Anxiety is about of nervousness and apprehension that visits when you think about or are about to engage in something you find stressful. Anxiety is a normal reaction to the anticipation of embarrassment or threat. It becomes a disorder when it starts to inhibit you from being able to enjoy life. 

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  • Feeling panic, fear and uneasiness
  • Nightmares
  • Repeated thoughts or flashbacks of traumatic experiences
  • Inability to be still and calm

  • Chemical imbalance
  • Social and Environmental factors
  • Increased stress
  • Low self-esteem

  • Cognitive behavioural therapy (CBT)
  • Exposure therapy
  • Anti-anxiety medications

  • Psychiatry
  • Psychology
  • Therapy

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What is Anxiety?

One of the most enduring recollections about the golden age of piracy is a rather crude means of punishment: tie up a human being, blindfold them and force them onto a plank peering over the ship’s end into the cold, cruel sea. 

Picture standing on that wobbling plank of wood, arms fastened tightly to quivering ribs, while sharp ends prod you from behind towards oblivion. The other end is waiting and you inch a trembling foot across the rough wood, you raise the other leg and drop it praying for the same flat texture and it finds you. In the taut silence of your mind, you get ready to take the next step, hoping to live, hoping for more wood, but it could be air, could be death, could be..a prank?

Though this pirate tradition has very little historical validity, it makes for great entertainment, while also being a perfect metaphor for the state of anxiety. Not the normal kind that you feel when holding up a queue, digging around for change, but something so crippling that you’re transfixed by thoughts of great ‘danger’.   


It bears emphasising heavily that Anxiety is perfectly normal, it’s more akin to a defensive mechanism or survival tactic in that it prepares us to respond to a threat. And when the perceived threat disappears, you return to normal. 

Anxiety only becomes a disorder when it persists despite the lack of an obvious trigger, while affecting your ability to function normally, leaving you unable to control your responses to situations, and in general is out of proportion to the situation or age-appropriate. 

Symptoms of Anxiety:

Meanwhile, the symptoms vary depending on the type of anxiety disorder you have. Basically, anxiety feels different depending on the person experiencing it. You might feel out of control like there’s a disconnect between your mind and body. General symptoms of an anxiety disorder include:

Physical symptoms:

  • Cold or sweaty hands.
  • Dry mouth. 
  • Fatigue
  • Heart palpitations.
  • Upset stomach or Nausea
  • Numbness or tingling in hands or feet.
  • Muscle tension.
  • Shortness of breath.

Mental symptoms:

  • Feeling panic, fear and uneasiness.
  • Nightmares. 
  • Repeated thoughts or flashbacks of traumatic experiences.
  • Uncontrollable, obsessive thoughts.
  • Difficulty concentrating

Behavioural symptoms:

  • Inability to be still and calm. 
  • Ritualistic behaviours, such as washing hands repeatedly.
  • Trouble sleeping.
  • Excessive and constant worrying
  • Irritability.

Anxiety may increase the likelihood of physical health conditions, and vice versa:

  • Irritable bowel syndrome (IBS), chronic pain disorders, high blood pressure, asthma, and other physical health issues are associated with anxiety disorders.
  • If you have both an anxiety disorder and a physical condition, it’s important to treat both to best manage your symptoms.

In many cases, anxiety is a learned coping mechanism. For instance, patterns of negative thoughts or catastrophic thinking — believing that something bad will happen to you — is related to anxiety. These thoughts are there to protect you from possible danger, but ultimately, they aren’t the most effective tool for making you feel better.

Another coping style is avoiding objects or situations that feel scary or harmful. This avoidance means that you don’t get exposed to that thing, so you aren’t able to learn that it’s actually harmless. This makes the cycle of anxiety difficult to break. 

Causes of Anxiety:

Anxiety disorders are like other forms of mental illness. They don’t come from personal weakness, character flaws or problems with upbringing. But researchers don’t know exactly what causes anxiety disorders. They suspect a combination of factors plays a role:

  • Chemical imbalance: Severe or long-lasting stress can change the chemical balance that controls your mood. Experiencing a lot of stress over a long period can lead to an anxiety disorder.
  • Social and Environmental factors: Social factors play a somewhat significant role in the development of anxiety disorders. Furthermore, experiencing a trauma might trigger an anxiety disorder, especially in someone who has inherited a higher risk to start. Domestic and sexual violence, enforcement of traditional gender roles, workplace harassment, and other social inequities are associated with an increased prevalence of anxiety disorders.
  • Heredity: Anxiety disorders tend to run in families. You may inherit them from one or both parents, like eye colour. Of those who have a diagnosis of anxiety, 25 percent have a first degree relative who also has a diagnosis of anxiety.
  • Increased stress, which can come from a variety of sources. It may be due to a health condition, sleep disorders, or life situations such as work, school, financial troubles, relationship issues, or the death of a loved one.  
  • Low self-esteem, particularly in young people, can indicate anxiety.
  • Major depressive disorder and other mental health disorders may often co-occur with anxiety. Additionally, thyroid problems and other health conditions can also make you prone to anxiety.
  • Stimulants and Substance abuse: Consuming caffeine, specific substances including drug and alcohol, and medications can increase or worsen your symptoms.

Other factors can make individuals in some communities more vulnerable to anxiety disorders, including:

  • poverty
  • displacement
  • loss of cultural heritage
  • degradation relating to climate change

Types of Anxiety:

Starting with the idea that anxiety is a response to a perceived flight or fight situation, it’s not difficult to see that the trigger is Stress. But the salient difference between stress and anxiety is that when the source of the stress disappears, the feelings of stress too disappear; meanwhile anxiety may stick around, and you’re left feeling like you may never escape its clutches. This is what makes anxiety disorders so debilitating, and also why it’s split into so many different types, which include: 

Generalized Anxiety Disorder (GAD):

Generalised anxiety disorder manifests as an extreme and unrealistic worry or tension about general things like school, health, relationships or minor matters such as chores, car repairs, or appointments. Sometimes there’s even nothing to trigger these feelings. 

This ongoing or unrelenting worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on-edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Often the worries focus on everyday things such as job responsibilities and family health, etc.

Panic Disorder:

To understand panic disorder in any measure, we must first discuss what a panic attack is. A panic attack is a feeling of intense fear that comes on suddenly and peaks within 10 to 20 minutes. The initial trigger of the fear can be known or unknown. Its physical symptoms can mimic a heart attack. You may also experience: 

  • Sweating, Chest pain and Heart palpitations. All of which may contribute to this feeling of choking, which can make you think you’re having a heart attack or “going crazy.”
  • Shaking, Chills, and Hot flashes
  • Numbness and tingling of hands, feet, or face
  • Nausea or upset stomach
  • Shortness of breath
  • Fear of dying
  • Fear of losing control
  • Feeling of impending doom

Panic attacks are very upsetting and symptoms may differ among individuals. In addition, the many symptoms of anxiety don’t happen to everyone, and they can change over time. This is important to know because the primary symptom of a panic disorder is recurrent panic attacks, an overwhelming combination of physical and psychological distress. The feelings of terror may start suddenly and unexpectedly or they may come from a trigger, like facing a situation you dread. 

This means you experience recurring panic attacks at unexpected times.

People with panic disorder often spend a lot of time worrying about the next panic attack. They also try to avoid situations that might trigger an attack. These attacks often feature stronger, more intense feelings than other types of anxiety disorders.

Another common fear that may exacerbate a panic attack is the fear that you might be judged negatively if you’re having an attack in public.


Phobias are an excessive and persistent fear of a specific object, situation or activity that is generally not harmful. You see this with people mortally afraid of things like insects, spiders, flying, public speaking, injections etc. They know their fear is excessive, but they can't overcome it. Like with other anxiety disorders, these fears cause such distress that some people go to extreme lengths to avoid what they fear. 


If you have agoraphobia, you may have an intense fear of being overwhelmed or unable to get help. In other words, it is the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms.

The fear is out of proportion to the actual situation and lasts generally six months or more and causes problems in functioning.

A person with agoraphobia experiences this fear in two or more of the following situations:

  • Using public transportation
  • Being in open spaces
  • Being in enclosed places
  • Standing in line or being in a crowd
  • Being outside the home alone

The individual actively avoids the situation, requires a companion or endures with intense fear or anxiety. Untreated agoraphobia can become so serious that a person may be unable to leave the house. A person can only be diagnosed with agoraphobia if the fear is intensely upsetting, or if it significantly interferes with normal daily activities.

Separation Anxiety Disorder:

A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation.

The feeling is beyond what is appropriate for the person's age, persists (at least four weeks in children and six months in adults) and causes problems functioning. 

This condition mostly happens to children or teens, who may worry about being away from their parents. Children with separation anxiety disorder may fear that their parents will be hurt in some way or not come back as promised. It happens a lot in preschoolers. But older children and adults who experience a stressful event may have separation anxiety disorder as well.

Social Anxiety Disorder (Social Phobia):

A person with social anxiety disorder has significant anxiety and discomfort about being embarrassed, humiliated, rejected or looked down on in social interactions. People with this disorder will try to avoid the situation or endure it with great anxiety. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public. The fear or anxiety causes problems with daily functioning and lasts at least six months.

Obsessive-Compulsive Disorder:

OCD is a condition in which you have frequent unwanted thoughts and sensations (obsessions) that cause you to perform repetitive behaviours (compulsions). It is usually a life-long (chronic) condition, but symptoms can come and go over time. 

However, the repetitive behaviours can significantly interfere with social interactions and performing daily tasks. Obsessions in OCD are unwanted, and people with OCD don’t enjoy performing compulsive behaviours. It might seem blase to hear that people who often use the phrases “obsessing” and “obsessed” very casually in everyday conversations are quite wrong about how extreme OCD can be. As common as it might be to occasionally double-check the stove or the locks, for someone with OCD it can take up hours of their day and get in the way of normal life and activities.

Illness Anxiety Disorder:

You may be more familiar with the term hypochondria or health anxiety. Healthcare providers now use the term illness anxiety disorder to describe people who have an unrealistic fear that they have a serious medical condition or fear that they’re at high risk of becoming ill. 

People with illness anxiety disorder can’t control how they feel, and may misinterpret typical body functions as signs of illness.

Their fears are very real to them, and even after medical tests show no problems, people with hypochondriasis are still preoccupied with the idea that they think they’re seriously sick. Their persistent health worries can interfere with their relationships, careers and life.

Diagnosis And Treatment:

We would like to reiterate a crucial point once more; anxiety is a normal aspect of human functioning. It allows us to be alert and ready to meet a challenge, but if the symptoms written above seem familiar and you would like to know what the procedure for diagnosis is, it begins with a healthcare provider taking a complete medical history and physical examination. 

There are no lab tests or scans that can diagnose anxiety disorders. But your provider may run some of these tests to rule out physical conditions that may be causing symptoms.

If your provider finds no signs of physical illness, they may refer you to a psychiatrist or psychologist. These mental health professionals specialise in diagnosing and treating mental illnesses. They may use specially designed interview and assessment tools to figure out if you have an anxiety disorder. Typically, the provider bases a diagnosis on:

  • Your reported symptoms, including how intense they are and how long they last.
  • Discussion of how the symptoms interfere with your daily life.
  • The provider’s observation of your attitude and behaviour. 

Providers also consult the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The American Psychiatric Association publishes the DSM-5. It’s the standard reference manual for diagnosing mental illnesses.

If an anxiety disorder is diagnosed, a mental health professional can work with you on finding the best treatment. Unfortunately, many people with anxiety disorders don't seek help. They don't realise that they have an illness for which there are effective treatments. 


Although each anxiety disorder has unique characteristics, most respond well to two types of treatment: psychotherapy or "talk therapy," and medications. Your healthcare provider will tailor a treatment plan that works for you. 

It may involve a more psychotherapeutic approach, which helps you deal with your emotional response to the illness. A mental health provider talks through strategies to help you better understand and manage the disorder. 

Negative thoughts and avoidance often occur together. That’s why cognitive behavioural therapy (CBT) and exposure therapy are two of the first line treatments for anxiety.

  • Cognitive behavioural therapy (CBT) is the most common type of psychotherapy used with anxiety disorders. CBT for anxiety teaches you to recognize thought patterns and behaviours that lead to troublesome feelings. You then work on changing them.
  • Exposure therapy focuses on dealing with the fears behind the anxiety disorder. It helps you engage with activities or situations you may have been avoiding. Your provider may also use relaxation exercises and imagery with exposure therapy.

Remember, these treatments can be given alone or in combination. Though, medications will not cure anxiety disorders, but can provide significant relief from symptoms. Medications for anxiety disorders often include:

  • Anti-anxiety medications, such as benzodiazepines, may decrease your anxiety, panic and worry. They work quickly, but you can build up a tolerance for them. That makes them less effective over time. Your healthcare provider may prescribe an anti-anxiety medication for the short-term, then taper you off or the provider may add an antidepressant to the mix.
  • Antidepressants can also help with anxiety disorders. They tweak how your brain uses certain chemicals to improve mood and reduce stress. Antidepressants may take some time to work, so be patient. If you feel like you’re ready to stop taking antidepressants, talk to your provider first.
  • Beta-blockers, usually used for high blood pressure, can help reduce some of the physical symptoms of anxiety disorders. They can relieve rapid heartbeat, shaking and trembling.

Your healthcare provider will work with you to find the right medication combination and dosage. Don’t change the dose without consulting your provider. They’ll monitor you to make sure the medicines are working without causing negative side effects.

Some other commonly used medications include:

  • Selective serotonin uptake inhibitors (SSRIs). Escitalopram, fluoxetine, and paroxetine are common SSRIs.
  • Selective norepinephrine reuptake inhibitors (SNRIs). Duloxetine and venlafaxine are common SNRIs.
  • Antipsychotics. Quetiapine and aripiprazole are common antipsychotics.
  • Benzodiazepines. Diazepam and clonazepam are common benzodiazepines.
  • Anxiolytics. Buspirone is a common anxiolytic.

An anxiety disorder is like any other health problem that requires treatment. You can’t will it away. It’s not a matter of self-discipline or attitude. Researchers have made a lot of progress in the last few decades in treating mental health conditions. 

Coping with Anxiety:

You can’t prevent anxiety disorders. But you can take steps to control or reduce your symptoms:

  • Check out medications: Talk to a healthcare provider or pharmacist before taking over-the-counter medications or herbal remedies. Some of these contain chemicals that may make anxiety symptoms worse.
  • Limit caffeine: Stop or limit how much caffeine you consume, including coffee, tea, cola and chocolate.
  • Live a healthy lifestyle: Exercise regularly and eat a healthy, balanced diet.
  • Seek help: Get counselling and support if you experienced a traumatic or disturbing event. Doing so can help prevent anxiety and other unpleasant feelings from disrupting your life.

How can I best cope with an anxiety disorder?

There are several steps you can take to cope with anxiety disorder symptoms. These strategies can also make your treatment more effective:

  • Explore stress management: Learn ways to manage stress, such as through meditation.
  • Join support groups: These groups are available in-person and online. They encourage people with anxiety disorders to share their experiences and coping strategies. 
  • Get educated: Learn about the specific type of anxiety disorder you have so you feel more in control. Help friends and loved ones understand the disorder as well so they can support you.
  • Limit or avoid caffeine: Many people with anxiety disorder find that caffeine can worsen their symptoms.
  • Talk to your healthcare provider: Your provider is your partner in your care. If you feel like treatment isn’t working or have questions about your medication, contact your provider. Together, you can figure out how to best move forward.

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