Anxiety

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    Nick Milazzo, Natalka Roshak

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    Last Updated: January 6, 2025

    Anxiety disorders are a group of disorders characterized by symptoms of excessive anxiety and/or fear. Anxiety itself, unlike fear, is persistent and future oriented. There are many types of anxiety disorders, including generalized anxiety disorder, social anxiety disorder, phobias, and panic disorder.

    22 references on this page
    9,134 participants in 17 trials and 12 meta-analyses

    What are anxiety disorders?

    Having an anxiety disorder is not the same thing as experiencing anxiety. Anxiety and fear can be normal, adaptive responses to stressful and scary situations. Anxiety symptoms can also occur in the context of other mental and physical disorders or as effects of medication or drugs of abuse. In anxiety disorders, however, the feelings of anxiety or fear are recurrent, excessive, consistent, and persistent. They may also be accompanied by other symptoms, like sleep disturbances or panic attacks.

    Anxiety disorders are defined by the 5th edition of the American Psychological Association (APA)’s Diagnostic and Statistical Manual (DSM-5) as a group of disorders "that share features of excessive fear and anxiety and related emotional disturbances".[11] The most common anxiety disorders in adults are specific phobias, panic disorder, social anxiety disorder, generalized anxiety disorder, and agoraphobia.[12]

    What are the differences between fear, anxiety, and anxiety disorders?What disorders are included in the category of anxiety disorders?

    What are the main signs and symptoms of anxiety disorders?

    Just experiencing anxiety symptoms does not mean that someone has an anxiety disorder. The American Psychological Association (APA) sets out diagnostic criteria for specific anxiety disorders in its Diagnostic and Statistical Manual of Mental Disorders (DSM). This table summarizes the symptoms used to diagnose the most common anxiety disorders.[11]

    DisorderSummary of symptoms
    Generalized anxiety disorderExcessive anxiety and worry which are difficult to control, which cause distress or difficulty functioning, and which are associated with at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, tension, sleep disturbance.
    Social anxiety disorderConsistent, persistent, and disproportionate fear or anxiety around being judged by others in one or more social situations which results in intense distress or in difficulties functioning.
    Specific phobiaA specific object or situation consistently and persistently provokes intense fear or anxiety out of proportion to the actual danger that results in intense distress or difficulties functioning.
    Panic disorderRecurrent, unexpected panic attacks, prompting worry or behavioural change.
    AgoraphobiaConsistent, persistent, disproportionate fear and anxiety about being in two or more of the following specific situations: public transportation, open spaces, enclosed spaces, being in a crowd or a line, or being away from home alone. The fear and anxiety cause avoidant behaviour and distress/difficulty functioning.

    Adapted from: American Psychological Association. (2013) Anxiety Disorders. In Diagnostic And Statistical Manual of Mental Disorders (5th ed.)

    For all of the above anxiety disorders, the diagnosis will only be made if the symptoms can't be better explained by the effects of a medication or drug, by another medical condition, or by another mental disorder.

    How are anxiety disorders diagnosed?

    Anxiety disorders shouldn’t be self-diagnosed: It takes clinical experience to distinguish between normal and disordered anxiety. Diagnosing an anxiety disorder is done through a psychological evaluation performed by a clinician, after ruling out other symptom causes such as medication, drugs, or medical conditions.[13] The psychological evaluation is typically based on diagnostic criteria set by a publication such as the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) or the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD). The symptoms in the APA’s diagnostic criteria for the most common anxiety disorders are summarized in What are the main signs and symptoms of anxiety disorders? The diagnosis can only be made if the symptoms can't be better explained by the effects of a medication or drug, by another medical condition, or by another mental disorder.

    What are some of the main medical treatments for anxiety disorders?

    Antianxiety medications like beta-blockers and antidepressants are commonly used either alone or in conjunction with therapy for the relief of anxiety symptoms. Types of therapy used for anxiety disorders include cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).[13]

    Have any supplements been studied for anxiety disorders?

    Several supplements have been studied for relief of anxiety symptoms, both in the contexts of anxiety disorders and in other contexts. While some supplements have been studied for anxiety relief in the context of anxiety disorders, there aren’t many with strong evidence.

    • Lavender oil capsules were effective in two trials in people with anxiety disorders.[14]
    • A 2010 systematic review noted that the majority of randomized controlled trials of kava saw significantly reduced anxiety in people with anxiety disorders or anxiety-related disorders, although the supplement carries a possible risk of inducing liver toxicity.[2] However, in a 2022 review of studies, it was not as effective in people with generalized anxiety disorder.[15]
    Are there any supplements that people with anxiety disorders should avoid?

    How could diet affect anxiety disorders?

    Certain dietary patterns may assist with anxiety symptoms, including in the context of anxiety disorders. See What’s the connection between diet and anxiety symptoms? on the anxiety symptoms page.

    Are there any other treatments for anxiety disorders?

    Some evidence shows that meditation can reduce anxiety symptoms,[16] performing better than no intervention or sham interventions in people without diagnosed anxiety disorders and comparably to other active therapies among people with diagnosed anxiety disorders.[17]

    Exercise, particularly high-intensity aerobic exercise and resistance training, may be effective for treating anxiety symptoms, including in the context of anxiety disorders.[18][19]

    What causes anxiety disorders?

    The causes of anxiety disorders are complex and not fully understood. Genetics, the environment, and brain biology can all play a role.[12]

    Examine Database: Anxiety

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    Frequently asked questions

    What are anxiety disorders?

    Having an anxiety disorder is not the same thing as experiencing anxiety. Anxiety and fear can be normal, adaptive responses to stressful and scary situations. Anxiety symptoms can also occur in the context of other mental and physical disorders or as effects of medication or drugs of abuse. In anxiety disorders, however, the feelings of anxiety or fear are recurrent, excessive, consistent, and persistent. They may also be accompanied by other symptoms, like sleep disturbances or panic attacks.

    Anxiety disorders are defined by the 5th edition of the American Psychological Association (APA)’s Diagnostic and Statistical Manual (DSM-5) as a group of disorders "that share features of excessive fear and anxiety and related emotional disturbances".[11] The most common anxiety disorders in adults are specific phobias, panic disorder, social anxiety disorder, generalized anxiety disorder, and agoraphobia.[12]

    What are the differences between fear, anxiety, and anxiety disorders?

    Anxiety, as defined by the APA, combines uneasiness or dread about future events, physical symptoms of tension, and the anticipation of impending danger.[20] In contrast, fear is an emotional and physiological response to an immediate threat.[21] Anxiety and fear are both normal emotions that everyone experiences from time to time. In anxiety disorders, however, anxiety and fear are persistent — present for longer than 6 months — and either are excessive or are present long after they’re developmentally appropriate. Anxiety disorders can often interfere with daily activities, either directly (as with selective mutism, in which people cannot talk in some situations) or because people with anxiety disorders may rearrange their lives to avoid situations that trigger their symptoms (as with agoraphobia, in which certain spaces or situations trigger anxiety).

    What disorders are included in the category of anxiety disorders?

    The 5th edition of the American Psychological Association (APA)’s Diagnostic and Statistical Manual (DSM-5) defines the following anxiety disorders:[11]

    Anxiety symptoms and panic attacks can be associated with any of these disorders.

    What are the main signs and symptoms of anxiety disorders?

    Just experiencing anxiety symptoms does not mean that someone has an anxiety disorder. The American Psychological Association (APA) sets out diagnostic criteria for specific anxiety disorders in its Diagnostic and Statistical Manual of Mental Disorders (DSM). This table summarizes the symptoms used to diagnose the most common anxiety disorders.[11]

    DisorderSummary of symptoms
    Generalized anxiety disorderExcessive anxiety and worry which are difficult to control, which cause distress or difficulty functioning, and which are associated with at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, tension, sleep disturbance.
    Social anxiety disorderConsistent, persistent, and disproportionate fear or anxiety around being judged by others in one or more social situations which results in intense distress or in difficulties functioning.
    Specific phobiaA specific object or situation consistently and persistently provokes intense fear or anxiety out of proportion to the actual danger that results in intense distress or difficulties functioning.
    Panic disorderRecurrent, unexpected panic attacks, prompting worry or behavioural change.
    AgoraphobiaConsistent, persistent, disproportionate fear and anxiety about being in two or more of the following specific situations: public transportation, open spaces, enclosed spaces, being in a crowd or a line, or being away from home alone. The fear and anxiety cause avoidant behaviour and distress/difficulty functioning.

    Adapted from: American Psychological Association. (2013) Anxiety Disorders. In Diagnostic And Statistical Manual of Mental Disorders (5th ed.)

    For all of the above anxiety disorders, the diagnosis will only be made if the symptoms can't be better explained by the effects of a medication or drug, by another medical condition, or by another mental disorder.

    How are anxiety disorders diagnosed?

    Anxiety disorders shouldn’t be self-diagnosed: It takes clinical experience to distinguish between normal and disordered anxiety. Diagnosing an anxiety disorder is done through a psychological evaluation performed by a clinician, after ruling out other symptom causes such as medication, drugs, or medical conditions.[13] The psychological evaluation is typically based on diagnostic criteria set by a publication such as the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) or the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD). The symptoms in the APA’s diagnostic criteria for the most common anxiety disorders are summarized in What are the main signs and symptoms of anxiety disorders? The diagnosis can only be made if the symptoms can't be better explained by the effects of a medication or drug, by another medical condition, or by another mental disorder.

    What are some of the main medical treatments for anxiety disorders?

    Antianxiety medications like beta-blockers and antidepressants are commonly used either alone or in conjunction with therapy for the relief of anxiety symptoms. Types of therapy used for anxiety disorders include cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).[13]

    Have any supplements been studied for anxiety disorders?

    Several supplements have been studied for relief of anxiety symptoms, both in the contexts of anxiety disorders and in other contexts. While some supplements have been studied for anxiety relief in the context of anxiety disorders, there aren’t many with strong evidence.

    • Lavender oil capsules were effective in two trials in people with anxiety disorders.[14]
    • A 2010 systematic review noted that the majority of randomized controlled trials of kava saw significantly reduced anxiety in people with anxiety disorders or anxiety-related disorders, although the supplement carries a possible risk of inducing liver toxicity.[2] However, in a 2022 review of studies, it was not as effective in people with generalized anxiety disorder.[15]
    Are there any supplements that people with anxiety disorders should avoid?

    Yohimbine and yohimbine-containing products — as well as supplements that have a similar mechanism, such as rauwolscine — should be avoided, because they can provoke anxiety in people with anxiety disorders.[22]

    Additionally, although stimulants do not always cause anxiety symptoms, many create a stress response that could worsen existing symptoms. People with anxiety disorders might not need to stop using stimulants entirely, but they may want to avoid frequent use, especially if anxiety symptoms worsen.

    Caffeine is the stimulant least likely to cause anxiety symptoms. Ideally, 100–200 mg of caffeine should be paired with an equal dose of theanine, an amino acid that can tame the anxiety caused by caffeine in some people without impairing caffeine’s stimulatory effect. In fact, the improvements in concentration (focus and attention span) induced by caffeine and theanine, respectively, have been shown to be synergistic (work together).

    How could diet affect anxiety disorders?

    Certain dietary patterns may assist with anxiety symptoms, including in the context of anxiety disorders. See What’s the connection between diet and anxiety symptoms? on the anxiety symptoms page.

    Are there any other treatments for anxiety disorders?

    Some evidence shows that meditation can reduce anxiety symptoms,[16] performing better than no intervention or sham interventions in people without diagnosed anxiety disorders and comparably to other active therapies among people with diagnosed anxiety disorders.[17]

    Exercise, particularly high-intensity aerobic exercise and resistance training, may be effective for treating anxiety symptoms, including in the context of anxiety disorders.[18][19]

    What causes anxiety disorders?

    The causes of anxiety disorders are complex and not fully understood. Genetics, the environment, and brain biology can all play a role.[12]

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    Examine Database References

    1. Anxiety Symptoms - Andrade C, Aswath A, Chaturvedi SK, Srinivasa M, Raguram RA double-blind, placebo-controlled evaluation of the anxiolytic efficacy ff an ethanolic extract of withania somniferaIndian J Psychiatry.(2000 Jul)
    2. Anxiety Symptoms - Cooley K, Szczurko O, Perri D, Mills EJ, Bernhardt B, Zhou Q, Seely DNaturopathic care for anxiety: a randomized controlled trial ISRCTN78958974PLoS One.(2009 Aug 31)
    3. Anxiety Symptoms - Camellia Akhgarjand, Farzaneh Asoudeh, Amir Bagheri, Zahra Kalantar, Zahra Vahabi, Sakineh Shab-Bidar, Hamid Rezvani, Kurosh DjafarianDoes Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trialsPhytother Res.(2022 Aug 25)
    4. Anxiety Symptoms - Alireza Milajerdi, Shima Jazayeri, Elham Shirzadi, Najmeh Hashemzadeh, Atieh Azizgol, Abolghassem Djazayery, Ahmad Esmaillzadeh, Shahin AkhondzadehThe effects of alcoholic extract of saffron (Crocus satious L.) on mild to moderate comorbid depression-anxiety, sleep quality, and life satisfaction in type 2 diabetes mellitus: A double-blind, randomized and placebo-controlled clinical trialComplement Ther Med.(2018 Dec)
    5. Anxiety Symptoms - Ehsan Moazen-Zadeh, Seyed Hesameddin Abbasi, Hamideh Safi-Aghdam, Nazila Shahmansouri, Akram Arjmandi-Beglar, Azita Hajhosseinn Talasaz, Abbas Salehiomran, Saeedeh Forghani, Shahin AkhondzadehEffects of Saffron on Cognition, Anxiety, and Depression in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Double-Blind Placebo-Controlled TrialJ Altern Complement Med.(2018 Apr)
    6. Anxiety Symptoms - A Ghajar, S M Neishabouri, N Velayati, L Jahangard, N Matinnia, M Haghighi, A Ghaleiha, M Afarideh, S Salimi, A Meysamie, S AkhondzadehCrocus sativus L. versus Citalopram in the Treatment of Major Depressive Disorder with Anxious Distress: A Double-Blind, Controlled Clinical TrialPharmacopsychiatry.(2017 Jul)
    7. Anxiety Symptoms - Mohsen Mazidi, Maryam Shemshian, Seyed Hadi Mousavi, Abdolreza Norouzy, Tayebe Kermani, Toktam Moghiman, Akram Sadeghi, Naghme Mokhber, Majid Ghayour-Mobarhan, Gordon A A FernsA double-blind, randomized and placebo-controlled trial of Saffron (Crocus sativus L.) in the treatment of anxiety and depressionJ Complement Integr Med.(2016 Jun 1)
    8. Anxiety Symptoms - Simon B Goldberg, Brian T Pace, Christopher R Nicholas, Charles L Raison, Paul R HutsonThe experimental effects of psilocybin on symptoms of anxiety and depression: A meta-analysisPsychiatry Res.(2020 Feb)
    9. Suicidal Thoughts - Zeifman RJ, Yu D, Singhal N, Wang G, Nayak SM, Weissman CRDecreases in Suicidality Following Psychedelic Therapy: A Meta-Analysis of Individual Patient Data Across Clinical Trials.J Clin Psychiatry.(2022-Jan-18)
    10. Anxiety Symptoms - Amsterdam JD, Yao Y, Mao JJ, Soeller I, Rockwell K, Shults JRandomized, double-blind, placebo-controlled trial of Cimicifuga racemosa (black cohosh) in women with anxiety disorder due to menopauseJ Clin Psychopharmacol.(2009 Oct)
    11. Anxiety Symptoms - Sarris J, Byrne GJ, Cribb L, Oliver G, Murphy J, Macdonald P, Nazareth S, Karamacoska D, Galea S, Short A, Ee C, Birling Y, Menon R, Ng CHL-theanine in the adjunctive treatment of generalized anxiety disorder: A double-blind, randomised, placebo-controlled trialJ Psychiatr Res.(2019 Mar)
    12. Anxiety Symptoms - Geier FP, Konstantinowicz TKava treatment in patients with anxietyPhytother Res.(2004 Apr)
    13. Anxiety Symptoms - Volz HP, Kieser MKava-kava extract WS 1490 versus placebo in anxiety disorders--a randomized placebo-controlled 25-week outpatient trialPharmacopsychiatry.(1997 Jan)
    14. Anxiety Symptoms - Lehrl SClinical efficacy of kava extract WS 1490 in sleep disturbances associated with anxiety disorders. Results of a multicenter, randomized, placebo-controlled, double-blind clinical trialJ Affect Disord.(2004 Feb)
    15. Anxiety Symptoms - Malsch U, Kieser MEfficacy of kava-kava in the treatment of non-psychotic anxiety, following pretreatment with benzodiazepinesPsychopharmacology (Berl).(2001 Sep)
    16. Anxiety Symptoms - Gastpar M, Klimm HDTreatment of anxiety, tension and restlessness states with Kava special extract WS 1490 in general practice: a randomized placebo-controlled double-blind multicenter trialPhytomedicine.(2003 Nov)
    17. Anxiety Symptoms - Pittler MH, Ernst EKava extract for treating anxietyCochrane Database Syst Rev.(2003)
    18. Anxiety Symptoms - Zhang W, Yan Y, Wu Y, Yang H, Zhu P, Yan F, Zhao R, Tian P, Wang T, Fan Q, Su ZMedicinal herbs for the treatment of anxiety: A systematic review and network meta-analysis.Pharmacol Res.(2022-May)
    19. Anxiety Symptoms - Pittler MH, Ernst EEfficacy of kava extract for treating anxiety: systematic review and meta-analysis.J Clin Psychopharmacol.(2000-Feb)
    20. Anxiety Symptoms - Kasper S, Gastpar M, Müller WE, Volz HP, Möller HJ, Dienel A, Schläfke SSilexan, an orally administered Lavandula oil preparation, is effective in the treatment of 'subsyndromal' anxiety disorder: a randomized, double-blind, placebo controlled trialInt Clin Psychopharmacol.(2010 Sep)
    21. Anxiety Symptoms - Yap WS, Dolzhenko AV, Jalal Z, Hadi MA, Khan TMEfficacy and safety of lavender essential oil (Silexan) capsules among patients suffering from anxiety disorders: A network meta-analysisSci Rep.(2019 Dec 2)
    22. Anxiety Symptoms - Dold M, Bartova L, Volz HP, Seifritz E, Möller HJ, Schläfke S, Kasper SEfficacy of Silexan in patients with anxiety disorders: a meta-analysis of randomized, placebo-controlled trials.Eur Arch Psychiatry Clin Neurosci.(2023-Jan-30)
    23. Anxiety Symptoms - Möller HJ, Volz HP, Dienel A, Schläfke S, Kasper SEfficacy of Silexan in subthreshold anxiety: meta-analysis of randomised, placebo-controlled trials.Eur Arch Psychiatry Clin Neurosci.(2019-Mar)
    24. Anxiety Symptoms - Kang HJ, Nam ES, Lee Y, Kim MHow Strong is the Evidence for the Anxiolytic Efficacy of Lavender?: Systematic Review and Meta-analysis of Randomized Controlled Trials.Asian Nurs Res (Korean Soc Nurs Sci).(2019-Dec)
    25. Fatigue Symptoms - Roland von Känel, Siegfried Kasper, Guido Bondolfi, Edith Holsboer-Trachsler, Josef Hättenschwiler, Martin Hatzinger, Christian Imboden, Ellen Heitlinger, Erich SeifritzTherapeutic effects of Silexan on somatic symptoms and physical health in patients with anxiety disorders: A meta-analysisBrain Behav.(2021 Feb 27)
    26. Anxiety Symptoms - Cases J, Ibarra A, Feuillère N, Roller M, Sukkar SGPilot trial of Melissa officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbancesMed J Nutrition Metab.(2011 Dec)
    27. Anxiety Symptoms - Nagano M, Shimizu K, Kondo R, Hayashi C, Sato D, Kitagawa K, Ohnuki KReduction of depression and anxiety by 4 weeks Hericium erinaceus intakeBiomed Res.(2010 Aug)
    28. Anxiety Symptoms - Tomohiko Mukai, Taro Kishi, Yuki Matsuda, Nakao IwataA meta-analysis of inositol for depression and anxiety disordersHum Psychopharmacol.(2014 Jan)
    29. Depression Symptoms - Ross SMRhodiola rosea (SHR-5), Part I: a proprietary root extract of Rhodiola rosea is found to be effective in the treatment of stress-related fatigueHolist Nurs Pract.(2014 Mar-Apr)