Anxiety: Symptoms, Causes and When It Becomes Something to Treat

Anxiety is not a malfunction. It is a normal and useful response that prepares the body to deal with threat. It sharpens attention before an exam, keeps you alert on a dark street and pushes you to prepare for a difficult conversation.

Anxiety becomes a medical concern when it turns up without a proportionate cause, lasts a long time and starts to shrink your life. At that point it is no longer preparing you for anything. It is interfering.

This article covers what anxiety looks like in the mind and the body, what drives it, the main recognised disorders and the point at which it is worth speaking to a doctor.

Symptoms of anxiety

Anxiety produces both psychological and physical effects, and the physical ones are the reason many people first visit a doctor believing something is wrong with their heart or stomach.

Emotional and mental symptoms

•      Persistent worry that is difficult to control or switch off

•      A sense of dread, or the feeling that something bad is about to happen

•      Restlessness or feeling permanently on edge

•      Difficulty concentrating, or the mind going blank

•      Irritability that is out of character

•      Anticipating the worst outcome in ordinary situations

•      Avoiding places, people or situations that trigger the feeling

Physical symptoms

•      A racing or pounding heartbeat

•      Rapid or shallow breathing, or a feeling of breathlessness

•      Sweating, trembling or shaking

•      Tight chest, or muscle tension particularly in the neck, shoulders and jaw

•      Stomach upset, nausea or a churning feeling

•      Dizziness, or a sense of unsteadiness

•      Tiredness that sleep does not fix

•      Difficulty falling asleep or staying asleep

These physical symptoms are real, not imagined. They come from the body's stress response releasing adrenaline and cortisol, which is why they can be so convincing and so frightening.

Panic attacks

A panic attack is a sudden surge of intense fear that peaks within minutes. It commonly includes a racing heart, chest tightness, breathlessness, shaking, a sense of unreality and a fear of losing control. Many people experiencing a first panic attack believe they are having a heart attack.

Panic attacks are deeply unpleasant but not physically dangerous in themselves. That said, chest pain and breathlessness should always be assessed by a doctor the first time they occur, because other conditions can produce similar symptoms and should be ruled out properly.

The main anxiety disorders

Condition	Central feature
Generalised anxiety disorder	Excessive worry about many everyday things, most days, for six months or more
Panic disorder	Recurring unexpected panic attacks and persistent fear of the next one
Social anxiety disorder	Intense fear of being judged or humiliated in social or performance situations
Specific phobias	Strong, disproportionate fear of a particular object or situation
Agoraphobia	Fear of situations where escape might be difficult, often leading to avoiding leaving home
Separation anxiety disorder	Excessive distress about being apart from a person one is attached to

Anxiety also frequently appears alongside depression, and the two share several symptoms, which is one reason a proper assessment matters rather than self diagnosis.

What causes anxiety

There is no single cause. In most people it is a combination of factors that interact.

Biological factors

Anxiety disorders tend to run in families, which points to a genetic contribution. Differences in the brain circuits that process threat, particularly the amygdala, and in chemical messengers such as serotonin and noradrenaline, also appear to play a part.

Life experience

Difficult or frightening experiences, particularly in childhood, raise the likelihood of anxiety disorders later. So do periods of prolonged stress such as financial pressure, caring responsibilities, bereavement, relationship breakdown or an unstable work situation.

Physical health conditions

Anxiety can be a symptom of an underlying medical problem. Thyroid disorders, heart and lung conditions, chronic pain, diabetes and hormonal changes can all produce anxiety symptoms. This is precisely why a doctor should assess new and persistent anxiety rather than assuming it is purely psychological.

Substances

Caffeine, nicotine, alcohol and recreational drugs can all trigger or worsen anxiety, and withdrawal from alcohol or sedatives can produce severe symptoms. Some prescription medications list anxiety among their side effects.

Personality and thinking style

Certain patterns raise vulnerability, including perfectionism, a strong need for control, a habit of interpreting ambiguous situations as threatening and low tolerance of uncertainty.

Risk factors

•      A family history of anxiety or other mental health conditions

•      Trauma or significant adversity, particularly early in life

•      Ongoing stress that has no clear endpoint

•      A serious or long term physical illness

•      Being naturally shy or behaviourally inhibited as a child

•      Heavy use of caffeine, alcohol or other substances

What helps

Anxiety disorders are among the most treatable mental health conditions, and most people improve substantially with the right support.

•      Psychological therapy. Cognitive behavioural therapy has strong evidence behind it, and exposure based approaches are particularly effective for phobias and panic.

•      Medication. Several classes of medication are used, always under the supervision of a doctor who can weigh benefits, side effects and duration.

•      Sleep. Poor sleep and anxiety reinforce each other, so a consistent sleep routine is usually one of the first things addressed.

•      Regular physical activity. Consistent exercise has a measurable effect on anxiety symptoms for many people.

•      Reducing caffeine and alcohol. Both are commonly underestimated as contributors.

•      Breathing and grounding techniques. Slow breathing with a longer exhale than inhale can reduce the intensity of acute symptoms.

•      Social connection. Isolation tends to amplify anxious thinking, and regular contact with others works against it.

When to see a doctor

Speak to a doctor or a qualified mental health professional if any of the following apply:

•      The worry feels excessive and is interfering with work, study, relationships or daily routine

•      You are avoiding situations you used to manage without difficulty

•      The symptoms have persisted for several weeks or longer

•      You are experiencing panic attacks

•      You are using alcohol or other substances to manage the feeling

•      You also have low mood, hopelessness or a loss of interest in things you normally enjoy

•      You have physical symptoms such as chest pain or breathlessness that have not been medically assessed

If you are in distress and feel unable to keep yourself safe, treat it as urgent and contact your doctor, a local crisis line or emergency services straight away. Support is available and this is not something you have to manage alone.

Frequently Asked Questions

Q. What is the difference between stress and anxiety?

A. Stress is usually a response to an identifiable external pressure and tends to ease once that pressure passes. Anxiety often continues after the trigger is gone, or appears without a clear cause, and can persist for weeks or months.

Q. Can anxiety cause real physical symptoms?

A. Yes. A racing heart, breathlessness, chest tightness, stomach upset, dizziness and muscle tension are genuine physical effects of the body's stress response, not imagined sensations. New chest pain or breathlessness should still be checked by a doctor.

Q. Is anxiety curable?

A. Many people recover fully and many others reduce their symptoms to a level that no longer restricts daily life. Outcomes are generally good with appropriate therapy, and where indicated, medication.

Q. Can anxiety start suddenly with no obvious reason?

A. It can appear to. Often there is an accumulation of stress, a change in circumstances, a physical health issue or a substance involved that is not obvious at first. This is one reason a medical assessment is worthwhile.

Q. Does exercise really help anxiety?

A. Regular physical activity has good evidence behind it as part of managing anxiety for many people. It works best alongside other measures rather than as a replacement for professional treatment where that is needed.

Disclaimer

This article is for general information only and is not a substitute for professional medical advice, diagnosis or treatment. If you are struggling, please speak to a qualified healthcare professional or a local support service.