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The Symptoms of Anxiety

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.

There are common symptoms of anxiety that people experience in terms of feelings, behaviors, thoughts, and physical sensations. Nonetheless, it is important to remember that anxiety is a highly subjective experience. Not everyone will experience the same symptoms, nor will each person experience the same intensity of a symptom. Still, it is helpful to provide some examples of the common physical, emotional, cognitive, and behavioral symptoms of anxiety.

list with boxes checkedPhysical symptoms of anxiety

The physical symptoms of anxiety refer to how we experience anxiety in our bodies. Examples include:

  • A feeling of restlessness, feeling "keyed up," or "on-edge;"
  • Shortness of breath, or a feeling of choking;
  • Sweaty palms;
  • A racing heart;
  • Chest pain or discomfort;
  • Muscle tension, trembling, feeling shaky;
  • Nausea and/or diarrhea;
  • "Butterflies" in the stomach;
  • Dizziness, or feeling faint;
  • Hot flashes;
  • Chills;
  • Numbness, or tingling sensations;
  • An exaggerated startle response; and,
  • Sleep disturbance and fatigue.

These symptoms are caused by the physiological changes that occur in the body during a fight-or-flight response. Unfortunately, our bodies do not distinguish between a real and present danger in the environment (fear), and an imagined or anticipated danger in the future (anxiety). For more information about why these symptoms occur, please refer to section on Biological Explanations of Anxiety

For people who experience panic attacks, the above symptoms are all too familiar. However, as previously stated, a person does not need to develop a full-blown anxiety disorder to be able to relate to any of the above symptoms. For these symptoms to be considered a "disorder" they must reach a certain level of intensity, duration, and frequency such that the symptoms cause significant distress and interfere with someone's functioning

Behavioral symptoms of anxiety

The behavioral symptoms of anxiety refer to what people do (or don't do) when they are anxious. Behavioral responses reflect attempts to cope with the unpleasant aspects of anxiety.

Typical behavioral responses to anxiety may include:

  • Avoidance behaviors such as avoiding anxiety-producing situations (e.g., avoiding social situations) or places (e.g., using the stairs instead of an elevator).
  • Escaping from an anxiety-producing situation (like a crowded lecture hall).
  • Engaging in unhealthy, risky, or self-destructive behaviors (such as excessive drinking or drug use to deal with the anxiety).
  • Feeling compelled to limit the amount and scope of one's daily activities to reduce the overall level of anxiety (e.g., remaining in the safety of one's home).
  • Becoming overly attached to a safety object or person (e.g., refusing to go out, away from home, to school, or to work in order to avoid separation).

Ironically, these coping strategies often worsen and maintain an anxiety disorder. This is discussed in more detail in the section, Maintenance of anxiety disorders: Maladaptive coping strategies

Emotional symptoms of anxiety

As we mentioned earlier, anxiety in its most basic form is an emotion. However, this emotion produces a set of feelings. Common words used to describe the feelings of anxiety include:

  • apprehension,
  • distress,
  • dread,
  • nervousness,
  • feeling overwhelmed,
  • panic,
  • uneasiness,
  • worry,
  • fear or terror,
  • jumpiness or edginess.

Some individuals, especially children, may not even be able to describe their feelings and may at times simply answer, "I don't know what I feel." Interestingly, many people find the emotional component of anxiety most distressing. However, the other symptoms of anxiety, such as thoughts, behaviors, and physical responses cause the greatest disturbance in terms of their daily functioning.

Cognitive symptoms of anxiety

Finally, there are the cognitive symptoms of anxiety. Whether we realize it or not, it is often quite common to have thoughts running through our mind when we feel anxious. Even when we do not feel anxious, we have thousands of thoughts every day! The thoughts people experience when anxious are commonly referred to as worry (Bourne, 2000). Although the content of the thoughts may vary depending on the person and situation, common themes include:

  • "What if _ happens?"
  • "I must have certainty."
  • "I can't possibly tolerate not knowing_."
  • "What do these physical symptoms mean?"
  • "People will laugh at me."
  • "I won't be able to escape."
  • "I am going crazy."
  • "Oh my God, what's happening to me?"

Depending on the nature of the specific anxiety disorder, and a person's own unique anxiety history, the possible worrisome thoughts may vary.

The psychological symptoms of anxiety may include:

  • Problems with concentration, or difficulty with staying on task;
  • Memory difficulties; and,
  • Depressive symptoms such as hopelessness, lethargy, and poor appetite.

Notwithstanding, what is often found at the heart of pathological anxiety is an inaccurate cognitive appraisal of a situation. This usually means overestimating the amount of threat in a given situation, while at the same time underestimating one's ability to cope with these threats. These concepts are discussed in more detail in the Psychological Explanations of Anxiety Disorders section.

The cost of anxiety

These physical, behavioral, cognitive, and emotional symptoms of anxiety can certainly take their toll.

The "cost" of unidentified and/or untreated anxiety can be quite high:

1. Lost social and professional opportunities because of excessive shyness or social anxiety;
2. Dysfunctional relationships because of a fear of asserting oneself;
3. Increased risk for cardio-vascular disease and suicide;
4. Other health-related problems such as irritable bowel syndrome, headaches, teeth grinding, and other jaw-related disorders;
5. Drug and alcohol problems; and,
6. High rates of absenteeism, reduced work performance, reduced productivity, unemployment, under-employment, and disability.

In more concrete terms, the WHO has reported that mental illnesses are the leading causes of disability adjusted life years (DALYs) worldwide, accounting for 37% of healthy years lost from non-communicable diseases (NCDs). The new report estimates the global cost of mental illness at nearly $2.5 trillion (two-thirds in indirect costs) in 2010, with a projected increase to over $6T by 2030.

Clearly, the cost of untreated anxiety disorders, which fall into these categories, is very high. This is particularly disturbing since there are highly effective treatments for anxiety disorders.