We all have feelings of anxiety, worry and fear sometimes. These can be normal responses to certain situations. For example, you might worry about a job interview, or about paying a bill on time. These feelings can give you an awareness of risks and what you need to do in a difficult or dangerous situation. This reaction is known as ‘fight or flight’. Your brain responds to a threat or danger by releasing stress hormones such as adrenaline and cortisol. Even if the danger is not real, these hormones cause the physical symptoms of anxiety.

Once the threatening situation has stopped, your body will usually return to normal. But if you have an anxiety disorder these feelings of fear and danger can be ongoing and interrupt your daily routine long after the threat has gone.

They can make you feel as though things are worse than they actually are. Everyone’s experience of anxiety disorders is different. Not everyone who has an anxiety disorder will experience the same symptoms.

Mental symptoms of anxiety can include:

• racing thoughts,
• uncontrollable over-thinking,
• difficulties concentrating,
• feelings of dread, panic or ‘impending doom’,
• feeling irritable,
• heightened alertness,
• problems with sleep,
• changes in appetite,
• wanting to escape from the situation you are in,
• dissociation.

If you dissociate you might feel like you are not connected to your own body. Or like you are watching things happen around you, without feeling it. Physical symptoms of anxiety can include:

• sweating,
• heavy and fast breathing,
•  hot flushes or blushing,
• dry mouth,
• shaking,
• hair loss,
• fast heartbeat,
• extreme tiredness or lack of energy
• dizziness and fainting,
• stomach aches and sickness. Anxiety can lead to depression if left untreated.

Generalised anxiety disorder (GAD)

GAD is common. The main symptom of GAD is over worrying about different activities and events. This may feel out of your control. You feel anxious a lot of the time if you have GAD. You might feel ‘on edge’ and alert to your surroundings. This can affect your day-to-day life. You might find that it affects your ability to work, travel places or leave the house. You might also get tired easily or have trouble sleeping or concentrating. You might have physical symptoms, such as muscle tension and sweating.

It is common to have other conditions such as depression or other anxiety

disorders if you have GAD.

GAD can be difficult to diagnose because it does not have some of the unique symptoms of other anxiety disorders. Your doctor is likely to say you have GAD if you have felt anxious for most days over six months and it has had a bad impact on areas of your life.

Panic disorder

You will have regular panic attacks with no particular trigger if you have panic disorder. They can happen suddenly and feel intense and frightening. You may also worry about having another panic attack.

Panic disorder symptoms can include the following.

• An overwhelming sense of dread or fear.

• Chest pain or a sensation that your heart is beating irregularly.

• Feeling that you might be dying or having a heart attack.

• Sweating and hot flushes or chills and shivering.

• A dry mouth, shortness of breath or choking sensation.

• Nausea, dizziness and feeling faint.

• Numbness, pins and needles or a tingling sensation in your fingers.

• A need to go to the toilet.

• A churning stomach.

• Ringing in your ears.

You may also dissociate during a panic attack. Such as feeling detached from yourself. Certain situations can cause panic attacks. For example, you may have a panic attack if you don’t like small places, but you have to, use a lift. This doesn’t mean that you have panic disorder.

Social anxiety disorder

Social anxiety disorder is sometimes known as social phobia. Lots of people may worry about social situations but if you have social anxiety you will have an intense fear or dread of social or performance situations. This will happen before, during or after the event.

Some common situations where you may experience anxiety are the following.

• Speaking in public or in groups.

• Meeting new people or strangers.

• Dating.

• Eating or drinking in public.

You may be worried that you will do something or act in a way that is embarrassing.

You might feel aware of the physical signs of your anxiety. This can include sweating, a fast heartbeat, a shaky voice and blushing. You may worry that others will notice this or judge you. You might find that you try to avoid certain situations. You might realise that your fears are excessive, but you find it difficult to control them.

Phobias

A phobia is an overwhelming fear of an object, place, situation, feeling or animal. Phobias are stronger than fears. They develop when a person has increased feelings of danger about a situation or object. Someone with a phobia may arrange their daily routine to avoid the thing that’s causing them anxiety.

Common examples of phobias include the following.

• Animal phobias. Such spiders, snakes or rodents.

• Environmental phobias. Such as heights and germs.

• Situational phobias. Such as going to the dentist.

• Body phobias. Such as blood or being sick.

• Sexual phobias. Such as performance anxiety.

Agoraphobia

Agoraphobia is a fear of being in situations where escape might be difficult. Or situations where help wouldn’t be available if things go wrong.

This could be the following.

• Leaving your home.

• Being in public spaces.

• Using public transport.

• Being in crowded spaces.

You might find that these situations make you feel distressed, panicky and anxious. You may avoid some situations altogether. This can affect day-to-day life. Agoraphobia can make it difficult to make an appointment with your GP to talk about your symptoms. You might not feel able to leave your house.

Obsessive-compulsive disorder (OCD)

You will have obsessions, compulsion or both if you have OCD.

• Obsession. An obsession is an unwelcome thought or image that you keep thinking about and is largely out of your control. These can be difficult to ignore. These thoughts can be disturbing, which can make you feel distressed and anxious.
• Compulsion. A compulsion is something you think about or do

repeatedly to relieve anxiety. This can be hidden or obvious. Such

as saying a phrase in your head to calm yourself. Or checking that

the front door is locked.

You might believe that something bad will happen if you do not do these

things. You may realise that your thinking and behaviour is not logical but

still find it very difficult to stop.

Skin-picking

Skin picking is medically known as dermatillomania. It is an impulse control disorder. You will regularly pick at your skin. Often you will pick healthy skin. This can cause damage to your skin, including bleeding, bruising and sometimes permanent marks. You will usually pick the skin on your face but might also pick other areas of the body. You will find it

difficult to stop yourself doing it. No one knows the cause for skin-picking. It is thought that it could be a type of addiction. Or it relieves tension and stress. It is common to have

OCD and dermatillomania at the same time. Your GP may arrange for you to see a specialist mental health doctor like a psychiatrist for diagnosis.

Hair pulling

Hair pulling is medically known as trichotillomania. It is an impulse control disorder. You feel the urge to pull out your hair if you have this condition. This can be from your scalp or other places such as your arms, eyelashes, legs or pubic area. You will find it difficult to stop yourself doing this. You might experience a build-up of tension which you can relieve by pulling out the strand of hair. You might not even be aware that you’re doing it. It can be difficult to stop, which can lead to hair loss. This in turn can make you feel guilty, embarrassed and affect how you feel about yourself or how your friends and family see you.

Look at the following to diagnose your condition.

• You repeatedly pull your hair out, causing noticeable hair loss
• You feel increasing tension before you pull your hair out
• You feel relief or pleasure when you have pulled your hair out
• There are no underlying illnesses, such as a skin condition, causing you to pull your hair out
• Pulling your hair out affects your everyday life or causes you distress.

Health anxiety

You may have health anxiety if you spend a lot of time worrying about if you are ill. Or worrying about getting ill. You may:

• worry that your doctor has missed something,
• check your body a lot for signs of illness,
• constantly worry about your health,
• spend a lot of time asking people if they think you are ill,
• spend a lot of time looking at health information on the internet, on the tv or in newspapers, or
• act as if you were ill.

Symptoms like headaches or a racing heartbeat can be caused by anxiety. But if you have health anxiety you may mistake these for signs of illness.

Body dysmorphic disorder (BDD)

You will have upsetting thoughts about the way you look if you have BDD. The thoughts don’t go away and have a big effect on daily life. This is not the same as being vain about your appearance. You may believe that you are ugly and that everyone sees you as ugly, even if they reassure you that this isn’t true. Or you may believe that people are focused on an area of your body such as scar or birthmark. It can be very distressing and lead to depression.

You may spend a large amount of time doing the following.

• Staring at your face or body in the mirror.
• Comparing your features with other people’s.
• Covering yourself with lots of makeup.
• Thinking about plastic surgery when you do not need it.

Post-Traumatic Stress Disorder (PTSD)

You may have PTSD if your anxiety symptoms developed after a stressful

or distressing event. Or if you have experienced trauma over a long period

of time.

What causes anxiety disorders?

We don’t fully understand what causes anxiety disorders. But it is thought

that the following factors can cause anxiety.

Genetics.  

Some people seem to be born more anxious than others. You may get anxiety through your genes.

Life experience.

This could be bad experiences such as being abused or losing a loved one. It could also include big changes in life such as moving home, losing your job or pregnancy.

Drugs.

Caffeine in coffee and alcohol can make you feel anxious. Illegal drugs, also known as street drugs can also have an effect.

Circumstances.

Sometimes you know what is causing your anxiety. When the problem goes, so does your anxiety.

How can I get help if I think I have an anxiety disorder?

Complementary therapies are treatments that are not usually part of

mainstream NHS care. Some people find them useful for helping with

symptoms of anxiety. Such as yoga and hypnotherapy.