Psychodynamic theory posits that anxiety is often the result of opposing unconscious wishes or fears that manifest via maladaptive defense mechanisms (such as suppression, repression, anticipation, regression, somatization, passive aggression, dissociation) that develop to adapt to problems with early objects (e.g., caregivers) and empathic failures in childhood. For example, persistent parental discouragement of anger may result in repression/suppression of angry feelings which manifests as gastrointestinal distress (somatization) when provoked by another while the anger remains unconscious and outside the individual's awareness. Such conflicts can be targets for successful treatment with psychodynamic therapy. While psychodynamic therapy tends to explore the underlying roots of anxiety, cognitive behavioral therapy has also been shown to be a successful treatment for anxiety by altering irrational thoughts and unwanted behaviors.
Experiencing a chronic medical condition or severe or frequent illness can also increase risk for anxiety disorders, as well as dealing with significant illness of a family member or loved one. Given that several medical conditions have been linked to significant anxiety, in some cases a physician may perform medical tests to rule out an underlying medical condition. For instance, thyroid disease is often characterized by experiencing significant symptoms of anxiety. Menopause, heart disease, and diabetes have also been linked to anxiety symptoms. Additionally, drug abuse or withdrawal for many substances is characterized by acute anxiety, and chronic substance abuse can increase risk for developing an anxiety disorder. Anxiety can also be a side effect of certain medications. Experiencing significant sleep disturbances, such as difficulty falling asleep or staying asleep, may also be a risk factor for developing an anxiety disorder.
Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or behaviors that seem impossible to stop or control. If you have OCD, you may be troubled by obsessions, such as a recurring worry that you forgot to turn off the oven or that you might hurt someone. You may also suffer from uncontrollable compulsions, such as washing your hands over and over.
To the extent that a person is fearful of social encounters with unfamiliar others, some people may experience anxiety particularly during interactions with outgroup members, or people who share different group memberships (i.e., by race, ethnicity, class, gender, etc.). Depending on the nature of the antecedent relations, cognitions, and situational factors, intergroup contact may be stressful and lead to feelings of anxiety. This apprehension or fear of contact with outgroup members is often called interracial or intergroup anxiety.[34]
Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering your panic attacks and helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.

Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.
Because symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness and may go to a hospital ER. Panic attacks may be expected, such as a response to a feared object, or unexpected, apparently occurring for no reason. The mean age for onset of panic disorder is 22-23. Panic attacks may occur with other mental disorders such as depression or PTSD.
A number of medical conditions can cause anxiety symptoms. These include an overactive thyroid, hypoglycemia, mitral valve prolapse, anemia, asthma, COPD, inflammatory bowel disease, Parkinson's disease, and dementia among others. Your physician may perform certain tests to rule out these conditions. But it is important to remember that anxiety is more often due to poor coping skills or substance abuse than any medical condition.
Medication can be used to control or lessen symptoms related to panic disorder. It is most effective when combined with other treatments, such as the aforementioned cognitive behavioral therapy and exposure therapy. Medications used to treat panic attacks and panic disorder include antidepressants, though they take several weeks to reach effectiveness. Benzodiazepines such as Ativan and Xanax work quickly. However they are addictive and should only be used for a short time,
Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future. Decisions about whether to apply for a clinical trial and which ones are best suited for a given individual are best made in collaboration with a licensed health professional.
The electrocardiograph in a person with panic attacks often shows tachycardia, but does not usually show any of the changes typically seen in people with heart attacks or angina. However, if significant risk factors for cardiovascular disease are present, a noninvasive evaluation to rule out coronary artery disease (CAD) may sometimes be a good idea.
I am 23 years old and this all started In 2017. My heart starts racing and I have and I start crying uncontrollably. I found myself getting away from anyone that was around me ( Going in the shower and just crying) my heart would race so fast. This has happened three times in the last two years. I hate the way this makes me feel. Should I b worried? Should I seek for help?

Obsessive-compulsive and related disorders are characterized by obsessive, intrusive thoughts (e.g. constantly worrying about staying clean, or about one's body size) that trigger related, compulsive behaviors (e.g. repeated hand-washing, or excessive exercise). These behaviors are performed to alleviate the anxiety associated with the obsessive thoughts. These types of disorders can restrict participation in everyday life and/or generate significant distress, for instance, by making it difficult to leave the house without many repetitions of a compulsive behavior (e.g. checking that the doors are locked). Periodically experiencing worry or having a few "idiosyncratic" habits does not constitute an obsessive-compulsive or related disorder. Instead, these disorders are characterized by unusually high levels of worry and related compulsive behaviors, in comparison with a typical range of individuals.


Foster the development of a strong peer network. It's probably no surprise to hear that peer relationships become a major source of support during adolescence. Encourage your child to engage in interests (like arts, music, and sports) that will help them develop and maintain friendships. If your child already has a very busy and structured schedule, try to carve out some time for more relaxed socializing. However, note that sometimes peers can be the source of anxiety, whether through peer pressure or bullying. Check in with your child about the nature of their relationships with others in their social circle (school or class).
About 12% of people are affected by an anxiety disorder in a given year and between 5-30% are affected at some point in their life.[49][50] They occur about twice as often in women than they do in men, and generally begin before the age of 25.[10][49] The most common are specific phobia which affects nearly 12% and social anxiety disorder which affects 10% at some point in their life. They affect those between the ages of 15 and 35 the most and become less common after the age of 55. Rates appear to be higher in the United States and Europe.[49]
Panic disorder is a type of anxiety disorder that is characterized by fear and worry. One of the most salient symptoms is the experience of persistent and often unanticipated panic attacks. Panic attacks are typically experienced through a combination of frightening physical sensations and distressing thoughts and emotions. These attacks bring on severe apprehension and discomfort, despite a lack of actual threat or danger.
“I was under a lot of stress — starting a new business, working 16-hour days, a close friend was ill and dying, and on top of all that, I was doing a super heavy workout regimen at the gym with a trainer," Sideman says. "So it was a lot of physical stress, emotional stress, and a lot of financial stresses." He says he also can see roots of anxiety in his childhood and teen years as well as in other family members.
Primarily, it is important to stay calm, patient, and understanding. Help your friend wait out the panic attack by encouraging them to take deep breaths in for four seconds and out for four seconds. Stay with them and assure them that this attack is only temporary and they will get through it. You can also remind them that they can leave the environment they are in if they would feel more comfortable elsewhere and try to engage them in light-hearted conversation.
An evolutionary psychology explanation is that increased anxiety serves the purpose of increased vigilance regarding potential threats in the environment as well as increased tendency to take proactive actions regarding such possible threats. This may cause false positive reactions but an individual suffering from anxiety may also avoid real threats. This may explain why anxious people are less likely to die due to accidents.[86]

Anxiety during social interactions, particularly between strangers, is common among young people. It may persist into adulthood and become social anxiety or social phobia. "Stranger anxiety" in small children is not considered a phobia. In adults, an excessive fear of other people is not a developmentally common stage; it is called social anxiety. According to Cutting,[32] social phobics do not fear the crowd but the fact that they may be judged negatively.
Whenever i make mistakes i feels like im useless and a burden to everyone around me.. i feels like want to run away and go to someplace that i cant “hurt” anyone.. the feelings that i feel in my head and my chest i hate it very much. I wanted to scream and punch but i cant.. i dont want people to see me that i crazy or something so i shut the feelings inside. I am a person who can go happy easily and can get very down after a second.. i dont know what to do.. i thought this feelings i can control it.. i thought i was getting better if i just stay positive but whenever my actions are “hurting” my bestfriends or someone that i love.. this uncomfortable feelings just hit me so hard that i wanted to just go somewhere that nobody can see me again.. what should i do? I dont like this situations

Mine is my husband 🙁 it pains me to say it but my triggers always come from him 🙁 how can I deal with this/ fix that? I’m ADHD and the panic attacks are just part of what I deal with. Typically they come after an argument, he’s been critical of a decision or something i’ve done. Even if it was just talking on the phone when he doesn’t feel its appropriate time or doesn’t like who i’m talking with or if i’m on my phone too much (when i’m consciously trying not to be) I feel chastised or hounded by him….. that’s my triggers that send me over the edge. I FEEL that if I don’t preform to his standards or specifications i’m just a failure and idiot…. although i’m certain this is incorrect thinking (as he tells me) I believe it’s simply part of my ADHD and its hard to control that or think/ feel any other way about things…. any advice? Thx 🙂


Facing Panic:Self Help for People with Panic Attacks. Learn seven self-help steps to break the cycle of panic and regain control of your life. This book includes techniques and exercises to manage and overcome panic attacks and panic disorder. The disorder often occurs with other mental and physical disorders, including other anxiety disorders, depression, irritable bowel syndrome, asthma, or substance abuse. This may complicate of getting a correct diagnosis.
Generalized anxiety disorder involves persistent and excessive worry that interferes with daily activities. This ongoing 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, family health or minor matters such as chores, car repairs, or appointments.
Generalized Anxiety Disorder (GAD) is characterized by chronic and exaggerated worry and tension, much more than the typical anxiety that most people experience in their daily lives. People may have trembling, twitching, muscle tension, nausea, irritability, poor concentration, depression, fatigue, headaches, light-headedness, breathlessness or hot flashes.
The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home.
An anxiety attack can be described as a sudden attack of fear, terror, or feelings of impending doom that strike without warning and for no apparent reason. This strong sensation or feeling can also be accompanied by a number of other symptoms, including pounding heart, rapid heart rate, sweating, lightheadedness, nausea, hot or cold flashes, chest pain, hands and feet may feel numb, tingly skin sensations, burning skin sensations, irrational thoughts, fear of losing control, and a number of other symptoms. (While other symptoms often do accompany anxiety attacks, they don’t necessarily have to.)
I was 34 before I knew anxiety was real. I had lived my life with these feelings, never knowing that everyone else wasn’t experiencing the same thing. I was 35 when I reached out to a friend, who is a nurse practitioner, to ask about my symptoms. That is when I began taking medication. I am on the lowest dose of anxiety medication and I have been taking it for six months. It has changed my life.
Anxiety can be either a short-term 'state' or a long-term personality "trait". Trait anxiety reflects a stable tendency across the lifespan of responding with acute, state anxiety in the anticipation of threatening situations (whether they are actually deemed threatening or not).[40] A meta-analysis showed that a high level of neuroticism is a risk factor for development of anxiety symptoms and disorders.[41] Such anxiety may be conscious or unconscious.[42]
The last strategy — learning what triggers your anxiety — is important. Sometimes you can take small steps to conquer your anxiety instead of letting the trigger conquer you. For example, if meeting new people causes you high anxiety, consider going with a friend to meet the new neighbors. Once you do this with ease, you can move forward and meet people on your own. All the pent-up fear and anxiety attacks will start to resolve as you become accustomed to reaching out in your community.
Anxiety disorders are the most commonly diagnosed mental disorders in the United States. The most common type of anxiety disorder are called “simple phobias,” which includes phobias of things like snakes or being in a high place. Up to 9 percent of the population could be diagnosed with this disorder in any given year. Also common are social anxiety disorder (social phobia, about 7 percent) — being fearful and avoiding social situations — and generalized anxiety disorder (about 3 percent).
You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, social phobia, or depression. Regardless of the cause, panic attacks are treatable. There are strategies you can use to cope with the symptoms as well as effective treatments.

Anxiety disorders fall into a set of distinct diagnoses, depending upon the symptoms and severity of the anxiety the person experiences. Anxiety disorders share the anticipation of a future threat, but differ in the types of situations or objects that induce fear or avoidance behavior. Different types of anxiety disorder also have different types of unhealthy thoughts associated with them.


People who have repeated, persistent attacks or feel severe anxiety about having another attack are said to have panic disorder. Panic disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked.[18] However, panic attacks experienced by those with panic disorder may also be linked to or heightened by certain places or situations, making daily life difficult.[19]
• Palpitations, pounding heart, or accelerated heart rate • Sweating • Trembling or shaking • Shortness of breath or a sensation of smothering • A choking feeling • Chest pain or discomfort • Nausea or abdominal distress • Feeling dizzy, unsteady, lightheaded, or faint • Feeling detached from oneself or reality • Fear of losing control or of impending doom • Fear of dying • Numbness or a tingling sensation • Chills or hot flashes
The last strategy — learning what triggers your anxiety — is important. Sometimes you can take small steps to conquer your anxiety instead of letting the trigger conquer you. For example, if meeting new people causes you high anxiety, consider going with a friend to meet the new neighbors. Once you do this with ease, you can move forward and meet people on your own. All the pent-up fear and anxiety attacks will start to resolve as you become accustomed to reaching out in your community.
Anxiety attacks, also called panic attacks, are episodes of intense fear and emotional distress that usually occur suddenly and without warning, and typically last from several minutes up to an hour. These attacks may have a discrete trigger, but they also can occur without any identifiable cause. Anxiety attacks are often recurrent, and are very distressing to the people who experience them, as well as their loved ones.
Once you are under enough stress, almost anything can set off a panic attack. Suppose you are under a lot of stress, but still managing. If you add even more stress, your brain will begin to feel under siege. Your body will respond by releasing adrenaline as part of the fight or flight response. That will cause more anxiety, which will create a vicious feedback that will turn into a panic disorder.
You do not need to be officially diagnosed with panic disorder to have an attack. Some people have only one or two panic attacks in their life and don't have panic disorder. Panic attacks are actually much more common than panic disorder. According to one Harvard Medical School survey, about 23 percent of people interviewed experienced at least one panic attack in their lifetime, while only about 3 percent of people experienced panic disorder in their lifetime. (1)
This blog comes from a parent of a child with “invisible disabilities.” It comes from a teacher whose students miss class for mental illnesses that no one can verify. It comes from a woman who lived 35 years thinking that the feeling of her heart racing, being short of breath, and having sleepless nights were normal because she didn’t know otherwise.
A licensed mental health professional that has earned a Master’s degree from a variety of educational backgrounds (e.g. general counseling background, social work, marriage and family counseling).  Once their formal education is completed, these clinicians are supervised in the field 1-2 years and pass a State exam to become fully licensed in the state in which they practice.  These mental health professionals are licensed to diagnose emotional, mental health and behavioral health problems.  They can provide mental health treatment in the form of counseling and psychotherapy, or work in other capacities as patient advocates or care managers. Licensed Master’s level clinicians work in many settings, including hospitals, community mental health clinics, private practice, school settings, nursing homes, and other social service agencies.  Titles and licensing requirements may vary from state to state.

This publication is in the public domain and may be reproduced or copied without permission from NIMH. Citation of NIMH as a source is appreciated. We encourage you to reproduce it and use it in your efforts to improve public health. However, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines:
In addition to the emotional turmoil and the physical manifestations that Caroline and Kirstie describe panic attacks can cause palpitations, pounding heart or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, light-headed or faint; chills or overheating; numbness or tingling; feelings of unreality (derealization) or being detached from oneself (depersonalization); fear of losing control or “going crazy”; and fear of dying.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used for diagnosis of mental health disorders, and is widely used by health care professionals around the world. For each disorder, the DSM has a description of symptoms and other criteria to diagnose the disorder. The DSM is important, because it allows different clinicians and/or researchers to use the same language when discussing mental health disorders. The first DSM was published in 1952 and has been updated several times after new research and knowledge became available. In 2013, the most recent version of the DSM, the DSM-5, was released. There are a few important differences with its predecessor DSM-IV regarding anxiety disorders. First, Obsessive Compulsive Disorder (OCD) is not part of the anxiety disorders any more, but now has its own category: Obsessive-Compulsive, Stereotypic and related disorders. Second, Post-Traumatic Stress Disorder (PTSD) now also has its own category: Trauma and Stressor-related Disorders.
×