Overview
Anxiety is the body's normal alarm, useful before an exam or when crossing a busy road. It becomes a disorder when the fear and worry are excessive, difficult to control, last for months and stop a person doing ordinary things.
Several conditions sit under this name: generalised anxiety disorder, with worry about many everyday matters; panic disorder, with sudden attacks of intense fear; social anxiety disorder; specific phobias; agoraphobia; and separation anxiety. Anxiety disorders often begin in childhood or the teenage years.
Symptoms
- Worry that is hard to switch off, and a sense of something bad about to happen
- Restlessness, irritability and difficulty concentrating
- A racing or pounding heart, sweating, trembling and a dry mouth
- Tight chest, breathlessness, or the feeling of not getting enough air
- Nausea, loose motions or stomach churning
- Dizziness, tingling in the hands, and muscle tension or headache
- Trouble falling asleep, or waking with worry
- Avoiding places, people or situations that bring on the fear
A panic attack is a sudden surge of intense fear with strong physical symptoms, often with a feeling of dread or of losing control. It peaks quickly and usually passes within five to twenty minutes.
When to see a doctor
See a doctor within a few days if worry is hard to control on most days for months, if panic attacks keep happening, if fear is causing work, school, travel or people to be avoided, if sleep is badly disturbed, or if anxiety comes with low mood or with drinking.
Causes
Anxiety disorders come from a mix of social, psychological and biological factors. Abuse, violence, bereavement, loss of work, long-term stress and other difficult experiences raise the risk, and the tendency can run in families.
Physical health plays a part too: thyroid problems, heart and lung conditions, some medicines, too much caffeine, alcohol and drug use, and withdrawal from them, can all cause or worsen anxiety symptoms.
Risk factors
- Anxiety or depression in a close relative
- Abuse, neglect or a frightening experience, in childhood or later
- Bereavement, separation, money problems or job insecurity
- Long-term physical illness, including heart disease
- Heavy caffeine, alcohol or drug use
- Another mental health condition, particularly depression
Complications
Untreated anxiety narrows life: work and study suffer, travel and social occasions are avoided, and relationships strain. Sleep is often poor, which worsens everything else.
Depression frequently follows, and some people begin to drink or use drugs to cope, which makes anxiety worse. Repeated tests for unexplained physical symptoms are common and can delay the right treatment.
Prevention
- Regular physical activity, most days of the week
- Keeping to regular sleeping and eating times
- Cutting down tea, coffee and energy drinks
- Avoiding alcohol and drugs as a way of coping
- Learning slow breathing or muscle relaxation, and practising it when calm
- Talking to someone trusted early, rather than waiting
- Facing feared situations gradually rather than avoiding them
Diagnosis
The diagnosis is made from the history: what the fear is about, how long it has lasted, how much it is controlling daily life, and whether there are panic attacks or avoidance. A short questionnaire is sometimes used.
Because anxiety and physical illness feel alike, the doctor examines the person and may order tests such as an , thyroid tests or a blood count, particularly when chest pain, palpitations or breathlessness are new. Finding no physical cause is part of making the diagnosis, not a sign that the symptoms are imagined.
Treatment
Talking therapy is the main treatment. Cognitive behavioural therapy has the strongest evidence, and exposure therapy, in which feared situations are approached step by step with support, is used for phobias and panic. Therapy may be one to one, in a group or online.
When medicine is needed, antidepressants from the SSRI group are usually chosen, and they take a few weeks to work. Sedatives from the benzodiazepine group are generally not recommended because the body becomes dependent on them.
During a panic attack it helps to stay where you are if it is safe, breathe slowly and deeply, and remind yourself that the attack will pass. Regular exercise, steady sleep, less caffeine and relaxation practice support the treatment.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A panic attack is a heart attack, or it can cause one.”What is true?
Fact
A panic attack can feel very like a heart attack, with chest pain, a racing heart and breathlessness, and it usually settles within five to twenty minutes. That is exactly why new chest pain or breathlessness must be checked by a doctor first. Once the heart has been cleared, repeated attacks can be treated as panic.
Myth“Anxiety is just overthinking. Stop worrying and it will go.”What is true?
Fact
An anxiety disorder is a recognised health condition, not a habit of thought that can be switched off. It involves real changes in the body, it lasts for months, and it responds to treatment such as cognitive behavioural therapy.
Myth“Sleeping tablets are the best treatment for anxiety.”What is true?
Fact
Medicines from the benzodiazepine group can calm anxiety quickly but are generally not recommended, because the body becomes used to them and stopping is difficult. Talking therapy is the main treatment, and when medicine is needed doctors usually choose an antidepressant instead.
Myth“Avoiding the things that frighten you is the sensible way to cope.”What is true?
Fact
Avoiding a feared situation brings relief for a short time and makes the fear stronger in the long run. Treatment works in the opposite direction, facing feared situations gradually and with support, which is why it is done with a trained therapist rather than alone.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How do I know whether my chest pain is anxiety or my heart?
You cannot tell reliably on your own, and neither can most doctors without tests. Chest pain, tightness or breathlessness that is new, or that happens in someone with diabetes, high blood pressure or heart disease, should be treated as an emergency until the heart and lungs have been checked. Once serious causes are excluded, repeated episodes can be treated as panic.
Are panic attacks dangerous?
A panic attack is frightening but not itself harmful, and it passes, usually within five to twenty minutes. The danger lies in assuming that every episode of chest pain or breathlessness is panic, so the first episode always needs checking, and any change in the usual pattern does too.
Will I need medicine, or is therapy enough?
Many people improve with talking therapy alone, particularly cognitive behavioural therapy. Medicine is added when symptoms are severe, when therapy is not available quickly, or when depression is present as well. The choice is made with the doctor, and both approaches can be combined.
Does anxiety mean I am mentally weak?
No. Anxiety disorders are among the most common health conditions in the world, they affect capable and successful people, and they arise from a mix of life experience, physical health and family tendency. They respond to treatment, and asking for help is a practical step rather than a failing.