Anxiety is an
emotion
Emotions are physical and mental states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavior, behavioral responses, and a degree of pleasure or suffering, displeasure. There is ...
characterised by an unpleasant state of inner
turmoil and includes feelings of dread over
anticipated events.
Anxiety is different from
fear
Fear is an unpleasant emotion that arises in response to perception, perceived dangers or threats. Fear causes physiological and psychological changes. It may produce behavioral reactions such as mounting an aggressive response or fleeing the ...
in that fear is defined as the emotional response to a present
threat, whereas anxiety is the anticipation of a future one. It is often accompanied by nervous behavior such as pacing back and forth,
somatic complaints, and
rumination.
Anxiety is a feeling of uneasiness and
worry
Worrying is the mental distress or agitation resulting from anxiety, usually coming from a place of anticipatory fear (terror) or fear coming from a present threat (horror). With more understanding of the situation, worry becomes concern, the ...
, usually generalized and unfocused as an
overreaction to a situation that is only subjectively seen as menacing. It is often accompanied by muscular tension,
restlessness,
fatigue
Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself.
Fatigue (in the medical sense) is sometimes associated wit ...
, inability to catch one's breath, tightness in the abdominal region, nausea, and problems in concentration. Anxiety is closely related to
fear
Fear is an unpleasant emotion that arises in response to perception, perceived dangers or threats. Fear causes physiological and psychological changes. It may produce behavioral reactions such as mounting an aggressive response or fleeing the ...
,
which is a response to a real or perceived immediate
threat (
fight-or-flight response); anxiety involves the expectation of a future threat including dread.
People facing anxiety may withdraw from situations which have provoked anxiety in the past.
The emotion of anxiety can persist beyond the developmentally appropriate time-periods in response to specific events, and thus turning into one of the multiple
anxiety disorders (e.g.
generalized anxiety disorder
Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning. Individuals with GAD are often overly con ...
,
panic disorder).
The difference between ''anxiety disorder'' (as
mental disorder
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
) and ''anxiety'' (as normal emotion), is that people with an anxiety disorder experience anxiety excessively or persistently during approximately 6 months, or even during shorter time-periods in children.
Anxiety disorders are among the most persistent mental problems and often last decades.
Anxiety can also be experienced within other
mental disorder
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
s, e.g.,
obsessive–compulsive disorder
Obsessive–compulsive disorder (OCD) is a mental disorder in which an individual has intrusive thoughts (an ''obsession'') and feels the need to perform certain routines (''Compulsive behavior, compulsions'') repeatedly to relieve the dis ...
,
post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is a mental disorder that develops from experiencing a Psychological trauma, traumatic event, such as sexual assault, domestic violence, child abuse, warfare and its associated traumas, natural disaster ...
.
World Health Organization
The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
(2023). ''International Classification of Diseases
The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnosis. The ICD is maintained by the World Health Organization (WHO), which is the dir ...
, eleventh revision – ICD-11''. Genova – icd.who.int.
Anxiety vs. fear
Anxiety is distinguished from
fear
Fear is an unpleasant emotion that arises in response to perception, perceived dangers or threats. Fear causes physiological and psychological changes. It may produce behavioral reactions such as mounting an aggressive response or fleeing the ...
, which is an appropriate cognitive and emotional response to a perceived
threat. Anxiety is related to the specific behaviors of
fight-or-flight responses, defensive behavior or escape. There is a false presumption that often circulates that anxiety only occurs in situations perceived as uncontrollable or unavoidable, but this is not always so.
David Barlow defines anxiety as "a future-oriented mood state in which one is not ready or prepared to attempt to
cope with upcoming negative events," and that it is a distinction between future and present dangers which divides anxiety and fear. Another description of anxiety is agony, dread, terror, or even apprehension. In
positive psychology
Positive psychology is the scientific study of conditions and processes that contribute to positive psychological states (e.g., contentment, joy), well-being, Positive psychology of relationships, positive relationships, and positive institutio ...
, anxiety is described as the mental state that results from a difficult challenge for which the subject has insufficient
coping
Coping refers to conscious or unconscious strategies used to reduce and manage unpleasant emotions. Coping strategies can be cognitions or behaviors and can be individual or social. To cope is to deal with struggles and difficulties in life. It ...
skills.
Fear and anxiety can be differentiated into four domains: (1) duration of emotional experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction. Fear is short-lived, present-focused, geared towards a specific threat, and facilitating escape from threat. On the other hand, anxiety is long-acting, future-focused, broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat and interferes with constructive coping.
Joseph E. LeDoux and
Lisa Feldman Barrett
Lisa Feldman Barrett is a Canadian-American psychologist. She is a University Distinguished Professor of psychology at Northeastern University, where she focuses on affective science and co-directs the Interdisciplinary Affective Science Labora ...
have both sought to separate automatic threat responses from additional associated cognitive activity within anxiety.
Symptoms
Anxiety can be experienced with long, drawn-out daily symptoms that reduce quality of life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful
panic attack
Panic attacks are sudden periods of intense fear and Comfort, discomfort that may include palpitations, otherwise defined as a Tachycardia, rapid, Arrhythmia, irregular Heart rate, heartbeat, Hyperhidrosis, sweating, chest pain or discomfort, s ...
s, known as acute anxiety. Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. However, most people do not suffer from chronic anxiety.
Anxiety can induce several psychological pains (e.g.
depression) or
mental disorder
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
s, and may lead to
self-harm
Self-harm refers to intentional behaviors that cause harm to oneself. This is most commonly regarded as direct injury of one's own skin tissues, usually without suicidal intention. Other terms such as cutting, self-abuse, self-injury, and s ...
or
suicide
Suicide is the act of intentionally causing one's own death.
Risk factors for suicide include mental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress (such as from financial or ac ...
.
The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative feelings in the past.
Other effects may include changes in sleeping patterns, changes in habits, increase or decrease in food intake, and increased motor tension (such as foot tapping).
The emotional effects of anxiety may include feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching for signs of danger, and a feeling of empty mindedness. as well as "nightmares/bad dreams, obsessions about sensations,
déjà vu, a trapped-in-your-mind feeling, and feeling like everything is scary." It may include a vague experience and feeling of helplessness.
The cognitive effects of anxiety may include thoughts about suspected dangers, such as an irrational fear of dying or having a heart attack, when in reality all one is experiencing is mild chest pain, for example.
The physiological symptoms of anxiety may include:
*Neurological, as
headache
A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of Depression (mood), depression in those with severe ...
,
paresthesia
Paresthesia is a sensation of the skin that may feel like numbness (''hypoesthesia''), tingling, pricking, chilling, or burning. It can be temporary or Chronic condition, chronic and has many possible underlying causes. Paresthesia is usually p ...
s,
fasciculations,
vertigo, or
presyncope.
*Digestive, as abdominal pain,
nausea
Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat.
Over 30 d ...
,
diarrhea,
indigestion,
dry mouth, or
globus. Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate
IBS.
*Respiratory, as
shortness of breath
Shortness of breath (SOB), known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that con ...
or sighing breathing.
*Cardiac, as
palpitations
Palpitations occur when a person becomes aware of their heartbeat. The heartbeat may feel hard, fast, or uneven in their chest.
Symptoms include a very fast or irregular heartbeat. Palpitations are a sensory symptom. They are often described as ...
,
tachycardia, or
chest pain.
*Muscular, as
fatigue
Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself.
Fatigue (in the medical sense) is sometimes associated wit ...
,
tremors, or
tetany.
*Cutaneous, as
perspiration, or
itchy skin.
*Uro-genital, as
frequent urination,
urinary urgency,
dyspareunia, or
impotence
Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a Human penis, penile erection with sufficient rigidity and durat ...
,
chronic pelvic pain syndrome.
Types
There are various types of anxiety.
Existential anxiety can occur when a person faces
angst, an
existential crisis, or
nihilistic feelings. People can also face
mathematical anxiety,
somatic anxiety,
stage fright, or
test anxiety
Test anxiety is a combination of physiological over-arousal, Stress (biology), tension and somatic symptoms, along with Worry, worry, dread, fear of failure, and Exaggeration, catastrophizing, that occur before or during test situations.Zeidner M. ...
.
Social anxiety refers to a fear of rejection and negative evaluation (being judged) by other people.
Existential
The philosopher
Søren Kierkegaard
Søren Aabye Kierkegaard ( , ; ; 5 May 1813 – 11 November 1855) was a Danes, Danish theologian, philosopher, poet, social critic, and religious author who is widely considered to be the first existentialist philosopher. He wrote critical tex ...
, in ''
The Concept of Anxiety'' (1844), described anxiety or dread associated with the "dizziness of freedom" and suggested the possibility for positive resolution of anxiety through the self-conscious exercise of responsibility and choosing. In ''Art and Artist'' (1932), the psychologist
Otto Rank
Otto Rank (; ; né Rosenfeld; 22 April 1884 – 31 October 1939) was an Austrian psychoanalyst, writer, and philosopher. Born in Vienna, he was one of Sigmund Freud's closest colleagues for 20 years, a prolific writer on psychoanalytic themes, ...
wrote that the
psychological trauma
Psychological trauma (also known as mental trauma, psychiatric trauma, emotional damage, or psychotrauma) is an emotional response caused by severe distressing events, such as Major trauma, bodily injury, Sexual assault, sexual violence, or ot ...
of birth was the pre-eminent human symbol of existential anxiety and encompasses the creative person's simultaneous fear of – and desire for – separation, individuation, and differentiation.
The
theologian
Theology is the study of religious belief from a religious perspective, with a focus on the nature of divinity. It is taught as an academic discipline, typically in universities and seminaries. It occupies itself with the unique content of ...
Paul Tillich characterized existential anxiety
as "the state in which a
being
Existence is the state of having being or reality in contrast to nonexistence and nonbeing. Existence is often contrasted with essence: the essence of an entity is its essential features or qualities, which can be understood even if one do ...
is aware of its possible nonbeing" and he listed three categories for the nonbeing and resulting anxiety:
ontic (fate and death),
moral
A moral (from Latin ''morālis'') is a message that is conveyed or a lesson to be learned from a story or event. The moral may be left to the hearer, reader, or viewer to determine for themselves, or may be explicitly encapsulated in a maxim. ...
(
guilt and condemnation), and
spiritual (emptiness and
meaninglessness). According to Tillich, the last of these three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times while the others were predominant in earlier periods. Tillich argues that this anxiety can be
accepted as part of the
human condition
The human condition can be defined as the characteristics and key events of human life, including birth, learning, emotion, aspiration, reason, morality, conflict, and death. This is a very broad topic that has been and continues to be pondered ...
or it can be resisted but with negative consequences. In its pathological form, spiritual anxiety may tend to "drive the person toward the creation of certitude in systems of meaning which are supported by
tradition
A tradition is a system of beliefs or behaviors (folk custom) passed down within a group of people or society with symbolic meaning or special significance with origins in the past. A component of cultural expressions and folklore, common e ...
and
authority
Authority is commonly understood as the legitimate power of a person or group of other people.
In a civil state, ''authority'' may be practiced by legislative, executive, and judicial branches of government,''The New Fontana Dictionary of M ...
" even though such "undoubted certitude is not built on the rock of
reality
Reality is the sum or aggregate of everything in existence; everything that is not imagination, imaginary. Different Culture, cultures and Academic discipline, academic disciplines conceptualize it in various ways.
Philosophical questions abo ...
".
According to
Viktor Frankl, the author of ''
Man's Search for Meaning
''Man's Search for Meaning'' () is a 1946 book by Viktor Frankl chronicling his experiences as a prisoner in Nazi concentration camps during World War II, and describing his psychotherapeutic method, which involved identifying a purpose to eac ...
'', when a person is faced with extreme mortal dangers, the most basic of all human wishes is to find a
meaning of life to combat the "trauma of nonbeing" as death is near.
Depending on the source of the threat,
psychoanalytic theory
Psychoanalytic theory is the theory of the innate structure of the human soul and the dynamics of personality development relating to the practice of psychoanalysis, a method of research and for treating of Mental disorder, mental disorders (psych ...
distinguishes three types of anxiety: realistic,
neurotic and moral.
Test, performance, and competitive
Test
According to
Yerkes-Dodson law, an optimal level of arousal is necessary to best complete a task such as an exam, performance, or competitive event. However, when the anxiety or level of arousal exceeds that optimum, the result is a decline in performance.
Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an
exam. Students who have test anxiety may experience any of the following: the association of
grades with
personal worth; fear of embarrassment by a teacher; fear of
alienation from parents or friends; time pressures; or feeling a loss of control. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, uncontrollable crying or laughing and drumming on a desk are all common. Because test anxiety hinges on
fear of negative evaluation,
debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social
phobia
A phobia is an anxiety disorder, defined by an irrational, unrealistic, persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected ...
.
The DSM-IV classifies test anxiety as a type of social phobia.
Research indicates that test anxiety among U.S. high-school and college students has been rising since the late 1950s. Test anxiety remains a challenge for students, regardless of age, and has considerable physiological and psychological impacts. Management of test anxiety focuses on achieving relaxation and developing mechanisms to manage anxiety.
The routine practice of slow, Device-Guided Breathing (DGB) is a
major component of behavioral treatments for anxiety conditions.
Performance and competitive
Performance anxiety and competitive anxiety (
competitive trait anxiety, competitive state anxiety) happen when an individual's performance is measured against others. An important distinction between competitive and non-competitive anxiety is that competitive anxiety makes people view their performance as a threat.
As a result, they experience a drop in their ordinary ability, whether physical or mental, due to that perceived stress.
Competitive anxiety is caused by a range of internal factors including high expectations, outside pressure,
lack of experience, and external factors like the location of a competition. It commonly occurs in those participating in high pressure activities like sports and debates. Some common symptoms of competitive anxiety include muscle tension, fatigue, weakness, sense of panic, apprehensiveness, and panic attacks.
There are
4 major theories of how anxiety affects performance: Drive theory, Inverted U theory, Reversal theory, and The Zone of Optimal Functioning theory.
''Drive theory'' believes that anxiety is positive and performance improves proportionally to the level of anxiety. This theory is not well accepted.
The ''Inverted U theory'' is based on the idea that performance peaks at a moderate stress level. It is called Inverted U theory because the graph that plots performance against anxiety looks like an inverted "U".
''Reversal theory'' suggests that performance increases in relation to the individual's interpretation of their arousal levels. If they believed their physical arousal level would help them, their performance would increase, if they didn't, their performance would decrease.
For example: Athletes were shown to worry more when focusing on results and perfection rather than the effort and growth involved.
The ''Zone of Optimal Functioning theory'' proposes that there is a zone where positive and
negative emotions are in a balance which lead to feelings of dissociation and intense concentration, optimizing the individual's performance levels.
Stranger, social, and intergroup anxiety
Humans generally require social acceptance and thus sometimes dread the disapproval of others. Apprehension of being judged by others may cause anxiety in social environments.
Anxiety during social interactions, particularly between strangers, is common among young people. It may persist into adulthood and become social anxiety or social phobia. "
Stranger anxiety
Stranger anxiety is a form of Distress (medicine), distress that children experience when exposed to strangers. Stranger anxiety and stranger fear are two interchangeable terms. Stranger anxiety is a typical part of the Child development stages, ...
" in small children is not considered a phobia. In adults, an excessive fear of other people is not a developmentally common stage; it is called
social anxiety. According to Cutting, social phobics do not fear the crowd but the fact that they may be judged negatively.
Social anxiety varies in degree and severity. For some people, it is characterized by experiencing discomfort or awkwardness during physical social contact (e.g. embracing, shaking hands, etc.), while in other cases it can lead to a fear of interacting with unfamiliar people altogether. Those with this condition may restrict their lifestyles to accommodate the anxiety, minimizing social interaction whenever possible. Social anxiety also forms a core aspect of certain personality disorders, including
avoidant personality disorder.
To the extent that a person is fearful of social encounters with unfamiliar others, some people may experience anxiety particularly during interactions with outgroup members, or people who share different group memberships (i.e., by race, ethnicity, class, gender, etc.). Depending on the nature of the antecedent relations, cognitions, and situational factors, intergroup contact may be stressful and lead to feelings of anxiety. This apprehension or fear of contact with outgroup members is often called interracial or intergroup anxiety.
As is the case with the more generalized forms of
social anxiety, intergroup anxiety has behavioral, cognitive, and affective effects. For instance, increases in schematic processing and simplified information processing can occur when anxiety is high. Indeed, such is consistent with related work on attentional bias in
implicit memory. Additionally recent research has found that
implicit racial evaluations (i.e. automatic prejudiced attitudes) can be amplified during intergroup interaction. Negative experiences have been illustrated in producing not only negative expectations, but also avoidant, or antagonistic, behavior such as hostility. Furthermore, when compared to anxiety levels and cognitive effort (e.g., impression management and self-presentation) in intragroup contexts, levels and depletion of resources may be exacerbated in the intergroup situation.
Trait
Anxiety can be either a short-term "state" or a long-term "
personality
Personality is any person's collection of interrelated behavioral, cognitive, and emotional patterns that comprise a person’s unique adjustment to life. These interrelated patterns are relatively stable, but can change over long time per ...
trait". Trait anxiety reflects a stable tendency across the lifespan of responding with acute, state anxiety in the anticipation of threatening situations (whether they are actually deemed threatening or not). A meta-analysis showed that a high level of
neuroticism
Neuroticism is a personality trait associated with negative emotions. It is one of the Big Five traits. Individuals with high scores on neuroticism are more likely than average to experience such feelings as anxiety, worry, fear, anger, shame ...
is a risk factor for development of anxiety symptoms and disorders.
Such anxiety may be conscious or unconscious.
Personality can also be a trait leading to anxiety and depression and their persistence.
[ Through experience, many find it difficult to collect themselves due to their own personal nature.
]
Choice or decision
Anxiety induced by the need to choose between similar options is recognized as a problem for some individuals and for organizations. In 2004, Capgemini wrote: "Today we're all faced with greater choice, more competition and less time to consider our options or seek out the right advice." Overthinking a choice is called analysis paralysis.
In a decision context, unpredictability or uncertainty may trigger emotional responses in anxious individuals that systematically alter decision-making. There are primarily two forms of this anxiety type. The first form refers to a choice in which there are multiple potential outcomes with known or calculable probabilities. The second form refers to the uncertainty and ambiguity related to a decision context in which there are multiple possible outcomes with unknown probabilities.
Panic disorder
Panic disorder may share symptoms of stress and anxiety, but it is actually very different. Panic disorder is an anxiety disorder that occurs without any triggers. According to the U.S. Department of Health and Human Services, this disorder can be distinguished by unexpected and repeated episodes of intense fear. Someone with panic disorder will eventually develop constant fear of another attack and as this progresses it will begin to affect daily functioning and an individual's general quality of life. It is reported by the Cleveland Clinic that panic disorder affects 2 to 3 percent of adult Americans and can begin around the time of the teenage and early adult years. Some symptoms include: difficulty breathing, chest pain, dizziness, trembling or shaking, feeling faint, nausea, fear that you are losing control or are about to die. Even though they have these symptoms during an attack, the main symptom is the persistent fear of having future panic attacks.
Anxiety disorders
Anxiety disorders are a group of mental disorder
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
s characterized by exaggerated feelings of anxiety
Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
and fear
Fear is an unpleasant emotion that arises in response to perception, perceived dangers or threats. Fear causes physiological and psychological changes. It may produce behavioral reactions such as mounting an aggressive response or fleeing the ...
responses. Anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a fast heart rate and shakiness. There are a number of anxiety disorders: including generalized anxiety disorder
Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning. Individuals with GAD are often overly con ...
, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. The disorder differs by what results in the symptoms. People often have more than one anxiety disorder.
Anxiety disorders are caused by a complex combination of genetic and environmental factors. To be diagnosed, symptoms typically need to be present for at least six months, be more than would be expected for the situation, and decrease a person's ability to function in their daily lives. Other problems that may result in similar symptoms include hyperthyroidism, heart disease
Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina pectoris, angina, myocardial infarction, heart attack), heart failure, ...
, caffeine
Caffeine is a central nervous system (CNS) stimulant of the methylxanthine chemical classification, class and is the most commonly consumed Psychoactive drug, psychoactive substance globally. It is mainly used for its eugeroic (wakefulness pr ...
, alcohol
Alcohol may refer to:
Common uses
* Alcohol (chemistry), a class of compounds
* Ethanol, one of several alcohols, commonly known as alcohol in everyday life
** Alcohol (drug), intoxicant found in alcoholic beverages
** Alcoholic beverage, an alco ...
, or cannabis use, and withdrawal from certain drugs, among others.
Without treatment, anxiety disorders tend to remain. Treatment may include lifestyle changes, counselling, and medications. Counselling is typically with a type of cognitive behavioral therapy. Medications, such as antidepressants or beta blockers, may improve symptoms. A 2023 review found that regular physical activity is effective for reducing anxiety.
About 12% of people are affected by an anxiety disorder in a given year and between 12% and 30% are affected at some point in their life. They occur about twice as often in women than they do in men, and generally begin before the age of 25. The most common anxiety disorders are specific phobias, which affect nearly 12% of people, and social anxiety disorder, which affects 10% of people at some point in their life. They affect those between the ages of 15 and 35 the most and become less common after the age of 55. Rates appear to be higher in the United States and Europe.
Short- and long-term anxiety
Anxiety can be either a short-term "state" or a long-term " trait". Whereas trait anxiety represents worrying about future events, anxiety disorders are a group of mental disorder
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
s characterized by feelings of anxiety and fears.
Four ways to be anxious
In his book ''Anxious: The Modern Mind in the Age of Anxiety'' Joseph LeDoux examines four experiences of anxiety through a brain-based lens:
# In the presence of an existing or imminent external threat, you worry about the event and its implications for your physical and/or psychological well-being. When a threat signal occurs, it signifies either that danger is present or near in space and time or that it might be coming in the future. Nonconscious threats processing by the brain activates defensive survival circuits, resulting in changes in information processing in the brain, controlled in part by increases in arousal and behavioral and physiological responses in the body that then produce signals that feed back to the brain and complement the physiological changes there, intensifying them and extending their duration.
# When you notice body sensations, you worry about what they might mean for your physical and/or psychological well-being. The trigger stimulus does not have to be an external stimulus but can be an internal one, as some people are particularly sensitive to body signals.
# Thoughts and memories may lead to you to worry about your physical and/or psychological well-being. We do not need to be in the presence of an external or internal stimulus to be anxious. An episodic memory of a past trauma or of a panic attack in the past is sufficient to activate the defence circuits.
# Thoughts and memories may result in existential dread, such as worry about leading a meaningful life or the eventuality of death. Examples are contemplations of whether one's life has been meaningful, the inevitability of death, or the difficulty of making decisions that have a moral value. These do not necessarily activate defensive systems; they are more or less pure forms of cognitive anxiety.
Co-morbidity
Anxiety disorders often occur with other mental health disorders, particularly major depressive disorder
Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive depression (mood), low mood, low self-esteem, and anhedonia, loss of interest or pleasure in normally ...
, bipolar disorder
Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...
, eating disorder
An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's health, physical or mental health, mental health. These behaviors may include eating too much food or too little food. Types of eatin ...
s, or certain personality disorders. It also commonly occurs with personality traits such as neuroticism. This observed co-occurrence is partly due to genetic and environmental influences shared between these traits and anxiety.
It is common for those with obsessive–compulsive disorder
Obsessive–compulsive disorder (OCD) is a mental disorder in which an individual has intrusive thoughts (an ''obsession'') and feels the need to perform certain routines (''Compulsive behavior, compulsions'') repeatedly to relieve the dis ...
to experience anxiety. Anxiety is also commonly found in those who experience panic disorders, phobic anxiety disorders, severe stress, dissociative disorders, somatoform disorders, and some neurotic disorders.
Anxiety has also been linked to the experience of intrusive thoughts. Studies have revealed that individuals who experience high levels of anxiety (also known as clinical anxiety) are highly vulnerable to the experience of intense intrusive thoughts or psychological disorders that are characterised by intrusive thoughts.
Risk factors
Anxiety disorders are partly genetic, with twin studies suggesting 30-40% genetic influence on individual differences in anxiety. Environmental factors are also important. Twin studies show that individual-specific environments have a large influence on anxiety, whereas shared environmental influences (environments that affect twins in the same way) operate during childhood but decline through adolescence. Specific measured 'environments' that have been associated with anxiety include child abuse, family history of mental health disorders, and poverty
Poverty is a state or condition in which an individual lacks the financial resources and essentials for a basic standard of living. Poverty can have diverse Biophysical environmen ...
. Anxiety is also associated with drug use, including alcohol
Alcohol may refer to:
Common uses
* Alcohol (chemistry), a class of compounds
* Ethanol, one of several alcohols, commonly known as alcohol in everyday life
** Alcohol (drug), intoxicant found in alcoholic beverages
** Alcoholic beverage, an alco ...
and caffeine
Caffeine is a central nervous system (CNS) stimulant of the methylxanthine chemical classification, class and is the most commonly consumed Psychoactive drug, psychoactive substance globally. It is mainly used for its eugeroic (wakefulness pr ...
, as well as benzodiazepine
Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of central nervous system (CNS) depressant, depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed t ...
s, which are often prescribed to treat anxiety.
Genetics
Genetics and family history (e.g. parental anxiety) may put an individual at increased risk of an anxiety disorder, but generally external stimuli will trigger its onset or exacerbation. Estimates of genetic influence on anxiety, based on studies of twins, range from 25 to 40% depending on the specific type and age-group under study. For example, genetic differences account for about 43% of variance in panic disorder and 28% in generalized anxiety disorder. Longitudinal twin studies have shown the moderate stability of anxiety from childhood through to adulthood is mainly influenced by stability in genetic influence. When investigating how anxiety is passed on from parents to children, it is important to account for sharing of genes as well as environments, for example using the intergenerational children-of-twins design.
Many studies in the past used a candidate gene approach to test whether single genes were associated with anxiety. These investigations were based on hypotheses about how certain known genes influence neurotransmitters (such as serotonin and norepinephrine) and hormones (such as cortisol) that are implicated in anxiety. None of these findings are well replicated, with the possible exception of TMEM132D, COMT and MAO-A. The epigenetic signature of ''BDNF
Brain-derived neurotrophic factor (BDNF), or abrineurin, is a protein found in the and the periphery. that, in humans, is encoded by the ''BDNF'' gene. BDNF is a member of the neurotrophin family of growth factors, which are related to the cano ...
'', a gene that codes for a protein called ''brain derived neurotrophic factor'' that is found in the brain, has also been associated with anxiety and specific patterns of neural activity. and a receptor gene for ''BDNF'' called ''NTRK2'' was associated with anxiety in a large genome-wide investigation. The reason that most candidate gene findings have not replicated is that anxiety is a complex trait that is influenced by many genomic variants, each of which has a small effect on its own. Increasingly, studies of anxiety are using a hypothesis-free approach to look for parts of the genome that are implicated in anxiety using big enough samples to find associations with variants that have small effects. The largest explorations of the common genetic architecture of anxiety have been facilitated by the UK Biobank, the ANGST consortium and the CRC Fear, Anxiety and Anxiety Disorders.
Epigenetics
Medical conditions
Many medical conditions can cause anxiety. This includes conditions that affect the ability to breathe, like COPD and asthma, and the difficulty in breathing that often occurs near death. Conditions that cause abdominal pain or chest pain can cause anxiety and may in some cases be a somatization of anxiety; the same is true for some sexual dysfunctions. Conditions that affect the face or the skin can cause social anxiety especially among adolescents, and developmental disabilities often lead to social anxiety for children as well. Life-threatening conditions like cancer also cause anxiety.
Furthermore, certain organic diseases may present with anxiety or symptoms that mimic anxiety. These disorders include certain endocrine diseases ( hypo- and hyperthyroidism, hyperprolactinemia), metabolic disorders ( diabetes), deficiency states (low levels of vitamin D
Vitamin D is a group of structurally related, fat-soluble compounds responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, along with numerous other biological functions. In humans, the most important compo ...
, B2, B12, folic acid
Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
), gastrointestinal diseases ( celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease), heart diseases, blood diseases ( anemia), cerebral vascular accidents ( transient ischemic attack, stroke
Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...
), and brain degenerative diseases (Parkinson's disease
Parkinson's disease (PD), or simply Parkinson's, is a neurodegenerative disease primarily of the central nervous system, affecting both motor system, motor and non-motor systems. Symptoms typically develop gradually and non-motor issues become ...
, dementia
Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform activities of daily living, everyday activities. This typically invo ...
, multiple sclerosis
Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...
, Huntington's disease), among others.
Substance-induced
Several drugs can cause or worsen anxiety, whether in intoxication, withdrawal or as side effect. These include alcohol
Alcohol may refer to:
Common uses
* Alcohol (chemistry), a class of compounds
* Ethanol, one of several alcohols, commonly known as alcohol in everyday life
** Alcohol (drug), intoxicant found in alcoholic beverages
** Alcoholic beverage, an alco ...
, tobacco
Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
, sedatives (including prescription benzodiazepine
Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of central nervous system (CNS) depressant, depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed t ...
s), opioids (including prescription pain killers and illicit drugs like heroin), stimulant
Stimulants (also known as central nervous system stimulants, or psychostimulants, or colloquially as uppers) are a class of drugs that increase alertness. They are used for various purposes, such as enhancing attention, motivation, cognition, ...
s (such as caffeine
Caffeine is a central nervous system (CNS) stimulant of the methylxanthine chemical classification, class and is the most commonly consumed Psychoactive drug, psychoactive substance globally. It is mainly used for its eugeroic (wakefulness pr ...
, cocaine
Cocaine is a tropane alkaloid and central nervous system stimulant, derived primarily from the leaves of two South American coca plants, ''Erythroxylum coca'' and ''Erythroxylum novogranatense, E. novogranatense'', which are cultivated a ...
and amphetamines), hallucinogens, and inhalants.
While many often report self-medicating anxiety with these substances, improvements in anxiety from drugs are usually short-lived (with worsening of anxiety in the long term, sometimes with acute anxiety as soon as the drug effects wear off) and tend to be exaggerated. Acute exposure to toxic levels of benzene
Benzene is an Organic compound, organic chemical compound with the Chemical formula#Molecular formula, molecular formula C6H6. The benzene molecule is composed of six carbon atoms joined in a planar hexagonal Ring (chemistry), ring with one hyd ...
may cause euphoria, anxiety, and irritability lasting up to 2 weeks after the exposure.
Psychological
Poor coping skills (e.g., rigidity/inflexible problem solving, denial, avoidance, impulsivity, extreme self-expectation, negative thoughts, affective instability, and inability to focus on problems) are associated with anxiety. Anxiety is also linked and perpetuated by the person's own pessimistic outcome expectancy and how they cope with feedback negativity. Temperament (e.g., neuroticism
Neuroticism is a personality trait associated with negative emotions. It is one of the Big Five traits. Individuals with high scores on neuroticism are more likely than average to experience such feelings as anxiety, worry, fear, anger, shame ...
) and attitudes (e.g. pessimism) have been found to be risk factors for anxiety.
Cognitive distortions such as overgeneralizing, catastrophizing, mind reading, emotional reasoning, binocular trick, and mental filter can result in anxiety. For example, an overgeneralized belief that something bad "always" happens may lead someone to have excessive fears of even minimally risky situations and to avoid benign social situations due to anticipatory anxiety of embarrassment
Embarrassment or awkwardness is an emotional state that is associated with mild to severe levels of discomfort, and which is usually experienced when someone commits (or thinks of) a socially unacceptable or frowned-upon act that is witnessed ...
. In addition, those who have high anxiety can also create future stressful life events. Together, these findings suggest that anxious thoughts can lead to anticipatory anxiety as well as stressful events, which in turn cause more anxiety. Such unhealthy thoughts can be targets for successful treatment with cognitive therapy.
Psychodynamic theory posits that anxiety is often the result of opposing unconscious wishes or fears that manifest via maladaptive defense mechanisms (such as suppression, repression, anticipation, regression, somatization, passive aggression, dissociation) that develop to adapt to problems with early objects (e.g., caregivers) and empathic failures in childhood. For example, persistent parental discouragement of anger may result in repression/suppression of angry feelings which manifests as gastrointestinal distress (somatization) when provoked by another while the anger remains unconscious and outside the individual's awareness. Such conflicts can be targets for successful treatment with psychodynamic therapy. While psychodynamic therapy tends to explore the underlying roots of anxiety, cognitive behavioral therapy has also been shown to be a successful treatment for anxiety by altering irrational thoughts and unwanted behaviors.
Evolutionary psychology
An evolutionary psychology
Evolutionary psychology is a theoretical approach in psychology that examines cognition and behavior from a modern evolutionary perspective. It seeks to identify human psychological adaptations with regard to the ancestral problems they evolved ...
explanation is that increased anxiety serves the purpose of increased vigilance regarding potential threats in the environment as well as increased tendency to take proactive actions regarding such possible threats. This may cause false positive reactions but an individual with anxiety may also avoid real threats. This may explain why anxious people are less likely to die due to accidents. There is ample empirical evidence that anxiety can have adaptive value. Within a school, timid fish are more likely than bold fish to survive a predator.
When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased blood flow in the amygdala. In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.
Social
Social risk factors for anxiety include a history of trauma (e.g., physical, sexual or emotional abuse or assault), bullying, early life experiences and parenting factors (e.g., rejection, lack of warmth, high hostility, harsh discipline, high parental negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behaviour, discouragement of emotions, poor socialization, poor attachment, and child abuse and neglect), cultural factors (e.g., stoic families/cultures, persecuted minorities including those with disabilities), and socioeconomics
Economic sociology is the study of the social cause and effect of various economic phenomena. The field can be broadly divided into a classical period and a contemporary one, known as "new economic sociology".
The classical period was concerned ...
(e.g., uneducated, unemployed, impoverished although developed countries have higher rates of anxiety disorders than developing countries).
A 2019 comprehensive systematic review of over 50 studies showed that food insecurity in the United States is strongly associated with depression, anxiety, and sleep disorders. Food-insecure individuals had an almost 3 fold risk increase of testing positive for anxiety when compared to food-secure individuals.
Gender socialization
Contextual factors that are thought to contribute to anxiety include gender socialization and learning experiences. In particular, learning mastery (the degree to which people perceive their lives to be under their own control) and instrumentality, which includes such traits as self-confidence, self-efficacy
In psychology, self-efficacy is an individual's belief in their capacity to act in the ways necessary to reach specific goals. The concept was originally proposed by the psychologist Albert Bandura in 1977.
Self-efficacy affects every area of hum ...
, independence, and competitiveness fully mediate the relation between gender and anxiety. That is, though gender differences in anxiety exist, with higher levels of anxiety in women compared to men, gender socialization and learning mastery explain these gender differences.
Treatment
The first step in the management of a person with anxiety symptoms involves evaluating the possible presence of an underlying medical cause, the recognition of which is essential in order to decide the correct treatment. Anxiety symptoms may mask an organic disease, or appear associated with or as a result of a medical disorder.
Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first line treatment. CBT appears to be equally effective when carried out via the internet. While evidence for mental health apps is promising, it is preliminary.
Anxiety often affects relationships, and interpersonal psychotherapy addresses these issues by improving communication and relationship skills.
Psychopharmacological treatment can be used in parallel to CBT or can be used alone. As a general rule, most anxiety disorders respond well to first-line agents. Such drugs, also used as anti-depressants, are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, that work by blocking the reuptake of specific neurotransmitters and resulting in the increase in availability of these neurotransmitters. Additionally, benzodiazepines are often prescribed to individuals with anxiety disorder. Benzodiazepines produce an anxiolytic response by modulating GABA and increasing its receptor binding. A third common treatment involves a category of drug known as serotonin agonists. This category of drug works by initiating a physiological response at 5-HT1A receptor by increasing the action of serotonin at this receptor. Other treatment options include pregabalin
Pregabalin, sold under the brand name Lyrica among others, is an anticonvulsant, analgesic, and anxiolytic amino acid medication used to treat epilepsy, neuropathic pain, fibromyalgia, restless legs syndrome, opioid withdrawal, generalized anx ...
, tricyclic antidepressants, and moclobemide, among others.
Anxiety is considered to be a serious psychiatric illness that has an unknown true pervasiveness due to affected individuals not asking for proper treatment or aid, and due to professionals missing the diagnosis.
Prevention
The above risk factors give natural avenues for prevention. Psychological or educational interventions have a small yet statistically significant benefit for the prevention of anxiety in varied population types. Improvement in dietary intake and habits may also help lower the risk of anxiety.
See also
* List of people with an anxiety disorder
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* Mental stress-induced myocardial ischemia
References
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Emotions
Symptoms or signs involving mood or affect