What is the symptoms of anxiety disorder

NIMH » Anxiety Disorders

Overview

Occasional anxiety is a normal part of life. Many people worry about things such as health, money, or family problems. But anxiety disorders involve more than temporary worry or fear. For people with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and various phobia-related disorders.

Signs and Symptoms

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) usually involves a persistent feeling of anxiety or dread, which can interfere with daily life. It is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events. People living with GAD experience frequent anxiety for months, if not years.

Symptoms of GAD include:

Feeling restless, wound-up, or on-edge
Being easily fatigued
Having difficulty concentrating
Being irritable
Having headaches, muscle aches, stomachaches, or unexplained pains
Difficulty controlling feelings of worry
Having sleep problems, such as difficulty falling or staying asleep

Panic Disorder

People with panic disorder have frequent and unexpected panic attacks. Panic attacks are sudden periods of intense fear, discomfort, or sense of losing control even when there is no clear danger or trigger. Not everyone who experiences a panic attack will develop panic disorder.

During a panic attack, a person may experience:

Pounding or racing heart
Sweating
Trembling or tingling
Chest pain
Feelings of impending doom
Feelings of being out of control

People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Panic attacks can occur as frequently as several times a day or as rarely as a few times a year.

Social Anxiety Disorder

Social anxiety disorder is an intense, persistent fear of being watched and judged by others. For people with social anxiety disorder, the fear of social situations may feel so intense that it seems beyond their control. For some people, this fear may get in the way of going to work, attending school, or doing everyday things.

People with social anxiety disorder may experience:

Blushing, sweating, or trembling
Pounding or racing heart
Stomachaches
Rigid body posture or speaking with an overly soft voice
Difficulty making eye contact or being around people they don’t know
Feelings of self-consciousness or fear that people will judge them negatively

Phobia-related disorders

A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.

People with a phobia:

May have an irrational or excessive worry about encountering the feared object or situation
Take active steps to avoid the feared object or situation
Experience immediate intense anxiety upon encountering the feared object or situation
Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders:

Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:

Flying
Heights
Specific animals, such as spiders, dogs, or snakes
Receiving injections
Blood

Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.

Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:

Using public transportation
Being in open spaces
Being in enclosed spaces
Standing in line or being in a crowd
Being outside of the home alone

People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.

Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.

Selective mutism: A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. People diagnosed with selective mutism are often also diagnosed with other anxiety disorders.

Risk Factors

Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder.

The risk factors for each type of anxiety disorder vary. However, some general risk factors include:

Shyness or feeling distressed or nervous in new situations in childhood
Exposure to stressful and negative life or environmental events
A history of anxiety or other mental disorders in biological relatives

Anxiety symptoms can be produced or aggravated by:

Some physical health conditions, such as thyroid problems or heart arrhythmia
Caffeine or other substances/medications

If you think you may have an anxiety disorder, getting a physical examination from a health care provider may help them diagnose your symptoms and find the right treatment.

Treatments and Therapies

Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety, and you should work with a health care provider to choose the best treatment for you.

Psychotherapy

Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at your specific anxieties and tailored to your needs.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to situations to help you feel less anxious and fearful. CBT has been well studied and is the gold standard for psychotherapy.

Exposure therapy is a CBT method that is used to treat anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises.

Acceptance and Commitment Therapy

Another treatment option for some anxiety disorders is acceptance and commitment therapy (ACT). ACT takes a different approach than CBT to negative thoughts. It uses strategies such as mindfulness and goal setting to reduce discomfort and anxiety. Compared to CBT, ACT is a newer form of psychotherapy treatment, so less data are available on its effectiveness.

Medication

Medication does not cure anxiety disorders but can help relieve symptoms. Health care providers, such as a psychiatrist or primary care provider, can prescribe medication for anxiety. Some states also allow psychologists who have received specialized training to prescribe psychiatric medications. The most common classes of medications used to combat anxiety disorders are antidepressants, anti-anxiety medications (such as benzodiazepines), and beta-blockers.

Antidepressants

Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects.

Antidepressants can take several weeks to start working so it’s important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a health care provider. Your provider can help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

In some cases, children, teenagers, and adults younger than 25 may experience increased suicidal thoughts or behavior when taking antidepressant medications, especially in the first few weeks after starting or when the dose is changed. Because of this, people of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

Anti-anxiety Medications

Anti-anxiety medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Although benzodiazepines are sometimes used as first-line treatments for generalized anxiety disorder, they have both benefits and drawbacks.

Benzodiazepines are effective in relieving anxiety and take effect more quickly than antidepressant medications. However, some people build up a tolerance to these medications and need higher and higher doses to get the same effect. Some people even become dependent on them.

To avoid these problems, health care providers usually prescribe benzodiazepines for short periods of time.

If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms, or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. Your provider can help you slowly and safely decrease your dose.

Beta-blockers

Although beta-blockers are most often used to treat high blood pressure, they can help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. These medications can help people keep physical symptoms under control when taken for short periods. They can also be used “as needed” to reduce acute anxiety, including to prevent some predictable forms of performance anxieties.

Choosing the Right Medication

Some types of drugs may work better for specific types of anxiety disorders, so people should work closely with a health care provider to identify which medication is best for them. Certain substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements may aggravate the symptoms of anxiety disorders or interact with prescribed medication. People should talk with a health care provider, so they can learn which substances are safe and which to avoid.

Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and should be based on a person’s needs and their medical situation. Your and your provider may try several medicines before finding the right one.

Support Groups

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Support groups are available both in person and online. However, any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a health care provider.

Stress Management Techniques

Stress management techniques, such as exercise, mindfulness, and meditation, also can reduce anxiety symptoms and enhance the effects of psychotherapy. You can learn more about how these techniques benefit your treatment by talking with a health care provider.

Join a Study

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

NIMH’s Clinical Trials webpage: Information about participating in clinical trials
Clinicaltrials.gov: Current Studies on Anxiety Disorders: List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country
Join a Study: Adults - Anxiety Disorders: List of studies being conducted on the NIH Campus in Bethesda, MD
Join a Study: Children - Anxiety Disorders: List of studies being conducted on the NIH Campus in Bethesda, MD

Learn More

Free Brochures and Shareable Resources

Generalized Anxiety Disorder (GAD): When Worry Gets Out of Control: This brochure describes the signs, symptoms, and treatment of generalized anxiety disorder.
I’m So Stressed Out!: This fact sheet intended for teens and young adults presents information about stress, anxiety, and ways to cope when feeling overwhelmed.
Obsessive-Compulsive Disorder: When Unwanted Thoughts Take Over: This brochure describes the signs, symptoms, and treatment of OCD.
Panic Disorder: When Fear Overwhelms: This brochure describes the signs, symptoms, and treatments of panic disorder.
Social Anxiety Disorder: More Than Just Shyness: This brochure describes the signs, symptoms, and treatment of social anxiety disorder.
Shareable Resources on Anxiety Disorders: Help support anxiety awareness and education in your community. Use these digital resources, including graphics and messages, to spread the word about anxiety disorders.

Multimedia

Mental Health Minute: Anxiety Disorders in Adults:Take a mental health minute to watch this video about anxiety disorders in adults.
Mental Health Minute: Stress and Anxiety in Adolescents: Take a mental health minute to watch this video about stress and anxiety in adolescents.
NIMH Expert Discusses Coping with the Pandemic and School Re-Entry Stress: Learn about the causes or triggers of stress and coping techniques to help reduce anxiety and improve the transition back to school.
NIMH Expert Discusses Managing Stress and Anxiety: Learn about coping with stressful situations and when to seek help.
GREAT: Learn helpful practices to manage stress and anxiety. GREAT was developed by Dr. Krystal Lewis, a licensed clinical psychologist at NIMH.
Getting to Know Your Brain: Dealing with Stress: Test your knowledge about stress and the brain. Also learn how to create and use a “stress catcher” to practice strategies to deal with stress.
Guided Visualization: Dealing with Stress: Learn how the brain handles stress and practice a guided visualization activity.
Panic Disorder: The Symptoms: Learn about the signs and symptoms of panic disorder.

Federal Resources

Anxiety Disorders (MedlinePlus – also en español)

Research and Statistics

Journal Articles: References and abstracts from MEDLINE/PubMed (National Library of Medicine).
Statistics: Anxiety Disorder: This webpage provides information on the statistics currently available on the prevalence and treatment of anxiety among people in the U.S.

Last Reviewed: April 2022
Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge. Citation of NIMH is appreciated. Please see our Citing NIMH Information and Publications page for more information.

When Worry Gets Out of Control

Do you often find yourself worrying about everyday issues for no obvious reason? Are you always waiting for disaster to strike or excessively worried about things such as health, money, family, work, or school?

If so, you may have a type of anxiety disorder called generalized anxiety disorder (GAD). GAD can make daily life feel like a constant state of worry, fear, and dread. The good news is GAD is treatable. Learn more about the symptoms of GAD and how to find help.

What is generalized anxiety disorder?

Occasional anxiety is a normal part of life. Many people may worry about things such as health, money, or family problems. But people with GAD feel extremely worried or nervous more frequently about these and other things—even when there is little or no reason to worry about them. GAD usually involves a persistent feeling of anxiety or dread that interferes with how you live your life. It is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events. People living with GAD experience frequent anxiety for months, if not years.

GAD develops slowly. It often starts around age 30, although it can occur in childhood. The disorder is more common in women than in men.

What are the signs and symptoms of generalized anxiety disorder?

People with GAD may:

Worry excessively about everyday things
Have trouble controlling their worries or feelings of nervousness
Know that they worry much more than they should
Feel restless and have trouble relaxing
Have a hard time concentrating
Startle easily
Have trouble falling asleep or staying asleep
Tire easily or feel tired all the time
Have headaches, muscle aches, stomachaches, or unexplained pains
Have a hard time swallowing
Tremble or twitch
Feel irritable or "on edge"
Sweat a lot, feel lightheaded, or feel out of breath
Have to go to the bathroom frequently

Children and teens with GAD often worry excessively about:

Their performance in activities such as school or sports
Catastrophes, such as earthquakes or war
The health of others, such as family members

Adults with GAD are often highly nervous about everyday circumstances, such as:

Job security or performance
Health
Finances
The health and well-being of their children or other family members
Being late
Completing household chores and other responsibilities

Both children and adults with GAD may experience physical symptoms such as pain, fatigue, or shortness of breath that make it hard to function and that interfere with daily life.

Symptoms may fluctuate over time and are often worse during times of stress—for example—with a physical illness, during school exams, or during a family or relationship conflict.

What causes generalized anxiety disorder?

Risk for GAD can run in families. Several parts of the brain and biological processes play a key role in fear and anxiety. By learning more about how the brain and body function in people with anxiety disorders, researchers may be able to develop better treatments. Researchers have also found that external causes, such as experiencing a traumatic event or being in a stressful environment, may put you at higher risk for developing GAD.

How is generalized anxiety disorder treated?

If you think you’re experiencing symptoms of GAD, talk to a health care provider. After discussing your history, a health care provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms. A health care provider may refer you to a mental health professional, such as a psychiatrist, psychologist, or clinical social worker. The first step to effective treatment is to get a diagnosis, usually from a mental health professional.

GAD is generally treated with psychotherapy (sometimes called “talk therapy”), medication, or both. Speak with a health care provider about the best treatment for you.