Anxiety

Anxiety

Feeling worried or nervous is a normal part of everyday life. Everyone frets or feels anxious from time to time. Mild to moderate anxiety can help you focus your attention, energy, and motivation. If anxiety is severe, you may have feelings of helplessness, confusion, and extreme worry that are out of proportion with the actual seriousness or likelihood of the feared event. Overwhelming anxiety that interferes with daily life is not normal. This type of anxiety may be a symptom of another problem, such as depression.

Anxiety can cause physical and emotional symptoms. A specific situation or fear can cause some or all of these symptoms for a short time. When the situation passes, the symptoms usually go away.

Physical symptoms of anxiety include:

• Trembling, twitching, or shaking.
• Feeling of fullness in the throat or chest.
• Breathlessness or rapid heartbeat.
• Lightheadedness or dizziness.
• Sweating or cold, clammy hands.
• Feeling jumpy.
• Muscle tension, aches, or soreness (myalgias).
• Extreme tiredness.
• Sleep problems, such as the inability to fall asleep or stay asleep, early waking, or restlessness (not feeling rested when you wake up).

Anxiety affects the part of the brain that helps control how you communicate. This makes it more difficult to express yourself creatively or function effectively in relationships. Emotional symptoms of anxiety include:

• Restlessness, irritability, or feeling on edge or keyed up.
• Worrying too much.
• Fearing that something bad is going to happen; feeling doomed.
• Inability to concentrate; feeling like your mind goes blank.

Anxiety disorders

Anxiety disorders occur when people have both physical and emotional symptoms. Anxiety disorders interfere with how a person gets along with others and affect daily activities. Women are twice as likely as men to have problems with anxiety disorders. Examples of anxiety disorders include panic attacks, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).

Often the cause of anxiety disorders is not known. Many people with an anxiety disorder say they have felt nervous and anxious all their lives. This problem can occur at any age. Children who have at least one parent with the diagnosis of depression are more than twice as likely to have an anxiety disorder than other children.

Anxiety disorders often occur with other problems, such as:

• Mental health problems, such as depression or substance abuse.
• A physical problem, such as heart or lung disease. A complete medical examination may be needed before an anxiety disorder can be diagnosed.

Panic attacks

A panic attack is a sudden feeling of extreme anxiety or intense fear without a clear cause or when there is no danger. Panic attacks are common. They sometimes occur in otherwise normal, healthy people and will usually last for several minutes.

Symptoms include feelings of dying or losing control of yourself, rapid breathing (hyperventilation), and a racing heart. You may feel dizzy, sweaty, or shaky. Other symptoms include trouble breathing, chest pain or tightness, and an irregular heartbeat. These symptoms come on suddenly and without warning.

Sometimes symptoms of a panic attack are so intense that the person fears he or she is having a heart attack. Many of the symptoms of a panic attack can occur with other illnesses, such as hyperthyroidism, coronary artery disease, or chronic obstructive pulmonary disease (COPD). A complete medical examination may be needed before an anxiety disorder can be diagnosed.

People who have repeated unexpected panic attacks and worry about the attacks are said to have a panic disorder.

Phobias

Phobias are extreme and irrational fears that interfere with daily life. People with phobias have fears that are out of proportion to real danger. And although these people are aware that their fears are not rational, they are not able to control them.

Phobias are common and are sometimes present with other conditions, such as panic disorder or Tourette's disorder. Most people deal with phobias by avoiding the situation or object that causes them to feel panic (avoidance behavior).

A phobic disorder occurs when the avoidance behavior becomes so extreme that it interferes with your ability to participate in your daily activities. There are three main types of phobic disorders:

• Fear of being alone or in public places where help might not be available or escape is impossible (agoraphobia)
• Fear of situations where the individual might be exposed to criticism by others (social phobia)
• Fear of specific things (specific phobia)

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

Emergencies

Do you have any of the following symptoms that require emergency treatment? Call 911 or other emergency services immediately.

• Chest pain that is crushing, squeezing, or feels like a heavy weight on the chest or that occurs with any other symptoms of a heart attack
• Seriously considering harming yourself or someone else, with a plan that includes:
  • Having the means, such as weapons or medicines, available to commit suicide or do harm to another person
  • Having set a time and place to commit suicide
  • Thinking there is no other way to solve your problem or end your pain

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

Yes

Does anxiety interfere with your daily activities?

See significance of anxiety that interferes with daily activities if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to any of the following questions.

Yes

Are you thinking about committing suicide but do not have a plan?

Yes

Have you had a change in your mental health and you are thinking about harming yourself or someone else?

Call your health professional today if you answer "Yes" to the following question.

Yes

Are you no longer able to perform your daily activities?

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.

Yes

Do general feelings of anxiety interfere with your daily activities?

Yes

Do you have intense, irrational fears of common places, objects, or situations?

Yes

Are you unable to feel certain about things, such as whether you unplugged the iron, no matter how many times you check?

Yes

Do repetitive actions that you cannot control interfere with your daily activities?

Yes

Do you still have symptoms after 1 week of home treatment?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Yes

Do you have sudden, severe attacks of fear or anxiety when there is no apparent reason to be afraid?

See significance of sudden, severe episodes of fear or anxiety if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to the following question.

Yes

Are you thinking about committing suicide but do not have a plan?

Call your health professional today if you answer "Yes" to the following question.

Yes

Are you no longer able to perform your daily activities?

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.

Yes

Do you still have symptoms of fear or anxiety after 1 week of home treatment?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Yes

Do you think your anxiety may be caused or made worse by a medicine?

See significance of medicines causing anxiety if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional today if you answer "Yes" to any of the following questions.

Yes

Do you think your feelings of anxiety are caused by a medicine?

Yes

Have you had new feelings of anxiety after starting a new medicine?

Yes

Has your anxiety gotten worse after starting a new medicine?

Note:

If you answered Yes to any of the above questions: Call the doctor who prescribed the medicine to determine whether you should stop taking the medicine or take a different one. If you are taking a nonprescription medicine, stop taking the medicine. Call your doctor if you feel you need to continue taking the medicine.

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Yes

Do you have frequent nightmares or flashbacks of traumatic events?

See significance of post-traumatic stress if you need information to help you answer the question below.

Review health risks that may increase the seriousness of your symptoms.

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.

Yes

Do you have severe nightmares or flashbacks, even after 1 to 2 weeks of home treatment?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home Treatment

Home treatment, combined with professional treatment, can help relieve anxiety.

• Recognize and accept your anxiety about specific fears or situations, and then make a plan for dealing with them. For example, if you are constantly worrying about finances, set up a budget or savings plan.
• Don't dwell on past problems. Change what you can to help you feel more comfortable with present concerns, but let go of past problems or things you cannot change.
• Be kind to your body:
  • Relieve tension with vigorous exercise or massage.
  • Practice relaxation techniques. For more information, see the topic Stress Management.
  • Get enough rest. If you have trouble sleeping, see the topic Sleep Problems, Age 12 and Older.
  • Avoid alcohol, caffeine, chocolate, and nicotine. They may increase your anxiety level.
• Engage your mind:
  • Get out and do something you enjoy, such as going to a funny movie or taking a walk or hike.
  • Plan your day. Having too much or too little to do can make you more anxious.
  • Keep a diary of your symptoms(What is a PDF document?) . Discuss your fears with a good friend. Confiding in others sometimes relieves stress.
• Get involved in social groups, or volunteer to help others. Being alone can make things seem worse than they are.
• Learn about resources available in your community:
  • Talk with your human resources officer about counseling benefits that may be available through your employee assistance program.
  • Check with your insurance company to see what mental health benefits are available.
  • Contact your public health department for information on community mental health programs.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if symptoms become more frequent or severe during home treatment.

Prevention

You can help prevent anxiety attacks:

• Avoid caffeine, such as coffee, tea, Mountain Dew, colas, and chocolate. Caffeine can keep you in a tense, aroused condition. For more information, see the topic Healthy Eating.
• Do not smoke or use smokeless (spit) tobacco products. Nicotine stimulates many physical and psychological processes, causes your blood vessels to constrict, and makes your heart work harder. For more information, see the topic Quitting Tobacco Use.
• Exercise during the day. Even a brisk walk around the block may help you stay calm. For more information, see the topic Fitness.

Cognitive-behavioral therapy can help control symptoms of anxiety or panic.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• What is your major symptom?
• How long have you had your symptoms? Do they come and go, or are they always present?
• What triggers the onset of your symptoms?
• What makes your symptoms better or worse?
• Do you have other symptoms that may be related to your major symptom? These other symptoms may include:
  • Rapid or irregular heartbeat.
  • Nausea or vomiting.
  • Numbness or weakness.
  • Excessive sweating.
  • Feeling that you are not able to get enough air (air hunger).
  • Restlessness, irritability, or feeling on edge.
  • Feeling depressed.
• Have you ever had a similar problem in the past? If so, how was it treated?
• Has anyone else in your family ever been diagnosed with an anxiety disorder, depression, or another mental illness?
• Has anyone in your family committed suicide or tried to commit suicide?
• What home treatment measures have you tried? Did they help?
• What prescription or nonprescription medicines are you currently using?
• What herbal supplements are you taking?
• Are you using alcohol or illegal drugs, such as marijuana or cocaine, to manage your symptoms?
• Do you smoke or use other tobacco products?
• Do you have any health risks?

While waiting for your appointment, it may be helpful to keep a diary of your symptoms(What is a PDF document?) .

Related Information

• Depression
• Feeling Depressed
• Fitness
• Mental Health Problems and Mind-Body Wellness
• Obsessive-Compulsive Disorder (OCD)
• Post-Traumatic Stress Disorder
• Sleep Problems, Age 12 and Older
• Stress Management

Credits

Author	Jan Nissl, RN, BS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Tracy Landauer
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Lisa S. Weinstock, MD - Psychiatry
Last Updated	September 12, 2008