Anxiety Disorders

Anxiety is a common human emotion that everyone feels to some extent. When anxiety becomes intense, persistent, or starts to get in the way of daily life, it may be described as an anxiety disorder.

Anxiety disorders are the most common mental health conditions worldwide. According to the World Health Organisation, an estimated 470 million people around the world were living with an anxiety disorder in 2023. Anxiety disorders can affect anyone, regardless of age, gender, or socioeconomic status. They often co-occur with other mental health conditions, such as depression or substance use disorders.

How Anxiety Can Show Up

Anxiety can show up as a broad range of physical, emotional, and cognitive experiences that can make everyday life a lot harder. These experiences vary from person to person, but there are some common threads.

On a cognitive level, people living with anxiety often experience persistent, intense worry about everyday situations that feels hard to control. This can be incredibly distracting, making it difficult to concentrate and complete tasks. The fear and worry are often bigger than the situation calls for, so people tend to overestimate the danger and underestimate their ability to cope. People often anticipate the worst, have racing thoughts, and find it difficult to be still and relaxed.

Emotionally, people may feel restless, tense, or on edge. They might experience a feeling of dread or impending doom, nervousness, and irritability. They may also become easily fatigued and have difficulty sleeping, including trouble falling asleep, waking up during the night, or experiencing restless and unsatisfying sleep.

Anxiety often shows up in the body too. This can include a faster heart rate, hyperventilation, dry mouth, dizziness, excessive sweating, trembling, and gastrointestinal problems like stomach upset or diarrhoea. People may experience muscle tension or headaches, as well as panic attacks, which are characterised by an intense feeling of fear and a range of physical sensations such as chest pain, shortness of breath, nausea, and a fear of dying.

These experiences can get in the way of a person’s usual routine, social life, or relationships. How intense and frequent they are can change over time, and if they keep showing up, it can help to reach out for professional support.

Common experiences include:

• Persistent, intense worry or fear
• Irritability
• Restlessness
• Difficulty concentrating
• Trouble sleeping
• Fatigue
• Muscle tension
• Rapid heartbeat
• Shortness of breath
• Sweating

What Causes Anxiety?

The exact causes of anxiety aren't fully understood, but anxiety is likely the result of a combination of factors. These can be divided into three broad categories: genetics, brain chemistry, and environmental factors.

Genetics seem to play a part. Studies suggest that anxiety tends to run in families, pointing to a genetic link. If a person has a close family member who lives with an anxiety disorder, they are more likely to experience anxiety themselves.

Brain chemistry may also play a part. Some research has linked anxiety to differences in how certain neurotransmitters work in the brain. Neurotransmitters are specialised chemicals that allow communication between nerve cells. The old idea of anxiety as a simple "chemical imbalance" is now seen as too simple, though, and brain chemistry is best understood as one piece of a bigger picture.

Life experiences and environment matter just as much. Traumatic experiences like abuse, victimisation, or exposure to combat can change how safe the world feels and make anxiety more likely. Long-term stress from work, relationships, or money worries can also contribute.

Some medical conditions can also cause experiences that look a lot like anxiety, including certain types of heart disease, hormonal conditions, and drug use or withdrawal. These factors don’t work independently and often interact with each other. For instance, a person may have inherited a genetic predisposition to anxiety and then a stressful life event sets it off. That's why it helps to consider all of these factors when understanding and supporting someone with anxiety.

Contributing factors may include:

• Family history of anxiety or other mental health conditions
• Childhood trauma or abuse
• Chronic medical conditions or pain
• Substance use or withdrawal
• Hormonal changes
• Personality traits such as perfectionism or low self-esteem
• Stressful life events

Types of Anxiety Disorders

There are several types of anxiety disorders.  Understanding the different types can help you make sense of what you're experiencing and find support that fits.

Generalised Anxiety Disorder (GAD)

One common type is generalised anxiety disorder, characterised by ongoing worry and fear about everyday events. It can be long-lasting and may get in the way of daily life.

Panic Disorder

Panic disorder is another anxiety disorder characterised by recurring panic attacks. People can experience sudden, unexpected waves of intense fear, with chest pain, sweating, and heart palpitations (which can feel like a heart attack).

Social Anxiety Disorder (aka Social Phobia)

Another type is social anxiety disorder, where people have an intense fear of social situations and feel very self-conscious. They are often afraid of being judged or embarrassed in front of others.

Phobia-related disorders

A phobia is a strong fear of a specific object or situation. The fear is often out of proportion to the actual danger and can lead to avoiding the thing that's feared. The fear and avoidance can affect quality of life. Common examples include arachnophobia (fear of spiders), ophidiophobia (fear of snakes), glossophobia (fear of public speaking), and acrophobia (fear of heights).

Agoraphobia

Intense fear of being in places where it might be hard to get out or get help in an emergency, such as:

• Open spaces
• Closed spaces
• Outside of the home (particularly when alone)
• In a crowd
• Public transport
• Standing in a line

Separation Anxiety Disorder

Separation anxiety disorder is common in children and occurs when they have an intense fear of being separated from their primary caregivers. It involves intense anxiety about being away from someone the person is close to, and while it is more common in childhood, it can also happen in adulthood.

Selective Mutism

More common in young children, this is a rare anxiety disorder that often co-occurs with other anxiety disorders and involves being unable to speak in specific social situations because of intense anxiety (not speech difficulties).

Medication-Induced Anxiety Disorder

Intense anxiety triggered by the use of or withdrawal from drugs (both prescribed and non-prescribed). Anxiety may be exacerbated by medication.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder used to be grouped with the anxiety disorders, but the DSM-5 now places it in its own group of obsessive-compulsive and related disorders. It involves obsessive thoughts and compulsive behaviours that people feel compelled to repeat, and anxiety is often a big part of it.

Support Options for Anxiety

Support for anxiety often involves a combination of therapy, medication, and self-help strategies. Some evidence-based options include:

Cognitive Behavioural Therapy (CBT): This form of therapy helps people notice and change unhelpful thought patterns and behaviours that keep anxiety going.

Exposure Therapy: This involves gradually facing feared situations or objects while building confidence in coping with the anxiety that comes up.

Medications: Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed for anxiety disorders. Benzodiazepines may be prescribed for short-term relief of severe anxiety.

Relaxation and Mindfulness Techniques: Deep breathing, progressive muscle relaxation, and mindfulness meditation can help ease anxiety.

Lifestyle Changes: Moving in ways you enjoy (if adequately nourished), eating regularly and enough, and getting enough sleep can support your overall mental health and ease anxiety.

Tips for Coping with Anxiety

Coping with anxiety is often an ongoing process that can involve lifestyle changes, cognitive behavioural strategies, and in some cases, professional support. Here are some ideas that may help:

1. Practise Mindful Relaxation: Building relaxation techniques into your daily routine can help ease anxiety. Mindfulness, meditation, progressive muscle relaxation, and deep breathing exercises can reduce feelings of anxiety by slowing down your thoughts and relaxing your body.
2. Eat Regularly and Move in Ways You Enjoy: Eating regularly and enough, and moving in ways you enjoy (if adequately nourished), can help your mood and energy. Physical activity can also help ease anxiety, as exercise releases endorphins, chemicals in the brain that can lift your mood.
3. Limit Alcohol and Avoid Drugs: These substances can trigger or exacerbate anxiety and can also interfere with the effectiveness of prescribed medication.
4. Get Enough Sleep: Lack of adequate sleep can exacerbate anxiety. Aim for 7-9 hours of quality sleep a night. Develop a regular sleep routine and create a quiet, dark environment in your bedroom.
5. Limit Caffeine Intake: Foods and drinks containing caffeine can trigger or worsen anxiety. Consider decreasing your caffeine intake or cutting it out entirely if you notice it causes you to feel jittery or anxious.
6. Stay Connected: Social interaction and support can both distract you from your worries and provide you with a sense of being understood and valued. It can help to talk about your anxiety with trusted friends, family members, or a support group.
7. Practise Cognitive Strategies: Learning to recognise and shift thought patterns that feed anxiety can help. This is often a part of cognitive behavioural therapy (CBT), a type of therapy with strong research support for anxiety.

If at any point anxiety feels overwhelming, it may help to reach out for professional support. Mental health professionals can offer extra strategies and options such as therapy and medication.

Do I have an anxiety condition?

Anxiety is a common emotion that we all experience from time to time, particularly when faced with stressful situations such as an interview or an examination. However, when feelings of worry and fear become chronic, overwhelming, and out of proportion to the actual stress in your life, it could point to an anxiety disorder. Anxiety disorders are a group of mental health conditions characterised by ongoing worry about everyday situations that is hard to switch off. The most common types include Generalised Anxiety Disorder, Panic Disorder, Phobia-related Disorders, and Social Anxiety Disorder.

Working out whether you have an anxiety disorder isn't always straightforward, as anxiety looks different from person to person. There are some common experiences that health professionals look for. If you often feel restless or on edge, easily tired, irritable, or caught up in worry that feels impossible to control, it might point to an anxiety disorder. If you find yourself avoiding situations that make you anxious or often expecting the worst, these can also be part of the picture. Diagnosis requires a thorough evaluation by a trained professional such as a psychiatrist or psychologist, who would use clinical interviews, psychological testing, and the diagnosis criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. For generalised anxiety disorder, these criteria include excessive anxiety and worry for at least six months, the inability to control worrying, and at least three physical or cognitive symptoms of anxiety. It can help to know that effective support is available, including therapy and, in some cases, medication. Getting support early can improve quality of life and reduce the risk of other difficulties, such as depression or problems with alcohol or drug use.

Related Conditions

Anxiety often doesn't come on its own and frequently co-occurs with other mental health conditions. Sometimes these come from living with intense, persistent anxiety, and at other times anxiety and these conditions may both be part of a wider set of difficulties. Understanding related conditions can give a fuller picture of how to support someone with anxiety.

Depression is one of the most common conditions to co-occur with anxiety. Major Depressive Disorder (MDD) is characterised by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. People with MDD may also experience weight changes, fatigue, difficulty concentrating, or suicidal thoughts. Similarly, Bipolar Disorder is also regularly associated with anxiety disorders. Also, Substance Use Disorders (SUDs), such as alcohol or drug dependence, are more common in people with anxiety, possibly because alcohol or drugs can become a way of coping with anxiety that brings its own problems.

There is a strong link between anxiety disorders and physical health conditions as well. For instance, people with chronic conditions such as cardiovascular disease, diabetes, and chronic respiratory conditions often experience anxiety too, which shows how closely physical and mental health are connected. For people living with these co-occurring conditions, support for anxiety often works best as part of an integrated approach that looks at the anxiety alongside their other health needs, including any medical treatment. The goal is to help people look after all aspects of their health.

Supporting someone else

Supporting someone with anxiety can be challenging, and it can make a big difference. It can help them cope and give them a sense of comfort and safety. Understanding anxiety is a good first step. Anxiety isn't something a person chooses to have. It can be intense and exhausting, with feelings of worry and fear strong enough to get in the way of daily life.

One way to support a loved one with anxiety is through patience and understanding. Since anxiety looks different for everyone, acknowledge their feelings, lend a listening ear, and avoid making judgemental comments. Try to be compassionate and steady during their anxious periods. It helps to be a source of comfort, not more stress. This might involve being with them during uncomfortable situations or reassuring them during an anxiety attack. It also means not pushing them to face their fears, as this can lead to more anxiety.

Gently encouraging them to seek professional support can also help. Psychologists, psychiatrists, and therapists are trained to deliver cognitive-behavioural therapy, conduct exposure therapy sessions or prescribe medications when necessary. For some people, joining a support group can also be beneficial. While you're taking care of someone else, it's important to look after your own mental health too. Balancing the two and getting support when you need it can make your support more sustainable.

When to get professional help

Knowing when to reach out for professional help with anxiety can make a big difference to your quality of life. Anxiety as a short-term response to stress is a common part of life. If feelings of anxiety persist for more than six months and start to get in the way of daily activities, it's a good time to reach out to a health professional. Ongoing worry, fear, agitation, restlessness, fatigue, difficulty sleeping, panic attacks, and avoiding things that make you anxious are all experiences where professional support can help.

Apart from how long anxiety has lasted and how intense it is, there are other times when it's a good idea to see your doctor. These include if you have a history of traumatic experiences, have had a recent major life change, are using alcohol or drugs to cope with anxiety, or have suicidal thoughts or behaviours. Furthermore, if you have other mental health conditions, or physical health conditions, such as heart disease, diabetes, or thyroid problems, it's particularly important to talk about your anxiety with your doctor, as these could be interconnected.

When seeking help, you can start with your GP, who may then refer you to a mental health professional, like a psychiatrist or psychologist. These professionals can provide a diagnosis, talk through options for support, and work with you on ways to cope. Reaching out for support is a good step towards feeling more in control and improving your overall wellbeing.