Anxiety Symptoms: Normal Worry vs an Anxiety Disorder

Common anxiety symptoms include constant worry, feeling restless or on edge, trouble concentrating, a pounding heart, sweating, an upset stomach and poor sleep. Everyone feels anxious at times, but it may be an anxiety disorder when the worry is intense, hard to control, lasts for months and gets in the way of work, studies or family life. Anxiety disorders are common, and effective treatments exist.

Worry about exams, money, a rishta, a sick parent or a job is part of ordinary life. This guide explains how to tell everyday worry apart from an anxiety disorder, what symptoms to look out for, and how to get help.

Normal worry vs an anxiety disorder

The National Institute of Mental Health (NIMH) puts it simply: feeling anxious is a normal part of life, and many people worry about health, money, school, work or family. But anxiety disorders involve more than occasional worry or fear. For people with these disorders, anxiety does not go away, is felt in many situations, and can get worse over time.

The World Health Organization (WHO) adds that in anxiety disorders the fear and worry are both intense and excessive, difficult to control, cause significant distress, and can last a long time if untreated.

The NHS says that most people feel anxious sometimes and it does not always mean you have generalised anxiety disorder (GAD). It is more likely to be GAD if you feel anxious most of the time and it affects your everyday life.

Psychological and physical anxiety symptoms

Anxiety affects both the mind and the body. Putting together what WHO and the NHS list:

In your thoughts and feelings

• feelings of stress or worry that affect your daily life and are hard to control
• trouble concentrating or making decisions
• feeling irritable, tense or restless
• a sense of impending danger, panic or doom
• low mood or depression
• avoiding situations that make you anxious

In your body

• a noticeable, fast or unusual heartbeat (palpitations)
• sweating, trembling or shaking
• nausea, stomach problems or abdominal discomfort
• feeling lightheaded or dizzy
• trouble sleeping
• getting tired easily (if tiredness is your main problem, our guide on why you might always feel tired covers other causes)
• feeling physically tense

WHO also notes that anxiety disorders increase the risk of depression and substance use problems, as well as the risk of suicidal thoughts and behaviours. This is one reason why anxiety deserves proper attention rather than being brushed aside.

Types of anxiety disorders, and who gets them

NIMH and WHO describe several types of anxiety disorder. WHO lists these:

• Generalised anxiety disorder (GAD): persistent and excessive worry about daily activities or events.
• Panic disorder: panic attacks and fear of having more panic attacks.
• Social anxiety disorder: high levels of fear and worry about social situations that might make the person feel humiliated, embarrassed or rejected.
• Agoraphobia: excessive fear, worry and avoidance of situations that might cause panic or make a person feel trapped, helpless or embarrassed.
• Separation anxiety disorder: excessive fear or worry about being separated from people the person is deeply attached to.
• Specific phobias: intense, irrational fears of particular objects or situations that lead to avoidance and distress.
• Selective mutism: consistently being unable to speak in certain social situations despite speaking comfortably in others, mainly affecting children.

It is common to have more than one anxiety disorder at the same time. WHO says symptoms often begin in childhood or adolescence and continue into adulthood, and that girls and women are more likely to be affected than boys and men.

Anxiety disorders come from a mix of social, psychological and biological factors. Anyone can develop one. According to WHO and the NHS, the chances are higher if you have:

• lived through abuse, severe loss, domestic violence, bullying or other traumatic experiences
• close relatives with anxiety, depression or other mental health conditions
• a painful long-term health condition, such as arthritis
• a history of drug or alcohol misuse
• another anxiety disorder already

Panic attacks: what they can feel like

WHO describes panic disorder as panic attacks along with a fear of having more of them. The NHS describes it as sudden attacks of anxiety and panic. Many of the physical anxiety symptoms listed above, such as a pounding heart, sweating, trembling, nausea, dizziness and a sense of doom, can feel overwhelming when they arrive suddenly and strongly.

WHO notes that people with anxiety disorders usually avoid the situations that make them anxious. For someone who fears panic, that might mean steering clear of a crowded bazaar, a bus or a wedding hall. When fear, worry and avoidance of situations that might cause panic or make a person feel trapped become excessive, WHO calls this agoraphobia.

Because a racing heart and dizziness can be frightening, it is sensible to see a doctor. They will ask about your worries and physical symptoms so they can diagnose or rule out an anxiety disorder.

Self-help that can ease anxiety

WHO says self-care can play an important role in supporting treatment. The NHS and WHO suggest:

• Talk about it. Share your feelings with a friend, family member, health professional or counsellor.
• Try self-help tools. Books, websites, apps and online courses based on cognitive behavioural therapy (CBT) can help.
• Learn to relax. Slow breathing, progressive muscle relaxation, yoga and a few minutes of mindfulness meditation each day can help.
• Move your body regularly. Even a short walk helps. Exercise can reduce anxiety and stress and improve sleep.
• Keep regular routines. Stick to regular meals and sleep as much as possible, and eat a healthy diet.
• Cut down on caffeine. The NHS advises not drinking lots of coffee, tea, cola or energy drinks, as caffeine can disrupt sleep and make anxiety harder to control. That includes those extra cups of chai through the day.
• Avoid unhealthy coping. Do not use alcohol, cigarettes, drugs or gambling to relieve anxiety.
• Face fears gradually. Instead of avoiding situations that make you anxious, slowly build up the time you spend in them.
• Focus on what you can change, rather than things outside your control.

Treatment: talking therapies and medicine

WHO says there are highly effective treatments for anxiety disorders, yet only about 1 in 4 people who need treatment receive any. Treatment can help you manage symptoms, though the NHS notes it may take time.

Talking therapies (psychological treatment) are, in WHO's words, essential treatments for anxiety disorders. They can be provided one-to-one or in groups, in person or online. The approaches with the most evidence are based on cognitive behavioural therapy (CBT), including exposure therapy, where people learn step by step to face their fears. These therapies teach new ways of thinking about and coping with anxiety. The NHS says a doctor will usually suggest talking therapies before prescribing medicine.

Medicine may also be helpful for some adults. WHO and the NHS mention a type of antidepressant called an SSRI. A doctor will weigh up possible side effects, what treatment is available, and your own preferences. WHO also says that benzodiazepines, which were often prescribed for anxiety in the past, are generally not recommended because of their high potential for dependence and limited long-term benefit. Please do not take sleeping pills or "nerve tablets" from a chemist or a relative. Whether you need medicine, and which one, is a decision for a qualified doctor.

Talking about anxiety in a Pakistani family

In many families, anxiety is still hard to talk about. A worried person may be told to "stop overthinking", or the family may worry about what relatives will say. WHO lists social stigma and lack of awareness that anxiety is a treatable health condition as major reasons people do not get care.

A few gentle reminders for families:

• Anxiety disorders are the most common mental health conditions in the world. WHO says 470 million people had one in 2023. Your loved one is not alone, and anxiety is not a personal failing.
• Listen without judging. Being able to talk openly is one of the first things the NHS suggests.
• Encourage a visit to a doctor, and offer to go along. The NHS says it helps to be honest with the doctor, even when emotions are hard to talk about.
• Join in healthy routines, like an evening walk together or regular family meals.
• If you are caring for someone with anxiety, look after yourself too.

When to get help, and when it is urgent

See a doctor if:

• you think you may have an anxiety disorder
• worry or fear is affecting your daily life, work, studies or relationships
• you feel anxious most of the time, and it has gone on for months
• you have already been diagnosed and treatment is not helping
• you are pregnant or have had a baby in the past year and are struggling with anxiety

Get help urgently if you or someone you know is in a mental health crisis, is having thoughts of suicide or self-harm, or is in danger. Call 1122 or go to the nearest hospital emergency department straight away. You do not have to wait until things get worse to ask for help.

You can find PMDC-verified doctors by city and specialty and book a visit on SehatDoc Booking.

Sources

• World Health Organization: Anxiety disorders
• NHS: Generalised anxiety disorder in adults
• National Institute of Mental Health: Anxiety disorders

Medical note: This guide is for general information and is not a substitute for advice from a doctor who can examine you.