Maybe you’ve tossed and turned on a Sunday night with worried thoughts of the week ahead. Maybe the idea of speaking at a professional conference made your heart quicken with fear. Maybe you’ve felt overwhelmed in a crowd and suddenly felt the urge to bolt. Experiencing anxiety from time to time is normal as we navigate life’s myriad challenges and uncertainties. But anxiety that persists long-term and keeps you from meeting responsibilities, taking care of yourself, or participating in activities you enjoy? That warrants a closer look.
The first thing to know about anxiety is that relief is possible. Thanks to a variety of therapeutic, behavioral, and lifestyle interventions, mental-health experts say even serious anxiety disorders can be treated. Keep reading to learn more about the causes of anxiety, the major symptoms of anxiety, and evidence-based approaches for managing this common condition.
What is anxiety?
Anxiety often gets conflated with stress, but the two aren’t quite the same. Stress is a response to a present threat or hazard—think: an aggressive person charging at us, a sudden job loss, or interpersonal turmoil. On the other hand, anxiety is marked by the anticipation of future threats, according to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
That being said, anxiety and stress can fuel one another, says Justin Baksh, LMHC, MCAP, chief clinical officer of Foundations Wellness Center in Port St. Lucie, Florida. Fear, nervousness, and worry about the future can take an emotional and physical toll in the moment, he explains, which contributes to stress. But stress can also arise from anxiety: When stressful situations leave us feeling helpless and overwhelmed, they can instill doubt in our ability to cope with future challenges.
Both stress and anxiety activate the body’s emergency-response system—the coordinated efforts of the hypothalamus, sympathetic nervous system, and pituitary and adrenal glands that prepare us to fight, flee, or freeze.
What causes anxiety?
Anxiety is rooted in our thoughts and perceptions, explains psychologist Tamar Chansky, PhD, author of Freeing Yourself from Anxiety: 4 Simple Steps to Overcome Worry and Create the Life You Want. When we appraise a challenge as manageable, we don’t typically fret much about it. But when we believe a challenge is beyond our capacity to cope with and work through it, we’re more likely to experience anxiety (read on for what that can feel like), and we may go out of our way to avoid the situation.
Exactly how anxious we get is influenced by biological, psychological, and circumstantial vulnerabilities, research shows. For example, factors such as being sleep-deprived, hungry, or having a headache can increase vulnerability to anxiety. So too can having a history of trauma. Lack of physical activity is associated with anxiety, likely because exercise helps reduce stress. Social connectedness plays a role, too: Feeling supported by others helps decrease anxiety-provoking feelings of helplessness and promotes stabilizing feelings of safety.
Sometimes, a bit of anxiety can be helpful, Dr. Chansky notes. Concerns about being unprepared for a presentation can prompt us to more carefully review our notes so we wow the audience. Worrying whether we’ll find a romantic partner with similar interests may galvanize us to put more effort into expanding our social circle based on things that matter to us. Imagining what might go wrong during an overseas trip may prompt us to formulate a helpful contingency plan just in case.
Anxiety becomes an issue when it holds back—rather than facilitates—a person’s personal, social, or occupational functioning, Dr. Chansky says.
Anxiety disorders
If anxiety regularly feels overwhelming or prevents you from doing things that matter to you or that you enjoy, something might be up.
Anxiety disorders are the most common mental-health diagnoses worldwide, affecting up to 284 million people. Roughly 31% of people in the U.S. will experience one in their lifetime; in any given year, nearly 20% of adults and 25% of adolescents grapple with anxiety disorders.
Here’s a quick guide to some of the most common anxiety disorders.
- Generalized anxiety disorder (GAD). An estimated 9% of Americans suffer from GAD at some point in their lifetimes. GAD involves excessive and persistent worry about multiple events or activities (like work, school, dating, finances, family, health...) for at least six months. People who have GAD also experience at least three of the following: muscle tension, difficulty concentrating, insomnia, restlessness, irritability, or fatigue.
- Panic disorder. Up to 3% of adults and adolescents in the U.S. experience panic disorder, which involves recurrent or unexpected panic attacks: sudden elevations in heart rate; sweating, trembling, or shaking; dizziness; a feeling of imminent doom; and chest pain and shortness of breath that may be mistaken for a heart attack. Panic attacks are acute; they tend to last 10 to 20 minutes.
- Social anxiety disorder. Affecting around 7% percent of people in the U.S., social anxiety disorder involves marked fear or anxiety about social situations that involve potential scrutiny. Common anxiety-inducing situations include meeting new people, performing in front of others, or being observed in professional evaluations. Many people with this disorder find their lives affected in trying to avoid such situations.
- Separation anxiety disorder. The most prevalent anxiety disorder in children younger than 12, separation anxiety disorder involves excessive worry or fear about being separated from a loved one, or an intense and debilitating preoccupation with the possibility of a loved one’s death—for example, via illness.
- Specific phobia. Up to 9% percent of Americans have a marked fear of a specific object or situation—think: air travel, heights, insects, or receiving injections. Avoidance of feared entities often impairs social and occupational functioning or physical health.
- Agoraphobia. Nearly 2% of U.S. adults and adolescents experience agoraphobia, marked by fear and avoidance of places or situations that make them feel trapped or helpless. People with agoraphobia may struggle with crowds, public transportation, open or enclosed spaces, or being alone outside their home.
11 signs and symptoms of anxiety
What does anxiety feel like? The answer depends on the person. Here are 11 symptoms of anxiety. Some people experience many symptoms; others just a few.
1. Excessive worrying
Excessive worry often involves mentally replaying potential negative outcomes, such as an anticipated failure or humiliation, or jumping to the conclusion that a loved one has abandoned you if they don’t respond to a text message right away. Continuously speculating on ways something can go wrong, to the detriment of other thoughts, can signal anxiety.
2. Agitation
Agitation includes feeling restless, keyed up, and on edge. You may feel unable to sit still, or experience an intense urge to flee your present surroundings.
3. Difficulty concentrating
Often due to the intrusive nature of worry, anxiety can thwart our attempts to focus on tasks or allow space for other thoughts. Trouble concentrating is a common symptom of anxiety.
4. Muscle tension
Clenched jaw. Hunched shoulders. A furrowed brow. At some point you may have noticed your body assuming a more rigid posture when you’re feeling anxious. In activating the sympathetic nervous system, anxiety can increase muscle tension.
5. Irrational fear
Anxiety can lower the bar for what we perceive as a threat. This means we can feel intense worry or fear around people, places, and things even in neutral or positive contexts.
6. Panic attacks
An estimated 5% of people in the U.S. will experience a panic attack during their lifetimes. Panic attacks are short-lived but terrifying states of sympathetic nervous system overactivation. They’re often characterized by heart palpitations, accelerated heart rate, sweating, trembling or shaking, shortness of breath, and feelings of being smothered or choked. Chest pain, nausea, and dizziness may also occur. Sufferers may feel numbness, tingling, chills, or heat throughout their bodies. Also common: a sensation of watching oneself from the outside (depersonalization), as well as a sense that something is “off” about one’s surroundings (derealization). Panic attack sufferers commonly experience intense fears of losing control, “going crazy,” or dying. Panic attacks tend to come on quickly and resolve in 10 to 20 minutes.
7. Irritability
Being easily annoyed by others or quick to lose your temper is a hallmark of anxiety thought to be caused by an overactive stress-response system designed to defend us from danger.
8. Sleep disturbances
It’s tough to get a good night’s sleep when your mind’s racing and your limbs are restless. In a cyclical effect that may amplify the hardship, sleep deprivation can exacerbate anxiety, studies suggest.
9. Fatigue
Worry, restlessness, and lost sleep mean many anxiety sufferers are easily fatigued. Activities that others might find invigorating may feel exhausting to folks with anxiety.
10. Hypervigilance
Hypervigilance is a state of high alert in which your senses are extremely sensitive to your surroundings. This mode can be protective in potentially dangerous situations—say, if you’re investigating sounds of a wild animal in your basement. In more benign settings, hypervigilance may cause you to feel unnecessarily jumpy.
11. Somatic symptoms
Anxiety can manifest as gastrointestinal distress in the form of constipation, diarrhea, or flatulence. Indeed, research suggests that over half of people living with irritable bowel syndrome also experience an anxiety disorder. Other physical symptoms of anxiety include increased sweating and increased heart rate (independent of a panic attack).
The above symptoms are not a definitive diagnostic checklist. In some cases, symptoms that appear disordered (e.g., hypervigilance) may actually be normal and adaptive (as in a situation where you might be harmed).
Another important point: Anxiety symptoms commonly occur with other mental illnesses, including post-traumatic stress disorder, depression, eating disorders, obsessive-compulsive disorder, gender dysphoria, and body dysmorphic disorder.
If you suspect you have an anxiety disorder or other disorder, it’s important to consult with your doctor or a mental-health professional who can fully assess your situation.
Can anxiety affect your weight?
Anxiety can influence weight. Factors such as genetics, how we cope with stress, and the specific symptoms we experience can all play a role in what happens on the scale. Some people struggling with anxiety gain weight, while others lose weight.
In terms of gaining weight, anxiety increases stress hormones like cortisol, which may promote fat storage—especially in our midsections. Anxiety can also result in sleep deprivation, which can hinder our ability to make healthier food choices or exercise. Some anxiety sufferers may also drink alcohol to manage symptoms. All of this can lead to weight gain.
As for losing weight, hyperarousal of the sympathetic nervous system can zap appetite, Dr. Chansky says. And if you’re the kind of person who experiences nausea with anxiety, digging into a meal might be the last thing you want to do. Excessive worrying can distract us from hunger cues or cause us to forget meals. Restlessness and agitation may also lead people to move around more—or over-exercise. In these ways, anxiety can lead to weight loss.
Anxiety treatment
Most anxiety disorders respond well to treatment, which means many people report feeling better once they receive professional support.
The gold-standard treatment for anxiety is cognitive behavioral therapy (CBT), which involves identifying, challenging, and replacing unhelpful thoughts that stoke anxiety. For example, CBT can help you focus on evidence to disprove a belief such as, “Everyone in the neighborhood dislikes me.” It can help you replace a persistent unhelpful thought like, “I’ll never be able to handle this,” with something like, “This is challenging, but I will get through it.” CBT also helps people become more flexible in their thinking—for example, reframing “My career is over if I mess this up” to be, “I am working hard to do a good job.”
Exposure therapy, a version of CBT, describes a variety of techniques that help reduce anxiety by bringing people face to face with objects or situations they fear. The exposure happens in a safe space, often gradually, while a therapist offers guidance on coping skills to manage uncomfortable feelings that come up.
Some people experiencing anxiety disorders benefit from medication. Psychiatrists may prescribe benzodiazepines for short-term symptom management or antidepressants for long-term symptom management.
Lifestyle changes can help with anxiety, too. Exercise helps regulate the body’s stress response system and promotes growth of neurons, which has been linked to improved mental health. Meditation can help people gain distance from their thoughts and can help regulate the nervous system to reduce stress.
Getting sufficient sleep may further lower anxiety by improving function in brain regions that control negative emotions. Cutting back on caffeine means less anxiety-mimicking stimulants in your system. Many people find breathing exercises helpful. Some preliminary research, largely conducted on animals, suggests that boosting intake vitamin B12, magnesium, zinc, omega-3 fatty acids, and probiotics may improve anxiety, but there’s still a lot to learn about the relationship between food and anxiety.
It’s important to consult a doctor before trying any intervention for anxiety.
The upshot: Could you have anxiety?
It’s normal to experience occasional tension and worry over negative possibilities in life. But when those feelings routinely prevent you from engaging in activities you wish to do—say, enjoying social outings, showing up for work, or taking care of your health—an anxiety disorder may be at play. If that feels familiar, consider reaching out to your doctor or asking your insurance company for a referral to a psychiatrist or mental health professional. WeightWatchers®’s mental-health resources hub offers some additional advice on finding a therapist and ways to learn more about anxiety. Anxiety disorders are highly treatable, and you deserve support.
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Katherine Schreiber, MFA, LMSW, is a social worker and freelance journalist in New York City. She is the author of The Truth About Exercise Addiction: Understanding the Dark Side of Thinspiration. Follow her on Twitter @ktschreib.