Anxiety and anxiety disorders: symptoms, causes and treatment

By Cristiano Antonino On Dec 28, 2022

Anxiety is a term widely used to refer to a complex of cognitive, behavioural and physiological reactions that occur as a result of the perception of a stimulus that is deemed threatening and to which we do not feel sufficiently capable of reacting

Anxiety in itself, however, is not an abnormal phenomenon

It is a basic emotion that involves a state of activation of the organism when a situation is subjectively perceived as dangerous.

Anxiety symptoms

Cognitive symptoms of anxiety

From a cognitive point of view, the typical symptoms of anxiety are:

a sense of mental emptiness
a growing sense of alarm and danger
the induction of negative images, memories and thoughts
the enactment of cognitive protective behaviour
the marked feeling of being observed and being the focus of others’ attention.

Behavioural symptoms of anxiety

In the human species, anxiety results in an immediate tendency to explore the environment, seeking explanations, reassurance and escape routes.

The main instinctive anxiety management strategy is also avoidance of the feared situation (‘better safe than sorry’ strategy).

Protective (being accompanied, taking anxiolytics as needed, etc.), anaxertive and submissive behaviour are also common.

Physical symptoms of anxiety

Anxiety is also often accompanied by physical and physiological manifestations such as

tension
trembling
sweating
palpitation
increased heart rate
dizziness
nausea
tingling in the extremities and around the mouth
derealisation and depersonalisation.

Below we will describe some of the physical symptoms of anxiety, how they manifest themselves and what the possible consequences are:

Palpitations

It is necessary, as far as possible, to distinguish different conditions related to palpitations: heart palpitation, tachycardia and arrhythmia.

The latter, for example, often occurs with irregular beats even in healthy people, during their daily activities and is more likely to occur when the person is anxious.

It can be induced by a number of agents such as nicotine, caffeine, alcohol and electrolyte imbalance.

Often the interpretation given to such a physical symptom during an anxious state is linked to the idea of having a heart attack.

This is even though underlying this is an increased electrophysiological excitability of the heart muscle that has no negative medical consequences.

Chest pain

This is a physical symptom that can occur during periods of high anxiety in the absence of a cardiac disorder.

It can arise from different sources such as chest breathing and gastrointestinal disorders (e.g. oesophageal reflux or oesophageal spasms).

When the person interprets the benign causes of pain catastrophically, it is possible that the anxious state increases, even leading to panic.

But in reality we know that when a very high state of anxiety emerges, the body secretes adrenaline which causes the heart rate to increase and the body works faster.

It is an evolutionary way to better prepare the person to handle dangerous situations.

If adrenaline damaged the heart, how could man have survived until today? So, the acceleration of the heartbeat due to anxiety states does not cause heart attacks; there must be something pathological for this to happen.

Sensation of breathlessness

Breathing is an action that functions independently of what a person thinks or does; it is automatically controlled by the brain.

In fact, brain controls work even when one tries to stop breathing.

The feeling of breathlessness is very common in anxiety disorders and results from prolonged and repeated chest (pectoral) breathing.

In fact, a physical response to stress is the relative dominance of thoracic breathing over abdominal breathing, which leads to fatigue of the intercostal muscles, which strain and spasm, causing discomfort and pectoral pain inducing the shortness of breath sensation.

If one fails to realise that these sensations are induced by thoracic breathing, then they will seem sudden, frightening, leading the person to become further alarmed.

Nausea or abdominal discomfort

The stomach contracts and relaxes in a regular and constant manner.

When this rhythm is disturbed, nausea occurs.

Various factors can lead to this physical sensation such as the ingestion of certain foods, vestibular disturbances, postural hypotension or even previously neutral stimuli.

The function of nutrition and digestion are the first to shut down during a state of alertness, but if the person misinterprets nausea as a sign of impending vomiting, anxiety is more likely to increase and lead to panic.

But, fortunately, that nausea leads to vomiting rarely happens, it is more likely that people overestimate this.

Tremors and sweating

The former are involuntary, oscillatory and rhythmic movements of one or more parts of the body, caused by the alternating contraction of opposing muscle movements.

Sweating, on the other hand, helps control body temperature, which rises when there is anxiety.

In fact, stress stimulates the sympathetic nervous system with increased levels of adrenalin and noradrenalin that stimulate an increase in metabolism, thus increasing the production of heat and the consequent sweating that helps lower body temperature.

Again, the greater the alertness and catastrophisation with respect to these physical symptoms, the greater the likelihood that they will increase in intensity.

Vertigo

Vertigo is the product of the illusion of movement of the self or the environment.

They consist of feelings of confusion or dizziness or light-headedness.

When information from the balance system (visual, somatosensory and vestibular systems) conflicts, vertigo occurs.

Balance problems and associated physical symptoms (unsteadiness, anxiety, cold sweats, palpitations) can also occur as a result of anxiety, hyperventilation and common stress reactions such as clenching of the jaw and teeth.

Obviously, the intensity of vertigo may increase if more attention is paid to these sensations.

Derealisation or depersonalisation

Depersonalisation (feeling of unreality) or depersonalisation (feeling detached from oneself), are experiences that can be induced by fatigue, sleep deprivation, meditation, relaxation or the use of substances, alcohol and benzodiazepines.

There are also other more subtle causes related to brief periods of sensory deprivation or reduction of sensory input, such as staring at a dot on a wall for three minutes.

The curious aspect is that, here too, the vicious circle is established according to the interpretation given to these physical symptoms. When experiencing depersonalisation or derealisation (which one third of the population has experienced), the more a person is frightened, the more he or she breathes, the more he or she is charged with oxygen (eliminating carbon dioxide) the more the feeling of depersonalisation or derealisation increases.

The fear of fear

The physical symptoms of anxiety often frighten by generating vicious circles, i.e. the so-called ‘fear of fear’.

However, they depend on the fact that, assuming it is in a situation of real danger, the anxious organism needs the maximum muscular energy at its disposal in order to escape or attack as effectively as possible, averting the danger and ensuring its survival.

Anxiety, therefore, is not just a limitation or a disorder, but an important resource.

It is in fact an effective physiological condition at many moments in life to protect us from risks, maintain a state of alertness and improve performance (e.g. under examination).

When the activation of the anxiety system is excessive, unjustified or disproportionate to the situation, however, we are faced with an anxiety disorder, which can greatly complicate a person’s life and make him or her unable to cope with even the most common situations.

Anxiety disorders

Known and clearly diagnosable anxiety disorders are the following (click for more details):

Specific phobia (aeroplane, enclosed spaces, spiders, dogs, cats, insects, etc.).
Panic disorder and agoraphobia (fear of being in situations from which there is no quick escape)
Obsessive-compulsive disorder
Social phobia
Post-traumatic stress disorder
Generalised anxiety disorder

These disorders are among the most frequent in the population, create great disability and often do not respond well to pharmacological treatment.

It is therefore necessary to effectively intervene on them with targeted short psychotherapeutic interventions with a cognitive-behavioural orientation, which have proven highly effective in hundreds of scientific studies.

By clicking on the individual disorders, you can learn more about them and the scientifically valid treatment methods.

Anxiety, treatment and remedies

When anxiety becomes extreme and uncontrollable, resulting in one of the above-mentioned anxiety disorders, professional intervention is needed to help the person manage such troublesome and disabling symptoms.

Psychotherapy for anxiety

Psychotherapy for anxiety disorders is undoubtedly the main treatment and one that is difficult to do without.

Cognitive behavioural therapy in particular has shown very high efficacy rates and has established itself in the scientific community as the strategy of first choice in the treatment of anxiety and its disorders.

The intervention usually takes several months, with weekly sessions, and it is extremely rare for it to be provided by public services.

It is therefore necessary to turn to a serious private cognitive-behavioural psychotherapy centre that guarantees high quality and professionalism.

Pharmacological anxiety therapy

Anxiolytic drugs, especially the ‘famous’ benzodiazepines, are widely used but are only useful if used occasionally and for very short periods.

Otherwise, they present major problems of addiction and withdrawal that make the situation worse rather than better.

Even the latest generation of antidepressant drugs are easily prescribed with an anxiolytic function in the treatment of anxiety disorders.

They have a certain efficacy, but this is usually lost when the therapy is discontinued, as well as very often presenting side effects (drowsiness, sexual dysfunction, gastrointestinal problems, weight gain, etc.).

Remedies of another nature

Anxiety, especially when it does not reach extreme levels typical of a true anxiety disorder, can be managed with relaxation techniques, mindfulness meditation strategies and natural remedies such as valerian or other calming herbal products.

These remedies for anxiety can be helpful and adjuvant to psychotherapeutic treatment, but are unlikely to be decisive.

Resources on anxiety