Anxiety disorders are the most common of mental disorders, according to the American Psychiatric Association (APA). Up to roughly 34 percent of the population—(or more than one in three Americans)—will experience symptoms of an anxiety disorder during their lifetime, the National Institutes of Health has said, basing its claim on data from large population-based surveys
But the fact that anxiety disorders are so widespread does not automatically mean that spotting one is easy to do. You or a loved one may experience symptoms that mimic a totally different condition. One common example: the person who suddenly becomes breathless, begins to experience heart palpitations, and then goes to the ER thinking they are having a heart attack. Both they and the doctors may not know—until diagnostic testing of their heart comes back normal—that what they just experienced is actually a panic attack.
What, then, are the signs and symptoms of anxiety disorders? This page will educate readers on the effects of this mental health condition and how they first manifest, types of anxiety disorders and their symptoms, and the diagnostic criteria for determining whether someone has an anxiety disorder.
The Effects of Anxiety Disorders
The effects of anxiety disorders can be far-reaching, affecting every facet of a person’s life. Unlike the kind of anxiety that is fleeting and temporary, and which occurs every so often and is both normal and largely universal, the anxiety that defines a real disorder never goes away and can progressively worsen over time— if left untreated. This more serious, clinical form of anxiety can often dramatically interfere with daily life functioning, whether at work, school or in one’s personal relationships.
In its most basic sense, anxiety is a physiological, fight-or-flight response that evolved in human beings as a mechanism for survival. In the face of acute danger—whether a bigger predator, natural disaster or another imminent threat to survival—your amygdala, in a region of the brain known as the limbic system, sends out a message that in turn triggers a cascade of neurochemical messages between brain and body.
The hypothalamus is next in this cascade, a small gland in the front center of the brain. It translates this danger signal, sending it on to the pituitary gland. From there, the message moves to the adrenal glands. These pump out adrenaline, which triggers faster breathing, dilating pupils, and a state of hyper-vigilance.
This intimately designed process saved many of our hunter-gatherer ancestors from evisceration by hungry tigers and other scary threats to survival. On the other hand, when this same process goes awry, failing to turn off when the threat goes away or misfiring when there is no threat at all, the daily effects can be nothing short of debilitating for the many Americans who suffer from anxiety disorders.
How Anxiety Disorders Begin to Manifest
Historically, then, fear and anxiety served a very important purpose: as a finely tuned alarm system signaling danger. And this finely tuned alarm system had to work around the clock. This may help to explain at least in part how in the 21st century, a large proportion of the U.S. population struggles with chronic, excessive and/or intense anxiety.
In most of these cases, there are early signs that point to a developing anxiety disorder:
- A person may experience a big, traumatic event— then have their first panic attack or first bout of severe insomnia. A study in the Journal of Affective Disorders found that childhood trauma raises the likelihood of anxiety issues.
- A buildup of stress over time may cause a person to constantly and excessively worry about many aspects of their life.
- An underlying medical issue, such as heart disease, diabetes, chronic pain, irritable bowel syndrome, and hyperthyroidism, can also signal the onset of anxiety problems.
- An inherited genetic tendency towards anxiety may surface as early as childhood—although the onset of an anxiety disorder may also occur well into adulthood—where social anxieties or separation anxieties may manifest in certain avoidance or ritual behaviors. (Genetically speaking, anxiety disorders can run in families and thus contribute to someone being predisposed to it; and, brain chemicals that transmit information between regions of the brain can be imbalanced, causing anxiety.)
What Symptoms Might You Experience if You Have an Anxiety Disorder?
There are various types of anxiety disorders—read on to learn how they run the gamut—so symptoms can vary, depending on the anxiety disorder. A report by the National Alliance on Mental Illness (NAMI) put it well: “Anxiety disorders are a group of related conditions, each having unique symptoms. However, all anxiety disorders have one thing in common: persistent, excessive fear or worry in situations that are not threatening.”
This paraphrased list of anxiety signs and symptoms from the Mayo Clinic provides a helpful general overview of the signs and symptoms that indicate “persistent, excessive fear or worry in situations that are not threatening”:
- Feelings of nervousness, restlessness or tension
- A sense of impending danger, panic or doom
- Increased heart rate
- Breathing faster
- Feeling weak or tired
- Trouble concentrating or thinking about anything other than the present worry
- Sleeping problems (having trouble falling asleep or staying asleep)
- Gastrointestinal (GI) problems
- Having difficulty controlling worry
- Compulsions to avoid things that trigger anxiety
So what exactly is an anxiety disorder? It’s a complex set of factors, including physiology, genetics, brain chemistry, and trauma. According to the Mayo Clinic people with an anxiety disorder have “intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).” For someone to be classified as having an anxiety disorder, his or her anxiety must be disproportionate to the situation and hinder his or her ability to function normally.
The signs and symptoms of an anxiety disorder can thus be both physical and mental. Mentally, an anxiety disorder can manifest as an inability to control worry. A typical person might worry that they will be late for work. Someone with an anxiety disorder can become overwhelmed by thoughts of being late, to the detriment of their functioning normally. An anxiety disorder may keep someone up all night ruminating about things they did wrong or said in the past, resulting in insomnia. Typically, treating the underlying anxiety will help resolve the sleep issues that stem from being overwhelmed by future thoughts of things like money, health, relationships and social events.
Other psychological signs and symptoms that can be present include:
- Feelings of panic
- Feelings of dread
- Excessive worry and tension
- Unrealistic view of problems
- Feeling of being on edge
Anxiety also affects the body physically. When the body reacts negatively it can create a cycle of being anxious which in turn causes physical symptoms, which in turn cause more anxiety. Rapid breathing and a heart that is beating abnormally fast can cause anxiety alone. (Read on to learn how some medical conditions can mimic anxiety or cause it.) Physical signs and symptoms of anxiety including the following:
- Rapid heart rate and rapid breathing
- Increased sweating
- Muscle tension
- Being easily startled
Some research shows that people with an anxiety disorder have a harder time shutting down their stress response compared to people without an anxiety disorder. So some of the physical symptoms experienced with anxiety may remain over a longer period of time after the initial stressor.
The signs and symptoms of an anxiety disorder are varied. Experiencing one or two of them may not be an indicator that you are dealing with an anxiety disorder. For example, sweating excessively can be its own issue. However, experiencing many of both the psychological and physical symptoms associated with anxiety could be an indication that you have an anxiety disorder.
Spotting Signs of Anxiety Disorders in Others
If you spot the above signs and symptoms in a friend or loved one, it is possible they could be suffering from an anxiety disorder.
Here are some other things to look for:
- Do they often seem overwhelmed or burned out with daily household and family responsibilities, such as bills, cleaning, taking care of kids, etc.?
- Do they have trouble holding down a job or spend an inordinate amount of time working and worrying about work responsibilities?
- Do they seem isolated and often avoid certain social activities or settings?
Differences in Types of Anxiety Disorders and Their Signs/Symptoms
There are many types of anxiety disorders, from generalized anxiety disorder (GAD) to panic disorder and various phobia-related disorders. Each type of anxiety disorder is distinguished by its own set of signs and symptoms.
- Social anxiety disorder involves excessive anxiety during and leading up to social interactions, out of fear of being embarrassed, judged or rejected by others. People with this particular form of anxiety will often avoid public places or social events. In more extreme cases, they will not even leave their own homes out of fear of social interactions.
- Obsessive compulsive disorder (OCD) is characterized by obsessive thoughts, urges or repetitive behaviors that are often irrational and ritualistic. For example, a person with OCD may feel compelled to wash their hands multiple times after a trip to the bathroom to protect themselves from germs. Or, they may be convinced that the only way to keep their loved one safe is by flipping the light switch a certain amount of times. There can therefore be variations in the ritualistic thoughts and behaviors that describe this anxiety disorder, as well as the fears that motivate these behaviors.
- Post-traumatic stress disorder (PTSD) is often misunderstood to be in a class of its own among mental health conditions, but in fact it’s yet another way that crippling anxiety can manifest in the aftermath of a traumatic event. Some examples of trauma include serious auto accidents, natural disasters, and violence and war, among other usually sudden and life-shattering experiences. The anxiety symptoms that define PTSD in particular:
- Avoiding people, places or things that remind you of the traumatic event
- Flashbacks and nightmares
- High reactivity to various stimuli (being quick to get startled or frightened)
- Panic disorder is characterized by panic attacks lasting for at least several minutes, sometimes longer. The symptoms of panic attacks can make you feel like you’re having a heart attack. What is striking about these episodes is that they can come on seemingly out of the blue without any clear and direct cause (when there is no real threat to be panicky about). Feelings of imminent doom or being out of control, breathlessness/trouble catching one’s breath, trembling, shaking, sweating and an accelerated heart rate can all be symptoms of panic attacks and the disorder they characterize.
- Phobias, also anxiety disorders, are another illustration of just how broad the category of “anxiety disorder” can be. A phobia is a very intense fear attached to a particular thing, activity, or situation. For example, people can have extreme fears of heights, public speaking, flying, or medical procedures. Some of the physical symptoms of phobias can mirror those that occur during a panic attack: intense anxiety, shortness of breath, sweating and increased heart rate, for example. For fear to qualify as a phobia, it usually also entails going out of the way to avoid the particular thing, activity or circumstance that is the object of fear.
Could My Anxiety Be Signs of Something Else?
Anxiety can sometimes be explained by an underlying medical condition that, when treated, causes the anxiety issue to go away. Health conditions like heart disease, diabetes, and hyperthyroidism are often associated with anxiety. In some cases, they may be the primary issue that requires treatment.
For example, a person who has the undiagnosed cardiovascular disease may experience increased blood pressure, a rapid heart rate and the first warning signs of an ensuing heart attack. But these symptoms may really feel more like anxiety to them— especially since an event like skyrocketing blood pressure or a heart attack can cause extreme agitation and panicky feelings akin to a panic attack. In this sense, the presenting signs and symptoms may point to anxiety as the main diagnosis, when in fact they’re masking the primary medical reason for why a person is acting so anxious.
Similarly, someone with an overactive thyroid gland can experience many of the symptoms that typically would suggest the presence of an anxiety disorder: nervousness, trembling, rapid heartbeat, sweating, and sleep problems. In this case, too, the co-occurring anxiety symptoms would be secondary to the primary medical issue, which when addressed should resolve a lot of the anxiety.
Diagnosing Mental Health Disorder Based on Signs and Symptoms
The fact that anxiety disorders can both mimic and be mimicked by other medical conditions means they are not self-diagnosable. Making an educated guess about what’s ailing you, by Googling your symptoms and reading Psychology Today, is a risky gamble— with any mental health disorder, not just anxiety. Given how potentially serious—even life-threatening—a misdiagnosis can be, anyone suffering from chronic, excessive anxiety should consult a qualified mental health professional. They should also schedule a full physical with their primary care doctor to rule out any medical explanations for the anxiety that they’re experiencing.