Anxiety Disorders
Anxiety is a normal human response to uncertainty, stress or perceived danger. It becomes a mental health concern when fear, worry or physical symptoms become excessive, difficult to control, persist over time, or begin interfering with work, study, relationships, sleep or everyday activities.
Anxiety disorders can take different forms. Some people experience persistent worry about many areas of life; others have recurrent panic attacks, intense fear of social situations, or strong fear and avoidance of particular places or situations.
Effective treatments are available. Depending on the type and severity of anxiety, treatment may include psychological therapy, self-management strategies, medication when clinically appropriate, and treatment of associated physical or mental health conditions.
What is an anxiety disorder?
An anxiety disorder involves fear or worry that is excessive or difficult to control and causes significant distress or impairment.
Anxiety may affect thoughts, emotions, the body and behaviour. Symptoms often persist over months rather than being limited to a single stressful event, although the exact pattern varies between disorders.
Important
Experiencing anxiety does not automatically mean that someone has an anxiety disorder. Professional assessment considers the severity, duration, triggers, functional impact and other possible psychiatric or medical explanations.
At a Glance
What it can feel like
Persistent worry, fear, nervousness, feeling on edge, panic or a sense that something bad is about to happen.
Physical symptoms
Palpitations, breathlessness, sweating, trembling, dizziness, stomach discomfort, muscle tension, fatigue or disturbed sleep can occur.
Treatment
Psychological therapies-particularly treatments based on cognitive behavioural therapy (CBT)-are important evidence-based treatments. Medication may also be considered depending on the disorder and individual clinical circumstances.
On this page
Normal Anxiety vs An Anxiety Disorder
Anxiety itself is not abnormal.
Feeling anxious before:
- An examination
- An interview
- An important presentation
- A medical procedure
- Financial uncertainty
- A difficult conversation
can be understandable and sometimes useful.
Normal anxiety generally reduces when the stressful situation passes and does not consistently prevent a person from living their life.
An anxiety disorder may be more likely when anxiety:
- Occurs very frequently
- Feels disproportionate to the actual situation
- Is difficult to control
- Persists for months
- Causes repeated panic attacks
- Produces substantial avoidance
- Interferes with sleep
- Affects relationships
- Reduces work or academic performance
- Restricts travel or social activities
- Leads to repeated reassurance seeking
- Causes significant distress
The key issue is therefore not simply:
Do I feel anxious?
but:
How severe is the anxiety, how persistent is it, and how much is it controlling my life?
Types of Anxiety Disorders
This is important because Anxiety Disorders is an umbrella term rather than one single condition.
WHO recognises several anxiety disorders, including generalised anxiety disorder, panic disorder, social anxiety disorder, agoraphobia, separation anxiety disorder and specific phobias.
Generalised Anxiety Disorder – GAD
GAD involves excessive worry about a range of everyday matters.
Worry may involve:
- Health
- Family
- Finances
- Work
- Studies
- Relationships
- Responsibilities
- Future events
The person may recognise that the worry is excessive but still find it very difficult to stop.
Panic Disorder
Panic disorder involves recurrent panic attacks together with continuing concern about having further attacks and/or behavioural changes designed to avoid them.
The fear of another panic attack may itself become a major source of anxiety.
Social Anxiety Disorder
Social anxiety involves intense fear or anxiety about social situations in which a person believes they may be:
- Watched
- Judged
- Criticised
- Rejected
- Embarrassed
- Humiliated
It is more than ordinary shyness.
NICE recommends assessing the person’s feared situations, avoidance, self-image, safety behaviours and impact on occupational, educational and social functioning.
Specific Phobias
A specific phobia involves marked fear of a particular object or situation.
Examples may include:
- Particular animals
- Heights
- Flying
- Blood or injections
- Enclosed spaces
People may arrange significant parts of their life around avoiding the feared stimulus.
Agoraphobia
Agoraphobia involves intense fear or avoidance of situations where the person worries that escape may be difficult or help may not be available if severe anxiety or panic occurs.
Examples may include:
- Travelling alone
- Crowded places
- Public transport
- Queues
- Open or enclosed public places
Signs and Symptoms of Anxiety
Anxiety can affect thoughts, emotions, bodily sensations and behaviour.
Different people experience different combinations.
Persistent worry
A person may:
- Worry excessively about ordinary situations
- Move rapidly from one worry to another
- Repeatedly imagine worst-case outcomes
- Find uncertainty particularly difficult
- Feel unable to switch offu00a0their thoughts
- Repeatedly ask others for reassurance
- Spend large amounts of time preparing for problems that may never occur
In GAD, worry is often spread across several areas of life rather than being confined to one specific fear.
Feeling tense or constantly on edge
People may describe:
- Nervousness
- Internal tension
- Restlessness
- Feeling unable to relax
- Feeling keyed up
- Becoming easily startled
- Becoming unusually irritable
WHO lists irritability, tension and restlessness among common anxiety symptoms.
Physical Symptoms of Anxiety
Physical symptoms are common and can be very distressing.
They may include:
Heart and circulation
- Racing heartbeat
- Pounding heartbeat
- Awareness of the heartbeat
- Palpitations
Breathing
- Rapid breathing
- Breathlessness
- Feeling unable to take a full breath
- Chest tightness
Nervous system
- Trembling
- Shaking
- Sweating
- Dizziness
- Light-headedness
- Tingling sensations
Gastrointestinal symptoms
- Nausea
- Abdominal discomfort
- Diarrhoea
- Butterflies in the stomach
- Appetite disturbance
Muscles
- Muscle tension
- Jaw clenching
- Neck or shoulder pain
- Tension headaches
Sleep
- Difficulty falling asleep
- Repeated waking
- Waking feeling tense
- Sleep disrupted by worry
General
- Fatigue
- Feeling exhausted after prolonged anxiety
- Difficulty relaxing
WHO specifically lists nausea or abdominal distress, palpitations, sweating, trembling and sleep disturbance among common anxiety symptoms.
Important clinical note
New, severe or unexplained physical symptoms should not automatically be assumed to be anxiety.
Chest pain, fainting, significant breathlessness, palpitations and other physical symptoms can have medical causes. Appropriate physical assessment may therefore be necessary depending on the presentation.
Cognitive Symptoms
Anxiety can significantly affect thinking.
A person may experience:
- Difficulty concentrating
- Indecisiveness
- Difficulty completing tasks
- Repeated mental checking
- Difficulty tolerating uncertainty
- Excessive attention to possible threats
- Catastrophising
- Difficulty remembering information because attention is consumed by worry
Students may find it hard to study despite spending many hours at their desk.
Professionals may repeatedly check work because of fear of making a mistake.
Avoidance
Avoidance is one of the most important behavioural features of many anxiety disorders.
A person may avoid:
- Travelling
- Crowds
- Driving
- Meetings
- Public speaking
- Eating in public
- Telephone calls
- Social gatherings
- Medical procedures
- Particular places
- Being alone
Avoidance often brings short-term relief.
That relief can reinforce the avoidance, making the feared situation feel even more threatening the next time.
This is one reason evidence-based psychological treatment often involves gradually learning to face feared situations safely rather than organising life around avoiding them.
Safety-Seeking Behaviours
Some anxiety symptoms are maintained by behaviours that feel protective.
Examples include:
- Repeatedly checking one’s pulse
- Always carrying medication just in case
- Sitting close to exits
- Attending situations only with a trusted person
- Rehearsing every sentence before speaking
- Avoiding eye contact
- Repeatedly seeking reassurance
- Constantly searching symptoms online
Such behaviours may temporarily reduce anxiety while preventing the person from learning that the feared outcome may not actually occur.
NICE specifically includes safety-seeking behaviours among factors to assess in social anxiety disorder.
What Does a Panic Attack Feel Like?
A panic attack is an episode of intense fear or discomfort that can rise rapidly.
Symptoms may include:
- Pounding or racing heartbeat
- Sweating
- Trembling
- Breathlessness
- Choking sensation
- Chest discomfort
- Nausea
- Dizziness
- Feeling detached or unreal
- Fear of losing control
- Fear of fainting
- Fear of dying
Because some symptoms resemble medical emergencies, a first, atypical or medically concerning episode may require physical assessment.
Does Having a Panic Attack Mean Panic Disorder?
No.
Panic attacks can occur:
- In panic disorder
- In other anxiety disorders
- During severe stress
- With some psychiatric conditions
- In association with substances or medications
- With some medical conditions
Panic disorder involves a broader pattern that includes recurrent attacks and significant continuing concern or behavioural change related to further attacks.
What Does Social Anxiety Look Like?
Social anxiety is not simply introversion.
A person may fear:
- Speaking in front of others
- Meeting unfamiliar people
- Eating while being watched
- Attending meetings
- Making telephone calls
- Talking to authority figures
- Being observed while performing a task
They may fear that others will notice:
- Blushing
- Sweating
- Trembling
- Appearing nervous
- Saying something wrong.
Some people then spend hours replaying a social interaction afterwards and criticising themselves.
NICE recommends assessing anticipatory anxiety, self-focused attention and post-event processing because these can be important features of social anxiety.
When Should Someone Seek Professional Help?
Consider professional assessment when anxiety:
- Persists for several weeks or months
- Becomes increasingly difficult to control
- Leads to panic attacks
- Affects sleep
- Interferes with work or study
- Restricts social or family life
- Causes substantial avoidance
- Leads to repeated emergency or medical visits
- Results in alcohol or drug use to cope
- Occurs together with depression
- Significantly reduces quality of life
You do not need to wait until anxiety becomes unbearable before asking for help
When Is Urgent Help Needed?
Seek urgent mental health or medical assistance when anxiety occurs together with:
- Suicidal thoughts or serious self-harm risk
- Severe inability to care for oneself
- Extreme agitation or behavioural disturbance
- Severe substance intoxication or withdrawal
- Psychotic symptoms
- An immediate risk to the person or others
Also seek appropriate medical evaluation for severe or concerning physical symptoms rather than assuming they are anxiety.
Why Do Anxiety Disorders Develop?
There is rarely one single cause.
Anxiety disorders arise through interactions between biological vulnerability, learning, life experiences, stress and social circumstances.
WHO describes them as arising from a complex combination of social, psychological and biological factors.
Possible contributing factors include:
Family and biological vulnerability
Some people may have greater underlying vulnerability to anxiety.
Stressful or traumatic experiences
Examples may include:
- abuse
- serious loss
- trauma
- major illness
- prolonged stress
WHO identifies severe losses, abuse and other adverse experiences as factors associated with increased vulnerability.
Learned patterns
Avoidance, reassurance seeking and repeated threat monitoring can strengthen anxiety over time.
Personality and coping style
Some people may:
- Worry excessively about mistakes
- Have difficulty tolerating uncertainty
- Be highly self-critical
- Feel excessive responsibility for preventing negative events
Physical illness
Some medical conditions can produce or worsen anxiety symptoms.
Alcohol, caffeine and substances
Alcohol or drugs may sometimes be used to cope with anxiety, but can worsen symptoms or complicate treatment.
High caffeine intake can also exacerbate symptoms such as:
- palpitations
- tremor
- restlessness
- poor sleep
in susceptible individuals.
How Are Anxiety Disorders Assessed?
Anxiety should not be diagnosed solely from an online questionnaire.
A psychiatric or psychological assessment may explore:
- The specific fears or worries
- When symptoms began
- Duration
- Frequency
- Triggers
- Physical symptoms
- Panic attacks
- Avoidance
- Reassurance seeking
- Sleep
- Functional impairment
- Work or academic impact
- Relationships
- Previous treatment
- Physical health
- Medications
- Caffeine
- Alcohol and substance use
- Depression
- Trauma
- Self-harm or suicide risk
NICE specifically recommends assessing both anxiety symptoms and distress/functional impairment, along with coexisting mental and physical health conditions and substance use.
Could Something Else Be Causing the Symptoms?
Yes.
Symptoms resembling anxiety can occur in association with:
- physical illness
- medication effects
- stimulant use
- substance use or withdrawal
- depression
- bipolar disorder
- trauma-related conditions
- obsessive-compulsive disorder
- other psychiatric conditions
This is particularly important when the main presentation is:
- palpitations
- dizziness
- chest discomfort
- tremor
- breathlessness
- gastrointestinal symptoms
The purpose of assessment is to understand the whole presentation, rather than automatically labelling physical symptoms as anxiety
How Are Anxiety Disorders Treated?
Treatment depends on:
- the specific anxiety disorder
- severity
- duration
- functional impairment
- previous treatment
- associated conditions
- patient preference
For GAD, NICE recommends a stepped-care model, beginning with identification, education and monitoring and progressing to self-help, psychological treatment or medication depending on severity and response.
Psychological Treatments
Cognitive Behavioural Therapy – CBT
CBT is one of the best-established psychological treatments for anxiety disorders.
It may help a person:
- understand patterns maintaining anxiety
- examine catastrophic predictions
- reduce avoidance
- gradually face feared situations
- change safety behaviours
- improve coping
Exposure-based work
Exposure involves gradually and systematically approaching feared situations or sensations rather than continually avoiding them.
It is particularly relevant to:
- phobias
- panic-related avoidance
- social anxiety
Exposure should be planned appropriately rather than simply telling someone to face their fears.
Applied relaxation
NICE lists applied relaxation alongside CBT as a high-intensity psychological treatment option for GAD.
CBT for social anxiety
NICE recommends individual CBT specifically designed for social anxiety disorder as the preferred initial treatment for adults.
Treatment can include:
- understanding self-focused attention
- reducing safety behaviours
- behavioural experiments
- exposure
- modifying negative beliefs
- reducing excessive post-event rumination
WHO recommends structured psychological interventions based on CBT principles for adults with GAD and/or panic disorder.
Self-Help and Lower-Intensity Interventions
For less severe GAD, structured CBT-based self-help or guided self-help may be appropriate.
NICE includes:
- non-facilitated self-help
- guided self-help
- psychoeducational groups
These should involve evidence-based material rather than random online advice.
Stress-Management Techniques
Relaxation and mindfulness-based stress-management techniques may help some adults with GAD or panic disorder as part of a broader treatment plan.
WHO recommends considering relaxation and/or mindfulness training in these conditions, while rating the evidence as less certain than for structured CBT.
Stress-management techniques can support treatment.
Physical Activity
Regular physical activity may support overall wellbeing and can be considered as part of anxiety management.
WHO conditionally recommends structured physical exercise for adults with GAD and/or panic disorder, while noting low certainty of evidence.
It should therefore be presented as a supportive measure, not a replacement for clinically indicated treatment.
Does Everyone With Anxiety Need Medication?
No.
Many people can be treated effectively with psychological interventions.
Medication may be considered according to:
- the type of anxiety disorder
- symptom severity
- functional impairment
- treatment history
- patient preference
- medical circumstances
For adults with GAD and panic disorder, WHO recommends that SSRIs may be considered.
For GAD with marked functional impairment, NICE recommends offering either an appropriate high-intensity psychological intervention or medication, based substantially on informed patient preference.
Medication for Anxiety
When medication is appropriate, commonly considered treatments may include antidepressant medicines such as SSRIs, depending on diagnosis and clinical circumstances.
The prescribing clinician should discuss:
- expected benefits
- adverse effects
- possible early increase in anxiety or agitation
- interactions
- withdrawal/discontinuation effects
- appropriate follow-up
NICE specifically recommends discussing these issues before prescribing medication for GAD.
Medication should be selected and monitored by an appropriately qualified clinician.
What About Benzodiazepines?
Benzodiazepines can reduce anxiety rapidly, but they are not preferred as routine long-term treatment for anxiety disorders because of concerns including dependence, tolerance and withdrawal.
WHO’s current mhGAP recommendation advises against benzodiazepines for routine treatment of adults with GAD or panic disorder. In acute severe anxiety, they may sometimes be considered only as a very short-term measure.
NICE similarly recommends avoiding benzodiazepines for routine GAD treatment except as a short-term crisis measure and advises against their use for longer-term panic-disorder treatment.
How Long Does Anxiety Treatment Take?
There is no single timeline.
Treatment duration varies according to:
- disorder type
- severity
- chronicity
- associated depression or other conditions
- treatment chosen
- response
For example, NICE describes structured CBT courses for GAD and panic disorder lasting several weeks to several months rather than being one or two counselling sessions
Improvement often occurs progressively, and treatment should be reviewed according to response rather than stopped prematurely because symptoms have not disappeared immediately.
How Ahana Can Help
Psychiatric Assessment
Assessment can help clarify whether symptoms represent an anxiety disorder, another mental health condition or require further medical evaluation.
Psychological Therapies
Evidence-based therapy can help reduce avoidance, change anxiety-maintaining patterns and improve coping.
Outpatient Care
Suitable for many people who can continue living at home while attending assessment, therapy and follow-up.
Telepsychiatry
Remote follow-up may be suitable for selected individuals depending on clinical needs and availability.
Urgent Mental Health Care
For anxiety accompanied by acute psychiatric risk or severe deterioration.
Recovery From Anxiety
Recovery does not necessarily mean that a person never experiences anxiety again.
A more realistic goal is being able to:
- tolerate normal uncertainty
- face previously avoided situations
- manage physical anxiety sensations
- return to work or study
- socialise more freely
- travel independently
- sleep more consistently
- reduce reassurance seeking
- make decisions without excessive fear
Someone can still experience ordinary anxiety while no longer being controlled by an anxiety disorder.
Preventing Relapse
A relapse-prevention plan may involve:
- recognising early warning signs
- continuing skills learned in therapy
- reducing avoidance
- maintaining sleep and physical activity
- monitoring excessive reassurance seeking
- following medication plans when prescribed
- seeking help before symptoms become severe again
For social anxiety, relapse prevention forms part of recommended CBT programmes.
Family and Caregiver Support
Family members can help by:
- taking symptoms seriously
- encouraging professional treatment
- avoiding criticism such as just stop worrying
- helping the person practise treatment strategies
- avoiding excessive reassurance where it unintentionally maintains anxiety
- supporting gradual independence rather than reinforcing avoidance
Family members should also recognise when anxiety is occurring alongside depression, substance use or safety concerns.
Frequently Asked Questions
What are the most common symptoms of anxiety?
Common symptoms include excessive worry, fear, tension, restlessness, difficulty concentrating, poor sleep, palpitations, sweating, trembling, gastrointestinal discomfort and avoidance. Symptoms vary between different anxiety disorders.
Can anxiety cause palpitations and breathlessness?
Yes. Anxiety can produce palpitations, rapid breathing and breathlessness. However, new, severe or unexplained physical symptoms should be medically assessed rather than automatically assumed to be anxiety.
What is the difference between anxiety and an anxiety disorder?
Ordinary anxiety is usually proportionate to a situation and improves when the stress passes. An anxiety disorder involves excessive or persistent anxiety that causes significant distress or interferes with everyday functioning.
What is a panic attack?
A panic attack is an episode of intense fear or discomfort accompanied by symptoms such as palpitations, breathlessness, sweating, trembling, dizziness or fear of losing control.
Does one panic attack mean I have panic disorder?
No. Panic disorder involves a broader pattern of recurrent panic attacks and continuing concern or behavioural change related to further attacks.
Can anxiety be treated without medication?
Yes. Psychological treatments, especially CBT-based interventions, are established treatments for several anxiety disorders.
Are anxiety medications addictive?
Not all medications used for anxiety are addictive. Benzodiazepines can cause dependence and are therefore not preferred for routine long-term management. Antidepressant medicines such as SSRIs have different pharmacological profiles and do not produce addiction in the same way, although discontinuation symptoms can occur and treatment should be medically supervised.
Can anxiety and depression occur together?
Yes. Anxiety disorders commonly coexist with depression, and treatment planning should consider both conditions.
Can anxiety cause stomach problems?
Yes. Anxiety may be associated with nausea, abdominal discomfort and other gastrointestinal symptoms, but persistent physical symptoms may also require medical evaluation.
Can anxiety be completely cured?
Many people experience substantial improvement or remission with appropriate treatment. Some remain vulnerable to recurrence during periods of stress, which is why treatment skills and relapse planning can remain useful.
Related Care
Related Conditions
Clinical Review
Dr. Vikhram Ramasubramanian
MD (General Medicine), MD (Psychiatry)
Consultant Psychiatrist, Ahana Hospitals
Clinical review: Pending
Next review: To be scheduled
Editorial Policy
How We Review Health Information
This information is intended for general health education. It does not replace an individual medical or psychiatric assessment.
References
Clinical sources and references
1. World Health Organization. Anxiety disorders. Updated 8 September 2025.
2. WHO mhGAP Guideline – Anxiety recommendations, 2023.
3. NICE CG113 – Generalised anxiety disorder and panic disorder in adults: management.
4. NICE CG159 – Social anxiety disorder: recognition, assessment and treatment.
Is anxiety starting to restrict your everyday life?
A mental health professional can help understand the pattern of your symptoms, identify the type of anxiety you may be experiencing and discuss appropriate treatment options.