
Psychotherapy
Cognitive behavioral therapy (CBT) is often the first-line treatment to help identify and change negative thought patterns contributing to anxiety. Exposure therapy gradually exposes the patient to feared situations in a controlled, safe way to conquer phobias and anxiety. Support groups can also be very beneficial.
Medications
Antidepressants like SSRIs (Prozac, Zoloft), SNRIs (Effexor, Cymbalta), and benzodiazepines (Xanax, Klonopin) can help manage anxiety symptoms. Beta blockers help control physical anxiety symptoms like a racing heart.
Mind-Body Practices
Relaxation techniques like meditation, mindfulness, yoga, and controlled breathing can help calm the mind and body. Regular exercise is also very effective at reducing anxiety.
Alternative Remedies
Some patients find supplements like chamomile, vitamin B complex, omega-3 fatty acids, and valerian root helpful for alleviating anxiety. Acupuncture and massage therapy may also provide symptom relief.
Lifestyle Changes
Stress management, limiting caffeine, not smoking, getting enough sleep, and having a strong support system can help keep anxiety under control.
While anxiety disorders cannot always be cured, the right combination of treatments tailored to the individual can effectively manage symptoms in most people and allow them to regain normal functioning and quality of life.
When to seek emergency treatment for anxiety
Most cases of anxiety, even very severe forms, are not medical emergencies. However, emergency medical care should be sought immediately if anxiety is accompanied by:
- Thoughts of harming yourself or suicide
- Symptoms of a heart attack like chest pain or pressure
- Difficulty breathing or sensations of choking
- Feeling detached from reality, paranoid, or having hallucinations
- Uncontrollable, reckless behavior
People having a panic attack characterized by intense fear, chest pain, dizziness, and numbness may feel they are having a heart attack and need emergency care. Their doctor can be called to help distinguish between panic attack and heart attack.
What is the prognosis for anxiety disorders?
With proper treatment and ongoing management, the prognosis for anxiety disorders is good. A recent major study found that over a 12 year period, 74% of people with anxiety disorders achieved remission (Scholten et al., 2019). The table below summarizes the prognosis for each major type of anxiety disorder:
| Anxiety Disorder | Prognosis with Treatment |
|---|---|
| Generalized anxiety disorder | Many achieve remission. Relapse common if treatment stopped. |
| Social anxiety disorder | Cognitive behavioral therapy leads to improvement in 70-80% of people. |
| Panic disorder | CBT helps 60-90%. Medications also highly effective. |
| Obsessive compulsive disorder | 70% experience substantial improvement with CBT and medication. |
| Post-traumatic stress disorder | Remission reached in about 50% after 1 year of treatment. |
| Phobias | Gradual exposure therapy successful in up to 90% of specific phobias. |
While anxiety disorders may recur even after successful treatment, continuing with maintenance therapy greatly lowers the risks of relapse and disruption in functioning.
Conclusion
Anxiety becomes disordered when it is excessive, persistent, and significantly interferes with someone’s quality of life. There are many types of anxiety disorders, but they share common symptoms of excessive fear, worry, avoidance, and physical symptoms. With professional treatment incorporating psychotherapy, medications, lifestyle changes, and alternative therapies tailored to the individual, most people with anxiety disorders can achieve remission of symptoms and restoration of normal function. Consistent maintenance treatment is key to preventing relapse and recurrence.