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Anxiety is an
emotion Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent with a proposition. Several of these states are a comb ...

emotion
characterized by an unpleasant state of inner turmoil, often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination. It includes subjectively unpleasant feelings of dread over
anticipated
anticipated
events. Anxiety is a feeling of uneasiness and
worry Worry refers to the thoughts, images, emotions Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent w ...

worry
, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing. It is often accompanied by muscular tension, restlessness,
fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...
and problems in concentration. Anxiety is closely related to
fear Fear is an intensely unpleasant emotion Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent with a pr ...

fear
, which is a response to a real or perceived immediate
threat A threat is a communication of intent to inflict harm or loss on another person. IntimidationIntimidation (also called cowing) is intentional behavior that "would cause a person of ordinary sensibilities" to fear injury Injury, also known a ...

threat
; anxiety involves the expectation of future threat. People facing anxiety may withdraw from situations which have provoked anxiety in the past.
Anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such fe ...
s differ from developmentally normative fear or anxiety by being excessive or persisting beyond developmentally appropriate periods. They differ from transient fear or anxiety, often stress-induced, by being persistent (e.g., typically lasting 6 months or more), although the criterion for duration is intended as a general guide with allowance for some degree of flexibility and is sometimes of shorter duration in children.


Anxiety vs. fear

Anxiety is distinguished from
fear Fear is an intensely unpleasant emotion Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent with a pr ...

fear
, which is an appropriate cognitive and emotional response to a perceived threat. Anxiety is related to the specific behaviors of
fight-or-flight response The fight-or-flight-or-freeze or the fight-flight response (also called hyperarousal or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack Attack may refer to: Warfare and comba ...
s, defensive behavior or escape. It occurs in situations only perceived as uncontrollable or unavoidable, but not realistically so. David Barlow defines anxiety as "a future-oriented mood state in which one is not ready or prepared to attempt to
cope The cope (known in Latin as ''pluviale'' 'rain coat' or ''cappa'' 'cape') is a liturgical vestment, more precisely a long mantle or cloak, open in front and fastened at the breast with a band or clasp. It may be of any liturgical colours, litu ...
with upcoming negative events," and that it is a distinction between future and present dangers which divides anxiety and fear. Another description of anxiety is agony, dread, terror, or even apprehension. In
positive psychology Positive psychology is the scientific study of what makes life most worth living, focusing on both individual and societal well-being. It studies "positive subjective experience, positive individual traits, and positive institutions...it aims t ...
, anxiety is described as the mental state that results from a difficult challenge for which the subject has insufficient
coping Coping is conscious or unconscious strategies used to reduce unpleasant emotions. Coping strategies can be cognitions or behaviours and can be individual or social. Theories of coping Hundreds of coping strategies have been identified. Classifi ...
skills. Fear and anxiety can be differentiated into 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.
Joseph E. LeDoux Joseph E. LeDoux (born December 7, 1949) is an American neuroscientist A neuroscientist (or neurobiologist) is a scientist A scientist is a person who conducts Scientific method, scientific research to advance knowledge in an Branches of science ...
and
Lisa Feldman Barrett Lisa Feldman Barrett is a distinguished professor of psychology Psychology is the scientific Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or some ...
have both sought to separate automatic threat responses from additional associated cognitive activity within anxiety.


Symptoms

Anxiety can be experienced with long, drawn-out daily symptoms that reduce quality of life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful
panic attack Panic attacks are sudden periods of intense fear Fear is an intensely unpleasant emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feel ...

panic attack
s, known as acute anxiety. Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. While almost everyone has experienced anxiety at some point in their lives, most do not develop long-term problems with anxiety. Anxiety may cause psychiatric and physiological symptoms. The risk of anxiety leading to depression could possibly even lead to an individual harming themselves, which is why there are many 24-hour suicide prevention hotlines. The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative feelings in the past. Other effects may include changes in sleeping patterns, changes in habits, increase or decrease in food intake, and increased motor tension (such as foot tapping). The emotional effects of anxiety may include "feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) of danger, and, feeling like your mind's gone blank" as well as "nightmares/bad dreams, obsessions about sensations,
déjà vu ''Déjà vu'' ( ; ) is the feeling that one has lived through the present situation before.Schnider, Armin. (2008). ''The Confabulating Mind: How the Brain Creates Reality''. Oxford University Press. pp. 167–168. Blom, Jan Dirk. (2010). ''A Dict ...
, a trapped-in-your-mind feeling, and feeling like everything is scary." It may include a vague experience and feeling of helplessness. The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of dying: "You may ... fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumor or an aneurysm. You feel an intense fear when you think of dying, or you may think of it more often than normal, or can't get it out of your mind." The physiological symptoms of anxiety may include: *Neurological, as
headache Headache is the symptom of pain Pain is a distressing feeling often caused by intense or damaging stimuli. The defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or ...

headache
,
paresthesia Paresthesia is an abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness Hypoesthesia or numbness is a common side effect of various medical conditions which manifests as a reduced sense of touch The somatosensory sy ...
s,
fasciculation A fasciculation, or muscle twitch, is a spontaneous, involuntary muscle contraction and relaxation, involving fine muscle fibers. They are common, with as much as 70% of people experiencing them. They can be benign, or associated with more serio ...
s,
vertigo Vertigo is a condition where a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea Nausea is a diffuse sensation of ...

vertigo
, or
presyncope Lightheadedness is a common and typically unpleasant sensation of dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-speci ...
. *Digestive, as abdominal pain,
nausea Nausea is a diffuse sensation of unease and discomfort, often perceived as an urge to vomiting, vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, upper abdomen, or ...

nausea
,
diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery defecation, bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration of ...
,
indigestion Indigestion, also known as dyspepsia or upset stomach, is a condition of impaired digestion Digestion is the breakdown of large insoluble food Food is any substance consumed to provide nutritional Nutrition is the biochemical Bioc ...
,
dry mouth Xerostomia, also known as dry mouth, is dryness in the mouth, which may be associated with a change in the composition of saliva Saliva (commonly referred to as spit) is an extracellular fluid Extracellular fluid (ECF) denotes all body fluid ou ...

dry mouth
, or bolus. *Respiratory, as
shortness of breath Shortness of breath (SOB), also known as dyspnea (BrE British English (BrE) is the standard dialect A standard language (also standard variety, standard dialect, and standard) is a language variety that has undergone substantial codificat ...
or sighing breathing. *Cardiac, as
palpitations Palpitations are perceived abnormalities of the heartbeat characterized by awareness of cardiac muscle contractions in the chest, which is further characterized by the hard, fast and/or irregular beatings of the heart. Symptoms include a rapid ...
,
tachycardia Tachycardia, also called tachyarrhythmia, is a heart rate Heart rate is the speed of the heartbeat Heartbeat or heartbeats may refer to: Physiology *Cardiac cycle, of the heart *Contraction of the cardiac muscle, muscles of the heart, or a per ...
, or
chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with na ...
. *Muscular, as
fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...
,
tremor A tremor is an involuntary, somewhat rhythmic, muscle contraction Muscle contraction is the activation of tension Tension may refer to: Science * Psychological stress * Tension (physics), a force related to the stretching of an object (the opp ...
s, or
tetany Tetany or tetanic seizure An epileptic seizure, formally known as a seizure, is a period of symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example ma ...
. *Cutaneous, as
perspiration Perspiration, also known as sweating, is the production of fluids secreted by the sweat gland Sweat glands, also known as sudoriferous or sudoriparous glands, , are small tubular structures of the skin Skin is the layer of usually soft, f ...
, or
itch ITCH is a HECT domain In molecular biology, the HECT domain is a protein domain A protein domain is a region of the protein's Peptide, polypeptide chain that is self-stabilizing and that folds independently from the rest. Each domain forms a c ...

itch
y skin. *Uro-genital, as
frequent urination Frequent urination is the need to urinate Urination is the release of urine Urine is a liquid by-product A by-product or byproduct is a secondary product derived from a production process, manufacturing process or chemical reaction; it is ...
,
urinary urgency Urinary urgency is a sudden, compelling urge to urination, urinate. MedNet defines it as “an immediate unstoppable urge to urinate, due to a sudden involuntary contraction of the muscular wall of the bladder.” It is often, though not necessar ...
,
dyspareunia Dyspareunia ( ) is painful sexual intercourse Sexual intercourse (or coitus or copulation) is a sexual activity Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and expre ...
, or
impotence Erectile dysfunction (ED), also called impotence, is the type of sexual dysfunction Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity Human sexual activity, human sexu ...

impotence
,
chronic pelvic pain syndrome Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), previously known as chronic nonbacterial prostatitis, is long-term pelvic pain Pelvic pain is pain in the area of the pelvis. Acute (medicine), Acute pain is more common than chronic pai ...
. Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate .


Types

There are various types of anxiety.
Existential Existentialism ( or ) is a form of philosophical inquiry that explores the problem of human existence and centers on the lived experience of the thinking, feeling, acting individual. In the view of the existentialist, the individual's starting ...
anxiety can occur when a person faces
angst Angst means fear Fear is an intensely unpleasant emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavioural responses, a ...

angst
, an
existential crisis Existential crisis, also known as existential dread, are moments when individuals question whether their lives have meaning, purpose, or value, and are negatively impacted by the contemplation. It may be commonly, but not necessarily, tied to dep ...

existential crisis
, or
nihilistic Nihilism (; ) is a philosophy Philosophy (from , ) is the study of general and fundamental questions, such as those about reason, Metaphysics, existence, Epistemology, knowledge, Ethics, values, Philosophy of mind, mind, and Philosop ...
feelings. People can also face
mathematical anxietyMathematical anxiety, also known as math phobia, is anxiety about one's ability to do mathematics. It is a phenomenon that is often considered when examining students' problems in mathematics. Math anxiety Mark H. Ashcraft defines math anxiety as "a ...
,
somatic anxiety Somatic anxiety, also known as somatization, is the physical manifestation of anxiety. It is commonly contrasted with ''cognitive anxiety'', which is the mental manifestation of anxiety, or the specific thought processes that occur during anxiety, s ...
,
stage fright Stage fright or performance anxiety is the anxiety Anxiety is an emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavioural ...
, or
test anxiety Test anxiety is a combination of physiological over-arousal, tension and somatic symptoms, along with worry, dread, fear of failure, and catastrophizing, that occur before or during test situations.Zeidner M. (1998). ''Test anxiety: The state of th ...
.
Social anxiety Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorder Anxiety disorders are a cluster of ment ...
refers to a fear of rejection and negative evaluation by other people.


Existential

The philosopher
Søren Kierkegaard Søren Aabye Kierkegaard ( , , ; 5 May 1813 – 11 November 1855) was a Danish theologian, philosopher, poet, social critic Social criticism is a form of Academic or journalistic criticism focusing on sociological issues in contemporar ...
, in ''
The Concept of Anxiety ''The Concept of Anxiety'' ( da, Begrebet Angest): ''A Simple Psychologically Orienting Deliberation on the Dogmatic Issue of Hereditary Sin'', is a philosophical work written by Danish Danish may refer to: * Something of, from, or related to th ...
'' (1844), described anxiety or dread associated with the "dizziness of freedom" and suggested the possibility for positive resolution of anxiety through the self-conscious exercise of responsibility and choosing. In ''Art and Artist'' (1932), the psychologist
Otto Rank Otto Rank (; ; né Rosenfeld; 22 April 1884 – 31 October 1939) was an Austrian psychoanalyst, writer, and teacher. Born in Vienna en, Viennese , iso_code = AT-9 , registration_plate = Vehicle regis ...
wrote that the
psychological trauma Psychological trauma is damage to a person's mind as a result of one or more events that cause overwhelming amounts of stress (psychological), stress that exceed the person's ability to cope or integrate the emotions involved, eventually leading t ...
of birth was the pre-eminent human symbol of existential anxiety and encompasses the creative person's simultaneous fear of – and desire for – separation, individuation, and differentiation. The
theologian Theology is the systematic study of the nature of the divine Divinity or the divine are things that are either related to, devoted to, or proceeding from a deity A deity or god is a supernatural The supernatural encompasses supposed ...
Paul Tillich Paul Johannes Tillich (August 20, 1886 – October 22, 1965) was a German-American Christian existentialist philosopher and Lutheran Protestant Protestantism is a form of Christianity that originated with the 16th-century Reformation, a ...
characterized existential anxiety as "the state in which a
being In philosophy Philosophy (from , ) is the study of general and fundamental questions, such as those about Metaphysics, existence, reason, Epistemology, knowledge, Ethics, values, Philosophy of mind, mind, and Philosophy of language, la ...

being
is aware of its possible nonbeing" and he listed three categories for the nonbeing and resulting anxiety: ontic (fate and death),
moral A moral (from Latin ''morālis'') is a message that is conveyed or a lesson to be learned from a narrative, story or wikt:event, event. The moral may be left to the hearer, reader, or viewer to determine for themselves, or may be explicitly enca ...

moral
(
guilt Guilt may refer to: *Guilt (emotion) Guilt is a moral emotion that occurs when a person believes or realizes—accurately or not—that they have compromised their own standards of conduct or have violated universal moral A moral (from ...
and condemnation), and (emptiness and meaninglessness). According to Tillich, the last of these three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times while the others were predominant in earlier periods. Tillich argues that this anxiety can be
accepted ''Accepted'' is a 2006 American comedy film directed by Steve Pink and written by Adam Cooper, Bill Collage and Mark Perez. The plot follows a group of high school graduates who create their own fake college after being rejected from the colleg ...
as part of the
human condition The human condition is all of the characteristics and key events that compose the essentials of human existence, including birth Birth is the act or process of bearing or bringing forth offspring, also referred to in technical contexts as pa ...
or it can be resisted but with negative consequences. In its pathological form, spiritual anxiety may tend to "drive the person toward the creation of certitude in systems of meaning which are supported by
tradition A tradition is a belief A belief is an attitude Attitude may refer to: Philosophy and psychology * Attitude (psychology) In psychology Psychology is the science of mind and behavior. Psychology includes the study of conscious ...

tradition
and
authority In the fields of sociology Sociology is the study of society, human social behaviour, patterns of social relationships, social interaction, and culture that surrounds everyday life. It is a social science that uses various methods of Empiric ...

authority
" even though such "undoubted certitude is not built on the rock of
reality Reality is the sum or aggregate of all that is real or existent within a system, as opposed to that which is only imaginary Imaginary may refer to: * Imaginary (sociology), a concept in sociology * The Imaginary (psychoanalysis), a concept by ...

reality
". According to
Viktor Frankl Viktor Emil Frankl (26 March 1905 – 2 September 1997) was an Austrian neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine Medicine is the Art (skil ...
, the author of ''
Man's Search for Meaning ''Man's Search for Meaning'' is a 1946 book by Viktor Frankl Viktor Emil Frankl (26 March 1905 – 2 September 1997) was an Austrian neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, ...
'', when a person is faced with extreme mortal dangers, the most basic of all human wishes is to find a
meaning of life The meaning of life, or the answer to the question: "What is the meaning of life?", pertains to the significance of living Living or The Living may refer to: Common meanings *Life, a condition that distinguishes organisms from inorganic obj ...

meaning of life
to combat the "trauma of nonbeing" as death is near. Depending on the source of the threat, psychoanalytic theory distinguishes the following types of anxiety: * realistic * neurotic * moral


Test and performance

According to Yerkes-Dodson law, an optimal level of arousal is necessary to best complete a task such as an exam, performance, or competitive event. However, when the anxiety or level of arousal exceeds that optimum, the result is a decline in performance. Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an
exam A test or examination (exam or evaluation) is an educational assessment Educational assessment or educational evaluation is the systematic process of documenting and using empirical data on the knowledge Knowledge is a familiarity o ...
. Students who have test anxiety may experience any of the following: the association of
grades Grade or grading may refer to: Arts and entertainment * Grade (band), punk rock band * Grades (producer), British electronic dance music producer and DJ Education * Grading (education), a teacher's evaluation of a student's performance in class * ...
with personal worth; fear of embarrassment by a teacher; fear of alienation from parents or friends; time pressures; or feeling a loss of control. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, uncontrollable crying or laughing and drumming on a desk are all common. Because test anxiety hinges on
fear of negative evaluationFear of negative evaluation (FNE), also atychiphobia, is a psychological construct reflecting "Fear, apprehension about others' evaluations, distress over negative evaluations by others, and the expectation that others would evaluate one negatively" ...
, debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social
phobia A phobia is a type of anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or i ...
. The DSM-IV classifies test anxiety as a type of social phobia. While the term "test anxiety" refers specifically to students, many workers share the same experience with regard to their career or profession. The fear of failing at a task and being negatively evaluated for failure can have a similarly negative effect on the adult. Management of test anxiety focuses on achieving relaxation and developing mechanisms to manage anxiety.


Stranger, social, and intergroup anxiety

Humans generally require social acceptance and thus sometimes dread the disapproval of others. Apprehension of being judged by others may cause anxiety in social environments. 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 Stranger anxiety is a form of Distress (medicine), distress that children experience when exposed to Stranger, strangers. Stranger anxiety and stranger fear are two interchangeable terms. Stranger anxiety is a typical part of the Child development ...
" 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 Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorder Anxiety disorders are a cluster of ment ...
. According to Cutting, social phobics do not fear the crowd but the fact that they may be judged negatively.
Social anxiety Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorder Anxiety disorders are a cluster of ment ...
varies in degree and severity. For some people, it is characterized by experiencing discomfort or awkwardness during physical social contact (e.g. embracing, shaking hands, etc.), while in other cases it can lead to a fear of interacting with unfamiliar people altogether. Those suffering from this condition may restrict their lifestyles to accommodate the anxiety, minimizing social interaction whenever possible. Social anxiety also forms a core aspect of certain personality disorders, including
avoidant personality disorder Avoidant personality disorder (AvPD) is a Cluster C Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and devi ...
. 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. As is the case with the more generalized forms of
social anxiety Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorder Anxiety disorders are a cluster of ment ...
, intergroup anxiety has behavioral, cognitive, and affective effects. For instance, increases in schematic processing and simplified information processing can occur when anxiety is high. Indeed, such is consistent with related work on attentional bias in implicit memory. Additionally recent research has found that implicit racial evaluations (i.e. automatic prejudiced attitudes) can be amplified during intergroup interaction. Negative experiences have been illustrated in producing not only negative expectations, but also avoidant, or antagonistic, behavior such as hostility. Furthermore, when compared to anxiety levels and cognitive effort (e.g., impression management and self-presentation) in intragroup contexts, levels and depletion of resources may be exacerbated in the intergroup situation.


Trait

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). A meta-analysis showed that a high level of
neuroticism In the study of psychology Psychology is the scientific Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or something, such as facts A fact is an o ...
is a risk factor for development of anxiety symptoms and disorders. Such anxiety may be conscious or unconscious. Personality can also be a trait leading to anxiety and depression. Through experience, many find it difficult to collect themselves due to their own personal nature.


Choice or decision

Anxiety induced by the need to choose between similar options is increasingly being recognized as a problem for individuals and for organizations. In 2004,
Capgemini Capgemini SE is a French multinational corporation A multinational company (MNC) is a corporate A corporation is an organization—usually a group of people or a company A company, abbreviated as co., is a Legal personality, leg ...

Capgemini
wrote: "Today we're all faced with greater choice, more competition and less time to consider our options or seek out the right advice." In a decision context, unpredictability or uncertainty may trigger emotional responses in anxious individuals that systematically alter decision-making. There are primarily two forms of this anxiety type. The first form refers to a choice in which there are multiple potential outcomes with known or calculable probabilities. The second form refers to the uncertainty and ambiguity related to a decision context in which there are multiple possible outcomes with unknown probabilities.


Panic disorder

Panic disorder may share symptoms of stress and anxiety, but it is actually very different. Panic disorder is an anxiety disorder that occurs without any triggers. According to the U.S Department of Health and Human Services, this disorder can be distinguished by unexpected and repeated episodes of intense fear. Someone who suffers from panic disorder will eventually develop constant fear of another attack and as this progresses it will begin to affect daily functioning and an individual's general quality of life. It is reported by the Cleveland Clinic that panic disorder affects 2 to 3 percent of adult Americans and can begin around the time of the teenage and early adult years. Some symptoms include: difficulty breathing, chest pain, dizziness, trembling or shaking, feeling faint, nausea, fear that you are losing control or are about to die. Even though they suffer from these symptoms during an attack, the main symptom is the persistent fear of having future panic attacks.


Anxiety disorders

Anxiety disorders are a group of
mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing In internal medici ...
s characterized by exaggerated feelings of
anxiety Anxiety is an emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavioural responses, and a degree of pleasure or suffering, disp ...
and
fear Fear is an intensely unpleasant emotion Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent with a pr ...

fear
responses. 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 Tachycardia, also called tachyarrhythmia, is a heart rateHeart rate is the speed of the heartbeat measured by the number of contractions (beats) of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pu ...
and shakiness. There are a number of anxiety disorders: including
generalized anxiety disorder Generalized anxiety disorder (GAD) is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi romantic ...

generalized anxiety disorder
,
specific phobia Specific phobia is an anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impair ...
,
social anxiety disorder Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental p ...
,
separation anxiety disorder Separation anxiety disorder (SAD) is an anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes signi ...
,
agoraphobia Agoraphobia is an anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impair ...
,
panic disorder Panic disorder is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi romantic-action movie * ''M ...
, and
selective mutism Selective mutism (SM) is an anxiety disorder in which a person who is otherwise capable of speech becomes unable to speech, speak when exposed to specific situations, specific places, or to specific people, one or multiple of which serving as Traum ...
. The disorder differs by what results in the symptoms. People often have more than one anxiety disorder. Anxiety disorders are caused by a complex combination of and environmental factors. To be diagnosed, symptoms typically need to be present for at least six months, be more than would be expected for the situation, and decrease a person's ability to function in their daily lives. Other problems that may result in similar symptoms include
hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormone File:Thyroid_system.svg, upright=1.5, The thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck ...
,
heart disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina pectoris, angina and myocardial infarction (commonly known as a heart attack). Other CVDs inc ...
,
caffeine Caffeine is a central nervous system The central nervous system (CNS) is the part of the nervous system In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structu ...

caffeine
,
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...
, or
cannabis ''Cannabis'' () is a genus Genus /ˈdʒiː.nəs/ (plural genera /ˈdʒen.ər.ə/) is a taxonomic rank In biological classification In biology Biology is the natural science that studies life and living organisms, including ...
use, and withdrawal from certain drugs, among others. Without treatment, anxiety disorders tend to remain. Treatment may include lifestyle changes,
counselling Counseling is the professional guidance of the individual by utilizing psychological methods especially in collecting case history data, using various techniques of the personal interview, and testing interests and aptitudes. This is a list of co ...
, and medications. Counselling is typically with a type of
cognitive behavioural therapy Cognitive behavioral therapy (CBT) is a Psychosocial, psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing cognitive distortions (e.g. thoughts, beliefs, and attitudes) and behaviors, improving e ...
. Medications, such as
antidepressants Antidepressants are medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, therapy, treat, or preventive medicine, prevent disea ...
or
beta blockers Beta blockers (beta-blockers, β-blockers, etc.) are a class of medications that are predominantly used to manage cardiac arrhythmia, abnormal heart rhythms, and to protect the heart from a second heart attack (myocardial infarction) after a firs ...
, may improve symptoms. 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. They occur about twice as often in women than they do in men, and generally begin before the age of 25. 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.


Short- and long-term anxiety

Anxiety can be either a short-term "state" or a long-term "
trait Trait may refer to: * Phenotypic trait in biology, which involve genes and characteristics of organisms * Trait (computer programming), a model for structuring object-oriented programs (a template class in the C++ programming language) * Trait the ...
." Whereas trait anxiety represents worrying about future events, anxiety disorders are a group of
mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing In internal medici ...
s characterized by feelings of anxiety and fear.


Co-morbidity

Anxiety disorders often occur with other mental health disorders, particularly
major depressive disorder Major depressive disorder (MDD), also known simply as depression, is a mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impai ...
,
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of ...

bipolar disorder
,
eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's health, physical or mental health, mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders ...
s, or certain
personality disorder Personality disorders (PD) are a class of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. ...
s. It also commonly occurs with personality traits such as neuroticism. This observed co-occurrence is partly due to genetic and environmental influences shared between these traits and anxiety. Anxiety is often experienced by those with
obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi r ...
and is an acute presence in
panic disorder Panic disorder is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi romantic-action movie * ''M ...
.


Risk factors

Anxiety disorders are partly genetic, with twin studies suggesting 30-40% genetic influence on individual differences in anxiety. Environmental factors are also important. Twin studies show that individual-specific environments have a large influence on anxiety, whereas shared environmental influences (environments that affect twins in the same way) operate during childhood but decline through adolescence. Specific measured ‘environments’ that have been associated with anxiety include
child abuse Child abuse or child maltreatment is physical Physical may refer to: *Physical examination, a regular overall check-up with a doctor *Physical (album), ''Physical'' (album), a 1981 album by Olivia Newton-John **Physical (Olivia Newton-John so ...

child abuse
, family history of mental health disorders, and
poverty Poverty is the state of having little material possessions or income In microeconomics, income is the Consumption (economics), consumption and saving opportunity gained by an entity within a specified timeframe, which is generally expresse ...

poverty
. Anxiety is also associated with drug use, including
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...
,
caffeine Caffeine is a central nervous system The central nervous system (CNS) is the part of the nervous system In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structu ...

caffeine
, and
benzodiazepines Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of psychoactive drug A psychoactive drug, psychopharmaceutical, psychoactive agent, or psychotropic drug, is a chemical substance that changes nervous system function and r ...
(which are often prescribed to treat anxiety).


Neuroanatomy

Neural circuitry involving the
amygdala The amygdala (; plural: amygdalae or amygdalas; also '; Latin from Greek language, Greek, , ', 'almond', 'tonsil') is one of two almond-shaped clusters of nucleus (neuroanatomy), nuclei located deep and lateral and medial, medially within the ...

amygdala
(which regulates emotions like anxiety and fear, stimulating the
HPA axis The pascal (symbol: Pa) is the SI derived unit SI derived units are units of measurement ' Measurement is the number, numerical quantification (science), quantification of the variable and attribute (research), attributes of an object or event, ...
and
sympathetic nervous system The sympathetic nervous system (SNS) is one of two divisions of the autonomic nervous system The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle ...
) and
hippocampus The hippocampus (via Latin from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its popul ...

hippocampus
(which is implicated in emotional memory along with the amygdala) is thought to underlie anxiety. People who have anxiety tend to show high activity in response to emotional stimuli in the amygdala. Some writers believe that excessive anxiety can lead to an overpotentiation of the limbic system (which includes the amygdala and nucleus accumbens), giving increased future anxiety, but this does not appear to have been proven. Research upon adolescents who as infants had been highly apprehensive, vigilant, and fearful finds that their
nucleus accumbens The nucleus accumbens (NAc or NAcc; also known as the accumbens nucleus, or formerly as the ''nucleus accumbens septi'', Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin w ...

nucleus accumbens
is more sensitive than that in other people when deciding to make an action that determined whether they received a reward. 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".


The gut-brain axis

The microbes of the gut can connect with the brain to affect anxiety. There are various pathways along which this communication can take place. One is through the major neurotransmitters. The gut microbes such as ''Bifidobacterium'' and ''Bacillus'' produce the neurotransmitters GABA and dopamine, respectively. The neurotransmitters signal to the nervous system of the gastrointestinal tract, and those signals will be carried to the brain through the vagus nerve or the spinal system. This is demonstrated by the fact that altering the microbiome has shown anxiety- and depression-reducing effects in mice, but not in subjects without vagus nerves. Another key pathway is the HPA axis, as mentioned above. The microbes can control the levels of cytokines in the body, and altering cytokine levels creates direct effects on areas of the brain such as the hypothalmus, the area that triggers HPA axis activity. The HPA axis regulates production of cortisol, a hormone that takes part in the body's stress response. When HPA activity spikes, cortisol levels increase, processing and reducing anxiety in stressful situations. These pathways, as well as the specific effects of individual taxa of microbes, are not yet completely clear, but the communication between the gut microbiome and the brain is undeniable, as is the ability of these pathways to alter anxiety levels. With this communication comes the potential to treat anxiety. Prebiotics and probiotics have been shown to reduced anxiety. For example, experiments in which mice were given fructo- and galacto-oligosaccharide prebiotics and ''Lactobacillus'' probiotics have both demonstrated a capability to reduce anxiety. In humans, results are not as concrete, but promising.


Genetics

Genetics and family history (e.g. parental anxiety) may put an individual at increased risk of an anxiety disorder, but generally external stimuli will trigger its onset or exacerbation. Estimates of genetic influence on anxiety, based on studies of twins, range from 25–40% depending on the specific type and age-group under study. For example, genetic differences account for about 43% of variance in panic disorder and 28% in generalized anxiety disorder. Longitudinal twin studies have shown the moderate stability of anxiety from childhood through to adulthood is mainly influenced by stability in genetic influence. When investigating how anxiety is passed on from parents to children, it is important to account for sharing of genes as well as environments, for example using the intergenerational children-of-twins design. Many studies in the past used a candidate gene approach to test whether single genes were associated with anxiety. These investigations were based on hypotheses about how certain known genes influence neurotransmitters (such as serotonin and norepinephrine) and hormones (such as cortisol) that are implicated in anxiety. None of these findings are well replicated, with the possible exception of TMEM132D, COMT and MAO-A. The epigenetic signature of ''BDNF'', a gene that codes for a protein called ''brain derived neurotrophic factor'' that is found in the brain, has also been associated with anxiety and specific patterns of neural activity. and a receptor gene for ''BDNF'' called ''NTRK2'' was associated with anxiety in a large genome-wide investigation. The reason that most candidate gene findings have not replicated is that anxiety is a complex trait that is influenced by many genomic variants, each of which has a small effect on its own. Increasingly, studies of anxiety are using a hypothesis-free approach to look for parts of the genome that are implicated in anxiety using big enough samples to find associations with variants that have small effects. The largest explorations of the common genetic architecture of anxiety have been facilitated by the UK Biobank, the ANGST consortium and th
CRC Fear, Anxiety and Anxiety Disorders


Medical conditions

Many medical conditions can cause anxiety. This includes conditions that affect the ability to breathe, like
COPD Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease The lungs are the primary Organ (anatomy), organs of the respiratory system in humans and many other animals including a few fish and some snails. In mammal ...

COPD
and
asthma Asthma is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank Consolidation", M. E. Sharpe, Inc., 2002 based in Greenwich, ...

asthma
, and the difficulty in breathing that often occurs near death. Conditions that cause abdominal pain or chest pain can cause anxiety and may in some cases be a
somatization Somatization is a tendency to experience and communicate psychological distress in the form of bodily and organic Organic may refer to: * Organic, of or relating to an organism, a living entity * Organic, of or relating to an anatomical organ (anat ...
of anxiety; the same is true for some sexual dysfunctions. Conditions that affect the face or the skin can cause social anxiety especially among adolescents, and developmental disabilities often lead to social anxiety for children as well. Life-threatening conditions like cancer also cause anxiety. Furthermore, certain organic diseases may present with anxiety or symptoms that mimic anxiety. These disorders include certain endocrine diseases ( and
hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormone File:Thyroid_system.svg, upright=1.5, The thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck ...
,
hyperprolactinemia Hyperprolactinaemia is the presence of abnormally high levels of prolactin Prolactin (PRL), also known as lactotropin, is a protein best known for its role in enabling mammals (and birds), usually females, to lactation, produce milk. It is i ...
), metabolic disorders (
diabetes Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorder A metabolic disorder is a disorder that negatively alters the body's processing and distribution of macronutrients such as proteins, fats, and carbohydrate ...
), deficiency states (low levels of
vitamin D Vitamin D is a group of fat-soluble secosteroid 250px, The parent steroid skeleton. The B-ring of the parent steroid is broken between C9 and C10 to yield D vitamins. A secosteroid () is a type of steroid , hypothetical a steroid with ...
, ,
B12 Vitamin B12, also known as cobalamin, is a water-soluble vitamin A vitamin is an organic molecule , CH4; is among the simplest organic compounds. In chemistry, organic compounds are generally any chemical compounds that contain carbo ...

B12
,
folic acid Folate, also known as vitamin B9 and folacin, is one of the B vitamins B vitamins are a class of water-soluble vitamin A vitamin is an organic molecule , CH4; is among the simplest organic compounds. In chemistry, organic compounds ar ...

folic acid
), gastrointestinal diseases (
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
,
non-celiac gluten sensitivity Non-celiac gluten sensitivity (NCGS) or gluten sensitivity is "a clinical entity induced by the ingestion of gluten Gluten is a protein naturally found in some grains including wheat, barley, and rye. Although, strictly speaking, "gluten" per ...
,
inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory Inflammatory may refer to: * Inflammation, a biological response to harmful stimuli * The word ''inflammatory'' is also used to refer literally to fire and flammability, and figuratively ...
), heart diseases, blood diseases (
anemia Anemia (American and British English spelling differences#ae and oe, also spelled anaemia) is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. When anemia c ...

anemia
), cerebral vascular accidents (
transient ischemic attack A transient ischemic attack (TIA), commonly known as a mini-stroke, is a brief episode of neurological dysfunction caused by loss of blood flow (ischemia Ischemia or ischaemia is a restriction in blood Blood is a body fluid Body fluids, ...
,
stroke A stroke is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. Di ...

stroke
), and brain degenerative diseases (
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a chronic condition, long-term neurodegeneration, degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disea ...
,
dementia Dementia manifests as a set of related symptoms, which usually surface when the brain is damaged by injury or disease. The symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or ...
,
multiple sclerosis Multiple sclerosis (MS), also known as encephalomyelitis disseminata, is the most common demyelinating disease A demyelinating disease is any disease of the nervous system in which the myelin sheath of neurons is damaged. This damage impa ...
,
Huntington's disease Huntington's disease (HD), also known as Huntington's chorea, is a neurodegenerative disease that is mostly Genetic disorder#Autosomal dominant, inherited. The earliest symptoms are often subtle problems with mood or mental abilities. A gener ...
), among others.


Substance-induced

Several drugs can cause or worsen anxiety, whether in intoxication, withdrawal or as side effect. These include
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...
,
tobacco Tobacco is the common name of several plants in the genus Genus /ˈdʒiː.nəs/ (plural genera /ˈdʒen.ər.ə/) is a taxonomic rank In biological classification In biology, taxonomy () is the scientific study of naming, defini ...

tobacco
,
cannabis ''Cannabis'' () is a genus Genus /ˈdʒiː.nəs/ (plural genera /ˈdʒen.ər.ə/) is a taxonomic rank In biological classification In biology Biology is the natural science that studies life and living organisms, including ...

cannabis
,
sedative A sedative or tranquilliser is a substance that induces sedation by reducing irritability or Psychomotor agitation, excitement. They are Central nervous system, CNS depressants and interact with brain activity causing its deceleration. Various ki ...
s (including prescription
benzodiazepine Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of psychoactive drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. The first such drug, chlordiazepoxide (Librium), was role of chance ...

benzodiazepine
s),
opioid Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use ...
s (including prescription pain killers and illicit drugs like heroin),
stimulant Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drug Uncoated tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and b ...
s (such as
caffeine Caffeine is a central nervous system The central nervous system (CNS) is the part of the nervous system In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structu ...

caffeine
,
cocaine Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a tropane alkaloid and stimulant drug obtained primarily from the leaves of two coca species native to South America, ''Erythroxylum coca'' and ''Erythroxylu ...

cocaine
and amphetamines),
hallucinogen A hallucinogen is a psychoactive agent that often or ordinarily causes hallucinations A hallucination is a perception Perception (from the Latin ''perceptio'', meaning gathering or receiving) is the organization, identification, ...
s, and
inhalants Inhalants are a broad range of household and industrial chemicals whose volatile vapors or pressurized gases can be concentrated and breathed in via the nose or mouth to produce intoxication, in a manner not intended by the manufacturer. They ...
. While many often report self-medicating anxiety with these substances, improvements in anxiety from drugs are usually short-lived (with worsening of anxiety in the long term, sometimes with acute anxiety as soon as the drug effects wear off) and tend to be exaggerated. Acute exposure to toxic levels of
benzene Benzene is an organic Organic may refer to: * Organic, of or relating to an organism, a living entity * Organic, of or relating to an anatomical organ (anatomy), organ Chemistry * Organic matter, matter that has come from a once-living organ ...

benzene
may cause euphoria, anxiety, and irritability lasting up to 2 weeks after the exposure.


Psychological

Poor
coping skills Coping is conscious or unconscious strategies used to reduce unpleasant emotions. Coping strategies can be cognitions or behaviours and can be individual or social. Theories of coping Hundreds of coping strategies have been identified. Classific ...
(e.g., rigidity/inflexible problem solving, denial, avoidance, impulsivity, extreme self-expectation, negative thoughts, affective instability, and inability to focus on problems) are associated with anxiety. Anxiety is also linked and perpetuated by the person's own pessimistic outcome expectancy and how they cope with feedback negativity. Temperament (e.g.,
neuroticism In the study of psychology Psychology is the scientific Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or something, such as facts A fact is an o ...
) and attitudes (e.g. pessimism) have been found to be risk factors for anxiety.
Cognitive distortion A cognitive distortion is an exaggerated or irrational thought pattern involved in the onset or perpetuation of psychopathological Psychopathology is the study of abnormal cognitions, behaviour and experiences which differs according to social ...
s such as overgeneralizing, catastrophizing, mind reading,
emotional reasoning Emotional reasoning is a cognitive process by which an individual concludes that their Emotion, emotional reaction proves something is true, despite contrary empirical evidence. Emotional reasoning creates an 'emotional truth', which may be in di ...
, binocular trick, and mental filter can result in anxiety. For example, an overgeneralized belief that something bad "always" happens may lead someone to have excessive fears of even minimally risky situations and to avoid benign social situations due to anticipatory anxiety of
embarrassment Embarrassment or awkwardness is an emotion Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent with ...

embarrassment
. In addition, those who have high anxiety can also create future stressful life events. Together, these findings suggest that anxious thoughts can lead to anticipatory anxiety as well as stressful events, which in turn cause more anxiety. Such unhealthy thoughts can be targets for successful treatment with
cognitive therapy Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one therapeutic approach within the larger group of cognitive behavior therapy, cognitive behavioral therapies (CBT) and was first expounded ...
.
Psychodynamic Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces that underlie human behavior, feelings, and emotions and how they might relate ...
theory posits that anxiety is often the result of opposing
unconscious Unconscious may refer to: Physiology * Unconsciousness, the lack of consciousness or responsiveness to people and other environmental stimuli Psychology * Unconscious mind, the mind operating well outside the attention of the conscious mind as ...
wishes or fears that manifest via maladaptive
defense mechanisms In psychoanalytic theory Psychoanalytic theory is the theory A theory is a rational Rationality is the quality or state of being rational – that is, being based on or agreeable to reason Reason is the capacity of consciously makin ...
(such as suppression, repression, anticipation, regression, somatization, passive aggression, dissociation) that develop to adapt to problems with early
objects Object may refer to: General meanings * Object (philosophy) An object is a philosophy, philosophical term often used in contrast to the term ''Subject (philosophy), subject''. A subject is an observer and an object is a thing observed. For mo ...
(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.


Evolutionary psychology

An
evolutionary psychology Evolutionary psychology is a theoretical approach in the social Social organisms, including humans, live collectively in interacting populations. This interaction is considered social whether they are aware of it or not, and whether the exchan ...
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 A false positive is an error in binary classification in which a test result incorrectly indicates the presence of a condition (such as a disease when the disease is not present), while a false negative is the opposite error, where the test result ...
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. There is ample empirical evidence that anxiety can have adaptive value. Within a school, timid fish are more likely than bold fish to survive a predator. When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased blood flow in the
amygdala The amygdala (; plural: amygdalae or amygdalas; also '; Latin from Greek language, Greek, , ', 'almond', 'tonsil') is one of two almond-shaped clusters of nucleus (neuroanatomy), nuclei located deep and lateral and medial, medially within the ...

amygdala
. In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.


Social

Social risk factors for anxiety include a history of trauma (e.g., physical, sexual or emotional abuse or assault), bullying, early life experiences and parenting factors (e.g., rejection, lack of warmth, high hostility, harsh discipline, high parental
negative affect Negative affectivity (NA), or negative affect, is a personality variable that involves the experience of negative emotions and poor self-concept. Negative affectivity subsumes a variety of negative emotions, including anger, contempt, disgust, guil ...
, anxious childrearing, modelling of dysfunctional and drug-abusing behaviour, discouragement of emotions, poor socialization, poor attachment, and child abuse and neglect), cultural factors (e.g., stoic families/cultures, persecuted minorities including the disabled), and socioeconomics (e.g., uneducated, unemployed, impoverished although developed countries have higher rates of anxiety disorders than developing countries). A 2019 comprehensive systematic review of over 50 studies showed that food insecurity in the United States is strongly associated with depression, anxiety, and sleep disorders. Food-insecure individuals had an almost 3 fold risk increase of testing positive for anxiety when compared to food-secure individuals.


Gender socialization

Contextual factors that are thought to contribute to anxiety include gender socialization and learning experiences. In particular, learning mastery (the degree to which people perceive their lives to be under their own control) and instrumentality, which includes such traits as self-confidence,
self-efficacy Self-efficacy, a concept originally proposed by the psychologist Albert Bandura Albert Bandura (; born December 4, 1925) is a Canadian Canadians (french: Canadiens) are people identified with the country of Canada. This connection may be r ...
, independence, and competitiveness fully mediate the relation between gender and anxiety. That is, though gender differences in anxiety exist, with higher levels of anxiety in women compared to men, gender socialization and learning mastery explain these gender differences.


Treatment

The first step in the management of a person with anxiety symptoms involves evaluating the possible presence of an underlying medical cause, the recognition of which is essential in order to decide the correct treatment. Anxiety symptoms may mask an
organic disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not due to any immediate external injury. Diseases are often known to be medical conditions that ar ...
, or appear associated with or as a result of a medical disorder.
Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (e. ...
(CBT) is effective for anxiety disorders and is a first line treatment. CBT appears to be equally effective when carried out via the internet. While evidence for mental health apps is promising, it is preliminary. Psychopharmacological treatment can be used in parallel to CBT or can be used alone. As a general rule, most anxiety disorders respond well to first-line agents. First-line drugs are the
selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs A drug class is a set of medication A medication (also referred to as medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, d ...
s and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, and moclobemide, among others.


Prevention

The above risk factors give natural avenues for prevention. A 2017 review found that psychological or educational interventions have a small yet statistically significant benefit for the prevention of anxiety in varied population types.


Pathophysiology

Anxiety disorder appears to be a genetically inherited neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol. In the
central nervous system The central nervous system (CNS) is the part of the nervous system In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecu ...

central nervous system
(CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the
autonomic nervous system The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle and glands, and thus influences the function of viscera, internal organs. The autonomic nervous ...

autonomic nervous system
, especially the sympathetic nervous system, mediates many of the symptoms. Increased flow in the right parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients are the diagnostic factors for prevalence of anxiety disorder. The amygdala is central to the processing of fear and anxiety, and its function may be disrupted in anxiety disorders. Anxiety processing in the basolateral amygdala has been implicated with dendritic arborization of the amygdaloid neurons. SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization.


See also

* List of people with an anxiety disorder * * * * *


References


External links

* * {{Authority control Emotions Mental states in Csikszentmihalyi's flow model