Anxiety is a typical stress response and can be beneficial. For instance, it may make us aware of danger and helps us stay alert to protect ourselves. Anxiety can motivate us to prepare for important events, like a big test or job interview.
Anxiety disorders, however, are different from normal feelings of anxiety. These disorders can be debilitating and often involve feelings of intense and excessive worry and fear. These episodes of fear and sometimes panic are often out of proportion to the potential danger of the situation and can be persistent.
According to a review in The Lancet, anxiety disorders comprise the most common group of mental disorders. In one study, researchers affirmed that anxiety disorders occur worldwide, finding evidence that one in every 14 people meets the criteria for an anxiety disorder, and over 40 million U.S. adults are affected.
The incidence of anxiety disorders is also increasing. From 1990 to 2019, the abovementioned study found that the number of anxiety disorders worldwide increased by 50 percent.
To be diagnosed as having an anxiety disorder, the anxiety suffered must:
There are several types of anxiety disorders.
If you have agoraphobia, you may fear being in situations where you can’t get help or where escape might be embarrassing or difficult. The anxiety generally lasts over six months and disrupts your ability to function in your daily routine. You may meet the diagnostic criteria if you find you experience fear in two or more of the following situations:
Left untreated, this disorder can be debilitating and cause some individuals to be unable to leave their homes due to intense fear and anxiety.
Generalized anxiety disorder is characterized by excessive and ongoing worry about activities or events, such as work, relationships, and health. Symptoms can include restlessness, difficulty concentrating, nervousness, or trouble sleeping.
If you have panic disorder, you experience recurrent panic attacks. The following symptoms are characteristic of a panic attack:
Some individuals have a panic attack due to specific triggers. Others may experience panic attacks seemingly out of the blue. Panic attacks can be very intense and scary to the individual.
If you have separation anxiety disorder, you will be excessively anxious or fearful about separation from one or more people to whom you are attached. The physical manifestations of distress typically develop in childhood, but the symptoms can persist into adulthood. If the feeling is beyond normal, persists for more than four weeks in children (six months in adults), and causes problems with daily functioning, then you may meet the criteria for diagnosis. You may exhibit some of these symptoms:
According to the American Psychiatric Association (APA), the second most common is social anxiety disorder, making up 7 percent of disorders. If you have social anxiety, you may feel significant anxiety about social situations. You may fear being humiliated, embarrassed, criticized, or rejected when interacting socially. This anxiety may manifest as an intense fear of speaking publicly, meeting new individuals, or even eating in public. If this fear affects your ability to function in your day-to-day activities and lasts at least six months, you might meet the criteria for social anxiety disorder.
The most prevalent form of anxiety disorder, specific phobias account for 8 to over 12 percent of anxiety disorders. You may have a specific phobia if you exhibit excessive and ongoing fear about a particular object, activity, or situation that is generally not harmful. Exposure to the object, activity, or situation causes intense anxiety, even though you may realize your fear is excessive. Following are some examples of specific phobias:
Anxiety disorders manifest in different ways depending on the individual. Symptoms that may indicate an anxiety disorder include:
What causes an anxiety disorder in one person may be very different from the cause of an anxiety disorder in another. For any individual, several factors are likely at play, including genetic, developmental, and environmental factors.
Anxiety can be caused by the following:
The sympathetic nervous system is one of the two main divisions of the autonomic nervous system (ANS). The ANS controls involuntary body functions. The sympathetic nervous system activates the body’s resources to prepare for a challenging or stressful situation. This is commonly referred to as the “fight or flight” response.
The amygdala, a small almond-shaped structure deep in the brain’s temporal lobe, plays a critical role in the processing of emotions, particularly anxiety and fear. Overactivation of the amygdala is known to cause anxiety. Chronic stress causes amygdala inflammation, and evidence suggests neuroinflammation and stress-mediated immune response play a role in anxiety disorders upon exposure to stress.
An imbalanced intestinal microbiome may also contribute to anxiety disorders.
In one study, researchers did a cross-sectional study of 36 healthy controls and 40 patients with generalized anxiety disorder (GAD). They discovered patients with GAD exhibited lower microbial richness and diversity in their intestinal microbiome.
The study further revealed these GAD patients had a significant decrease in the anti-inflammatory bacteria Faecalibacterium and an overgrowth of certain bacteria such as Escherichia-Shigella and the proinflammatory Fusobacterium.
This study was not the only one to find that GAD patients had lower microbial richness—other research, such as that published in the International Journal of Molecular Sciences, found this to be true, as well.
The APA notes that anxiety disorders affect almost 30 percent of adults at some point. It further points out that women are more likely to suffer from anxiety disorders than men. In fact, anxiety disorders are about twice as common in females than in males.
Since anxiety disorders can run in families, some individuals may have a strong genetic predisposition to an anxiety disorder.
Other environmental and developmental factors may play a role in contributing to the onset of an anxiety disorder; however, this is difficult to untangle since the cause of anxiety disorders appears to be multifactorial.
Anxiety disorders are usually diagnosed through a comprehensive set of tests given by a mental health professional, such as a licensed therapist, psychiatrist, or psychologist. They may ask you to complete questionnaires or self-assessments to measure anxiety symptoms and their impact on your daily life.
The mental health professional will use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a widely used manual that provides guidance for diagnosing mental health disorders. The DSM-5 provides specific criteria for each anxiety disorder, and the mental health professional will compare your symptoms to these criteria.
To rule out any underlying medical conditions, the mental health professional may request your primary care physician assess you and may request specific lab tests.
Despite their being a mental condition, untreated anxiety disorders can lead to physical complications and a worse psychological state. Some of the complications stemming from prolonged anxiety include:
Treatment of an anxiety disorder should be conducted on a case-by-case basis. Not everyone with an anxiety disorder needs treatment; some individuals can manage their disorder without too much stress and disruption to their daily lives.
Treatment is crucial when the patient is suffering significant distress or experiencing adverse complications from their disorder, such as depression, substance abuse, or suicidal ideation.
Many individuals with an anxiety disorder benefit from cognitive behavioral therapy (CBT), medication, or a combination of CBT and medication.
CBT is a widely used and evidence-based form of psychotherapy. It is an effective treatment method for several mental health conditions, including anxiety disorders. CBT focuses on the connection between our emotions, thoughts, and behaviors and seeks to identify and change unhealthy patterns of thinking and behavior contributing to anxiety.
Medication recommendations for anxiety disorders in adults include several classes of pharmaceuticals:
Mindset can play a significant role in how you experience and manage anxiety. Maintaining a positive or growth mindset can change how you perceive and understand situations. Often anxiety is fueled by distortions of cognition such as catastrophizing, where you anticipate the worst-case scenario, or participating in black-and-white thinking, where you see situations as all good or all bad.
Training yourself to develop a more balanced mindset rooted in realistic thinking will help you manage your anxious thoughts. Adopting a compassionate view of yourself and speaking kindly to yourself can go a long way in helping you manage symptoms of anxiety.
Ongoing stress can contribute to inflammation. Finding stress-reducing activities to lower your stress levels and help lower inflammation is important.
A few natural solutions can help mitigate some anxiety disorder symptoms, including diet, exercise, and supplements.
Since inflammation appears to play a role in anxiety, following an anti-inflammatory diet may be beneficial in helping lessen the presence and severity of anxiety symptoms.
Individual needs may vary, but here are some guidelines for an anti-inflammatory diet:
A large review study in the academic journal Nutrients further substantiates the importance of a healthy diet for reducing anxiety. Authors noted that foods rich in zinc and selenium should be considered for anti-anxiety effects. Zinc can be found in leafy and root vegetables, meat, oysters, and crustaceans. Selenium can be found in Brazil nuts, beans, lentils, seafood, and meat.
The authors stated that zinc and selenium are required coenzymes in neurotransmitter and neurotrophic factor synthesis and regulation, thus helping explain why these micronutrients are so essential to mental well-being.
Since researchers have found imbalanced microbiomes in patients with GAD, microbiome modulation may be a helpful tool in treating individuals with anxiety disorders. Microbiome modulation refers to purposefully altering the microbial communities in our intestines.
The review published in the International Journal of Molecular Sciences offers several approaches to microbiome modulation:
Physical activity can also decrease symptoms of anxiety. Authors Elizabeth Anderson and Geetha Shivakumar state in their research article, “There is strong evidence from animal studies that exercise and regular activity positively impacts the pathophysiological processes of anxiety.” They go on to say that no single exercise mechanism adequately explains all the anti-anxiety effects of exercise. Regardless, numerous studies suggest that exercise is associated with decreased anxiety.
Some herbs and supplements can have a powerful effect on anxiety.
One systematic review and meta-analysis looked at randomized controlled trials that assessed the effectiveness of lavender on anxiety and depression. Researchers found lavender had a substantial effect in decreasing anxiety and depression. Treatment with lavender, particularly aromatherapy, was better than no treatment and placebo treatment in decreasing anxiety and depression and even helped lower patients’ systolic blood pressure. Using lavender oil for massage can also have a positive effect.
One clinical study investigated the anxiety-lowering effects of ashwagandha (Withania somnifera (L.) Dunal) in adults with high stress. Sixty adults were randomly assigned to one of two groups: one group was given a placebo, and the other group was given 240 milligrams of ashwagandha extract once daily.
As a group, the patients who took ashwagandha extract had a statistically significant decrease in Hamilton Anxiety Rating Scale (HAM-A) scores and more significant reductions in morning cortisol levels. The authors concluded that this might have been due to the effects of ashwagandha on the hypothalamus-pituitary-adrenal (HPA) axis, which regulates the body’s stress response.
One double-blind study looked at how effective passionflower (Passiflora incarnata) is at lowering anxiety compared to the pharmaceutical oxazepam, a benzodiazepine.
Thirty-six patients who met the DSM-4 diagnostic criteria for GAD were assigned randomly to one of two treatment groups: 18 individuals were given oxazepam 30 milligrams per day plus placebo drops, and the other 18 individuals were given Passiflora extract: 45 drops daily, plus a placebo tablet. The trial lasted four weeks, and researchers concluded that both Passiflora extract and oxazepam effectively treated GAD in these patients, with no significant difference between the two treatment groups at the end of the study. Further studies should be done, but these results are promising.
In one study, rats were exposed to a chronic mild stress (CMS) protocol for six weeks. Treating the rats with Rhodiola rosea L. extract (RHO) completely reversed the negative changes that occurred due to the CMS protocol. In fact, the effects were similar to those of fluoxetine, an SSRI more commonly known as Prozac.
The authors stated: “These findings strongly showed that chronic administration of RHO results in potent inhibition of the behavioral and physiological changes induced by chronic exposure to mild stressors.”
In one six-month clinical trial, participants with low serum 25-hydroxy vitamin D—the primary circulating form of vitamin D in the bloodstream—were randomly selected to be in a control group or a group that received daily vitamin D supplementation. Researchers found a significant improvement in anxiety symptoms in patients within the vitamin D supplementation group compared to the control group.
In their review article, authors Şerife Akpınar and Makbule Gezmen Karadağ concluded that vitamin D has neuroprotective, neurotrophic, and immunomodulatory properties, and low vitamin D levels contribute to an increase in symptoms of anxiety.
While you cannot prevent an anxiety disorder, there are steps you can take to decrease the presence and severity of symptoms. These steps include reducing inflammation by decreasing stress, choosing healthy foods with anti-inflammatory effects, and ensuring you get enough micronutrients—particularly zinc and selenium. Further, add foods or supplements to your diet that contribute healthy microorganisms to your intestine. Finally, take advantage of the powerful tool of exercise to reduce your symptoms of anxiety.
Medically reviewed by Beverly Timerding, MD.