People facing anxiety may withdraw from situations which have provoked anxiety in the past.[5] There are various types of anxiety. Existential anxiety can occur when a person faces angst, an existential crisis, or nihilistic feelings. People can also face mathematical anxiety, somatic anxiety, stage fright, or test anxiety. Social anxiety and stranger anxiety are caused when people are apprehensive around strangers or other people in general. Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate IBS. Anxiety is often experienced by those who have an OCD and is an acute presence in panic disorder. The first step in the management of a person with anxiety symptoms involves evaluating the possible presence of an underlying medical cause, whose recognition is essential in order to decide the correct treatment.[6][7] Anxiety symptoms may mask an organic disease, or appear associated with or as a result of a medical disorder.[6][7][8][9]
Panic attacks are a symptom of an anxiety disorder and affect a significant number of adult Americans. Other facts about panic include that many people in the United States will have full-blown panic disorder at some time in their lives, usually beginning between 15-19 years of age. Panic attacks occur suddenly and often unexpectedly, are unprovoked, and can be disabling.
Agoraphobia 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:

Anxiety disorders are a group of mental disorders characterized by exaggerated feelings of anxiety and fear responses.[10] Anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a fast heart rate and shakiness. There are a number of anxiety disorders: including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. The disorder differs by what results in the symptoms. People often have more than one anxiety disorder.[10]
According to the American Psychological Association, "most specialists agree that a combination of cognitive and behavioral therapies are the best treatment for panic disorder. Medication might also be appropriate in some cases."[50] The first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they are "going crazy" or that the panic might induce a heart attack. Cognitive restructuring helps people replace those thoughts with more realistic, positive ways of viewing the attacks.[51] Avoidance behavior is one of the key aspects that prevent people with frequent panic attacks from functioning healthily.[14] Exposure therapy,[52] which includes repeated and prolonged confrontation with feared situations and body sensations, helps weaken anxiety responses to these external and internal stimuli and reinforce realistic ways of viewing panic symptoms.
To receive a diagnosis of panic disorder, the panic attacks must be unexpected and during the attack four or more of the above symptoms must occur. For panic attacks that are expected, meaning they might not be expected by the individual but are expected in relation to any phobia, anxiety or other mental health disorder, four or more symptoms must also occur.
Anxiety attacks that occur while sleeping, also called nocturnal panic attacks, occur less often than panic attacks during the daytime but affect about 40%-70% of those who suffer from daytime panic attacks. This symptom is also important because people who suffer from panic symptoms during sleep tend to have more respiratory distress associated with their panic. They also tend to experience more symptoms of depression and other psychiatric disorders compared to people who do not have panic attacks at night. Nocturnal panic attacks tend to cause sufferers to wake suddenly from sleep in a state of sudden fear or dread for no apparent reason. In contrast to people with sleep apnea and other sleep disorders, sufferers of nocturnal panic can have all the other symptoms of a panic attack. The duration of nocturnal panic attacks tends to be less than 10 minutes, but it can take much longer to fully calm down for those who experience them.
Those who experience anxiety attack disorder are not alone. It’s estimated that 19 percent of the North American adult population (ages 18 to 54) experiences an anxiety disorder, and 3 percent of the North American adult population experiences anxiety attack disorder. We believe that number is much higher, since many conditions go undiagnosed and unreported.

When we experience an involuntary high degree stress response, the sensations can be so profound that we think we are having a medical emergency, which anxious personalities can react to with more fear. And when we become more afraid, the body is going to produce another stress response, which causes more changes, which we can react to with more fear, and so on.
In the midst of a panic attack, it’s inevitable that you’ll feel like you’ve lost control of your body, but muscle relaxation techniques allow you to gain back some of that control. Progressive muscle relaxation (PMR) is a simple but effective technique for panic and anxiety disorders. Start by clenching your fist and holding this clench until the count of 10. Once you get to 10, release the clench and let your hand relax completely. Next, try the same technique in your feet and then gradually work your way up your body clenching and relaxing each muscle group: legs, glutes, abdomen, back, hands, arms, shoulders, neck, and face.
Panic disorder is a diagnosis given to people who experience recurrent unexpected panic attacks— that is, the attack appears to occur from out of the blue. The term recurrent refers to the fact that the individual has had more than one unexpected panic attack. In contrast, expected panic attacks occur when there is an obvious cue or trigger, such as a specific phobia or generalized anxiety disorder. In the U.S., roughly 50% of people with panic disorder experience both unexpected and expected panic attacks.
Medications — most often antidepressants and anti-anxiety drugs — can also be used to help treat panic disorder. Your doctor may initially prescribe you an anti-anxiety drug, such as Xanax (alprazolam), and then add an antidepressant, such as Effexor XR (venlafaxine). After a month or sooner, your doctor may stop the Xanax and have you remain on the antidepressant.

Fear and anxiety can be differentiated in four domains: (1) duration of emotional experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction. Fear is short lived, present focused, geared towards a specific threat, and facilitating escape from threat; anxiety, on the other hand, is long-acting, future focused, broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat and interferes with constructive coping.[17]
Depression is a condition in which a person feels discouraged, sad, hopeless, unmotivated, or disinterested in life in general for more than two weeks and when the feelings interfere with daily activities. Major depression is a treatable illness that affects the way a person thinks, feels, behaves, and functions. At any point in time, 3 to 5 percent of people suffer from major depression; the lifetime risk is about 17 percent.
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 cause of anxiety disorders is a combination of genetic and environmental factors.[47] Anxiety can stem itself from certain factors: genetics, medicinal side-effects, shortness of oxygen.[48] Risk factors include a history of child abuse, family history of mental disorders, and poverty. Anxiety disorders often occur with other mental disorders, particularly major depressive disorder, personality disorder, and substance use disorder.[49] To be diagnosed symptoms typically need to be present at least six months, be more than would be expected for the situation, and decrease functioning.[10][49] Other problems that may result in similar symptoms including hyperthyroidism, heart disease, caffeine, alcohol, or cannabis use, and withdrawal from certain drugs, among others.[49][7]
Research upon adolescents who as infants had been highly apprehensive, vigilant, and fearful finds that their nucleus accumbens is more sensitive than that in other people when deciding to make an action that determined whether they received a reward.[56] This suggests a link between circuits responsible for fear and also reward in anxious people. As researchers note, "a sense of 'responsibility', or self-agency, in a context of uncertainty (probabilistic outcomes) drives the neural system underlying appetitive motivation (i.e., nucleus accumbens) more strongly in temperamentally inhibited than noninhibited adolescents".[56]
Approximately one-third of people with panic disorder will also develop agoraphobia. People with agoraphobia are afraid that they will have some anxiety symptoms or a full-blown panic attack in a place where it would be very challenging or embarrassing for them to flee. This condition can lead to avoidance behaviors, in which they try to stay away from all places or situations in which they may have a panic attack.
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.
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]
The avoidance behaviors associated with agoraphobia can greatly restrict a person’s life. People with agoraphobia often develop groups of feared situations that are related. For example, many people with agoraphobia become extremely upset and uncomfortable in areas where there are many people in a confined space. This fear may limit them from standing in line at a store, going to a movie theater, or traveling on an airplane. Other commonly feared situations for people with agoraphobia include forms of travel, being alone, and open spaces. These fears may result in an inability to even leave their homes.

There are many types of psychotherapies used to treat anxiety. Unlike counseling, psychotherapy is more long-term and targets a broader range of issues such as patterns of behavior. The patient's particular anxiety diagnosis and personal preference guides what therapies would be best suited to treat them. The ultimate goal with any type of psychotherapy, is to help the patient regulate their emotions, manage stress, understand patterns in behavior that affect their interpersonal relationships. Evidenced-based therapies like Cognitive Behavioral Therapy (CBT), Prolonged Exposure Therapy (PE), and Dialectical Behavioral Therapy (DBT) are some of the most effective at treating anxiety.
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.
In fact, some studies have suggested that people with chronic anxiety disorders have an increased prevalence of CAD—that is, chronic anxiety may be a risk factor for CAD. So doctors should not be too quick to simply write the chest pain off as being “simply” due to anxiety. They should at least entertain the possibility that both disorders may be present and should do an appropriate evaluation.
Carbonell says that understanding the physiology of fainting and reminding yourself of it is important. People faint when their blood pressure drops. A anxiety attack can make you feel like you’re going to faint, but you won’t because your blood pressure doesn't drop during an attack. Remind yourself out loud of truths like these to counter your fears.

Anxiety can be either a short-term "state" or a long-term "trait". Whereas trait anxiety represents worrying about future events, anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fear.[10] Anxiety disorders are partly genetic but may also be due to drug use, including alcohol, caffeine, and benzodiazepines (which are often prescribed to treat anxiety), as well as withdrawal from drugs of abuse. They often occur with other mental disorders, particularly bipolar disorder, eating disorders, major depressive disorder, or certain personality disorders. Common treatment options include lifestyle changes, medication, and therapy. Metacognitive therapy seeks to diminish anxiety through reducing worry, which is seen[by whom?] as a consequence of metacognitive beliefs.[11]
Some benefits of benzodiazepines are that they are effective in relieving anxiety and take effect more quickly than antidepressant medications often prescribed for anxiety. Some drawbacks of benzodiazepines are that people can build up a tolerance to them if they are taken over a long period of time and they may need higher and higher doses to get the same effect. Some people may even become dependent on them.
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