Everyone experiences anxiety occasionally - it is a normal response to stress or perceived danger. However, when anxiety becomes persistent, overwhelming, and interferes with daily life, it may be an anxiety disorder. Anxiety disorders are the most common mental health conditions, affecting an estimated 301 million people worldwide in 2019 according to the WHO.
Normal Anxiety vs. Anxiety Disorders
Normal Anxiety
- Related to a specific situation (exam, job interview, medical appointment)
- Proportionate to the situation
- Temporary - resolves once the situation passes
- Does not significantly impair daily functioning
Anxiety Disorder
- Persistent and excessive worry (lasting weeks or months)
- Disproportionate to the actual risk
- Difficult to control
- Significantly affects work, relationships, and daily activities
- May occur without an obvious trigger
Types of Anxiety Disorders
Generalised Anxiety Disorder (GAD)
- Persistent, excessive worry about many different things (health, work, family, finances)
- Difficulty controlling the worry
- Physical symptoms: tension, restlessness, fatigue, difficulty concentrating, irritability, sleep problems
Panic Disorder
- Recurrent unexpected panic attacks: sudden intense episodes of fear with physical symptoms
- Symptoms peak within minutes: racing heart, chest pain, shortness of breath, sweating, trembling, dizziness, numbness, fear of losing control or dying
- Fear of having another panic attack
- Avoidance of situations where panic attacks have occurred
Social Anxiety Disorder
- Intense fear of social situations where you may be judged, embarrassed, or humiliated
- Avoidance of social interactions
- More than just shyness - it significantly impacts daily life
Specific Phobias
- Intense fear of a specific object or situation (heights, flying, needles, animals)
- The fear is disproportionate to the actual danger
Physical Symptoms of Anxiety
Anxiety produces real physical symptoms because it activates the body's stress response:
- Rapid heartbeat (palpitations)
- Chest tightness
- Shortness of breath
- Dizziness or lightheadedness
- Upset stomach, nausea
- Muscle tension
- Headaches
- Sweating
- Trembling
- Tingling or numbness
- Difficulty swallowing (feeling a lump in the throat)
- Frequent urination
Many people with anxiety first visit a doctor thinking they have a physical illness. It is important to rule out physical causes, but also important to recognise that these symptoms can be caused by anxiety.
Effective Treatments
Self-Help Strategies
NICE guideline CG113 recommends the following as first steps:
- Exercise: Regular physical activity (at least 150 minutes per week) has proven anxiety-reducing effects
- Sleep hygiene: Poor sleep worsens anxiety; improve your sleep routine
- Reduce caffeine and alcohol: Both can worsen anxiety symptoms
- Mindfulness and relaxation: Deep breathing exercises, progressive muscle relaxation, mindfulness meditation
- Structured problem-solving: Writing down worries and breaking them into manageable steps
Talking Therapies
- Cognitive Behavioural Therapy (CBT): The most evidence-based psychological treatment for anxiety disorders. CBT helps identify and challenge unhelpful thought patterns and gradually face feared situations
- NICE recommends CBT as a first-line treatment for GAD, panic disorder, and social anxiety
- Can be delivered individually, in groups, or through guided self-help programmes
Medication
When therapy alone is insufficient, medication may be recommended:
- SSRIs (selective serotonin reuptake inhibitors): Sertraline is the first-choice SSRI recommended by NICE for generalised anxiety disorder, and is also licensed for panic disorder and social anxiety disorder. Other SSRIs include fluoxetine and escitalopram
- SNRIs: Venlafaxine or duloxetine
- These medications take 2-6 weeks to reach full effect
- Not recommended for anxiety: Benzodiazepines for long-term use (risk of dependence), beta-blockers alone (limited evidence for generalised anxiety)
When to Seek Help
Seek professional help if:
- Anxiety persists for more than 2 weeks and is interfering with your life
- You are avoiding activities or situations due to anxiety
- Physical symptoms are causing distress
- You are using alcohol or substances to cope
- You have thoughts of self-harm
There is no shame in seeking help. Anxiety disorders are highly treatable, and most people improve significantly with appropriate treatment.
Supporting Someone With Anxiety
- Listen without judgement
- Avoid minimising their feelings ("just relax", "there's nothing to worry about")
- Encourage them to seek professional help
- Learn about anxiety disorders
- Be patient - recovery takes time
This article is for informational purposes only and does not replace professional medical advice. If you are in crisis, please contact your nearest emergency department or call a helpline.