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Anxiety

Topic Overview

Anxiety

Feeling worried or nervous is a normal part of everyday life. Everyone frets or feels anxious from time to time. Mild to moderate anxiety can help you focus your attention, energy, and motivation. If anxiety is severe, you may have feelings of helplessness, confusion, and extreme worry that are out of proportion with the actual seriousness or likelihood of the feared event. Overwhelming anxiety that interferes with daily life is not normal. This type of anxiety may be a symptom of another problem, such as depression.

Anxiety can cause physical and emotional symptoms. A specific situation or fear can cause some or all of these symptoms for a short time. When the situation passes, the symptoms usually go away.

Physical symptoms of anxiety include:

  • Trembling, twitching, or shaking.
  • Feeling of fullness in the throat or chest.
  • Breathlessness or rapid heartbeat.
  • Lightheadedness or dizziness.
  • Sweating or cold, clammy hands.
  • Feeling jumpy.
  • Muscle tension, aches, or soreness (myalgias).
  • Extreme tiredness.
  • Sleep problems, such as the inability to fall asleep or stay asleep, early waking, or restlessness (not feeling rested when you wake up).

Anxiety affects the part of the brain that helps control how you communicate. This makes it harder to express yourself creatively or function effectively in relationships. Emotional symptoms of anxiety include:

  • Restlessness, irritability, or feeling on edge or keyed up.
  • Worrying too much.
  • Fearing that something bad is going to happen; feeling doomed.
  • Inability to concentrate; feeling like your mind goes blank.

Anxiety disorders

Anxiety disorders occur when people have both physical and emotional symptoms. Anxiety disorders interfere with how a person gets along with others and affect daily activities. Women are twice as likely as men to have problems with anxiety disorders. Examples of anxiety disorders include panic attacks, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).

Often the cause of anxiety disorders is not known. Many people with an anxiety disorder say they have felt nervous and anxious all their lives. This problem can occur at any age. Children who have at least one parent with the diagnosis of depression are more than twice as likely to have an anxiety disorder than other children.

Anxiety disorders often occur with other problems, such as:

  • Mental health problems, such as depression.
  • Substance use problems.
  • A physical problem, such as heart or lung disease. A complete medical examination may be needed before an anxiety disorder can be diagnosed.

Panic attacks

A panic attack is a sudden feeling of extreme anxiety or intense fear without a clear cause or when there is no danger. Panic attacks are common. They sometimes occur in otherwise healthy people. An attack starts suddenly and usually lasts from 5 to 20 minutes but may last even longer, up to a few hours. You have the most anxiety about 10 minutes after the attack starts.

Symptoms include feelings of dying or losing control of yourself, rapid breathing (hyperventilation), numbness or tingling of the hands or lips, and a racing heart. You may feel dizzy, sweaty, or shaky. Other symptoms include trouble breathing, chest pain or tightness, and an irregular heartbeat. These symptoms come on suddenly and without warning.

Sometimes symptoms of a panic attack are so intense that the person fears he or she is having a heart attack. Many of the symptoms of a panic attack can occur with other illnesses, such as hyperthyroidism, coronary artery disease, or chronic obstructive pulmonary disease (COPD). A complete medical examination may be needed before an anxiety disorder can be diagnosed.

People who have repeated unexpected panic attacks and worry about the attacks are said to have a panic disorder.

Phobias

Phobias are extreme and irrational fears that interfere with daily life. People with phobias have fears that are out of proportion to real danger. And although these people are aware that their fears are not rational, they are not able to control them.

Phobias are common and are sometimes present with other conditions, such as panic disorder or Tourette's disorder. Most people deal with phobias by avoiding the situation or object that causes them to feel panic (avoidance behavior).

A phobic disorder occurs when the avoidance behavior becomes so extreme that it interferes with your ability to participate in your daily activities. There are three main types of phobic disorders:

  • Fear of being alone or in public places where help might not be available or escape is impossible (agoraphobia)
  • Fear of situations where the individual might be exposed to criticism by others (social phobia).
  • Fear of specific things (specific phobia).

Check your symptoms to decide if and when you should see a doctor.

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  Anxiety: Stop Negative Thoughts

Check Your Symptoms

Are you having a problem with anxiety?
This also could include concerns about panic attacks, fear, or obsessive or compulsive behaviors.
Yes
Anxiety or anxiety-related concern
No
Anxiety or anxiety-related concern
How old are you?
Less than 12 years
Less than 12 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Could you be having symptoms of a heart attack?
Anxiety and stress can cause symptoms similar to those of a heart attack.
Yes
Symptoms of heart attack
No
Symptoms of heart attack
Are you thinking seriously of committing suicide or harming someone else right now?
Yes
Thinking seriously of committing suicide or harming someone else
No
Thinking seriously of committing suicide or harming someone else
Are you thinking about suicide but do not have a plan?
Yes
Considering suicide but does not have a plan
No
Considering suicide but does not have a plan
Is a concern about abuse causing feelings of anxiety or depression?
Yes
Concern about abuse causing feelings of anxiety or depression
No
Concern about abuse causing feelings of anxiety or depression
Are you concerned about self-harm?
It can include acts like cutting, burning, or choking yourself on purpose, or pushing objects under your skin (like pieces of metal, glass, or wood). People doing these acts usually are not trying to kill themselves, but the results can still be dangerous.
Yes
Concerns about self-harm
No
Concerns about self-harm
Do you think that a medicine may be causing the anxiety?
Think about whether the anxiety started soon after you began using a new medicine or a higher dose of a medicine.
Yes
Medicine may be causing anxiety
No
Medicine may be causing anxiety
Does anxiety, fear, or obsessive or compulsive behavior interfere with your daily activities at work, school, or home?
Yes
Anxiety interferes with daily activities
No
Anxiety interferes with daily activities
Are you able to do your daily activities at all?
Yes
Able to perform daily activities
No
Not able to perform daily activities
Do you have sudden, severe attacks of fear or anxiety when there is no clear reason to be afraid?
Yes
Sudden, severe attacks of fear or anxiety
No
Sudden, severe attacks of fear or anxiety
Do you often have nightmares or have flashbacks to a traumatic event?
The event could have been something that happened to you directly or something that you saw or heard about.
Yes
Frequent nightmares or flashbacks to traumatic events
No
Frequent nightmares or flashbacks to traumatic events
Have you had severe anxiety for more than a week?
Yes
Severe anxiety for more than 1 week
No
Severe anxiety for more than 1 week

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Call 911 Now

Based on your answers, you need emergency care.

Call911or other emergency services now.

After you call 911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Many prescription and nonprescription medicines can cause anxiety. A few examples are:

  • Decongestants.
  • Diet pills.
  • Steroid medicines.
  • Thyroid medicines.

Some illegal drugs, such as cocaine, crack, and speed (amphetamines), also can cause anxiety.

The risk of a suicide attempt is highest if:

  • You have the means to kill yourself, such as a weapon or medicines.
  • You have set a time and place to do it.
  • You think there is no other way to solve the problem or end the pain.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call911or other emergency services now.

A few examples of obsessive or compulsive behaviors that can interfere with your daily activities include:

  • Frequently washing your hands, showering, or brushing your teeth.
  • Constantly cleaning, straightening, and ordering certain objects.
  • Checking lights, appliances, or doors again and again to be sure they are turned off or closed.
  • Repeating certain physical activities, such as sitting down and getting up from a chair, or saying the same thing over and over.
  • Hoarding objects, such as newspapers.
  • Avoiding public places or taking extreme measures to prevent harm or embarrassment to yourself or others.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of a heart attack may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

The more of these symptoms you have, the more likely it is that you're having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, numbness, tingling, or a strange feeling in your chest or other areas.

Home Treatment

Home treatment, combined with professional treatment, can help relieve anxiety.

  • Recognize and accept your anxiety about specific fears or situations, and then make a plan for dealing with it. For example, if you are constantly worrying about finances, set up a budget or savings plan.
  • Don't dwell on past problems. Change what you can to help you feel more comfortable with present concerns, but let go of past problems or things you cannot change.
  • Be kind to your body:
    • Relieve tension with vigorous exercise or massage.
    • Practice relaxation techniques. For more information, see the topic Stress Management.
    • Get enough rest. If you have trouble sleeping, see the topic Sleep Problems, Age 12 and Older.
    • Practice Click here to view an Actionset.healthy thinking and stop negative thoughts.
    • Avoid alcohol, caffeine, chocolate, and nicotine. They may increase your anxiety level. Some illegal drugs, such as cocaine, crack, and speed (amphetamines), also can cause anxiety.
  • Engage your mind:
    • Get out and do something you enjoy, such as going to a funny movie or taking a walk or hike.
    • Plan your day. Having too much or too little to do can make you more anxious.
    • Keep a diary of your symptomsdiary of your symptoms(What is a PDF document?). Discuss your fears with a good friend. Confiding in others sometimes relieves stress.
  • Get involved in social groups, or volunteer to help others. Being alone can make things seem worse than they are.
  • Learn about resources available in your community:
    • Talk with your human resources officer about counseling benefits that may be available through your employee assistance program.
    • Check with your insurance company to see what mental health benefits are available.
    • Contact your public health department for information on community mental health programs.

Symptoms to watch for during home treatment

Call your doctor if symptoms become more frequent or severe during home treatment.

Prevention

You can help prevent anxiety attacks:

  • Avoid caffeine, such as coffee, tea, colas, energy drinks, and chocolate. Caffeine can keep you in a tense, aroused condition. For more information, see the topic Healthy Eating.
  • Do not smoke or use smokeless (spit) tobacco products. Nicotine stimulates many physical and psychological processes, causes your blood vessels to constrict, and makes your heart work harder. For more information, see the topic Quitting Smoking.
  • Exercise during the day. Even a brisk walk around the block may help you stay calm. For more information, see the topic Fitness.

Cognitive-behavioral therapy can help control symptoms of anxiety or panic.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • What is your major symptom?
  • How long have you had your symptoms? Do they come and go, or are they always present?
  • What triggers the onset of your symptoms?
  • What makes your symptoms better or worse?
  • Do you have other symptoms that may be related to your major symptom? These other symptoms may include:
    • Rapid or irregular heartbeat.
    • Nausea or vomiting.
    • Numbness or weakness.
    • Excessive sweating.
    • Feeling that you are not able to get enough air (air hunger).
    • Restlessness, irritability, or feeling on edge.
    • Feeling depressed.
  • Have you ever had a similar problem in the past? If so, how was it treated?
  • Has anyone else in your family ever been diagnosed with an anxiety disorder, depression, or another mental illness?
  • Has anyone in your family committed suicide or tried to commit suicide?
  • What home treatment measures have you tried? Did they help?
  • What prescription or nonprescription medicines are you currently using?
  • What herbal supplements are you taking?
  • Are you using alcohol or illegal drugs, such as marijuana or cocaine, to manage your symptoms?
  • Do you smoke or use other tobacco products?
  • Do you have any health risks?

While waiting for your appointment, it may be helpful to keep a diary of your symptomsdiary of your symptoms(What is a PDF document?).

Credits

By Healthwise Staff
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
David Messenger, MD
Last Revised May 9, 2013

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

© 1995-2014 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

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