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If you experience anxiety from time to time, fret not. Worry and anxiousness are part of life.
Feelings of anxiety are a natural response to the world’s challenges or uncertainties. Had our ancestors not responded to the various threats they perceived—a nearby pride of lions, a neighboring tribe looking to secure scarce resources, a lengthy drought—we wouldn’t be here.
We worry in order to prevent bad things from happening. At least, that’s how anxiety is supposed to work. But for some, proportional, run-of-the-mill anxiousness can tip (or tumble) into a mental health condition. The trappings of modern life certainly aren’t helping.
If it seems like worries and stress are taking over your thoughts or interfering with your life, you might wonder if it’s more than just anxiety. The line between a diagnosable anxiety disorder and everyday worry can be hard to draw. Here’s how to tell the difference.
What is anxiety?
In a nutshell, anxiety is a mood state wrapped up in thoughts of worry or fear.
In addition, these thoughts tend to be future-oriented, meaning they’re focused on something that may happen down the road instead of something that has already happened (Chand, 2021).
Common symptoms of anxiety
Experts break down anxiety symptoms into three categories.
The first category involves cognitive symptoms. These include (Chand, 2021):
- Intense fear
- Fear of losing control or “going crazy”
- Fear of injury or death
- Fear of negative judgment from others
- Poor concentration
- A sense of unreality or detachment
The second category involves what happens in the body. These physical symptoms include:
- A racing heart rate or heart palpitations
- Shortness of breath
- Chest pain
- Sweating or sweaty palms
- Muscle tension
- Rapid breathing
- Hot flashes
- Upset stomach
- Weakness or unsteadiness
- Problems sleeping
The final category includes behavioral symptoms. Some of these are:
- Avoiding certain things or situations
- Feeling an urge to escape or flee
- Moving away from sources of fear or worry and toward safer situations
- Seeking reassurance
Some of these symptoms are more typical of certain types of anxiety, which we’ll delve into below.
Types of anxiety
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the official guide that mental health professionals use to identify and diagnose mental illnesses (SAMSA, 2016). According to the DSM-5, there are several separate anxiety disorders. These include:
Generalized anxiety disorder
Generalized anxiety disorder (GAD) makes it difficult to control anxiousness or worrying that stems from things like school, work, and everyday activities.
You may have GAD if you experience anxiety more days than not over a period of six months. This type of anxiety causes symptoms including restlessness, problems concentrating, fatigue, muscle tension, and sleep issues. GAD often interferes with your ability to work or engage in typical day-to-day activities (SAMSA-a, 2016).
Social anxiety disorder
Also known as social phobia, social anxiety disorder is a fear of spending time around others or being in situations where you may be judged or scrutinized. Some examples are having a conversation with new people or giving a public speech.
This form of anxiety lasts for at least six months and is characterized by changes in behavior like avoiding situations that cause you stress (SAMSA-b, 2016).
A phobia is an intense fear about a particular thing or situation that lasts for at least six months.
For example, you might be afraid of heights, spiders, flying in airplanes, or seeing blood. The fear is also consistent, meaning you almost always experience it when you’re around the trigger.
Anxiety associated with specific phobias is out of proportion to the perceived threat or danger. Like social anxiety disorder, phobias also cause you to take steps to avoid the sources of your fear (SAMSA-c, 2016).
Separation anxiety disorder
Separation anxiety disorder is excessively worrying fear when you’re away from certain people or loved ones in your life. This fear or anxiousness may involve thoughts of a loved one being hurt, lost, kidnapped, or threatened in some way.
You may feel distressed just thinking about being away from your loved one, and this may cause you to stay home, skip work or school, or otherwise disrupt your life. All of this lasts for six months or more (or for at least four weeks if you’re a child or adolescent) (SAMSA-d 2016).
This form of anxiety is triggered by a cluster of specific, fear-inducing situations. According to the DSM-5, you may have agoraphobia if you have noticeable anxiety or fear when you’re in two or more of the following situations (SAMSA-e, 2016):
- Using public transportation
- Being in wide-open spaces
- Being in enclosed spaces (like a store or movie theater)
- Standing in line or being in a crowd
- Leaving your home
These situations result in noticeable worry or distress, which persists for at least six months (SAMSA-e, 2016).
Panic attacks typify this type of anxiety disorder. Panic attacks are a sudden surge of intense worry or fear that peaks within minutes.
Symptoms include a racing heart, sweating, trembling, rapid breathing, nausea, and dizziness. These symptoms are not mild. You may feel like you’re dying, “going crazy,” or having a heart attack.
Even if you only have one panic attack, you could still have panic disorder if you’re intensely worried about having an attack or you change your behavior in harmful ways to dodge one (SAMSA-e, 2016).
There are several other less common types of anxiety disorder. These include (Chand, 2021):
- Selective mutism, which is an inability to talk due to anxiety in social situations
- Anxiety triggered by prescription medications, alcohol, and drugs, or withdrawal from them
- Stress that stems from other medical conditions, such as heart disease, asthma, or a brain illness
What’s the difference between anxiety and an anxiety disorder?
As you can see from the above criteria, it matters a lot how long your anxiety sticks around for it to be considered a disorder. If your anxiety persists for six months or more, you may have a diagnosable condition.
The amount of anxiety you experience matters as well. Most of these disorders are defined by anxiety that causes you distress (SAMSA, 2016). According to the DSM, anxious distress occurs when you experience two or more of the following (McIntyre, 2016):
- You feel keyed up or tense
- You feel unusually restless
- You have problems concentrating due to worry
- You’re afraid that something awful will happen
- You think that you might lose control of yourself
It’s important to understand that anxiety disorders are tricky to diagnose, and often overlap a bit with one another. For example, most people who meet the criteria for agoraphobia or social anxiety disorder also have symptoms of another anxiety disorder (Goodwin, 2015).
A medical professional can help you determine whether you have an anxiety disorder and what to do about it. Questionnaires like the Anxiety Symptoms Questionnaire (ASQ) can help determine if a person has an anxiety disorder. The ASQ asks you to rate how often you’ve had symptoms during the past week and how severe they are on a scale from zero to 10 (Baker, 2019).
Some of the symptoms a questionnaire may ask about includes:
- Muscle tension
- Problems concentrating
- Upset stomach or nausea
- Shortness of breath
Once you’ve completed the questionnaire, which takes just 2 to 3 minutes, your medical provider will total up your scores (Baker, 2019). This total can help them figure out if you have an anxiety disorder.
Conditions related to anxiety
Symptoms of anxiety also show up in people who have other mental health disorders. For example, there is a lot of overlap between anxiety, depression, and obsessive-compulsive disorder (Goodwin, 2015). Some people with post-traumatic stress disorder also experience anxiety (Price, 2019).
If you’ve read this and feel like you may have an issue related to anxiety, your next move is to talk with a medical provider. You’ll need a professional’s help to determine what’s going on and the most helpful treatment options, whether that’s psychotherapy, medication, or simple relaxation techniques.
- Baker, A., Simon, N., Keshaviah, A., Farabaugh, A., Deckersbach, T., Worthington, J. J., Hoge, E., Fava, M., & Pollack, M. P. (2019). Anxiety Symptoms Questionnaire (ASQ): development and validation. General Psychiatry, 32(6), e100144. doi: 10.1136/gpsych-2019-100144. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936972/.
- Chand, S. P., & Marwaha, R. (2021). Anxiety. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470361/
- Goodwin G. M. (2015). The overlap between anxiety, depression, and obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 17(3), 249–260. doi: 10.31887/DCNS.2015.17.3/goodwin. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610610/
- McIntyre, R. S., Woldeyohannes, H. O., Soczynska, J. K., Vinberg, M., Cha, D. S., Lee, Y., Gallaugher, L. A., Dale, R. S., Alsuwaidan, M. T., Mansur, R. B., Muzina, D. J., Carvalho, A., & Kennedy, S. (2016). The prevalence and clinical characteristics associated with Diagnostic and Statistical Manual Version-5-defined anxious distress specifier in adults with major depressive disorder: results from the International Mood Disorders Collaborative Project. Therapeutic Advances in Chronic Disease, 7(3), 153–159. doi: 10.1177/2040622315627805. Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/2040622315627805
- Price, M., Legrand, A. C., Brier, Z., & Hébert-Dufresne, L. (2019). The symptoms at the center: Examining the comorbidity of posttraumatic stress disorder, generalized anxiety disorder, and depression with network analysis. Journal of Psychiatric Research, 109, 52–58. doi: 10.1016/j.jpsychires.2018.11.016. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30502492/
- Substance Abuse and Mental Health Services Administration (SAMSA). (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519697/
- Substance Abuse and Mental Health Services Administration (SAMSA)-a. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t15/
- Substance Abuse and Mental Health Services Administration (SAMSA)-b. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t12/
- Substance Abuse and Mental Health Services Administration (SAMSA)-c. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t11/?report=objectonly
- Substance Abuse and Mental Health Services Administration (SAMSA)-d. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t25/
- Substance Abuse and Mental Health Services Administration (SAMSA)-e. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t10/
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.