Written by Dr. Inez Van Roy on
August 5, 2021
Reading Time: 12 minutes

Medically Reviewed by our Medical Affairs Team

Written by Dr. Inez Van Roy on:

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Feeling anxious is a normal part of life. Still, there is a big difference between slight nervousness before a big test and “will not enter a shop for dear life”. Other things you might be struggling with are physical symptoms.

Some very uncomfortable symptoms might be nausea, diarrhoea but also heart palpitations could be included. If your life is impacted by anxiety disorder, then this is the article for you.

If you get anxious once in a while, that means your primitive brain is great at protecting your life. As the above example makes clear, however, our brain is not so great at distinguishing between life or death situations. So, when does a normal anxious reaction transform into an anxiety disorder?

What are the anxiety symptoms?

Anxiety is a way to defend our body. Our primitive brain made sure we could run when we saw a lion, even though you might have twisted your ankle. 

You are on high alert. This reaction is called the fight-or-flight response, later more about this subject. Your reaction, as a result, is anxiety. When asking about anxiety symptoms, people usually refer to general anxiety disorder. Some symptoms are: 

  • Excessive worrying or rumination
  • No more control over the worrying
  • Feeling agitated, keyed up or on edge
  • Restlessness
  • Often tired or easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance: trouble falling, staying asleep, restless, bad quality of sleep

You might recognize your symptoms in this list. If you are unlucky, you might be able to add other examples like panic attacks or avoidance of certain people, places or situations. In short, we can say that anxiety becomes a mental illness when 

  • You have been suffering for a long time (>6 months)
  • It has an impact on your everyday life 
  • And the perceived anxiety does not match reality anymore, aka it is an irrational fear.

What does anxiety or anxiety disorder feel like physically?

As mentioned above, anxiety is a physical reaction. A perceived threat can trigger anxiety.  Our logical part, the prefrontal cortex, gets overwhelmed by our emotional part, the amygdala.

Our other parts follow this lead and get ready for the threat. What follows is a chain reaction in our body, that makes sure we survive the attack. 

Adrenaline or epinephrine gets released. With that the following physical symptoms present themselves:

  • An elevated heart rate
  • Increase in blood pressure
  • Faster breathing 

At this point, your body says “there is no time for thinking”. Sleeping would also be a bad idea, as you don’t want to be a pray to the threat. Your muscles get activated or are twitching and your energy is conserved. One way to conserve your energy is to slow down or stop digestion. 

These symptoms are usually interpreted rather negatively and can build up over time. Many people search for help when they start to notice these symptoms transform from normal fear to an anxiety disorder.

What are the types of anxiety disorders?

To have an anxiety disorder one should have a reaction of fear or anxiety that is not proportionate with the dangers imposed by the trigger (f.e. a social situation, a dog, a needle). 

In general, a mental health specialist should be able to discriminate between these anxiety diagnoses. It should not be better explained by another mental illness, a medical condition or substance (ab)use.

The DSM-5 (diagnostic and statistical manual) defines a time criteria of at least 6 months. They include that the condition should have an impact on your daily life (occupational, relationship, school).

And lastly, most of these should be accompanied by either a reaction of avoidance to the situation or intense fear while undergoing it.

GAD or Generalized Anxiety Disorder (1)

Generalized anxiety disorder is usually described when people talk about anxiety. 

They mention the above-mentioned symptoms of excessive anxiety and worry. Adults with this disorder show at least 3 of these six symptoms. 

Further the DSM-5, written by the American Psychiatric Association, adds the following criterias. These are prerequisites to have generalized anxiety disorder:

  • The worry and anxiety occurs more days than not for at least 6 months.
  • You can’t control it.

PD or Panic Disorder (2)

Panic disorders are categorized under anxiety disorders. A panic disorder can be diagnosed as a mental illness under the DSM-5 when you show four or more of the following symptoms:

  • Sudden onset of recurring panic attacks. 
  • Where one of these attacks was at least followed by 1 month of persistent worrying 
    • about an additional panic attack or their consequences like losing control, having a heart attack, going crazy, throwing up)
    • A significant maladaptive behavioral change (to avoid the panic attack).

What is a panic attack?

A panic attack is an intense fear or discomfort. It usually reaches a peak after some minutes and is characterized by at least four of these 13 symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control or “going crazy”
  • Fear of dying
  • Paresthesias (numbness or tingling sensation)
  • Chills or heat sensations.

You can probably notice the similarities with natural fight-or-flight reactions.

Specific Phobias (or simple phobias) (3)

Specific phobias are anxiety disorders tied to the outside. A specific phobia or simple phobia can characterized by:

  • A marked fear or anxiety about a specific object or situation
  • This object or situation almost always triggers immediate fear or anxiety.
  • The reaction is out of proportion to the actual danger to the sociocultural context.
  • These situations or objects are actively avoided or endured by with intense anxiety or fear

There are 5 types of specific phobia:

  1. Animals
  2. Natural environment (f.e. thunder, water, heights)
  3. Blood-Injection-Injury (f.e. needles)
  4. Situational types (f.e. elevators, small places, planes)
  5. Other types (f.e. contracting an illness, fear of choking/vomiting, loud sounds or costumed characters for kids).

Social Phobia or Social Anxiety Disorder (4)

This form of anxiety disorder is characterized by the interpretation of social situations. It is mostly defined by

  • A marked fear or anxiety about one or more social situations where the individual is exposed to possible scrutiny. 
  • The fear mostly relates to acting in a way or showing anxiety symptoms that might negatively evaluate them to others.
  • This social phobia can also be specified if needed as “Performance only”. In this case, the anxiety and the fear only presents itself when speaking or performing in public.

Agoraphobia (5)

Agoraphobia is an anxiety disorder that used to be tied to panic disorder. Today, that is not necessary anymore. People with agoraphobia have a strong fear of at least of the following situations:

  • Using public transportation
  • Being in open spaces
  • Being in enclosed spaces (e.g., shops, theaters, cinemas)
  • Standing in line or being in a crowd
  • Being outside the home alone

Separation Anxiety Disorder (6)

While this mental illness before was classified as a disorder in infancy or early childhood. Today, it is classified as an anxiety disorder. It is characterized by 

  • A developmentally inappropriate and excessive fear or anxiety concerning separation from their attachment figure

They should at least follow three of the following symptoms. The distress/fear/worrying or reluctance should be recurrent, excessive and persistent.

  1. Distress when anticipating or experiencing separation from home or from major attachment figures.
  2. Worrying about losing or possible harm to major attachment figures (f.e. illness, injury, disasters, or death).
  3. Worrying about experiencing an untoward event. This could be getting lost, being kidnapped, having an accident, becoming ill. This event would cause separation from a major attachment figure.
  4. Reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
  5. Fear of or reluctance about being alone or without major attachment figures at home or in other settings.
  6. Reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
  7. Repeated nightmares involving the theme of separation

This pattern can already be diagnosed after 4 weeks of consistent symptoms in children. Adults still need to show symptoms for 6 months.

Selective Mutism (7)

Selective mutism is a new category under anxiety disorders. It is an anxiety disorder diagnosed with children who are not able to speak in some circumstances, although they seem to speak with ease at home. 

Selective mutism can interfere with their life (occupation, education and social life). The symptoms show themselves for at least a month, in which this is not limited to the first month at school.

The cause of this mutism is not because of a lack of knowledge. Neither is it because the child is not comfortable with the language. Lastly, the symptoms can’t be better explained by

  • a communication disorder
  • or another mental health disorder (like autism spectrum disorder for example).

What are the four levels of anxiety?

Speaking about the levels of anxiety is not an official diagnosis. It is another way to communicate about anxiety in levels of severity. Research shows that it is more cost-effective and easier to understand.

This way of communicating about anxiety is founded by the expert in psychiatric nursing Hilde E. Peplau.

It defines:

  1. Mild anxiety: common anxiety in daily life, dissipates quickly. This anxiety motivates you to look for solutions
  2. Moderate anxiety: anxiety that is focused on the stressor. It will only dissipate once the stressor is no longer there. You might feel small physical symptoms of anxiety, like sweating, fidgeting.
  3. Severe anxiety: this anxiety is also only focused on the stressor, it is more difficult to snap out of it. You can no longer problem solve or focus on your needs. Symptoms are more intense like vomiting, a fast heartbeat, headaches, a sense of dread.
  4. Panic-level anxiety: usually set on by extreme life stressors. You will no longer be able to function and might have a flight or freeze reaction. There is no more room for rational thinking and your perception might be distorted.

When to Seek a Doctor

When does anxiety need treatment or when should you seek a doctor? It would be a great idea to ask for help when:

  • Your worrying is interfering with your occupational and social life.
  • You feel upset by this anxiety and can’t control it anymore.
  • Your anxiety is making you feel depressed or is leading to other mental health issues.
  • Your coping is alcohol and drug use, and the behavior is starting to be troubling.
  • Your anxiety or worries are concerning physical problems.
  • You are having suicidal thoughts or behaviors. You can contact emergency services at 1-800-273-8255 or at 911.

Normal fear or anxiety can snowball into a bigger problem over time. The earlier you get help, the better.

How do doctors test for anxiety?

Only a doctors or a registered mental health specialist can diagnose your anxiety disorder. 

First a doctor should exclude other causes. They can provide medical advice and should perform:

  • A physical exam (to exclude underlying physical conditions and to exclude medication as a cause) 
  • Blood and urine tests, if needed
  • Evaluate your medical history

Your mental health specialist or doctor should also:

  • Ask detailed questions about your anxiety symptoms
  • Use psychological questionnaires to map your anxiety symptoms
  • Use the most recent version of the DSM as a guideline and diagnostic tool.

What are natural ways to reduce anxiety? How can I prevent anxiety disorder?

How do you calm down anxiety? Anxiety disorder can be an attack on your social life, however it does not need to be. The following tips can help prevent your anxiety.

Sometimes anxiety or uncontrollable fear grows into an anxiety disorder. These positive lifestyle changes can steer you in the right direction.

Learn about your anxiety disorder

Psycho-education can be the first step to recovery. Mental health professionals can support you on this path and teach you more coping skills. It can validate your feelings and what is happening in your life and you can learn other ways of coping.

Stick to the treatment plan

Sticking to the treatment plan is crucial. It takes at least a month before medication works properly. Don’t just quit or take it inconsistently. These medications can change the chemical balance of your brain. This means that unsupervised adaptations are not recommended. 

Furthermore, when a treatment plan asks you to work with exposure, try to follow along at your own pace. Practice makes perfect and avoidance can make for a stronger anxiety disorder.

Eating a healthy diet

Eating a healthy and balanced diet full of fruits, vegetables, fiber-rich grains and fish can help your overall health. This diet can also suppor your mental health. Further, it is advised to consume enough omega-3 fatty acids. This is also a great booster for brain health.

Limit your coffee consumption

Too much caffeine is a known culprit for worsening your anxiety disorder and stress levels.  By activating your fight-or-flight system with caffeine, you might interpret this as another stressor.

It might even trigger an anxiety attack. Bad caffeine habits can also disrupt your sleep, which might already be the case if you have anxiety disorder.

Let go of the bottle

Anxiety disorder and alcohol are not a great mix. If drinking wine, beer or strong liquors is the way you cope with anxiety disorder, then we have bad news for you. While alcohol can calm you down, it also picks you back up. 

Many people notice this effect, and use alcohol in social occasions to feel a bit less stressed and more outgoing. While that can be fun, it is rather dangerous for people with anxiety disorder.

Mostly people with social anxiety disorder seem to be victim of this tactic. Research shows that about 20% of people with social anxiety disorder suffer from alcohol dependency.

Ban recreational drugs

Recreational drugs like cannabis, cocaine, or amphetamine are sometimes used to have some fun or so you do not have to feel a certain way. Not only can that lead to substance abuse or addiction, it sometimes can be destructive to your chemical brain balance. 

Today, some people with anxiety disorder use marijuana more and more as coping.  Marijuana is a complex substance with two main active ingredients, THC and CBD.

THC is the ingredient that makes you high. While CBD is the nonpsychoactive ingredient that is used for therapeutic purposes sometimes. Some people find it calling. 

Many people still smoke or consume a mix of both. This light be because both low levels of THC and all levels of CBD can have a positive effect. However high levels of THC will have bad effects on your anxiety disorder. While legal in some states, you should still be careful when considering this solution.

It is important to know that marijuana is still a crutch, and does not provide a long term solution for this problem. Also, certain negative side effects like an elevated heartbeat, anxious thoughts and so on can look like a panic attack. 

A study even found significant correlations between marijuana use and panic attacks. If you keep smoking pot for your whole life there consequences could be worse. There is a positive correlation between your usage and suffering your whole life from panic disorders and panic attacks.

Exercise often

Physical exercise provides your body with endorphins (so called feel-good hormones). It is a very natural solution to improve your anxiety disorder and depression symptoms. 

Also, it is somehow true what they say. Look good, feel good. Exercise is great for your overall health. You can keep a healthy body weight, and prevent some scary diseases like cancer, cardiovascular diseases and diabetes. Also your brain functions might profit from a regular exercise routine.

Develop a healthy sleep hygiene

Get more sleep, our mother tried to install a nice sleep routine since a young age, however we surely did not listen. Although your mother might not be a sleep expert, the national sleep foundation is. They (and many others) recommend an adult to get 7 to 9 hours sleep per night. 

A lack of sleep and insomnia is related to multiple symptoms of anxiety. We do understand that your ruminating (or racing) thoughts (or anticipatory anxiety) might prevent you from sleeping. Yet, we still recommend to follow sleep hygiene rules to not make the symptoms of anxiety worse. 

These sleep hygiene rules or building such a routine can give your brain the signal to rest.

  • Keep a sleep routine, wake up and go to sleep at the same time every night and day
  • Avoid blue light in the evening (smartphones, tablets, television)
  • Avoid naps during the day
  • Avoid caffeine in the evening
  • Avoid substance use 
  • Have a quiet, dark bedroom
  • Don’t stay awake in bed for more than 5 to 10 minutes, get up if needed

Use relaxation techniques

  • Meditation
  • Practice some yoga
  • Deep breathing 
  • Selfcare actions
  • Use the 333 rule for anxiety disorders

Build a support network: friends

Researchers say that a strong support network can be beneficial. Your family and friends can support you when things are rough. If you are lacking this resource, you can try support groups. In a support group people with the same conditions come together and discuss how they handle their symptoms of anxiety.

What causes anxiety disorders?

We are not sure yet what causes these anxiety disorders. We understand that sometimes it might be triggered by a traumatic event, some people have a personality that is more sensitive to it. Others might have a medical cause. 

In the following lines we will discuss some of the options.

Medical Causes

  • Heart disease
  • Diabetes
  • Thyroid problems, f.e. hyperthyroidism
  • Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma
  • Illicit drug misuse or withdrawal
  • Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications
  • Chronic pain or irritable bowel syndrome
  • Rare cancers
  • Stress caused by any of these illnesses

Risk Factors

  • Trauma or negative life events
    • Children who go through (sexual) abuse or trauma (or have witnessed this) are more sensitive to developing anxiety disorders. Adults who go through trauma or deep negative life events also have a higher chance of developing anxiety disorders.
  • Sustained stress
    • Both the American Psychological Association and the National Institute of Mental Health seem to have in common that a sustained threat is bad news for generalized anxiety disorder. 
  • Personality
    • People who have a personality with high neuroticism and low extra version seem to be more sensitive for anxiety disorders. Also, showing personality traits associated with cluster C could make you more susceptible. Examples of traits are: avoidany, low self-esteem, tendencies of perfection or obsessive-compulsive behavior, being shy).
  • Other mental disorder
    • For example, people who are depressed can also show anxiety symptoms.  
  • Family history
    • Mental health illnesses can run in the family, anxiety disorders are no exception. 

Treatment and Therapy

Treatment might include therapy (such as cognitive behavioral therapy) or medications that help with mental symptoms. Stress management techniques can be an essential tool as well. 

If these treatments do not work well enough to control your mental symptoms, other treatments can be tried. People usually search for treatment when they suffer from generalized anxiety disorder, social anxiety disorder or panic disorders combined with agoraphobia.

The recommendation is to treat anxiety disorders (generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorders) in a traditional way. That means a combination of therapy and medication.


  • Cognitive behavioral therapy or CBT
  • Talk therapy if CBT is not available


  • First-line medications are the modern antidepressants:
    • SSRI’s or serotonin reuptake inhibitors
    • SNRI’s or serotonin and norepinephrine reuptake inhibitors
    • MAOI’s or  Monoamine oxidase inhibitors 
  • Other options are
    • Pregabalin 
    • Tricyclic antidepressants 
    • Buspirone, 
    • Moclobemide
    • And others
  • Only if absolutely necessary
    • Benzodiazepines

Mindfulness-based Stress Management Techniques

Researchers show an overall reduction in anxiety, depression and worry symptoms. These researchers believe that mindfulness meditation can help. It develops a nonjudgmental stance of observation towards their negative thoughts and feelings. Some studies even show a better result as compared to the usual therapy.

What are related conditions?

Some anxiety disorders, f.e. social anxiety disorder, can be accompanied with other disorders like:

  • Depression
  • Substance use
  • Attention Deficit Hyperactivity Disorder, or ADHD
  • Eating disorders 
  • Body dysmorphic disorder or BDD
  • Trouble sleeping
  • Obsessive compulsive disorder or OCD
  • Skin-picking
  • Trichotillomania
  • Health anxiety
  • Post-traumatic stress disorder or PTSD


There are multiple types of anxiety disorders some examples are generalized anxiety disorder, social anxiety disorder,separation anxiety disorder and panic disorder. People with anxiety disorders feel chronic anxiety or dread, other anxiety disorder symptoms could be physical symptoms.

Some substances or behaviors might make your anxiety symptoms worse. Further there are some lifestyle changes that you can implement for a better overall health and wellbeing.

We are still not sure what causes these anxiety disorder. It might be a combination of multiple factors. Anxiety disorder can be accompanied with other mental health difficulties like depression, ADHD, substance abuse and more. 

Treating anxiety is possible. A doctor can give you advice on the best combination between medication and therapy that works for you.

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