Overview
Anxiety, defined by the American Psychological Association (APA), is:
Those “somatic symptoms” they’re referring to differ from what you feel when you temporarily fear something in the present moment.[1]
The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) says anxiety is associated with muscle tension and increased mental vigilance to keep an eye out for future threats. In anxiety disorders, the feelings of fear, dread, and uneasiness are not temporary and can be overwhelming. Not only do these feelings persist, but they can also worsen over time and interfere with normal daily activities — grocery shopping, work, sleep, to name a few.
Causes
The causes of anxiety disorders are complex, and risk factors can differ by type of anxiety (i.e., separation anxiety, generalized anxiety, panic). Your genetics, environment, and brain biology can all play a role. General risk factors across anxiety disorders include:
Exposure to traumatic, highly negative or stressful events
A family history of anxiety disorders
Physical health conditions that may contribute to or aggravate anxiety, such as thyroid dysfunction, and heart arrhythmias
Personality traits, such as excessive shyness or becoming withdrawn in social situations
Anxiety is, to some extent, an overactive and poorly regulated fear response with roots in dysfunctional brain and endocrine activity, so it may be influenced by therapy, drugs, supplements, exercise, or food. Foods and supplements that affect anxiety may do so by affecting the production of neurotransmitters and hormones involved in the fear response.
Symptoms
Different anxiety disorders can have different symptoms. Below, we’ve detailed some of the common ones.
| GENERALIZED ANXIETY DISORDER | PANIC DISORDER (at least 4 symptoms) | SOCIAL ANXIETY DISORDERS | PHOBIA-RELATED DISORDERS |
|---|---|---|---|
Persistent feelings of worry or tension for at least 6 months, with no clear cause | Chest pain or discomfort | Blushing | Intense anxiety when faced with a feared situation or object |
Difficulty breathing | Chills | Difficulty talking | Irrational or excessive worry |
Difficulty concentrating | Difficulty breathing | Fear of social occasions or situations (e.g., parties, dinners, public speaking, public restrooms) | Persistent intense anxiety when a feared situation or object is unavoidable |
Easily fatigued | Dizziness | Nausea | Taking intrusive steps to avoid a fear (situation or object) |
Emotional outbursts | Feeling detached | Sweating | |
Headaches | Feeling out of control | Trembling | |
Irritability | Heart palpitations | ||
Muscle tension | Hot flashes | ||
Restlessness | Numbness or tingling of hands, feet, or face | ||
Sleep problems | Persistent feeling of impending doom or death | ||
Stomach upset | Stomach upset | ||
Sweating | Sweating | ||
Under- or overeating | Trembling/shaking |
Diagnosis
Diagnosing anxiety disorders is a complicated process, so don’t self-diagnose. If you suspect you’re overstressed or anxious, see a mental-health clinician or your primary care doctor.
During your appointment, they’ll ask you about your symptoms and may take a full medical history. If deemed necessary, you may undergo a physical exam or additional lab tests to further pinpoint a proper diagnosis. The doctor may also order a psychological evaluation.
Anxiety is largely measured through a variety of questionnaires or behavioral observations designed to assess the severity of symptoms as well as neuroimaging tests, but the latter are less common in research.
The DSM-5 lays out specific criteria for when fear and anxiety cross the line into anxiety disorders.
They’re persistent
They’re out of proportion to the actual threat
The types of anxiety disorders DSM-5 recognizes are summarized in the table below. You’ll notice one recurring criterion: to rank as a disorder, the fear, anxiety, or avoidance behavior should interfere with living a normal life.
| DISORDER | DEFINITION |
|---|---|
Strong fear in situations where escape feels difficult, such as wide-open spaces or crowded, enclosed places. Often accompanied by dysfunctional avoidance of those situations | |
Excessive, disruptive fear or worry about a wide range of subjects | |
Life-disrupting, troubling anxiety that doesn’t fall into any of the categories above | |
Frequent panic attacks and a fear of future attacks. Avoidance behavior | |
Failure to speak in specific social situations where speaking is expected. Usually develops in childhood. Often accompanied by social anxiety disorder | |
High levels of fear and anxiety caused by separation from home or a particular person. Usually develops in childhood | |
Life-disrupting fear, anxiety, or avoidance behavior caused by social situations | |
Life-disrupting fear, anxiety, or avoidance behavior caused by a specific situation or object | |
Substance-, medication-, and disease-related disorders | Anxiety that can be traced to another disease, a medicine, or substance withdrawal |
Reference: Diagnostic and Statistical Manual of Mental Disorders, fifth edition. American Psychiatric Association. 2013.[2]
Treatments
Supplements
Supplements such as magnesium and lavender have good evidence for dampening anxiety severity to a moderate extent. On the flip side, nicotine and yohimbine may worsen anxiety.
The table below displays an analysis of human studies and indicates how supplements may affect anxiety. While there is no cure-all, some supplements may aid in anxiety control or symptom relief.
Therapy
Cognitive behavioral therapy (CBT) works well for many anxiety disorders,[3][4] especially in combination with drugs.[5] Other therapies, such as relaxation therapy,[6] also work quite well and may bring results on par with CBT.
Meditation
The quality of research on meditation’s effects has been questioned.[7][8][9] Keeping that in mind, there is some evidence that meditation can reduce symptoms of anxiety,[10] especially among people for whom anxiety is a secondary concern.[11] It may also reduce physical signs[12] and mental symptoms[13] of stress.
Exercise
Aerobic exercise (i.e., running, jogging) reduces anxiety in people who have clinical anxiety, with higher-intensity exercise tending to be more effective.[14] Resistance training (i.e., weight lifting, bodyweight exercise) has less evidence, but that evidence suggests it can also benefit people with anxiety disorders.[15]
Exercise benefits are roughly on par with therapy but lower than with drug treatment.[5]
Diet
It is difficult to say if specific diets can lessen anxiety, but tasty foods can benefit your mood in the short term, and healthy food can help in the long run. The evidence for improved mood is especially strong in favor of Mediterranean-style diets,[16][17] but that may be because no other type of healthy diet has been seriously studied for its effects on mood or anxiety, specifically.
Even studies can’t prove how much of the improvement in mood was due to the Mediterranean diet itself versus the placebo effect — switching to a healthier diet and expecting to feel better — or even regression to the mean, where people feel better as time passes. But we can say that healthy eating patterns won’t hurt, at the very least.
Drugs
When it comes to anxiety disorders, drugs work better, on average, than exercise and therapy. Medication also boosts the effectiveness of therapy.[5] Antianxiety medications, beta-blockers, and antidepressants are commonly used to help relieve symptoms, but some drugs work better than others, depending on the anxiety disorder.
For instance, duloxetine (Cymbalta), a selective serotonin-norepinephrine reuptake inhibitor (SNRI), works really well for generalized anxiety disorder[18] but is no better than a placebo for panic disorder, for which tricyclic antidepressants seem to work best.[19]
The first step is to discuss a specific treatment plan with your physician or healthcare provider.
