Anxiety Disorders

Learn about signs, risk factors, treatment, and more for anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder.

Learn more about anxiety disorders:

Definition

Anxiety disorders are mental disorders that can occur at any age. Everyone feels worried and fearful at times. People with anxiety disorders worry a lot and are fearful and nervous. These feelings cause distress and impair daily life. The person may avoid situations such as work, school, and social activities.

There are several types of anxiety disorders. This summary focuses on generalized anxiety disorder, panic disorder, and social anxiety disorder.

Signs and Symptoms

Generalized Anxiety Disorder

A person with generalized anxiety disorder (GAD) has excessive feelings, thoughts, emotions, and actions. He or she has anxiety or worrying most of the time for at least six months. The worry may be related to job performance, money, health, and other activities. Sometimes the worry shifts from one focus to another. An adult with GAD has several of the following symptoms; a child may have just one symptom:

  • Restlessness, or feeling wound up or on edge
  • Being easily tired
  • Trouble concentrating, or feeling that their “mind goes blank”
  • Irritability
  • Muscle tension, aching, or soreness
  • Sleep problems, such as trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep
  • A person with GAD also may have a change in appetite and frequent sweating, nausea, or diarrhea

Panic Disorder

A person with panic disorder has unexpected or expected panic attacks. Panic attacks are sudden periods of intense fear, anxiety, or discomfort. The attack reaches a peak within minutes. It may cause an urge to escape or flee. During a panic attack, a person has several of the following symptoms:

  • Pounding heart or fast heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Dizziness or feeling lightheaded
  • Chills or feeling overheated
  • Numbness or tingling
  • Feelings of unreality or being unconnected to oneself
  • Fear of going crazy or losing control
  • Fear of dying

After one or more panic attacks, he or she usually has one or both of:

  • Worry that another panic attack might occur, and irrational fear that this will lead to loss of control of thoughts and feelings, a heart attack, or dying
  • Trying to avoid panic attacks, such as by avoiding certain situations or places, or by stopping exercise or other activities.

Social Anxiety Disorder

Social anxiety disorder is sometimes called “social phobia.” The person fears being embarrassed or negatively judged by others in a social setting. This worry often causes him or her to withdraw or avoid certain situations. This causes problems at work, at school, or in relationships.

A person with social anxiety disorder often has the following symptoms for more than six months:

  • Being afraid of or worrying about social situations, such as meeting new people or eating in front of others
  • Feeling very self-conscious in front of others and worrying about offending others or being humiliated, embarrassed, or rejected
  • Avoiding social situations that cause fear and anxiety, feeling dread or doom leading up to a feared situation, or being very uncomfortable if able to stay in the situation
  • Feeling fear or worry about a situation greater than the actual threat and beyond what most people would feel
  • Having problems at work, school, or in relationships due to the symptoms
  • Changing the daily routine in response to the symptoms

A person with social anxiety disorder sometimes feels nauseous. They may blush, tremble, sweat, or say their mind “goes blank” in feared situations.

A small subgroup of people with social anxiety disorder fear having to perform, present, or talk in front of a group.

Risk Factors

There is no single cause of anxiety disorders. Genetics, brain structure and function, and environmental factors all seem to be involved.

General Anxiety Disorder

About 3% of adults and 1% of adolescents have GAD. Females are much more likely than males to have GAD. Most people with GAD develop symptoms between childhood and middle age.

Panic Disorder

About 3% of adults and adolescents have panic disorder. Females are more likely than males to have panic disorder. Most people develop panic disorder between ages 20–24. It can occur much earlier, but rarely starts after age 45.                      

About 25–50% of people with panic disorder also have agoraphobia. They start avoiding places such as crowded areas, buses, and elevators. Agoraphobia can occur without panic disorder.

Risk factors for panic disorder include having stressors in the months before the first panic attack. Stressors can include marriage problems, health problems, use of illicit drugs, misuse of medications, or death of a close family member.

Social Anxiety Disorder

About 7% of adults have social anxiety disorder in a given year. Children may have social anxiety symptoms. The rate of social anxiety disorder decreases with age. It is more common in women than in men.

All Anxiety Disorders

Genetics and biological factors. Anxiety disorders tend to run in families. A person who has a close relative with an anxiety disorder or depression is more likely to develop an anxiety disorder. It is unclear whether one or more genes are involved. In some people, an overactive thyroid can contribute to anxiety disorders. A person who tends to feel distress and withdraw from unfamiliar situations, people, and places may be more likely to develop an anxiety disorder.

Brain structure and function. Certain brain structures seem to play a role in anxiety disorders. The amygdala, the part of the brain that controls emotion, may be involved.

Environment factors. Environmental factors that may lead to anxiety disorders include:

  • Smoking or using tobacco products, and nicotine withdrawal
  • Having a parent with anxiety, depression, or bipolar disorder
  • Having breathing problems, such as asthma, and fearing suffocation
  • Withdrawal from alcohol or a medication such as a benzodiazepine
  • Exposure to stressful life events in childhood and/or adulthood
  • Physical or mental abuse, death of a loved one, desertion, divorce, or isolation
  • Caffeine, prescription medications, and over-the-counter medicines such as diet pills and allergy medications that contain pseudoephedrine

For statistics on anxiety disorders, access National Institute of Mental Health Statistics.

Evidence-based Treatments

Anxiety disorders do not go away on their own, but they are among the most treatable mental disorders. If untreated, anxiety disorders can become chronic. Anxiety disorders can be treated with a combination of psychotherapy, sometimes called “talk therapy,” and medication. The treatment plan should consider each person’s needs and choices. A person should consult a healthcare professional when choosing the right treatment and consider their own gender, race, ethnicity, language, and culture.

Psychotherapy

Cognitive behavioral therapy can help people with anxiety disorders. It teaches a person new ways of thinking, acting, and reacting to situations that cause anxiety. It can also help people learn social skills, which is vital for treating social anxiety disorder. Cognitive behavioral therapy may be done one-on-one or with a group of people who have similar problems. Two helpful approaches are cognitive therapy and exposure therapy. Cognitive therapy focuses on challenging unhelpful thoughts related to anxiety. Exposure therapy focuses on confronting fears so people no longer feel they must avoid certain activities.

Family therapy helps family members improve communication and resolve conflicts. Family therapy is usually short term. It is sometimes used if a person’s family may be contributing to their anxiety. The family members learn to avoid doing so.

Acceptance and commitment therapy (ACT) is helpful for people with anxiety disorders. Unlike cognitive behavioral therapy (which aims to reduce problematic thoughts and actions), ACT focuses on acceptance. The person gains insight into patterns of thinking, patterns of avoidance, and the presence or absence of action that is in line with chosen life values. The goal is to reduce the struggle to control or do away with these things, and to increase involvement in meaningful activities. ACT is especially helpful for people with GAD, and may be a good fit for older adults.

Medication

Medications are helpful in treating anxiety disorders. Medications do not cure anxiety disorders but often relieve symptoms. Medication and psychotherapy can be used separately or in combination. Medication may be used if psychotherapy alone is not effective, or if a person does not have access to psychotherapy.

The most common medications for anxiety disorders are antidepressants, benzodiazepines, and beta-blockers.

Antidepressants can be helpful for treating anxiety disorders. A doctor should closely monitor anyone who recently started taking an antidepressant. In some cases, children, teenagers, and young adults (under age 25) may have more suicidal thoughts or actions when taking antidepressants. This is more likely in the first few weeks after starting a medication, or when the dose is changed. Women who are pregnant, planning to become pregnant, or breastfeeding should talk to their prescriber about possible health risks to herself, the fetus, or her nursing child. It is important to consult with a healthcare prescriber before stopping an antidepressant. Stopping these medications abruptly can cause serious health problems.

Benzodiazepines are often prescribed to people with anxiety disorders to help reduce worrying, panic attacks, or extreme fear. Benzodiazepines should be monitored by the prescriber. They can lead to physical dependency.

Beta blockers are helpful in treating the physical symptoms of anxiety, especially social anxiety. Physicians prescribe them to control rapid heartbeat, shaking, trembling, and blushing.

For basic information about medications, visit Mental Health Medications at the National Institute of Mental Health. For up-to-date information on medications, side effects, and warnings, visit the Food and Drug Administration.

Complementary Therapies and Activities

Complementary therapies and activities can help people with mental disorders improve their well-being and are meant to be used along with evidence-based treatments. For more information on natural products or mind-body practices, access the National Center for Complementary and Integrative Health.

Stress-management techniques, mindfulness, and meditation can help people with anxiety disorders learn to calm their thoughts and may enhance the effects of therapy.

Progressive muscle relaxation management includes forms of meditation and exercises that help reduce muscle tension and anxiety. These guided exercises help break the cycle of muscle tensions tied to anxiety.

Daily exercise, healthy nutrition, and adequate sleep improve a person’s motivation and ability to participate in treatment and reduce stress levels.

Chamomile capsules may have some benefits for some people with mild to moderate GAD.

Apps for health improvement and personal support are available for smartphones and tablets. The SAMHSA App Store and the federal National Center for Telehealth & Technology have free apps for download. For an up-to-date list of federal apps, see the Federal Government Mobile App Directory.

Recovery and Social Support Services and Activities

Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. This includes:

  • Overcoming or managing one’s condition(s) or symptoms
  • Having a stable and safe place to live
  • Conducting meaningful daily activities, such as a job, school, volunteerism, and family caretaking
  • Having relationships and social networks that provide support, friendship, love, and hope

Recovery helps a person develop resilience, increasing the ability to cope with adversity and adapt to challenges or change. To learn more, visit the SAMHSA Recovery and Recovery Support topic.

Self-help and support groups can provide people with the knowledge and support to make treatment decisions that work for them. Organizations and websites provide self-help information and help people find local support groups. Peer and family support services can help foster hope and promote outreach and engagement for those with behavioral health conditions. This includes both peer-to-peer and family-to-family supports provided by a certified peer or family support specialist who can promote hope, foster recovery, and build resilience skills.

Resources for people with anxiety disorders and their families include:

Future Directions in Research and Treatment

Researchers are exploring the role of genes in anxiety disorders. Some research has found that a subgroup of people with panic disorder have a common gene. It is unclear whether there are distinct genetic forms of panic disorder, or one set of genes that make a person more likely to have panic disorder or anxiety disorders generally.

Research is also studying new treatments. Certain types of treatments might work better for certain groups such as military veterans, children, and adolescents. Use of computers, cell phone, tablets, and mobile applications to treat anxiety disorders is a growing area of interest.

Finding Treatment

Consult a healthcare professional who has training and experience working with anxiety disorders. For general information on mental disorders and to locate treatment services in your area, contact SAMHSA’s National Helpline, 1-800-662-HELP (4357). SAMHSA’s Behavioral Health Treatment Locator and the National Institute of Mental Health Help for Mental Illnesses webpage have more information and resources.

If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).

Last Updated: 04/05/2017