Anxiety disorders are among the most common mental disorders. They often present mainly with physical symptoms, which delays diagnosis.
What it is
We all feel anxious in demanding situations; at moderate levels, anxiety helps us prepare and respond. In an anxiety disorder, worry or fear is excessive for the context, hard to control and accompanied by distress or avoidance that limits personal and working life.
Forms and symptoms
Generalised anxiety
Excessive, hard-to-control worry about several topics (health, work, family, money) on most days, for months, with muscle tension, fatigue, irritability, difficulty concentrating and disturbed sleep.
Panic disorder
Sudden attacks of intense fear that peak within minutes, with palpitations, shortness of breath, chest tightness, trembling, dizziness, tingling and a feeling of losing control or dying. They are often followed by fear of another attack and avoidance of places or situations (agoraphobia).
Social anxiety and specific phobias
Marked fear of social or performance situations, in which the person fears being judged negatively, or of specific objects and situations, with disproportionate avoidance.
When to seek an assessment
When anxiety has persisted for weeks or months, leads you to avoid important situations, disturbs sleep, causes repeated visits to the emergency department for physical symptoms, or when alcohol or sedatives are used to control it.
What the assessment involves
Besides characterising the symptoms and their impact, the assessment looks for associated depression, substance use and medical causes that mimic anxiety, such as thyroid disorders, cardiac arrhythmias, medication effects or excess caffeine. When physical symptoms predominate, liaising with your GP or a cardiologist can be helpful.
Treatment
- Psychotherapy: cognitive behavioural therapy is the psychological treatment with the best evidence, including gradual exposure to avoided situations.
- Medication: some antidepressants (selective serotonin and noradrenaline reuptake inhibitors) are first-line pharmacological treatments for long-term management. Other medicines may be considered in specific situations.
- Benzodiazepines: they bring quick relief, but continued use leads to tolerance and dependence. They are generally reserved for short, well-defined periods.
Regular sleep, less caffeine and alcohol, and physical activity are part of treatment and enhance the other measures.
Frequently asked questions
Is a panic attack dangerous?
It is a very intense experience, but an isolated panic attack does not damage the heart or cause death. At the first attack, or when in doubt, it is important to rule out a medical cause, especially a cardiac one.
Can anxiety cause physical symptoms?
Yes. Palpitations, shortness of breath, chest pain or tightness, dizziness, digestive complaints and muscle tension are common. Once a medical cause has been ruled out, these symptoms are part of the condition and improve with treatment of the anxiety.
Do sedatives cure anxiety?
Benzodiazepines relieve symptoms in the short term, but they do not treat the disorder, and prolonged use causes tolerance and dependence. The core treatment is psychotherapy and, when indicated, antidepressants.
References
- National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113). 2011, updated 2020.
- Baldwin DS, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014;28(5):403–439.
- American Psychiatric Association. DSM-5-TR. 2022.
This page is for information only and does not replace an individual medical assessment. Clinical review: Pedro Zuzarte, psychiatrist · Published and reviewed: .