Anxiety: Symptoms, Causes & Treatment

Anxiety is a response to stress, uncertainty, or perceived danger. Before a difficult conversation, a medical appointment, or a high-stakes deadline, feeling anxious is your body's way of signalling that something matters. In small, proportionate amounts, anxiety can be helpful, it sharpens attention and motivates preparation.

The problem starts when anxiety becomes persistent, excessive, or hard to control. When worry starts interfering with your work, relationships, or daily life, or when you find yourself avoiding situations to prevent the feeling, then it may have crossed into anxiety disorder territory.

Anxiety disorders are the most common mental health conditions in the world. According to the World Health Organization, an estimated 301 million people were living with an anxiety disorder in 2019. In the United States, the National Institute of Mental Health estimates that 31.1% of adults will experience an anxiety disorder at some point in their lives. Despite how common they are, only about 1 in 4 people with an anxiety disorder receive treatment.

When you perceive a threat, whether it's real or anticipated, your brain triggers a stress response. A part of the brain called the amygdala detects the threat and sends a signal to your body to prepare. Stress hormones, including adrenaline and cortisol, are released. Your heart rate increases, your breathing quickens, your muscles tense, and your senses sharpen. This is sometimes called the fight-or-flight response, and it's designed to help you respond quickly to danger.

In the short term, this response is helpful. The difficulty with anxiety disorders is that this system gets activated too often, too intensely, or in situations that don't warrant it. Your body responds as if there's a threat even when there isn't one. Over time, if the stress response stays activated frequently, it can contribute to physical health problems including high blood pressure, fatigue, and changes in how the brain processes future stressors.

People with anxiety disorders also tend to have difficulty "switching off" the alarm response once it's started. The part of the brain responsible for calming the stress response has a harder time doing its job, which is why anxiety can feel like a loop that's hard to exit, though it is not impossible to do so.

Anxiety symptoms fall into three categories: emotional and cognitive, physical, and behavioural. You may experience some or all of these, and they can vary in intensity from day to day.

Emotional and cognitive symptoms:

• Persistent worry that's difficult to control
• Expecting the worst outcome, even without clear evidence
• Feeling on edge, restless, or keyed up
• Difficulty concentrating or your mind going blank
• Irritability
• A sense of dread or impending doom without a clear cause

Physical symptoms:

• Racing or pounding heart
• Shortness of breath or feeling like you can't get a full breath
• Muscle tension, particularly in the jaw, neck, and shoulders
• Headaches
• Stomach problems: nausea, diarrhea, or general digestive discomfort
• Sweating, trembling, or shaking
• Fatigue
• Sleep problems: difficulty falling asleep, staying asleep, or waking up already feeling tense

Behavioural symptoms:

• Avoiding people, places, or situations that trigger anxiety
• Seeking reassurance from others repeatedly
• Checking behaviours (for example, repeatedly checking locks, health symptoms, or messages)
• Procrastinating on tasks that feel threatening
• Withdrawing from social activities

It's worth knowing that anxiety often presents as physical symptoms. Many people with anxiety disorders visit their doctor or emergency room with physical complaints, heart palpitations, chest tightness, dizziness, and receive a clean bill of physical health. If you've been told your symptoms appear stress-related after ruling out medical causes, your anxiety is worth taking care of.

Anxiety disorders don't have a single cause. They usually develop from a combination of factors.

Genetics. Anxiety tends to run in families, which suggests a genetic component. Having a close family member with an anxiety disorder increases your risk.

Brain chemistry. Differences in certain neurotransmitters, the chemical messengers in the brain, are associated with anxiety disorders. This includes serotonin, GABA, and norepinephrine. These differences can affect how your brain processes threat and regulates emotional responses.

Life experiences. Difficult or traumatic experiences, particularly in childhood, can shape how your nervous system responds to stress later in life. A history of abuse, neglect, or chronic unpredictability can leave the stress response more sensitive than it would otherwise be.

Ongoing stress. Long-term stress from work, finances, relationships, or caregiving can accumulate over time and contribute to an anxiety disorder, even without a single traumatic event.

Medical conditions. Certain health conditions can cause or worsen anxiety symptoms, including thyroid disorders, heart conditions, and hormonal changes. Some medications and substances can also trigger anxiety.

Personality and temperament. Some people are naturally more sensitive to stress or prone to negative thinking. This doesn't mean anxiety is inevitable, but it does mean the threshold may be lower.

Major life changes. Transitions like moving to a new country, job loss, relationship breakdown, bereavement, or becoming a parent can trigger anxiety, particularly when they involve a prolonged period of uncertainty.

The term "anxiety" covers several distinct conditions, each with its own characteristics and treatment profile. The American Psychiatric Association's DSM-5 recognises the following:

• Generalized Anxiety Disorder (GAD). If you have GAD, you experience excessive worry about a wide range of everyday things like health, money, work, family, minor daily tasks, that is difficult to control and present more days than not for at least six months. The worry feels out of proportion to the situation and interferes with daily functioning. GAD affects an estimated 6.8 million adults in the US, yet only 43% receive treatment.
• Social Anxiety Disorder. Social anxiety disorder involves an intense fear of being judged, embarrassed, or humiliated in social or performance situations. If you have social anxiety, even routine interactions, speaking in a meeting, attending a party, making a phone call can feel threatening. It affects approximately 7% of the US population and typically begins around age 13. Notably, a 2007 survey found that 36% of people with social anxiety disorder reported experiencing symptoms for 10 or more years before seeking help.
• Panic Disorder. Panic disorder is diagnosed when you experience recurrent, unexpected panic attacks, sudden episodes of intense fear with severe physical symptoms, and develop persistent worry about future attacks or change your behaviour to try to avoid them. It affects approximately 2.7% of US adults, and women are twice as likely to be affected as men.
• Agoraphobia. Agoraphobia involves fear and avoidance of situations where you might feel trapped, helpless, or unable to get help if you panic, such as crowded spaces, public transport, open areas, or being outside your home alone. It is not simply a fear of open spaces, as is commonly assumed. Agoraphobia is often triggered by panic attacks and, in the DSM-5, is a separate diagnosis from panic disorder.
• Obsessive-Compulsive Disorder (OCD). OCD involves unwanted, intrusive thoughts (obsessions) that cause significant anxiety, and repetitive behaviours or mental acts (compulsions) carried out to relieve that distress. While OCD has its own chapter in the DSM-5, it is closely related to anxiety disorders and commonly discussed alongside them. OCD affects approximately 2.5 million adults in the US, with an average age of onset of 19.
• Specific Phobia. A specific phobia is an intense, persistent fear of a particular object or situation such as heights, flying, needles, or animals, that is disproportionate to any actual danger and causes you to avoid the trigger. Specific phobias are the most common type of anxiety disorder, affecting 8-12% of adults.
• Separation Anxiety Disorder. This involves excessive fear or distress about being separated from attachment figures. It is most common in children but also occurs in adults, and is now formally classified as an anxiety disorder in the DSM-5.

Anxiety and depression are often talked about together, and for good reason, they frequently occur at the same time. Research shows that nearly half of people diagnosed with depression also have an anxiety disorder. Despite their overlap, they are distinct conditions with different core experiences.

• Anxiety is primarily future-focused. If you have anxiety, your mind tends to be preoccupied with what might go wrong, anticipating threats, worst-case outcomes, or situations you won't be able to handle. The emotional experience is dominated by fear, worry, and tension. Your body stays in a state of alertness.
• Depression is primarily present- and past-focused. If you have depression, you may feel a persistent sense of hopelessness, emptiness, or worthlessness. Rather than fearing the future, you may feel indifferent to it. Energy and motivation drop significantly, and things that used to bring pleasure no longer do.

Anxiety often travels with specific thought and behaviour patterns that keep it going. Recognising which patterns are present in your experience is an important part of addressing anxiety, symptoms and what sustains them.

Common patterns observed from people dealing with anxiety on Renée include:

• Catastrophizing - automatically jumping to worst-case interpretations of situations
• Rumination - replaying worries or past events repeatedly without resolution
• People-Pleasing - suppressing your own needs to avoid conflict or disapproval
• Perfectionism - holding yourself to standards where any failure feels catastrophic
• Hypervigilance - staying on high alert for signs of threat, even in safe situations
• Avoidance - steering clear of feared situations, which reinforces anxiety over time
• Emotional Suppression - pushing feelings down rather than processing them

• Slow your breathing. When you're anxious, your breathing tends to become shallow and quick, which can worsen physical symptoms. Try breathing in for 4 counts and out for 8. The extended exhale activates your body's calming response. Even a few minutes of this can reduce the physical intensity of anxiety.
• Name what you're feeling. Research has shown that putting a label on your emotional state, even just saying "I feel anxious", reduces the brain's threat response. You don't need to analyse it, just name it.
• Move your body. Even a short walk can help. Exercise metabolises the stress hormones that accumulate during anxious periods and has been shown to reduce anxiety for hours afterward.
• Reduce caffeine. Caffeine directly stimulates your body's stress response. If your anxiety is high, it may be making things measurably worse, particularly if you consume it in the afternoon.
• Limit reassurance-seeking. When anxious, it's natural to want confirmation from others that things will be okay. But repeatedly seeking reassurance keeps anxiety going rather than resolving it, because it reinforces the belief that you can't tolerate uncertainty on your own. Notice the urge before acting on it.
• Separate the feeling from the facts. Anxiety often makes a feeling feel like evidence. Write down what you're feeling, then separately write down what is actually true in the situation. The gap between the two is often wider than anxiety suggests.
• Set a worry window. Designate a specific 15-20 minute period each day for intentional worrying. When worry comes up outside of that window, note it down and return to it at the designated time. Research suggests this reduces intrusive worry throughout the rest of the day.
• Protect your sleep. Anxiety disrupts sleep, and poor sleep makes anxiety worse. Keeping a consistent sleep schedule, avoiding screens before bed, and keeping your room cool are some of the most practical things you can do to break this cycle.

Anxiety disorders are among the most treatable mental health conditions. Most people who receive appropriate treatment see significant improvement.

• Therapy is the most evidence-based approach. Cognitive Behavioural Therapy (CBT) has the strongest research support for anxiety disorders and is considered a first-line treatment. It helps you identify thought patterns that maintain anxiety and test them against reality. For panic disorder and phobias, exposure therapy, a component of CBT, is particularly effective. Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches are also well-supported, particularly for GAD.
• Medication can be helpful, particularly SSRIs and SNRIs, which are commonly prescribed for anxiety disorders and are often used alongside therapy. Benzodiazepines may be prescribed for short-term relief but are generally not recommended for long-term use. Discuss your options with a qualified healthcare provider.
• Self-tracking, understanding when your anxiety is highest, what triggers it, and how it connects to sleep, social patterns, and daily habits, is a useful complement to professional support.

Anxiety is often not the enemy, avoidance is. What keeps anxiety alive, more than anything, is the pattern of escaping the things that feel threatening. Every time you avoid, you send your brain the message that the situation was dangerous. Every time you approach, even while feeling anxious, you start to rewrite that message. The goal in treatment is never the complete absence of anxiety. It's building a relationship with it that doesn't run your life.

— Rita George, Clinical Phycologist