Introduction
Most of us know what it feels like to be anxious. We might worry before an important meeting, feel nervous about something unfamiliar or find ourselves lying awake thinking about a problem that needs sorting.
That kind of anxiety is part of being human. It can be uncomfortable, but it often has a clear reason and settles once the situation has passed.
For some people, anxiety becomes much more persistent or begins to affect everyday life. It may centre on particular situations, appear suddenly as panic, attach itself to worries about health or seem to spread across almost everything.
Understanding some of those differences can make anxiety easier to recognise, both in ourselves and in the people around us.
What do we mean by anxiety?
Anxiety is our response to feeling threatened, worried or uncertain. It can affect our thoughts and emotions, but it can also produce very physical symptoms.
Someone who is anxious might notice a racing or more noticeable heartbeat, sweating, shaking, dizziness, nausea, breathlessness or tension. They may find it difficult to concentrate, sleep or switch off from worrying.
The experience varies enormously. Two people can both describe themselves as anxious and mean very different things.
Anxiety also has a purpose. Our bodies are designed to respond when we think something may be dangerous. The difficulty comes when that response is happening frequently, feels disproportionate to what is going on or starts restricting the way somebody lives.
When does anxiety become more than everyday worry?
Feeling anxious does not automatically mean that somebody has an anxiety disorder.
The distinction is not simply about how worried a person feels on one particular day. Things such as persistence, intensity and the effect on everyday life matter too.
If anxiety is difficult to control, keeps returning or is beginning to affect work, relationships, sleep, social life or ordinary activities, it may be worth seeking professional advice.
Different anxiety conditions also have different patterns. Knowing a little about those patterns can help us understand why telling somebody simply to “stop worrying” is unlikely to be useful.
Generalised anxiety disorder
Generalised anxiety disorder, usually shortened to GAD, involves anxiety and worry across a wide range of areas rather than one particular situation.
Someone may find themselves worrying about work, money, health, family, things that might happen in the future and relatively everyday decisions. As one concern settles, another can quickly take its place.
The worry can feel difficult to control and may be accompanied by restlessness, irritability, tiredness, difficulty concentrating, problems sleeping or physical tension.
Most people worry about several areas of life from time to time. With GAD, the anxiety is more persistent and begins to have a significant effect on everyday life.
Panic disorder
A panic attack is a sudden rush of intense fear or anxiety accompanied by strong physical sensations. These might include a racing heart, trembling, sweating, dizziness, nausea, chest discomfort or feeling short of breath.
Panic attacks can be extremely frightening, particularly when someone does not understand what is happening.
Having an occasional panic attack does not necessarily mean somebody has panic disorder. Panic disorder involves recurring, unexpected panic attacks and often an ongoing fear of another attack happening.
That fear itself can begin to change behaviour. Someone might avoid places or situations where a previous panic attack happened, or where they worry it would be difficult to leave or get help. Over time, the fear of another panic attack can become almost as restrictive as the attacks themselves.
Social anxiety
Social anxiety is much more than simply being shy or preferring small groups to large ones.
Someone experiencing social anxiety may have an intense and persistent fear of social situations. They might worry about being judged, criticised, embarrassed or doing something that other people will notice.
That can affect apparently ordinary things such as making a telephone call, meeting someone new, eating around other people, speaking in a meeting, shopping or joining a group conversation.
The anxiety can begin well before the situation itself and continue afterwards, with someone replaying what happened and worrying about how they came across.
When that fear begins to affect work, education, relationships or everyday activities, social anxiety can have a considerable impact on someone’s life.
Phobias
A phobia is an intense fear associated with a particular object or situation.
Some people have specific phobias involving things such as spiders, dogs, flying, heights, enclosed spaces, blood or medical procedures. Someone may know intellectually that the level of danger is relatively small while still experiencing a powerful physical and emotional fear response.
Avoidance can then become part of the problem. If someone is frightened of flying, they may organise their life so that they never need to board a plane. Other phobias can have a much wider effect on everyday life.
Agoraphobia, for example, can involve anxiety about being in situations where escaping or getting help might feel difficult. This can make travelling, using public transport, being in crowds or even leaving home extremely challenging for some people.
Again, the important distinction is not simply “being frightened of something”. It is the strength of the fear and the impact it has on someone’s life.
Health anxiety
Most of us worry about our health occasionally, particularly when we notice something unusual or are waiting for medical information.
Health anxiety becomes more problematic when worries about being ill, or becoming ill, begin to take over someone’s life.
A person might repeatedly check their body for symptoms, seek reassurance from other people, search constantly for health information or remain convinced that something serious has been missed despite medical reassurance.
There can be a particularly difficult cycle here because anxiety itself can create very real physical sensations, including headaches, stomach problems or a racing heartbeat. Those sensations can then become further evidence, in the person’s mind, that something must be wrong.
The symptoms are real. The difficulty lies in the way worry, checking and reassurance can begin feeding one another.
Conditions where anxiety can play a major part
Some mental health conditions are closely associated with anxiety but are better understood in their own right rather than simply being described as another “type of anxiety”.
This is one place where the original version of this article needed updating.
Obsessive-compulsive disorder
Obsessive-compulsive disorder, or OCD, is often misunderstood as being unusually tidy, organised or particular about how things are done.
In reality, OCD involves obsessions and compulsions that can cause considerable distress.
Obsessions are unwanted and intrusive thoughts, images or urges that repeatedly enter someone’s mind. Compulsions are behaviours or mental acts the person feels driven to perform, often in an attempt to reduce the anxiety or distress caused by those thoughts.
That might involve repeated checking, washing, counting, seeking reassurance or doing something mentally that other people cannot see.
The relief provided by a compulsion is generally temporary, which can create a repeating cycle of intrusive thought, anxiety, compulsion and short-lived relief.
Post-traumatic stress disorder
Post-traumatic stress disorder, or PTSD, can develop after experiencing, witnessing or sometimes learning about a traumatic event.
Anxiety may be a significant part of PTSD, but the condition involves more than feeling anxious.
Someone may experience flashbacks, nightmares or intrusive memories of what happened. They may avoid people, places or situations that remind them of the trauma, feel disconnected from themselves or other people, have difficulty sleeping or remain highly alert to possible danger.
Symptoms can begin soon after an event, but they can also emerge months or even years later.
Anxiety doesn’t always fit neatly into one box
These descriptions are useful, but real lives are rarely as tidy as article headings.
Someone can experience more than one anxiety condition. Anxiety can also occur alongside depression and other mental health difficulties, or as part of a difficult period without meeting the criteria for a particular disorder.
Symptoms overlap too. Poor sleep, difficulty concentrating, avoidance, physical tension and a sense of dread can appear in many different experiences of anxiety.
That is why reading an article like this can help with understanding, but it cannot tell somebody what diagnosis they have.
The NHS specifically advises people not to self-diagnose anxiety conditions and to speak to a GP if they are worried about how they are feeling.
How can you support someone experiencing anxiety?
You do not need to identify exactly what kind of anxiety somebody is experiencing before you can be supportive.
Start by listening.
Try not to dismiss the fear because it seems small from your perspective. Saying “there’s nothing to worry about” may be well intentioned, but the person’s anxiety is already telling them otherwise.
You might instead ask what is happening, what tends to help and whether there is anything practical you can do.
It is also worth being careful about automatically helping somebody avoid everything that makes them anxious. Avoidance can sometimes provide immediate relief while making the situation more difficult in the longer term. Supporting somebody does not mean forcing them into situations either. It means listening, encouraging appropriate help and recognising the limits of your role.
Sometimes the most useful thing we can offer is a calm conversation in which somebody does not have to justify why they are finding something difficult.
When to seek help for anxiety
Anxiety is worth taking seriously when it is persistent, difficult to manage or beginning to interfere with everyday life.
That might mean someone is regularly avoiding things they want or need to do, losing sleep, finding it difficult to work, struggling with relationships or spending a significant amount of time worrying about what might happen.
A GP can help explore what is happening and discuss appropriate support or treatment. Different anxiety conditions may need different approaches, which is another reason why understanding the broad categories can be helpful without trying to diagnose ourselves.
There is no requirement to wait until anxiety has become unbearable before asking for help.
Understanding anxiety helps us respond better
One of the problems with using a single word like “anxiety” is that it can make very different experiences sound the same.
The person worrying about almost every aspect of everyday life may need something different from the person terrified of social judgement. Someone experiencing recurring panic attacks has a different experience again, as does somebody caught in the cycle of OCD or living with the effects of trauma.
We do not need to memorise diagnostic criteria to be helpful.
What matters is recognising that anxiety can be much more than nervousness, taking people’s experiences seriously and becoming more confident about listening, responding and knowing when further support may be needed.
Understanding the differences gives us a better starting point.
