View source for Medicine:Anxiety

{{Short description|Unpleasant state of inner turmoil over anticipated events}}
{{Emotion}}
[[File:Los Angeles, California. Lockheed Employment. A worried applicant waiting to be interviewed - NARA - 532210.jpg|thumb|A job applicant with a facial expression indicative of anxiety]]
'''Anxiety''' is an [[Philosophy:Emotion|emotion]] which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events.<ref>{{cite book|title=Abnormal Psychology|vauthors=Davison GC |publisher=Veronica Visentin |year=2008|isbn=978-0-470-84072-6 |location=Toronto|page=154}}</ref><ref>{{Cite book |vauthors=Miceli M, Castelfranchi C|date=2014-11-27 |url=https://books.google.com/books?id=z0aPBQAAQBAJ&pg=PP1 |title=Expectancy and emotion|publisher=Oxford University Press |place=Oxford |isbn=978-0-19-150927-8|language=en |access-date=2022-05-09|archive-date=2023-01-17|archive-url=https://web.archive.org/web/20230117022600/https://books.google.com/books?id=z0aPBQAAQBAJ&pg=PP1|url-status=live}}</ref><ref name = "Chand_2022">{{cite book | vauthors = Chand SP, Marwaha R | chapter = Anxiety |date=2022 | chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK470361/ | title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29262212 |access-date=2022-12-15 |archive-date=2022-06-21 |archive-url=https://web.archive.org/web/20220621101211/http://www.ncbi.nlm.nih.gov/books/NBK470361/ |url-status=live | quote=Anxiety is linked to fear and manifests as a future-oriented mood state that consists of a complex cognitive, affective, physiological, and behavioral response system associated with preparation for the anticipated events or circumstances perceived as threatening. }}</ref> Anxiety is different from [[Philosophy:Fear|fear]] in that fear is defined as the emotional response to a real threat, whereas anxiety is the anticipation of a future threat.<ref>{{cite journal | vauthors = Crocq MA | title = A history of anxiety: from Hippocrates to DSM | journal = Dialogues in Clinical Neuroscience | volume = 17 | issue = 3 | pages = 319–325 | date = September 2015 | pmid = 26487812 | pmc = 4610616 | doi = 10.31887/DCNS.2015.17.3/macrocq }}</ref> It is often accompanied by nervous behavior such as pacing back and forth, [[Medicine:Somatic anxiety|somatic complaints]], and [[Philosophy:Rumination (psychology)|rumination]].<ref name="Seligman">{{cite book | vauthors = Seligman ME, Walker EF, Rosenhan DL |title= Abnormal psychology |edition=4th |location= New York |publisher= W.W. Norton & Company}}{{Page needed|date= May 2013}}</ref>

Anxiety is a feeling of uneasiness and [[Medicine:Worry|worry]], usually generalized and unfocused as an [[Overreaction|overreaction]] to a situation that is only subjectively seen as menacing.<ref>{{cite book|url=https://books.google.com/books?id=E_9Rlqs4T7oC |title=Psychiatric and Behavioral Disorders in Intellectual and Developmental Disabilities|vauthors=Bouras N, Holt G |year=2007 |publisher=Cambridge University Press |isbn=9781139461306 |edition=2nd |access-date=2018-11-22|archive-date=2023-01-17 |archive-url=https://web.archive.org/web/20230117022650/https://books.google.com/books?id=E_9Rlqs4T7oC|url-status=live}}{{Page needed|date=May 2013}}</ref> It is often accompanied by muscular tension,<ref name="DSM-5 189">{{Cite book | last= American Psychiatric Association | year= 2013 | title= Diagnostic and Statistical Manual of Mental Disorders | edition=5th | publisher= American Psychiatric Publishing | location= Arlington, VA | page= [https://archive.org/details/diagnosticstatis0005unse/page/189 189] | isbn= 978-0-89042-555-8 | url= https://archive.org/details/diagnosticstatis0005unse/page/189}}</ref> restlessness, fatigue, inability to catch one's breath, tightness in the abdominal region, nausea, and problems in concentration. Anxiety is closely related to [[Philosophy:Fear|fear]],<ref name = "Chand_2022" /> which is a response to a real or perceived immediate threat (fight or flight response); anxiety involves the expectation of future threat including dread.<ref name="DSM-5 189" /> People facing anxiety may withdraw from situations which have provoked anxiety in the past.<ref name="Barker, P. 2003">{{cite book | vauthors = Barker P |year= 2003 |title= Psychiatric and Mental Health Nursing: The Craft of Caring |publisher= Edward Arnold |location= London |isbn= 978-0-340-81026-2}}{{Page needed|date= May 2013}}</ref>

The emotion of anxiety can persist beyond the developmentally appropriate time-periods in response to specific events, and thus turning into one of the multiple [[Medicine:Anxiety disorder|anxiety disorder]]s (e.g. [[Medicine:Generalized anxiety disorder|generalized anxiety disorder]], [[Medicine:Panic disorder|panic disorder]]).<ref name="Robinson Pike Cornwell Grillon 2019 pp. jnnp–2019–321400">{{cite journal | vauthors = Robinson OJ, Pike AC, Cornwell B, Grillon C | title = The translational neural circuitry of anxiety | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 90 | issue = 12 | pages = 1353–1360 | date = December 2019 | pmid = 31256001 | doi = 10.1136/jnnp-2019-321400 | publisher = BMJ | quote = Anxiety is an adaptive response that promotes harm avoidance, but at the same time excessive anxiety constitutes the most common psychiatric complaint. | s2cid = 195758112 | doi-access = free }}</ref><ref name="Treating and Preventing Adolescent Mental Health Disorders: What We Know and What We Don't Know. A Research Agenda for Improving the Mental Health of Our Youth">{{cite book |url=https://oxfordmedicine.com/view/10.1093/9780195173642.001.0001/med-9780195173642-chapter-10 |publisher=Oxford University Press |publication-place=New York |doi=10.1093/9780195173642.001.0001 |title=Treating and preventing adolescent mental health disorders: what we know and what we don't know. A research agenda for improving the mental health of our youth |year=2005 |isbn=978-0-19-517364-2 |veditors=Evans DL, Foa EB, Gur RE, Hendin H, O'Brien CP, Seligman ME, Walsh BT |oclc=56324679 |access-date=2021-06-02 |archive-date=2021-12-16 |archive-url=https://web.archive.org/web/20211216111841/https://oxfordmedicine.com/view/10.1093/9780195173642.001.0001/med-9780195173642-chapter-10 |url-status=live }}</ref> The difference between ''anxiety disorder'' (as [[Medicine:Mental disorder|mental disorder]]) and ''anxiety'' (as normal emotion), is that people with an anxiety disorder experience anxiety most of the days during approximately 6 months, or even during shorter time-periods in children.<ref name="DSM-5 189" /> Anxiety disorders are among the most persistent mental problems and often last decades.<ref name=Lancet2021>{{cite journal | vauthors = Hovenkamp-Hermelink JH, Jeronimus BF, Myroniuk S, Riese H, Schoevers RA | title = Predictors of persistence of anxiety disorders across the lifespan: a systematic review | journal = The Lancet. Psychiatry | volume = 8 | issue = 5 | pages = 428–443 | date = May 2021 | pmid = 33581052 | doi = 10.1016/S2215-0366(20)30433-8 | s2cid = 231919782 | url = https://pure.rug.nl/ws/files/177228875/Predictors_of_persistence_of_anxiety_disorders_across_the_lifespan_a_systematic_review.pdf }}</ref> Besides, strong percepts of anxiety exist within other [[Medicine:Mental disorder|mental disorder]]s, e.g. obsessive-compulsive disorder, [[Medicine:Post-traumatic stress disorder|post-traumatic stress disorder]].<ref name="Marras et al. (2016)">{{cite journal | vauthors = Marras A, Fineberg N, Pallanti S | title = Obsessive compulsive and related disorders: comparing DSM-5 and ICD-11 | journal = CNS Spectrums | volume = 21 | issue = 4 | pages = 324–333 | date = August 2016 | pmid = 27401060 | doi = 10.1017/S1092852916000110 | s2cid = 13129793 }}</ref><ref name=ICD11>[[Organization:World Health Organization|World Health Organization]] (2023). ''[[International Classification of Diseases]], eleventh revision – ICD-11''. Genova – icd.who.int.</ref>

==Anxiety vs. fear==
Anxiety is distinguished from [[Philosophy:Fear|fear]], which is an appropriate cognitive and emotional response to a perceived threat.<ref>[[Biography:Andreas Dorschel|Andreas Dorschel]], ''Furcht und Angst.'' In: Dietmar Goltschnigg (ed.), ''Angst. Lähmender Stillstand und Motor des Fortschritts.'' Stauffenburg, Tübingen 2012, pp. 49–54</ref> Anxiety is related to the specific behaviors of [[Fight-or-flight response|fight-or-flight response]]s, defensive behavior or escape.<ref>{{cite journal |vauthors=Heeren A |title=On the distinction between fear and anxiety in a (post)pandemic world: a commentary on Schimmenti et al. (2020) |journal=Clinical Neuropsychiatry |year=2020 |pages=189–191 |volume=17 |issue=3 |pmid=34908991 |pmc=8629083 |doi=10.36131/cnfioritieditore20200307 |url=https://www.clinicalneuropsychiatry.org/download/on-the-distinction-between-fear-and-anxiety-in-a-postpandemic-world-a-commentary-on-schimmenti-et-al-2020/ |access-date=2020-12-13 |archive-date=2021-12-16 |archive-url=https://web.archive.org/web/20211216235415/https://www.clinicalneuropsychiatry.org/download/on-the-distinction-between-fear-and-anxiety-in-a-postpandemic-world-a-commentary-on-schimmenti-et-al-2020/ |url-status=live }}</ref> There is a false presumption that often circulates that anxiety only occurs in situations perceived as uncontrollable or unavoidable, but this is not always so.<ref>{{cite book|title=Handbook of emotions| vauthors = Öhman A |publisher=The Guilford Press |year=2000 |isbn=978-1-57230-529-8| veditors = Lewis M, Haviland-Jones JM |location=New York|pages=[https://archive.org/details/handbookofemotio0000unse/page/573 573–93] |chapter=Fear and anxiety: Evolutionary, cognitive, and clinical perspectives |chapter-url=https://archive.org/details/handbookofemotio0000unse/page/573}}</ref> David Barlow defines anxiety as "a future-oriented mood state in which one is not ready or prepared to attempt to [[Social:Coping (psychology)|cope]] with upcoming negative events,"<ref>{{cite journal | vauthors = Barlow DH | title = Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory | journal = The American Psychologist | volume = 55 | issue = 11 | pages = 1247–1263 | date = November 2000 | pmid = 11280938 | doi = 10.1037/0003-066X.55.11.1247 }}</ref> and that it is a distinction between future and present dangers which divides anxiety and fear. Another description of anxiety is agony, dread, terror, or even apprehension.<ref>{{cite journal | vauthors = Iacovou S |year=2011 |title=What is the difference between existential anxiety and so called neurotic anxiety? 'The sine qua non of true vitality' an examination of the difference between existential anxiety and neurotic anxiety |journal=Existential Analysis |volume=22 |issue=2 |id={{Gale|A288874227}} }}</ref> In [[Social:Positive psychology|positive psychology]], anxiety is described as the mental state that results from a difficult challenge for which the subject has insufficient [[Social:Coping (psychology)|coping]] skills.<ref name = "Chand_2022" /><ref>{{cite book|title=Finding Flow |url=https://archive.org/details/findingflowpsych00csik|url-access=registration| vauthors=Csíkszentmihályi M |year=1997 |publisher=Basic Books |isbn=9780465045136 |author-link=Mihaly Csikszentmihalyi}}{{Page needed|date=May 2013}}</ref>

Fear and anxiety can be differentiated into four domains: (1) duration of emotional experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction. Fear is short-lived, present-focused, geared towards a specific threat, and facilitating escape from threat. On the other hand, anxiety is long-acting, future-focused, broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat and interferes with constructive coping.<ref>{{cite journal | vauthors = Sylvers P, Lilienfeld SO, LaPrairie JL | title = Differences between trait fear and trait anxiety: implications for psychopathology | journal = Clinical Psychology Review | volume = 31 | issue = 1 | pages = 122–137 | date = February 2011 | pmid = 20817337 | doi = 10.1016/j.cpr.2010.08.004 }}</ref>

[[Biography:Joseph E. LeDoux|Joseph E. LeDoux]] and [[Biography:Lisa Feldman Barrett|Lisa Feldman Barrett]] have both sought to separate automatic threat responses from additional associated cognitive activity within anxiety.<ref>{{Cite web|url=https://brainworldmagazine.com/on-fear-emotions-and-memory-an-interview-with-dr-joseph-ledoux/|title=On Fear, Emotions, and Memory: An Interview with Dr. Joseph LeDoux|vauthors=Emory M|date=June 7, 2018|website=Brain World|language=en-US|access-date=September 11, 2019|archive-date=April 22, 2021|archive-url=https://web.archive.org/web/20210422224955/https://brainworldmagazine.com/on-fear-emotions-and-memory-an-interview-with-dr-joseph-ledoux/|url-status=live}}</ref><ref>{{cite journal | vauthors = Barrett LF | title = The theory of constructed emotion: an active inference account of interoception and categorization | journal = Social Cognitive and Affective Neuroscience | volume = 12 | issue = 1 | pages = 1–23 | date = January 2017 | pmid = 27798257 | pmc = 5390700 | doi = 10.1093/scan/nsw154 }}</ref>

==Symptoms==
Anxiety can be experienced with long, drawn-out daily symptoms that reduce quality of life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful [[Medicine:Panic attack|panic attack]]s, known as acute anxiety.<ref>{{cite journal | vauthors = Rynn MA, Brawman-Mintzer O | title = Generalized anxiety disorder: acute and chronic treatment | journal = CNS Spectrums | volume = 9 | issue = 10 | pages = 716–723 | date = October 2004 | pmid = 15448583 | doi = 10.1017/S1092852900022367 | s2cid = 24207457 }}</ref> Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. However, most people do not suffer from chronic anxiety.<ref>{{Cite web |title=Generalized Anxiety Disorder |url=https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder |access-date=2023-03-29 |website=National Institute of Mental Health (NIMH) |language=en}}</ref>

Anxiety can induce several psychological pains (e.g. [[Medicine:Depression (mood)|depression]]) or [[Medicine:Mental disorder|mental disorder]]s, and may lead to [[Medicine:Self-harm|self-harm]] or [[Medicine:Suicide|suicide]] for which dedicated hotlines exist.<ref name="WHO2009" /><ref name="TestaGiannuzzi2013partI" /><ref>{{Cite news|url=https://www.psychguides.com/guides/depression-hotline/|title=Depression Hotline {{!}} Call Our Free, 24 Hour Depression Helpline|work=PsychGuides.com|access-date=October 11, 2018|archive-date=October 11, 2018|archive-url=https://web.archive.org/web/20181011214543/https://www.psychguides.com/guides/depression-hotline/|url-status=live}}</ref>

The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative feelings in the past.<ref name="Barker, P. 2003" /> Other effects may include changes in sleeping patterns, changes in habits, increase or decrease in food intake, and increased motor tension (such as foot tapping).<ref name="Barker, P. 2003" />

The emotional effects of anxiety may include "feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) of danger, and, feeling like your mind's gone blank"<ref>{{cite web | vauthors = Smith M | date = June 2008 | title = Anxiety attacks and disorders: Guide to the signs, symptoms, and treatment options. | access-date = 3 March 2009 | work = Helpguide | url = http://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htm |archive-url=https://web.archive.org/web/20090307161028/http://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htm |archive-date= 7 March 2009 }}</ref> as well as "nightmares/bad dreams, obsessions about sensations, [[Déjà vu|déjà vu]], a trapped-in-your-mind feeling, and feeling like everything is scary."<ref>{{cite web | vauthors = Folk J | veditors = Liashko V | orig-date = 1987 | date = 13 October 2021 | title = Anxiety Symptoms, Causes, Treatment | access-date = 3 March 2009 | work = Anxiety Centre | url = http://www.anxietycentre.com/anxiety-symptoms.shtml | url-status=live |archive-url=https://web.archive.org/web/20090307132218/http://www.anxietycentre.com/anxiety-symptoms.shtml |archive-date=March 7, 2009 }}</ref> It may include a vague experience and feeling of helplessness.<ref>{{cite journal | vauthors = Milfayetty S, Fadli RP, Ifdil I, Zola N, Amalianita B, Putri YE, Ardi Z | title = The Effectiveness of Multidimensional Counseling in the Intervention of Student Anxiety. | journal = Addictive Disorders & Their Treatment | date = September 2020 | volume = 19 | issue = 3 | pages = 131–5 | doi = 10.1097/ADT.0000000000000187 | s2cid = 209255441 | url = http://digilib.unimed.ac.id/53048/1/Turnitin.pdf }}</ref>

The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of dying: "You may&nbsp;... fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumor or an aneurysm. You feel an intense fear when you think of dying, or you may think of it more often than normal, or can't get it out of your mind."<ref>{{cite web | vauthors = Folk J | veditors = Folk M | orig-date = 1987 | date = 27 March 2021 | title = Anxiety symptoms – Fear of dying. | access-date = 3 March 2009 | work = Anxiety Centre| url=http://www.anxietycentre.com/anxiety-symptoms/fear-of-dying.shtml |url-status=live |archive-url=https://web.archive.org/web/20090305104407/http://www.anxietycentre.com/anxiety-symptoms/fear-of-dying.shtml |archive-date=March 5, 2009 }}</ref>

The physiological symptoms of anxiety may include:<ref name="WHO2009" /><ref name="TestaGiannuzzi2013partI" />
*Neurological, as [[Medicine:Headache|headache]], [[Unsolved:Paresthesia|paresthesia]]s, fasciculations, [[Medicine:Vertigo|vertigo]], or [[Medicine:Presyncope|presyncope]].
*Digestive, as abdominal pain, nausea, [[Medicine:Diarrhea|diarrhea]], indigestion, dry mouth, or [[Biology:Bolus (digestion)|bolus]]. Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate [[Medicine:Irritable bowel syndrome|IBS]].
*Respiratory, as shortness of breath or sighing breathing.
*Cardiac, as [[Medicine:Palpitations|palpitations]], [[Medicine:Tachycardia|tachycardia]], or [[Medicine:Chest pain|chest pain]].
*Muscular, as fatigue, tremors, or [[Medicine:Tetany|tetany]].
*Cutaneous, as [[Medicine:Perspiration|perspiration]], or itchy skin.
*Uro-genital, as frequent urination, urinary urgency, dyspareunia, or [[Medicine:Erectile dysfunction|impotence]], chronic pelvic pain syndrome.

==Types==
[[File:Edvard Munch - Anxiety - Google Art Project.jpg|thumb|upright|Painting entitled ''Anxiety'', 1894, by Edvard Munch]]
There are various types of anxiety. Existential anxiety can occur when a person faces [[Philosophy:Angst|angst]], an [[Philosophy:Existential crisis|existential crisis]], or [[Philosophy:Nihilism|nihilistic]] feelings. People can also face [[Mathematical anxiety|mathematical anxiety]], [[Medicine:Somatic anxiety|somatic anxiety]], [[Medicine:Stage fright|stage fright]], or [[Medicine:Test anxiety|test anxiety]]. [[Medicine:Social anxiety|Social anxiety]] refers to a fear of rejection and negative evaluation (being judged) by other people.<ref name="DSM-5 189" />

===Existential===
{{Further|Philosophy:Angst|Philosophy:Existential crisis|Philosophy:Nihilism}}

The philosopher [[Biography:Søren Kierkegaard|Søren Kierkegaard]], in ''[[Medicine:The Concept of Anxiety|The Concept of Anxiety]]'' (1844), described anxiety or dread associated with the "dizziness of freedom" and suggested the possibility for positive resolution of anxiety through the self-conscious exercise of responsibility and choosing. In ''Art and Artist'' (1932), the psychologist Otto Rank wrote that the [[Medicine:Psychological trauma|psychological trauma]] of birth was the pre-eminent human symbol of existential anxiety and encompasses the creative person's simultaneous fear of – and desire for – separation, individuation, and differentiation.<ref name=":1">{{Cite book| vauthors = Rank O |title=Art and Artist|publisher=Norton, W. W. & Company, Inc.|year=1932|isbn=9780393305746}}</ref>

The [[Religion:Theology|theologian]] [[Biography:Paul Tillich|Paul Tillich]] characterized existential anxiety<ref name="Tillich">{{cite book | vauthors = Tillich P |year=1952 |title=The Courage To Be |location=New Haven |publisher=Yale University Press |isbn=978-0-300-08471-9|page=76}}</ref> as "the state in which a [[Philosophy:Being|being]] is aware of its possible nonbeing" and he listed three categories for the nonbeing and resulting anxiety: ontic (fate and death), [[Philosophy:Morality|moral]] ([[Philosophy:Guilt (emotion)|guilt]] and condemnation), and [[Philosophy:Spirituality|spiritual]] (emptiness and [[Philosophy:Meaning (existential)|meaninglessness]]). According to Tillich, the last of these three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times while the others were predominant in earlier periods. Tillich argues that this anxiety can be accepted as part of the [[Philosophy:Human condition|human condition]] or it can be resisted but with negative consequences. In its pathological form, spiritual anxiety may tend to "drive the person toward the creation of certitude in systems of meaning which are supported by [[Philosophy:Tradition|tradition]] and [[Philosophy:Authority|authority]]" even though such "undoubted certitude is not built on the rock of [[Philosophy:Reality|reality]]".<ref name="Tillich" />

According to Viktor Frankl, the author of ''Man's Search for Meaning'', when a person is faced with extreme mortal dangers, the most basic of all human wishes is to find a [[Philosophy:Meaning of life|meaning of life]] to combat the "trauma of nonbeing" as death is near.<ref>{{cite book| vauthors = Abulof U |title=The Mortality and Morality of Nations|date=2015|location=New York|publisher=Cambridge University Press|isbn=978-1-107-09707-0|page=26}}</ref>

Depending on the source of the threat, psychoanalytic theory distinguishes the following types of anxiety:
* realistic
* neurotic
* moral<ref>{{cite book | vauthors = Hjelle L, Ziegler D |date= 1981 |title= Personality Theories: Basic Assumptions, Research, and Applications|publisher=McGraw-Hill |page=494 |isbn= 9780070290631 }}</ref>

===Test, performance, and competitive===
<!-- This section is linked from [[Social:Educational psychology|Educational psychology]] -->

==== Test ====
{{Main|Medicine:Test anxiety|Mathematical anxiety}}
According to Yerkes-Dodson law, an optimal level of arousal is necessary to best complete a task such as an exam, performance, or competitive event. However, when the anxiety or level of arousal exceeds that optimum, the result is a decline in performance.<ref name="Teigen">{{cite journal |doi=10.1177/0959354394044004 |title=Yerkes-Dodson: A Law for all Seasons |journal=Theory & Psychology |volume=4 |issue=4 |pages=525–547 |year=1994 |vauthors=Teigen KH |s2cid=145516099}}</ref>

Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an exam. Students who have test anxiety may experience any of the following: the association of grades with [[Philosophy:Self-esteem|personal worth]]; fear of embarrassment by a teacher; fear of [[Philosophy:Social alienation|alienation]] from parents or friends; time pressures; or feeling a loss of control. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, uncontrollable crying or laughing and drumming on a desk are all common.<ref>{{Cite journal |last1=Colangelo |first1=Raychel |last2=Audet |first2=Karyn |date=2020-12-31 |title=Stress in Post-Secondary: Toward an Understanding of Test-Anxiety, Cognitive Performance, and Brief Mindfulness Meditation |journal=Behavioural Sciences Undergraduate Journal |volume=3 |issue=1 |pages=31–44 |doi=10.29173/bsuj500 |issn=2562-4687|doi-access=free }}</ref> Because test anxiety hinges on [[Medicine:Fear of negative evaluation|fear of negative evaluation]],<ref name="Liebert">{{cite journal |vauthors=Liebert RM, Morris LW |title=Cognitive and emotional components of test anxiety: a distinction and some initial data |journal=Psychological Reports |volume=20 |issue=3 |pages=975–978 |date=June 1967 |pmid=6042522 |doi=10.2466/pr0.1967.20.3.975 |s2cid=33689633 |doi-access=}}</ref> debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social [[Medicine:Phobia|phobia]].<ref name="Beidel">{{cite journal |vauthors=Beidel DC, Turner SM |title=Comorbidity of test anxiety and other anxiety disorders in children |journal=Journal of Abnormal Child Psychology |volume=16 |issue=3 |pages=275–287 |date=June 1988 |pmid=3403811 |doi=10.1007/BF00913800 |s2cid=38476947}}</ref> The DSM-IV classifies test anxiety as a type of social phobia.<ref name="Rapee">{{cite journal |vauthors=Rapee RM, Heimberg RG |title=A cognitive-behavioral model of anxiety in social phobia |journal=Behaviour Research and Therapy |volume=35 |issue=8 |pages=741–756 |date=August 1997 |pmid=9256517 |doi=10.1016/S0005-7967(97)00022-3}}</ref>

Research indicates that test anxiety among U.S. high-school and college students has been rising since the late 1950s. Test anxiety remains a challenge for students, regardless of age, and has considerable physiological and psychological impacts.<ref>{{cite journal |last1=Stearns |first1=Peter |title=Student Anxiety and Its Impact: A Recent American History |journal=History of Education Quarterly |date=May 2023 |volume=63 |issue=2 |pages=271–297 |doi=10.1017/heq.2023.10|s2cid=258190141 }}</ref> Management of test anxiety focuses on achieving relaxation and developing mechanisms to manage anxiety.<ref name="Mathur">{{cite journal |vauthors=Mathur S, Khan W |year=2011 |title=Impact of Hypnotherapy on Examination Anxiety and Scholastic Performance among School |url=http://medind.nic.in/daa/t11/i2/daat11i2p337.pdf |url-status=live |journal=Delhi Psychiatry Journal |volume=14 |issue=2 |pages=337–342 |citeseerx=10.1.1.1027.7497 |archive-url=https://ghostarchive.org/archive/20221009/http://medind.nic.in/daa/t11/i2/daat11i2p337.pdf |archive-date=2022-10-09}}</ref> The routine practice of slow, Device-Guided Breathing (DGB) is a
major component of behavioral treatments for anxiety conditions.<ref>{{cite journal |vauthors=Ovadia-Blechman Z, Tarrasch R, Velicki M, Chalutz Ben-Gal H |title=Reducing Test Anxiety by Device-Guided Breathing: A Pilot Study |journal=Frontiers in Psychology |year=2022 |volume=13 |page=678098 |url=https://english.afeka.ac.il/media/2235899/frintiers-in-psychology-2022.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://english.afeka.ac.il/media/2235899/frintiers-in-psychology-2022.pdf |archive-date=2022-10-09 |url-status=live |doi=10.3389/fpsyg.2022.678098 |pmid=35677145 |pmc=9167931 |doi-access=free}}</ref>

==== Performance and competitive ====
[[Medicine:Stage fright|Performance anxiety]] and competitive anxiety (competitive trait anxiety, competitive state anxiety) happen when an individual's performance is measured against others. An important distinction between competitive and non-competitive anxiety is that competitive anxiety makes people view their performance as a threat.<ref name=":0">{{cite journal | vauthors = Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG | title = The Mental Health of Elite Athletes: A Narrative Systematic Review | journal = Sports Medicine | volume = 46 | issue = 9 | pages = 1333–1353 | date = September 2016 | pmid = 26896951 | pmc = 4996886 | doi = 10.1007/s40279-016-0492-2 }}</ref> As a result, they experience a drop in their ordinary ability, whether physical or mental, due to that perceived stress.<ref name=":12">{{cite journal | vauthors = Ford JL, Ildefonso K, Jones ML, Arvinen-Barrow M | title = Sport-related anxiety: current insights | language = English | journal = Open Access Journal of Sports Medicine | volume = 8 | pages = 205–212 | date = 2017-10-27 | pmid = 29138604 | pmc = 5667788 | doi = 10.2147/OAJSM.S125845 | doi-access = free }}</ref>

Competitive anxiety is caused by a range of internal factors including high expectations, outside pressure,<ref name=":12" /> lack of experience, and external factors like the location of a competition.<ref>{{Cite journal | vauthors = Kang H, Jang S |date=2018-08-13 |title=Effects of competition anxiety on self-confidence in soccer players: Modulation effects of home and away games. |journal=Journal of Men's Health |volume=14 |issue=3 |pages=62–68 |doi=10.22374/1875-6859.14.3.9 |doi-broken-date=2024-01-23 |issn=1875-6867|doi-access=free }}</ref> It commonly occurs in those participating in high pressure activities like sports and debates. Some common symptoms of competitive anxiety include muscle tension, fatigue, weakness, sense of panic, apprehensiveness, and panic attacks.<ref>{{cite journal | vauthors = Rowland DL, van Lankveld JJ | title = Anxiety and Performance in Sex, Sport, and Stage: Identifying Common Ground | journal = Frontiers in Psychology | volume = 10 | pages = 1615 | date = 2019 | pmid = 31379665 | pmc = 6646850 | doi = 10.3389/fpsyg.2019.01615 | doi-access = free }}</ref>

There are 4 major theories of how anxiety affects performance: Drive theory, Inverted U theory, Reversal theory, and The Zone of Optimal Functioning theory.

''Drive theory'' believes that anxiety is positive and performance improves proportionally to the level of anxiety. This theory is not well accepted.<ref name = "Jarvis_2006">{{Cite book | vauthors = Jarvis M |url=https://www.worldcat.org/oclc/60971762 |title=Sport psychology : a student's handbook |date=2006 |publisher=Routledge |isbn=1-84169-581-5 |location=London |oclc=60971762}}</ref>

The ''Inverted U theory'' is based on the idea that performance peaks at a moderate stress level. It is called Inverted U theory because the graph that plots performance against anxiety looks like an inverted "U".<ref name = "Jarvis_2006" />

''Reversal theory'' suggests that performance increases in relation to the individual's interpretation of their arousal levels. If they believed their physical arousal level would help them, their performance would increase, if they didn't, their performance would decrease.<ref name=":12" /> For example: Athletes were shown to worry more when focusing on results and perfection rather than the effort and growth involved.<ref name=":0" />

The ''Zone of Optimal Functioning theory'' proposes that there is a zone where positive and negative emotions are in a balance which lead to feelings of dissociation and intense concentration, optimizing the individual's performance levels.<ref name=":22">{{Cite book |url=https://onlinelibrary.wiley.com/doi/book/10.1002/9780470479216 |title=The Corsini Encyclopedia of Psychology |date=2010-01-30 |publisher=Wiley |isbn=978-0-470-17024-3 | veditors = Weiner IB, Craighead WE |edition=1st |language=en |doi=10.1002/9780470479216.corpsy0626 }}</ref>

===Stranger, social, and intergroup anxiety===
{{Main|Social:Stranger anxiety|Medicine:Social anxiety}}

Humans generally require social acceptance and thus sometimes dread the disapproval of others. Apprehension of being judged by others may cause anxiety in social environments.<ref>{{Cite book |doi=10.1016/B978-0-12-375096-9.00028-6 |chapter=Introduction: Toward an Understanding of Social Anxiety Disorder |title=Social Anxiety |pages=xix–xxvi |year=2010 | vauthors = Hofmann SG, Dibartolo PM |isbn=978-0-12-375096-9 }}</ref>

Anxiety during social interactions, particularly between strangers, is common among young people. It may persist into adulthood and become social anxiety or social phobia. "[[Social:Stranger anxiety|Stranger anxiety]]" in small children is not considered a phobia. In adults, an excessive fear of other people is not a developmentally common stage; it is called [[Medicine:Social anxiety|social anxiety]]. According to Cutting, social phobics do not fear the crowd but the fact that they may be judged negatively.<ref>{{cite book | veditors = Thomas B, Hardy S, Cutting P |year=1997 |title=Mental Health Nursing: Principles and Practice |publisher=Mosby |location=London |isbn=978-0-7234-2590-8 |url-access=registration |url=https://archive.org/details/stuartsundeensme0000unse }}{{Page needed|date=May 2013}}</ref>

[[Medicine:Social anxiety|Social anxiety]] varies in degree and severity. For some people, it is characterized by experiencing discomfort or awkwardness during physical social contact (e.g. embracing, shaking hands, etc.), while in other cases it can lead to a fear of interacting with unfamiliar people altogether. Those with this condition may restrict their lifestyles to accommodate the anxiety, minimizing social interaction whenever possible. Social anxiety also forms a core aspect of certain personality disorders, including [[Medicine:Avoidant personality disorder|avoidant personality disorder]].<ref>{{cite journal | vauthors = Settipani CA, Kendall PC | title = Social functioning in youth with anxiety disorders: association with anxiety severity and outcomes from cognitive-behavioral therapy | journal = Child Psychiatry and Human Development | volume = 44 | issue = 1 | pages = 1–18 | date = February 2013 | pmid = 22581270 | doi = 10.1007/s10578-012-0307-0 | s2cid = 39915581 }}</ref>

To the extent that a person is fearful of social encounters with unfamiliar others, some people may experience anxiety particularly during interactions with outgroup members, or people who share different group memberships (i.e., by race, ethnicity, class, gender, etc.). Depending on the nature of the antecedent relations, cognitions, and situational factors, intergroup contact may be stressful and lead to feelings of anxiety. This apprehension or fear of contact with outgroup members is often called interracial or intergroup anxiety.<ref>{{cite journal |doi=10.1111/j.1540-4560.1985.tb01134.x |title=Intergroup Anxiety |journal=Journal of Social Issues |volume=41 |issue=3 |pages=157–175 |year=1985 | vauthors = Stephan WG, Stephan CW }}</ref>

As is the case with the more generalized forms of [[Medicine:Social anxiety|social anxiety]], intergroup anxiety has behavioral, cognitive, and affective effects. For instance, increases in schematic processing and simplified information processing can occur when anxiety is high. Indeed, such is consistent with related work on attentional bias in implicit memory.<ref>{{cite journal | vauthors = Richeson JA, Trawalter S | title = The threat of appearing prejudiced and race-based attentional biases | journal = Psychological Science | volume = 19 | issue = 2 | pages = 98–102 | date = February 2008 | pmid = 18271854 | doi = 10.1111/j.1467-9280.2008.02052.x | s2cid = 11212529 }}</ref><ref>{{cite journal | vauthors = Mathews A, Mogg K, May J, Eysenck M | title = Implicit and explicit memory bias in anxiety | journal = Journal of Abnormal Psychology | volume = 98 | issue = 3 | pages = 236–240 | date = August 1989 | pmid = 2768658 | doi = 10.1037/0021-843x.98.3.236 }}</ref><ref>{{cite journal |doi=10.1016/0191-8869(91)90096-t |title=Effects of encoding and anxiety on implicit and explicit memory performance |journal=Personality and Individual Differences |volume=12 |issue=2 |pages=131–139 |year=1991 | vauthors = Richards A, French CC }}</ref> Additionally recent research has found that implicit racial evaluations (i.e. automatic prejudiced attitudes) can be amplified during intergroup interaction.<ref>{{cite journal | vauthors = Amodio DM, Hamilton HK | title = Intergroup anxiety effects on implicit racial evaluation and stereotyping | journal = Emotion | volume = 12 | issue = 6 | pages = 1273–1280 | date = December 2012 | pmid = 22775128 | doi = 10.1037/a0029016 | citeseerx = 10.1.1.659.5717 }}</ref> Negative experiences have been illustrated in producing not only negative expectations, but also avoidant, or antagonistic, behavior such as hostility.<ref>{{cite journal | vauthors = Plant EA, Devine PG | title = The antecedents and implications of interracial anxiety | journal = Personality & Social Psychology Bulletin | volume = 29 | issue = 6 | pages = 790–801 | date = June 2003 | pmid = 15189634 | doi = 10.1177/0146167203029006011 | s2cid = 8581417 }}</ref> Furthermore, when compared to anxiety levels and cognitive effort (e.g., impression management and self-presentation) in intragroup contexts, levels and depletion of resources may be exacerbated in the intergroup situation.

===Trait===
Anxiety can be either a short-term "state" or a long-term personality "trait." Trait anxiety reflects a stable tendency across the lifespan of responding with acute, state anxiety in the anticipation of threatening situations (whether they are actually deemed threatening or not).<ref>{{cite web | vauthors = Schwarzer R | collaboration = Psychosocial Working Group | date = December 1997 |title=Anxiety |url=https://macses.ucsf.edu/research/psychosocial/anxiety.php | archive-url = https://web.archive.org/web/20180307141654/https://macses.ucsf.edu/research/psychosocial/anxiety.php | archive-date = 7 March 2018 |website=MacArthur SES & Health Network }}</ref> A meta-analysis showed that a high level of [[Medicine:Neuroticism|neuroticism]] is a risk factor for development of anxiety symptoms and disorders.<ref name="NeuroticismMA">{{cite journal | vauthors = Jeronimus BF, Kotov R, Riese H, Ormel J | title = Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants | journal = Psychological Medicine | volume = 46 | issue = 14 | pages = 2883–2906 | date = October 2016 | pmid = 27523506 | doi = 10.1017/S0033291716001653 | s2cid = 23548727 | url = https://zenodo.org/record/895885 | access-date = 2019-07-28 | archive-date = 2019-07-24 | archive-url = https://web.archive.org/web/20190724213253/https://zenodo.org/record/895885 | url-status = live }}</ref> Such anxiety may be conscious or unconscious.<ref>{{cite book | vauthors = Giddey M, Wright H |title=Mental Health Nursing: From first principles to professional practice |year=1993 |publisher=Stanley Thornes | isbn = 978-0-412-41210-3 }}{{Page needed|date=May 2013}}</ref>

Personality can also be a trait leading to anxiety and depression and their persistence.<ref name=Lancet2021/> Through experience, many find it difficult to collect themselves due to their own personal nature.<ref>{{Cite news|url=https://www.gulfbend.org/poc/view_doc.php?type=doc&id=8948|title=Gulf Bend MHMR Center|access-date=October 11, 2018|archive-date=October 11, 2018|archive-url=https://web.archive.org/web/20181011214432/https://www.gulfbend.org/poc/view_doc.php?type=doc&id=8948|url-status=dead}}</ref>

=== Choice or decision ===
Anxiety induced by the need to choose between similar options is increasingly being recognized as a problem for individuals and for organizations.<ref>{{cite news |url=http://www.thesundaytimes.co.uk/sto/style/fashion/trends/article85734.ece |work=The Times |location=London |title=Premium choice anxiety |date=April 27, 2008 |access-date=April 25, 2010 | vauthors = Downey J |archive-url=https://web.archive.org/web/20140203132027/http://www.thesundaytimes.co.uk/sto/style/fashion/trends/article85734.ece |archive-date=February 3, 2014 }}</ref> In 2004, [[Company:Capgemini|Capgemini]] wrote: "Today we're all faced with greater choice, more competition and less time to consider our options or seek out the right advice."<ref>[https://www.uk.capgemini.com/news/pr1487 Is choice anxiety costing british 'blue chip' business?] {{webarchive|url=https://web.archive.org/web/20151222143245/https://www.uk.capgemini.com/news/pr1487 |date=December 22, 2015 }}, [[Company:Capgemini|Capgemini]], August 16, 2004</ref>

In a decision context, unpredictability or uncertainty may trigger emotional responses in anxious individuals that systematically alter decision-making.<ref name="Hartley">{{cite journal | vauthors = Hartley CA, Phelps EA | title = Anxiety and decision-making | journal = Biological Psychiatry | volume = 72 | issue = 2 | pages = 113–118 | date = July 2012 | pmid = 22325982 | pmc = 3864559 | doi = 10.1016/j.biopsych.2011.12.027 }}</ref> There are primarily two forms of this anxiety type. The first form refers to a choice in which there are multiple potential outcomes with known or calculable probabilities. The second form refers to the uncertainty and ambiguity related to a decision context in which there are multiple possible outcomes with unknown probabilities.<ref name="Hartley" />

===Panic disorder===
{{Main|Medicine:Panic disorder}}

Panic disorder may share symptoms of stress and anxiety, but it is actually very different. Panic disorder is an anxiety disorder that occurs without any triggers. According to the U.S. Department of Health and Human Services, this disorder can be distinguished by unexpected and repeated episodes of intense fear.<ref>{{Cite web |date=June 8, 2015 |title=What are the five major types of anxiety disorders? |url=https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-five-major-types-of-anxiety-disorders/index.html |url-status=live |archive-url=https://web.archive.org/web/20191025023728/https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-five-major-types-of-anxiety-disorders/index.html |archive-date=October 25, 2019 |access-date=October 25, 2019 |publisher=U.S. Department of Health & Human Services}}</ref> Someone with panic disorder will eventually develop constant fear of another attack and as this progresses it will begin to affect daily functioning and an individual's general quality of life. It is reported by the Cleveland Clinic that panic disorder affects 2 to 3 percent of adult Americans and can begin around the time of the teenage and early adult years. Some symptoms include: difficulty breathing, chest pain, dizziness, trembling or shaking, feeling faint, nausea, fear that you are losing control or are about to die. Even though they have these symptoms during an attack, the main symptom is the persistent fear of having future panic attacks.<ref>{{Cite web |title=Panic Disorder & Panic Attacks |url=https://my.clevelandclinic.org/health/diseases/4451-panic-disorder |url-status=live |archive-url=https://web.archive.org/web/20191005194749/https://my.clevelandclinic.org/health/diseases/4451-panic-disorder |archive-date=2019-10-05 |access-date=2019-10-25 |work=The Cleveland Clinic}}</ref>

== Anxiety disorders ==
{{Main|Medicine:Anxiety disorder}}
<!-- Do not add new content here.  Add to body of Anxiety disorder article, and only if it rises to the importance of the lead there, update the lead there, then update this. Per WP:SYNC -->
Anxiety disorders are a group of [[Medicine:Mental disorder|mental disorder]]s characterized by exaggerated feelings of anxiety and [[Philosophy:Fear|fear]] responses.<ref name="DSM-5 189" /> Anxiety is a worry about future events and fear is a reaction to current events.<!-- <ref name= DSM5/> --> These feelings may cause physical symptoms, such as a [[Medicine:Tachycardia|fast heart rate]] and shakiness.<!-- <ref name= DSM5/> --> There are a number of anxiety disorders: including [[Medicine:Generalized anxiety disorder|generalized anxiety disorder]], [[Medicine:Phobia|specific phobia]], [[Medicine:Social anxiety disorder|social anxiety disorder]], [[Medicine:Separation anxiety disorder|separation anxiety disorder]], [[Medicine:Agoraphobia|agoraphobia]], [[Medicine:Panic disorder|panic disorder]], and [[Medicine:Selective mutism|selective mutism]].<!-- <ref name= DSM5/> --> The disorder differs by what results in the symptoms.<!-- <ref name= DSM5/> --> People often have more than one anxiety disorder.<ref name="DSM-5 189" />

<!-- Causes and diagnosis -->
Anxiety disorders are caused by a complex combination of [[Biology:Heredity|genetic]] and environmental factors.<ref>{{Cite web|vauthors=Hurley K|date=|title=Anorexia & Depression: When Eating Disorders Co-Exist with Depression|url=https://www.psycom.net/anorexia-and-depression/|access-date=2020-06-05|website=Psycom.net - Mental Health Treatment Resource Since 1986|language=en-US|archive-date=2020-06-04|archive-url=https://web.archive.org/web/20200604221258/https://www.psycom.net/anorexia-and-depression/|url-status=live}}</ref><ref name="Genetics of generalized anxiety dis">{{cite journal | vauthors = Gottschalk MG, Domschke K | title = Genetics of generalized anxiety disorder and related traits | journal = Dialogues in Clinical Neuroscience | volume = 19 | issue = 2 | pages = 159–168 | date = June 2017 | pmid = 28867940 | pmc = 5573560 | doi = 10.31887/DCNS.2017.19.2/kdomschke }}</ref> To be diagnosed, symptoms typically need to be present for at least six months, be more than would be expected for the situation, and decrease a person's ability to function in their daily lives.<ref name="DSM-5 189" /><ref>{{Cite web|title=Anxiety|url=https://medlineplus.gov/anxiety.html|access-date=2021-10-27|website=medlineplus.gov|archive-date=2021-10-27|archive-url=https://web.archive.org/web/20211027151723/https://medlineplus.gov/anxiety.html|url-status=live}}</ref> Other problems that may result in similar symptoms include [[Medicine:Hyperthyroidism|hyperthyroidism]], heart disease, [[Biology:Caffeine|caffeine]], [[Chemistry:Alcohol (drug)|alcohol]], or [[Biology:Cannabis (drug)|cannabis]] use, and withdrawal from certain drugs, among others.<ref>{{cite journal | vauthors = Derrick K, Green T, Wand T | title = Assessing and responding to anxiety and panic in the Emergency Department | journal = Australasian Emergency Care | volume = 22 | issue = 4 | pages = 216–220 | date = December 2019 | pmid = 31530499 | doi = 10.1016/j.auec.2019.08.002 | s2cid = 202672894 }}</ref>

<!-- Management  -->
Without treatment, anxiety disorders tend to remain.<ref name="DSM-5 189" /><ref name="NIH2016">{{cite web|url=http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#pub2|title=Anxiety Disorders|date=March 2016|website=NIMH|archive-url=https://web.archive.org/web/20160727230427/http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#pub2|archive-date=July 27, 2016|url-status=live|access-date=August 14, 2016}}</ref> Treatment may include lifestyle changes, [[Medicine:Psychotherapy|counselling]], and medications.<!-- <ref name=Lancet2016/> --> Counselling is typically with a type of [[Medicine:Cognitive behavioral therapy|cognitive behavioral therapy]].<ref name="Lancet2016" /> Medications, such as antidepressants or beta blockers, may improve symptoms.<ref name="NIH2016" /> A 2023 review found that regular physical activity is effective for reducing anxiety.<ref>{{Cite journal|display-authors=3 |last1=Singh |first1=Ben |last2=Olds |first2=Timothy |last3=Curtis |first3=Rachel |last4=Dumuid |first4=Dorothea |last5=Virgara |first5=Rosa |last6=Watson |first6=Amanda |last7=Szeto |first7=Kimberley |last8=O'Connor |first8=Edward |last9=Ferguson |first9=Ty |last10=Eglitis |first10=Emily |last11=Miatke |first11=Aaron |last12=Simpson |first12=Catherine EM |last13=Maher |first13=Carol |date=2023-02-16 |title=Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews |journal=British Journal of Sports Medicine |volume=57 |issue=18 |pages=1203–1209 |language=en |doi=10.1136/bjsports-2022-106195 |issn=0306-3674 |pmid=36796860|doi-access=free |pmc=10579187 }}</ref>

<!-- Epidemiology -->
About 12% of people are affected by an anxiety disorder in a given year and between 12 and 30% are affected at some point in their life.<ref name="Lancet2016" /><ref name="Kess2007">{{cite journal | vauthors = Kessler RC, Angermeyer M, Anthony JC, DE Graaf R, Demyttenaere K, Gasquet I, DE Girolamo G, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Ustün TB | display-authors = 6 | title = Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative | journal = World Psychiatry | volume = 6 | issue = 3 | pages = 168–176 | date = October 2007 | pmid = 18188442 | pmc = 2174588 }}</ref> They occur about twice as often in women than they do in men, and generally begin before the age of 25.<ref name="DSM-5 189" /><ref name="Lancet2016">{{cite journal | vauthors = Craske MG, Stein MB | title = Anxiety | journal = Lancet | volume = 388 | issue = 10063 | pages = 3048–3059 | date = December 2016 | pmid = 27349358 | doi = 10.1016/S0140-6736(16)30381-6 | s2cid = 208789585 }}</ref> The most common anxiety disorders are specific phobias, which affect nearly 12% of people, and social anxiety disorder, which affects 10% of people at some point in their life.<!-- <ref name=Lancet2016/> --> They affect those between the ages of 15 and 35 the most and become less common after the age of 55.<!-- <ref name=Lancet2016/> --> Rates appear to be higher in the United States and Europe.<ref name="Lancet2016" />

===Short- and long-term anxiety===
Anxiety can be either a short-term "state" or a long-term "[[Social:Trait theory|trait]]." Whereas trait anxiety represents worrying about future events, anxiety disorders are a group of [[Medicine:Mental disorder|mental disorder]]s characterized by feelings of anxiety and fears.<ref name="DSM-5 189" />

===Four ways to be anxious===
In his book ''Anxious: The Modern Mind in the Age of Anxiety''<ref>{{Cite book| vauthors = LeDoux JE |title=Anxious: the modern mind in the age of anxiety|date=2015|isbn=978-1-78074-767-5|location=London |publisher=Oneworld |oclc=920462582}}</ref> [[Biography:Joseph E. LeDoux|Joseph LeDoux]] examines four experiences of anxiety through a brain-based lens:

# In the presence of an existing or imminent external threat, you worry about the event and its implications for your physical and/or psychological well-being. When a threat signal occurs, it signifies either that danger is present or near in space and time or that it might be coming in the future. Nonconscious threats processing by the brain activates defensive survival circuits, resulting in changes in information processing in the brain, controlled in part by increases in arousal and behavioral and physiological responses in the body that then produce signals that feed back to the brain and complement the physiological changes there, intensifying them and extending their duration.
# When you notice body sensations, you worry about what they might mean for your physical and/or psychological well-being. The trigger stimulus does not have to be an external stimulus but can be an internal one, as some people are particularly sensitive to body signals.
# Thoughts and memories may lead to you to worry about your physical and/or psychological well-being. We do not need to be in the presence of an external or internal stimulus to be anxious. An episodic memory of a past trauma or of a panic attack in the past is sufficient to activate the defence circuits.
# Thoughts and memories may result in existential dread, such as worry about leading a meaningful life or the eventuality of death. Examples are contemplations of whether one's life has been meaningful, the inevitability of death, or the difficulty of making decisions that have a moral value. These do not necessarily activate defensive systems; they are more or less pure forms of cognitive anxiety.

==Co-morbidity==
Anxiety disorders often occur with other mental health disorders, particularly major depressive disorder, [[Medicine:Bipolar disorder|bipolar disorder]], [[Medicine:Eating disorder|eating disorder]]s, or certain [[Medicine:Personality disorder|personality disorder]]s. It also commonly occurs with personality traits such as neuroticism. This observed co-occurrence is partly due to genetic and environmental influences shared between these traits and anxiety.<ref>{{cite journal | vauthors = Smoller JW, Andreassen OA, Edenberg HJ, Faraone SV, Glatt SJ, Kendler KS | title = Correction to: Psychiatric genetics and the structure of psychopathology | journal = Molecular Psychiatry | volume = 24 | issue = 3 | pages = 471 | date = March 2019 | pmid = 29540840 | doi = 10.1038/s41380-018-0026-4 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Kendler KS |title=Major Depression and Generalised Anxiety Disorder |journal=FOCUS |date=July 2004 |volume=2 |issue=3 |pages=416–425 |doi=10.1176/foc.2.3.416 }}</ref>

It is common for those with [[Medicine:Obsessive–compulsive disorder|obsessive–compulsive disorder]] to experience anxiety. Anxiety is also commonly found in those who experience panic disorders, phobic anxiety disorders, severe [[Medicine:Psychological stress|stress]], dissociative disorders, somatoform disorders, and some neurotic disorders.<ref>{{cite journal | vauthors = Stein DJ, Fineberg NA, Bienvenu OJ, Denys D, Lochner C, Nestadt G, Leckman JF, Rauch SL, Phillips KA | display-authors = 6 | title = Should OCD be classified as an anxiety disorder in DSM-V? | journal = Depression and Anxiety | volume = 27 | issue = 6 | pages = 495–506 | date = June 2010 | pmid = 20533366 | doi = 10.1002/da.20699 | s2cid = 17606388 | doi-access = free }}</ref>
Anxiety has also been linked to the experience of intrusive thoughts. Studies have revealed that individuals who experience high levels of anxiety (also known as clinical anxiety) are highly vulnerable to the experience of intense intrusive thoughts or psychological disorders that are characterised by intrusive thoughts.<ref>{{cite journal | vauthors = Omoregie J, Carson J |title=Reductive mechanisms for unwanted intrusive thoughts: exploring affectivity in clinical and non-clinical samples |journal=Mental Health and Social Inclusion |date=1 January 2022 |volume=27 |issue= |pages=51–65 |doi=10.1108/MHSI-06-2022-0040|s2cid=251511163 }}</ref>

==Risk factors==
[[File:Emperor Traianus Decius (Mary Harrsch).jpg|thumb|upright|A marble bust of the Roman Emperor Decius from the Capitoline Museum. This portrait "conveys an impression of anxiety and weariness, as of a man shouldering heavy [state] responsibilities".<ref>{{cite book | vauthors = Scarre C |title=Chronicle of the Roman Emperors |publisher=Thames & Hudson |year=1995 |pages=168–9 |isbn=978-5-00-050775-9}}{{page needed|date=October 2018}}</ref>]]
Anxiety disorders are partly genetic, with twin studies suggesting 30-40% genetic influence on individual differences in anxiety.<ref>{{cite journal |vauthors=Reynolds CA |title=Robert Plomin, John C. DeFries, Valerie S. Knopik, Jenae M. Neiderhiser, Behavioral Genetics (6th Edition) |journal=Behavior Genetics |date=June 16, 2013 |volume=43 |issue=4 |pages=360–361 |doi=10.1007/s10519-013-9598-6 |s2cid=141211176}}</ref> Environmental factors are also important. Twin studies show that individual-specific environments have a large influence on anxiety, whereas shared environmental influences (environments that affect twins in the same way) operate during childhood but decline through adolescence.<ref>{{cite journal | vauthors = Smoller JW, Block SR, Young MM | title = Genetics of anxiety disorders: the complex road from DSM to DNA | journal = Depression and Anxiety | volume = 26 | issue = 11 | pages = 965–975 | date = November 2009 | pmid = 19885930 | doi = 10.1002/da.20623 | s2cid = 35349081 | doi-access = free }}</ref> Specific measured 'environments' that have been associated with anxiety include child abuse, family history of mental health disorders, and poverty.<ref>{{cite journal | vauthors = Craske MG, Stein MB, Eley TC, Milad MR, Holmes A, Rapee RM, Wittchen HU | title = Anxiety disorders | journal = Nature Reviews. Disease Primers | volume = 3 | issue = 1 | pages = 17024 | date = May 2017 | pmid = 28470168 | doi = 10.1038/nrdp.2017.24 | s2cid = 52852105 }}</ref> Anxiety is also associated with [[Medicine:Mood disorder#Substance-induced|drug use]], including [[Chemistry:Alcohol (drug)|alcohol]], [[Biology:Caffeine|caffeine]], and benzodiazepines (which are often prescribed to treat anxiety).

===Neuroanatomy===
Neural circuitry involving the [[Medicine:Amygdala|amygdala]] (which regulates emotions like anxiety and fear, stimulating the [[Medicine:Hypothalamic–pituitary–adrenal axis|HPA axis]] and sympathetic nervous system) and [[Biology:Hippocampus|hippocampus]] (which is implicated in emotional memory along with the amygdala) is thought to underlie anxiety.<ref name="Rosen">{{cite journal | vauthors = Rosen JB, Schulkin J | title = From normal fear to pathological anxiety | journal = Psychological Review | volume = 105 | issue = 2 | pages = 325–350 | date = April 1998 | pmid = 9577241 | doi = 10.1037/0033-295X.105.2.325 }}</ref> People who have anxiety tend to show high activity in response to emotional stimuli in the amygdala.<ref>{{cite book |vauthors=Nolen-Hoeksema S |year=2013 |title=(Ab)normal Psychology |edition=6th |publisher=McGraw Hill}}{{page needed|date=October 2018}}</ref> Some writers believe that excessive anxiety can lead to an overpotentiation of the limbic system (which includes the amygdala and nucleus accumbens), giving increased future anxiety, but this does not appear to have been proven.<ref>{{cite book |title=Compassion and Healing in Medicine and Society: On the Nature and Use of Attachment Solutions to Separation Challenges |vauthors=Fricchione G |date=2011 |publisher=Johns Hopkins University Press |isbn=978-1-4214-0220-8 |page=172}}</ref><ref>{{cite book |title=How the Brain Talks to Itself: A Clinical Primer of Psychotherapeutic Neuroscience |vauthors=Harris J |date=1998 |publisher=Haworth |isbn=978-0-7890-0408-6 |page=284}}</ref>

Research upon adolescents who as infants had been highly apprehensive, vigilant, and fearful finds that their [[Biology:Nucleus accumbens|nucleus accumbens]] is more sensitive than that in other people when deciding to make an action that determined whether they received a reward.<ref name="Bar-Haim">{{cite journal | vauthors = Bar-Haim Y, Fox NA, Benson B, Guyer AE, Williams A, Nelson EE, Perez-Edgar K, Pine DS, Ernst M | display-authors = 6 | title = Neural correlates of reward processing in adolescents with a history of inhibited temperament | journal = Psychological Science | volume = 20 | issue = 8 | pages = 1009–1018 | date = August 2009 | pmid = 19594857 | pmc = 2785902 | doi = 10.1111/j.1467-9280.2009.02401.x }}</ref> This suggests a link between circuits responsible for fear and also reward in anxious people. As researchers note, "a sense of 'responsibility', or self-agency, in a context of uncertainty (probabilistic outcomes) drives the neural system underlying appetitive motivation (i.e., nucleus accumbens) more strongly in temperamentally inhibited than noninhibited adolescents".<ref name="Bar-Haim" />

==== The gut-brain axis ====
The microbes of the gut can connect with the brain to affect anxiety.<ref name="Gut microbiota in anxiety and depre">{{cite journal | vauthors = Bibbò S, Fusco S, Ianiro G, Settanni CR, Ferrarese D, Grassi C, Cammarota G, Gasbarrini A | display-authors = 6 | title = Gut microbiota in anxiety and depression: Pathogenesis and therapeutics.| journal = Frontiers in Gastroenterology | volume = 1 | date = 2022 | doi = 10.3389/fgstr.2022.1019578 | hdl = 10807/229103 | hdl-access = free | doi-access = free }}</ref> There are various pathways along which this communication can take place. One is through the major neurotransmitters.<ref name=pmid27392632>{{cite journal | vauthors = Kennedy PJ, Cryan JF, Dinan TG, Clarke G | title = Kynurenine pathway metabolism and the microbiota-gut-brain axis | journal = Neuropharmacology | volume = 112 | issue = Pt B | pages = 399–412 | date = January 2017 | pmid = 27392632 | doi = 10.1016/j.neuropharm.2016.07.002 | hdl = 10468/5302 | s2cid = 12743048 | hdl-access = free }}</ref> The gut microbes such as ''[[Biology:Bifidobacterium|Bifidobacterium]]'' and ''[[Biology:Bacillus|Bacillus]]'' produce the neurotransmitters GABA and [[Biology:Dopamine|dopamine]], respectively.<ref name=pmid25772005>{{cite journal | vauthors = Dinan TG, Stilling RM, Stanton C, Cryan JF | title = Collective unconscious: how gut microbes shape human behavior | journal = Journal of Psychiatric Research | volume = 63 | pages = 1–9 | date = April 2015 | pmid = 25772005 | doi = 10.1016/j.jpsychires.2015.02.021 | doi-access = free | hdl = 11019/2099 | hdl-access = free }}</ref> The neurotransmitters signal to the nervous system of the gastrointestinal tract, and those signals will be carried to the brain through the [[Biology:Vagus nerve|vagus nerve]] or the spinal system.<ref name=pmid27392632/><ref name=pmid25772005/><ref name=pmid28918360>{{cite journal | vauthors = de Weerth C | title = Do bacteria shape our development? Crosstalk between intestinal microbiota and HPA axis | journal = Neuroscience and Biobehavioral Reviews | volume = 83 | pages = 458–471 | date = December 2017 | pmid = 28918360 | doi = 10.1016/j.neubiorev.2017.09.016 | s2cid = 40601114 }}</ref> This is demonstrated by the fact that altering the microbiome has shown anxiety- and depression-reducing effects in mice, but not in subjects without vagus nerves.<ref name="pmid21876150">{{cite journal | vauthors = Bravo JA, Forsythe P, Chew MV, Escaravage E, Savignac HM, Dinan TG, Bienenstock J, Cryan JF | display-authors = 6 | title = Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 108 | issue = 38 | pages = 16050–16055 | date = September 2011 | pmid = 21876150 | pmc = 3179073 | doi = 10.1073/pnas.1102999108 | doi-access = free }}</ref>

Another key pathway is the HPA axis, as mentioned above.<ref name=pmid28918360/> The microbes can control the levels of cytokines in the body, and altering cytokine levels creates direct effects on areas of the brain such as the [[Biology:Hypothalamus|hypothalamus]], the area that triggers HPA axis activity. The HPA axis regulates production of cortisol, a hormone that takes part in the body's stress response.<ref name=pmid28918360/> When HPA activity spikes, [[Chemistry:Cortisol|cortisol]] levels increase, processing and reducing anxiety in stressful situations. These pathways, as well as the specific effects of individual taxa of microbes, are not yet completely clear, but the communication between the gut microbiome and the brain is undeniable, as is the ability of these pathways to alter anxiety levels.

With this communication comes the potential to treat.<ref name="Gut microbiota in anxiety and depre"/> Prebiotics and probiotics have been shown to reduce anxiety. For example, experiments in which mice were given [[Chemistry:Fructooligosaccharide|fructo-]] and [[Chemistry:Galactooligosaccharide|galacto-oligosaccharide]] prebiotics<ref>{{cite journal | vauthors = Burokas A, Arboleya S, Moloney RD, Peterson VL, Murphy K, Clarke G, Stanton C, Dinan TG, Cryan JF | display-authors = 6 | title = Targeting the Microbiota-Gut-Brain Axis: Prebiotics Have Anxiolytic and Antidepressant-like Effects and Reverse the Impact of Chronic Stress in Mice | journal = Biological Psychiatry | volume = 82 | issue = 7 | pages = 472–487 | date = October 2017 | pmid = 28242013 | doi = 10.1016/j.biopsych.2016.12.031 | hdl = 10468/3890 | s2cid = 206106596 | hdl-access = free }}</ref> and ''[[Biology:Lactobacillus|Lactobacillus]]'' probiotics<ref name=pmid21876150/> have both demonstrated a capability to reduce anxiety. In humans, results are not as concrete, but promising.<ref>{{cite journal | vauthors = Benton D, Williams C, Brown A | title = Impact of consuming a milk drink containing a probiotic on mood and cognition | journal = European Journal of Clinical Nutrition | volume = 61 | issue = 3 | pages = 355–361 | date = March 2007 | pmid = 17151594 | doi = 10.1038/sj.ejcn.1602546 | s2cid = 2132501 | doi-access =  }}</ref><ref>{{cite journal | vauthors = Schmidt K, Cowen PJ, Harmer CJ, Tzortzis G, Errington S, Burnet PW | title = Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers | journal = Psychopharmacology | volume = 232 | issue = 10 | pages = 1793–1801 | date = May 2015 | pmid = 25449699 | pmc = 4410136 | doi = 10.1007/s00213-014-3810-0 }}</ref>

===Genetics===
Genetics and family history (e.g. parental anxiety) may put an individual at increased risk of an anxiety disorder, but generally external stimuli will trigger its onset or exacerbation.<ref>{{cite journal | vauthors = Davies MR, Kalsi G, Armour C, Jones IR, McIntosh AM, Smith DJ, Walters JT, Bradley JR, Kingston N, Ashford S, Beange I, Brailean A, Cleare AJ, Coleman JR, Curtis CJ, Curzons SC, Davis KA, Dowey LR, Gault VA, Goldsmith KA, Bennett MH, Hirose Y, Hotopf M, Hübel C, Kanz C, Leng J, Lyall DM, Mason BD, McAtarsney-Kovacs M, Monssen D, Moulton A, Ovington N, Palaiologou E, Pariante CM, Parikh S, Peel AJ, Price RK, Rimes KA, Rogers HC, Sambrook J, Skelton M, Spaul A, Suarez EL, Sykes BL, Thomas KG, Young AH, Vassos E, Veale D, White KM, Wingrove J, Eley TC, Breen G | display-authors = 6 | title = The Genetic Links to Anxiety and Depression (GLAD) Study: Online recruitment into the largest recontactable study of depression and anxiety | journal = Behaviour Research and Therapy | volume = 123 | pages = 103503 | date = December 2019 | pmid = 31715324 | pmc = 6891252 | doi = 10.1016/j.brat.2019.103503 }}</ref> Estimates of genetic influence on anxiety, based on studies of twins, range from 25 to 40% depending on the specific type and age-group under study. For example, genetic differences account for about 43% of variance in panic disorder and 28% in generalized anxiety disorder.<ref name="Genetics of generalized anxiety dis"/> Longitudinal twin studies have shown the moderate stability of anxiety from childhood through to adulthood is mainly influenced by stability in genetic influence.<ref>{{cite journal | vauthors = Waszczuk MA, Zavos HM, Gregory AM, Eley TC | title = The phenotypic and genetic structure of depression and anxiety disorder symptoms in childhood, adolescence, and young adulthood | journal = JAMA Psychiatry | volume = 71 | issue = 8 | pages = 905–916 | date = August 2014 | pmid = 24920372 | doi = 10.1001/jamapsychiatry.2014.655 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Nivard MG, Dolan CV, Kendler KS, Kan KJ, Willemsen G, van Beijsterveldt CE, Lindauer RJ, van Beek JH, Geels LM, Bartels M, Middeldorp CM, Boomsma DI | display-authors = 6 | title = Stability in symptoms of anxiety and depression as a function of genotype and environment: a longitudinal twin study from ages 3 to 63 years | journal = Psychological Medicine | volume = 45 | issue = 5 | pages = 1039–1049 | date = April 2015 | pmid = 25187475 | doi = 10.1017/S003329171400213X | s2cid = 15183002 }}</ref> When investigating how anxiety is passed on from parents to children, it is important to account for sharing of genes as well as environments, for example using the intergenerational children-of-twins design.<ref>{{cite journal | vauthors = Eley TC, McAdams TA, Rijsdijk FV, Lichtenstein P, Narusyte J, Reiss D, Spotts EL, Ganiban JM, Neiderhiser JM | display-authors = 6 | title = The Intergenerational Transmission of Anxiety: A Children-of-Twins Study | journal = The American Journal of Psychiatry | volume = 172 | issue = 7 | pages = 630–637 | date = July 2015 | pmid = 25906669 | doi = 10.1176/appi.ajp.2015.14070818 | pmc = 8515953 }}</ref>

Many studies in the past used a candidate gene approach to test whether single genes were associated with anxiety. These investigations were based on hypotheses about how certain known genes influence neurotransmitters (such as serotonin and norepinephrine) and hormones (such as cortisol) that are implicated in anxiety. None of these findings are well replicated,<ref name=":2" /> with the possible exception of TMEM132D, COMT and MAO-A.<ref name=":2">{{cite journal | vauthors = Howe AS, Buttenschøn HN, Bani-Fatemi A, Maron E, Otowa T, Erhardt A, Binder EB, Gregersen NO, Mors O, Woldbye DP, Domschke K, Reif A, Shlik J, Kõks S, Kawamura Y, Miyashita A, Kuwano R, Tokunaga K, Tanii H, Smoller JW, Sasaki T, Koszycki D, De Luca V | display-authors = 6 | title = Candidate genes in panic disorder: meta-analyses of 23 common variants in major anxiogenic pathways | journal = Molecular Psychiatry | volume = 21 | issue = 5 | pages = 665–679 | date = May 2016 | pmid = 26390831 | doi = 10.1038/mp.2015.138 | s2cid = 3394824 | doi-access = free }}</ref> The epigenetic signature of ''BDNF'', a gene that codes for a protein called ''brain derived neurotrophic factor'' that is found in the brain, has also been associated with anxiety and specific patterns of neural activity.<ref name="Purves" /> and a receptor gene for ''BDNF'' called ''NTRK2'' was associated with anxiety in a large genome-wide investigation.<ref name="Purves">{{cite journal | vauthors = Purves KL, Coleman JR, Meier SM, Rayner C, Davis KA, Cheesman R, Bækvad-Hansen M, Børglum AD, Wan Cho S, Jürgen Deckert J, Gaspar HA, Bybjerg-Grauholm J, Hettema JM, Hotopf M, Hougaard D, Hübel C, Kan C, McIntosh AM, Mors O, Bo Mortensen P, Nordentoft M, Werge T, Nicodemus KK, Mattheisen M, Breen G, Eley TC | display-authors = 6 | title = A major role for common genetic variation in anxiety disorders | journal = Molecular Psychiatry | volume = 25 | issue = 12 | pages = 3292–3303 | date = December 2020 | pmid = 31748690 | pmc = 7237282 | doi = 10.1038/s41380-019-0559-1 }}</ref> The reason that most candidate gene findings have not replicated is that anxiety is a complex trait that is influenced by many genomic variants, each of which has a small effect on its own. Increasingly, studies of anxiety are using a hypothesis-free approach to look for parts of the genome that are implicated in anxiety using big enough samples to find associations with variants that have small effects. The largest explorations of the common genetic architecture of anxiety have been facilitated by the UK Biobank, the ANGST consortium and the [https://www.crchealth.com/disorders/anxiety-disorder-panic-treatment/ CRC Fear, Anxiety and Anxiety Disorders].<ref name="Purves" /><ref>{{cite journal | vauthors = Otowa T, Hek K, Lee M, Byrne EM, Mirza SS, Nivard MG, Bigdeli T, Aggen SH, Adkins D, Wolen A, Fanous A, Keller MC, Castelao E, Kutalik Z, Van der Auwera S, Homuth G, Nauck M, Teumer A, Milaneschi Y, Hottenga JJ, Direk N, Hofman A, Uitterlinden A, Mulder CL, Henders AK, Medland SE, Gordon S, Heath AC, Madden PA, Pergadia ML, van der Most PJ, Nolte IM, van Oort FV, Hartman CA, Oldehinkel AJ, Preisig M, Grabe HJ, Middeldorp CM, Penninx BW, Boomsma D, Martin NG, Montgomery G, Maher BS, van den Oord EJ, Wray NR, Tiemeier H, Hettema JM | display-authors = 6 | title = Meta-analysis of genome-wide association studies of anxiety disorders | journal = Molecular Psychiatry | volume = 21 | issue = 10 | pages = 1391–1399 | date = October 2016 | pmid = 26754954 | pmc = 4940340 | doi = 10.1016/j.euroneuro.2016.09.604 }}</ref><ref>{{cite journal | vauthors = Deckert J, Weber H, Villmann C, Lonsdorf TB, Richter J, Andreatta M, Arias-Vasquez A, Hommers L, Kent L, Schartner C, Cichon S, Wolf C, Schaefer N, von Collenberg CR, Wachter B, Blum R, Schümann D, Scharfenort R, Schumacher J, Forstner AJ, Baumann C, Schiele MA, Notzon S, Zwanzger P, Janzing JG, Galesloot T, Kiemeney LA, Gajewska A, Glotzbach-Schoon E, Mühlberger A, Alpers G, Fydrich T, Fehm L, Gerlach AL, Kircher T, Lang T, Ströhle A, Arolt V, Wittchen HU, Kalisch R, Büchel C, Hamm A, Nöthen MM, Romanos M, Domschke K, Pauli P, Reif A | display-authors = 6 | title = GLRB allelic variation associated with agoraphobic cognitions, increased startle response and fear network activation: a potential neurogenetic pathway to panic disorder | journal = Molecular Psychiatry | volume = 22 | issue = 10 | pages = 1431–1439 | date = October 2017 | pmid = 28167838 | doi = 10.1016/j.euroneuro.2016.09.607 | s2cid = 54353612 }}</ref>

====Epigenetics====
{{excerpt|Epigenetics of anxiety and stress–related disorders}}

===Medical conditions===
Many medical conditions can cause anxiety. This includes conditions that affect the ability to breathe, like COPD and [[Medicine:Asthma|asthma]], and the difficulty in breathing that often occurs near death.<ref>{{cite journal | vauthors = Baldwin J, Cox J | title = Treating Dyspnea: Is Oxygen Therapy the Best Option for All Patients? | journal = The Medical Clinics of North America | volume = 100 | issue = 5 | pages = 1123–1130 | date = September 2016 | pmid = 27542431 | doi = 10.1016/j.mcna.2016.04.018 }}</ref><ref>{{cite journal | vauthors = Vanfleteren LE, Spruit MA, Wouters EF, Franssen FM | title = Management of chronic obstructive pulmonary disease beyond the lungs | journal = The Lancet. Respiratory Medicine | volume = 4 | issue = 11 | pages = 911–924 | date = November 2016 | pmid = 27264777 | doi = 10.1016/S2213-2600(16)00097-7 }}</ref><ref name="TselebisPachi2016">{{cite journal | vauthors = Tselebis A, Pachi A, Ilias I, Kosmas E, Bratis D, Moussas G, Tzanakis N | title = Strategies to improve anxiety and depression in patients with COPD: a mental health perspective | journal = Neuropsychiatric Disease and Treatment | volume = 12 | pages = 297–328 | year = 2016 | pmid = 26929625 | pmc = 4755471 | doi = 10.2147/NDT.S79354 | doi-access = free }}</ref> Conditions that cause abdominal pain or chest pain can cause anxiety and may in some cases be a [[Medicine:Somatization|somatization]] of anxiety;<ref>{{cite journal | vauthors = Muscatello MR, Bruno A, Mento C, Pandolfo G, Zoccali RA | title = Personality traits and emotional patterns in irritable bowel syndrome | journal = World Journal of Gastroenterology | volume = 22 | issue = 28 | pages = 6402–6415 | date = July 2016 | pmid = 27605876 | pmc = 4968122 | doi = 10.3748/wjg.v22.i28.6402 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Remes-Troche JM | title = How to Diagnose and Treat Functional Chest Pain | journal = Current Treatment Options in Gastroenterology | volume = 14 | issue = 4 | pages = 429–443 | date = December 2016 | pmid = 27709331 | doi = 10.1007/s11938-016-0106-y | s2cid = 19634934 }}</ref> the same is true for some sexual dysfunctions.<ref>{{cite journal | vauthors = Brotto L, Atallah S, Johnson-Agbakwu C, Rosenbaum T, Abdo C, Byers ES, Graham C, Nobre P, Wylie K | display-authors = 6 | title = Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction | journal = The Journal of Sexual Medicine | volume = 13 | issue = 4 | pages = 538–571 | date = April 2016 | pmid = 27045257 | doi = 10.1016/j.jsxm.2016.01.019 | url = https://eprints.soton.ac.uk/390453/1/Final%2520-%2520JSM%2520chapter%2520on%2520psych%2520factors%2520-%2520part%25201%2520-%2520ACCEPTED.doc | access-date = 2019-12-07 | archive-date = 2020-07-26 | archive-url = https://web.archive.org/web/20200726065113/https://eprints.soton.ac.uk/390453/1/Final%2520-%2520JSM%2520chapter%2520on%2520psych%2520factors%2520-%2520part%25201%2520-%2520ACCEPTED.doc | url-status = live }}</ref><ref>{{cite journal| vauthors = McMahon CG, Jannini EA, Serefoglu EC, Hellstrom WJ | title = The pathophysiology of acquired premature ejaculation | journal = Translational Andrology and Urology | volume = 5 | issue = 4 | pages = 434–449 | date = August 2016 | pmid = 27652216 | pmc = 5001985 | doi = 10.21037/tau.2016.07.06 | doi-access = free }}</ref> Conditions that affect the face or the skin can cause social anxiety especially among adolescents,<ref>{{cite journal | vauthors = Nguyen CM, Beroukhim K, Danesh MJ, Babikian A, Koo J, Leon A | title = The psychosocial impact of acne, vitiligo, and psoriasis: a review | journal = Clinical, Cosmetic and Investigational Dermatology | volume = 9 | pages = 383–392 | year = 2016 | pmid = 27799808 | pmc = 5076546 | doi = 10.2147/CCID.S76088 | doi-access = free }}</ref> and developmental disabilities often lead to social anxiety for children as well.<ref>{{cite journal | vauthors = Caçola P | title = Physical and Mental Health of Children with Developmental Coordination Disorder | journal = Frontiers in Public Health | volume = 4 | pages = 224 | year = 2016 | pmid = 27822464 | pmc = 5075567 | doi = 10.3389/fpubh.2016.00224 | doi-access = free }}</ref> Life-threatening conditions like cancer also cause anxiety.<ref>{{cite journal | vauthors = Mosher CE, Winger JG, Given BA, Helft PR, O'Neil BH | title = Mental health outcomes during colorectal cancer survivorship: a review of the literature | journal = Psycho-Oncology | volume = 25 | issue = 11 | pages = 1261–1270 | date = November 2016 | pmid = 26315692 | pmc = 4894828 | doi = 10.1002/pon.3954 }}</ref>

Furthermore, certain organic diseases may present with anxiety or symptoms that mimic anxiety.<ref name="WHO2009" /><ref name="TestaGiannuzzi2013partIII" /> These disorders include certain endocrine diseases ([[Medicine:Hypothyroidism|hypo-]] and [[Medicine:Hyperthyroidism|hyperthyroidism]], hyperprolactinemia),<ref name="TestaGiannuzzi2013partIII" /><ref name="Samuels2008">{{cite journal | vauthors = Samuels MH | title = Cognitive function in untreated hypothyroidism and hyperthyroidism | journal = Current Opinion in Endocrinology, Diabetes and Obesity | volume = 15 | issue = 5 | pages = 429–433 | date = October 2008 | pmid = 18769215 | doi = 10.1097/MED.0b013e32830eb84c | s2cid = 27235034 }}</ref> metabolic disorders ([[Medicine:Diabetes mellitus|diabetes]]),<ref name="TestaGiannuzzi2013partIII" /><ref name="BuchbergerHuppertz2016">{{cite journal | vauthors = Buchberger B, Huppertz H, Krabbe L, Lux B, Mattivi JT, Siafarikas A | title = Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis | journal = Psychoneuroendocrinology | volume = 70 | pages = 70–84 | date = August 2016 | pmid = 27179232 | doi = 10.1016/j.psyneuen.2016.04.019 | s2cid = 19858996 }}</ref><ref name="GrigsbyAnderson2002">{{cite journal | vauthors = Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ | title = Prevalence of anxiety in adults with diabetes: a systematic review | journal = Journal of Psychosomatic Research | volume = 53 | issue = 6 | pages = 1053–1060 | date = December 2002 | pmid = 12479986 | doi = 10.1016/S0022-3999(02)00417-8 }}</ref> deficiency states (low levels of [[Chemistry:Vitamin D|vitamin D]], [[Biology:Riboflavin|B2]], [[Biology:Vitamin B12|B12]], folic acid),<ref name="TestaGiannuzzi2013partIII" /> gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, [[Medicine:Inflammatory bowel disease|inflammatory bowel disease]]),<ref name="ZingoneSwift2015">{{cite journal | vauthors = Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC | title = Psychological morbidity of celiac disease: A review of the literature | journal = United European Gastroenterology Journal | volume = 3 | issue = 2 | pages = 136–145 | date = April 2015 | pmid = 25922673 | pmc = 4406898 | doi = 10.1177/2050640614560786 }}</ref><ref name="MolinaInfanteSantolaria2015SystematicReview">{{cite journal | vauthors = Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F | title = Systematic review: noncoeliac gluten sensitivity | journal = Alimentary Pharmacology & Therapeutics | volume = 41 | issue = 9 | pages = 807–820 | date = May 2015 | pmid = 25753138 | doi = 10.1111/apt.13155 | s2cid = 207050854 }}</ref><ref name="NeuendorfHarding2016">{{cite journal | vauthors = Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H | title = Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review | journal = Journal of Psychosomatic Research | volume = 87 | pages = 70–80 | date = August 2016 | pmid = 27411754 | doi = 10.1016/j.jpsychores.2016.06.001 }}</ref> heart diseases, blood diseases ([[Medicine:Anemia|anemia]]),<ref name="TestaGiannuzzi2013partIII" /> cerebral vascular accidents ([[Medicine:Transient ischemic attack|transient ischemic attack]], [[Medicine:Stroke|stroke]]),<ref name="TestaGiannuzzi2013partIII" /> and brain degenerative diseases ([[Medicine:Parkinson's disease|Parkinson's disease]], [[Medicine:Dementia|dementia]], multiple sclerosis, [[Medicine:Huntington's disease|Huntington's disease]]), among others.<ref name="TestaGiannuzzi2013partIII" /><ref name="ZhaoTan2016">{{cite journal | vauthors = Zhao QF, Tan L, Wang HF, Jiang T, Tan MS, Tan L, Xu W, Li JQ, Wang J, Lai TJ, Yu JT | display-authors = 6 | title = The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis | journal = Journal of Affective Disorders | volume = 190 | pages = 264–271 | date = January 2016 | pmid = 26540080 | doi = 10.1016/j.jad.2015.09.069 }}</ref><ref name="WenChan2016">{{cite journal | vauthors = Wen MC, Chan LL, Tan LC, Tan EK | title = Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies | journal = European Journal of Neurology | volume = 23 | issue = 6 | pages = 1001–1019 | date = June 2016 | pmid = 27141858 | pmc = 5084819 | doi = 10.1111/ene.13002 }}</ref><ref name="MarrieReingold2015">{{cite journal | vauthors = Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, Cutter G, Reider N | display-authors = 6 | title = The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review | journal = Multiple Sclerosis | volume = 21 | issue = 3 | pages = 305–317 | date = March 2015 | pmid = 25583845 | pmc = 4429164 | doi = 10.1177/1352458514564487 }}</ref>

===Substance-induced===
Several drugs can cause or worsen anxiety, whether in intoxication, withdrawal or as side effect. These include [[Chemistry:Alcohol (drug)|alcohol]], [[Biology:Tobacco|tobacco]], [[Chemistry:Sedative|sedative]]s (including prescription [[Chemistry:Benzodiazepine|benzodiazepine]]s), [[Chemistry:Opioid|opioid]]s (including prescription pain killers and illicit drugs like heroin), [[Chemistry:Stimulant|stimulant]]s (such as [[Biology:Caffeine|caffeine]], [[Biology:Cocaine|cocaine]] and amphetamines), [[Unsolved:Hallucinogen|hallucinogen]]s, and inhalants.<ref>{{Cite web | author = National Institute on Drug Abuse |date=2012-08-03 |title=Prescription Drug Facts, Effects, Teen Use |url=https://teens.drugabuse.gov/drug-facts/prescription-drugs |access-date=2022-05-24 |website=NIDA for Teens |language=en |archive-date=2022-05-18 |archive-url=https://web.archive.org/web/20220518000257/https://teens.drugabuse.gov/drug-facts/prescription-drugs |url-status=live }}</ref>

While many often report self-medicating anxiety with these substances, improvements in anxiety from drugs are usually short-lived (with worsening of anxiety in the long term, sometimes with acute anxiety as soon as the drug effects wear off) and tend to be exaggerated.<ref>{{cite journal | vauthors = Brady KT, Haynes LF, Hartwell KJ, Killeen TK | title = Substance use disorders and anxiety: a treatment challenge for social workers | journal = Social Work in Public Health | volume = 28 | issue = 3–4 | pages = 407–423 | date = 2013 | pmid = 23731428 | pmc = 3775646 | doi = 10.1080/19371918.2013.774675 }}</ref><ref>{{cite journal | vauthors = Turner S, Mota N, Bolton J, Sareen J | title = Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature | journal = Depression and Anxiety | volume = 35 | issue = 9 | pages = 851–860 | date = September 2018 | pmid = 29999576 | pmc = 6175215 | doi = 10.1002/da.22771 }}</ref> Acute exposure to toxic levels of [[Chemistry:Benzene|benzene]] may cause euphoria, anxiety, and irritability lasting up to 2 weeks after the exposure.<ref>{{Cite web|title = CDC – The Emergency Response Safety and Health Database: Systemic Agent: BENZENE – NIOSH|url = https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750032.html|website = www.cdc.gov|access-date = January 27, 2016|url-status = live|archive-url = https://web.archive.org/web/20160117001341/http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750032.html|archive-date = January 17, 2016|df = mdy-all}}</ref>

===Psychological===
Poor [[Social:Coping (psychology)|coping skills]] (e.g., rigidity/inflexible problem solving, denial, avoidance, impulsivity, extreme self-expectation, negative thoughts, affective instability, and inability to focus on problems) are associated with anxiety. Anxiety is also linked and perpetuated by the person's own pessimistic outcome expectancy and how they cope with feedback negativity.<ref>{{cite journal | vauthors = Gu R, Huang YX, Luo YJ | title = Anxiety and feedback negativity | journal = Psychophysiology | volume = 47 | issue = 5 | pages = 961–967 | date = September 2010 | pmid = 20374540 | doi = 10.1111/j.1469-8986.2010.00997.x }}</ref><ref>{{cite journal | vauthors = Watkins ER | title = Constructive and unconstructive repetitive thought | journal = Psychological Bulletin | volume = 134 | issue = 2 | pages = 163–206 | date = March 2008 | pmid = 18298268 | pmc = 2672052 | doi = 10.1037/0033-2909.134.2.163 }}</ref> Temperament (e.g., [[Medicine:Neuroticism|neuroticism]])<ref name="NeuroticismMA" /> and attitudes (e.g. pessimism) have been found to be risk factors for anxiety.<ref name="Bienvenu Ginsburg 2007">{{cite journal | vauthors = Bienvenu OJ, Ginsburg GS | title = Prevention of anxiety disorders | journal = International Review of Psychiatry | volume = 19 | issue = 6 | pages = 647–654 | date = December 2007 | pmid = 18092242 | doi = 10.1080/09540260701797837 | s2cid = 95140 }}</ref>

[[Cognitive distortion]]s such as overgeneralizing, catastrophizing, mind reading, [[Philosophy:Emotional reasoning|emotional reasoning]], binocular trick, and mental filter can result in anxiety. For example, an overgeneralized belief that something bad "always" happens may lead someone to have excessive fears of even minimally risky situations and to avoid benign social situations due to anticipatory anxiety of embarrassment. In addition, those who have high anxiety can also create future stressful life events.<ref>{{cite journal | vauthors = Phillips AC, Carroll D, Der G | title = Negative life events and symptoms of depression and anxiety: stress causation and/or stress generation | journal = Anxiety, Stress, and Coping | volume = 28 | issue = 4 | pages = 357–371 | year = 2015 | pmid = 25572915 | pmc = 4772121 | doi = 10.1080/10615806.2015.1005078 }}</ref> Together, these findings suggest that anxious thoughts can lead to anticipatory anxiety as well as stressful events, which in turn cause more anxiety. Such unhealthy thoughts can be targets for successful treatment with [[Medicine:Cognitive therapy|cognitive therapy]].

Psychodynamic theory posits that anxiety is often the result of opposing [[Biology:Unconscious mind|unconscious]] wishes or fears that manifest via maladaptive defense mechanisms (such as suppression, repression, anticipation, regression, somatization, passive aggression, dissociation) that develop to [[Social:Ego psychology|adapt]] to problems with early [[Philosophy:Object relations theory|objects]] (e.g., caregivers) and [[Philosophy:Self psychology|empathic failures]] in childhood. For example, persistent parental discouragement of anger may result in repression/suppression of angry feelings which manifests as gastrointestinal distress (somatization) when provoked by another while the anger remains unconscious and outside the individual's awareness. Such conflicts can be targets for successful treatment with [[Medicine:Psychodynamic psychotherapy|psychodynamic therapy]]. While psychodynamic therapy tends to explore the underlying roots of anxiety, cognitive behavioral therapy has also been shown to be a successful treatment for anxiety by altering irrational thoughts and unwanted behaviors.

====Evolutionary psychology====
An [[Philosophy:Evolutionary psychology|evolutionary psychology]] explanation is that increased anxiety serves the purpose of increased vigilance regarding potential threats in the environment as well as increased tendency to take proactive actions regarding such possible threats. This may cause false positive reactions but an individual with anxiety may also avoid real threats. This may explain why anxious people are less likely to die due to accidents.<ref>{{cite journal | vauthors = Andrews PW, Thomson JA | title = The bright side of being blue: depression as an adaptation for analyzing complex problems | journal = Psychological Review | volume = 116 | issue = 3 | pages = 620–654 | date = July 2009 | pmid = 19618990 | pmc = 2734449 | doi = 10.1037/a0016242 }}</ref> There is ample empirical evidence that anxiety can have adaptive value. Within a school, timid fish are more likely than bold fish to survive a predator.<ref>{{Cite book| vauthors = Gluckman P |title=Principles of Evolutionary Medicine|publisher=Oxford University Press|year=2009|isbn=978-0199236398|pages=249}}</ref>

When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, [[Physics:Positron emission tomography|PET-scans]] show increased blood flow in the [[Medicine:Amygdala|amygdala]].<ref>{{cite journal | vauthors = Zald DH, Pardo JV | title = Emotion, olfaction, and the human amygdala: amygdala activation during aversive olfactory stimulation | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 94 | issue = 8 | pages = 4119–4124 | date = April 1997 | pmid = 9108115 | pmc = 20578 | doi = 10.1073/pnas.94.8.4119 | doi-access = free | bibcode = 1997PNAS...94.4119Z }}</ref><ref>{{cite journal | vauthors = Zald DH, Hagen MC, Pardo JV | title = Neural correlates of tasting concentrated quinine and sugar solutions | journal = Journal of Neurophysiology | volume = 87 | issue = 2 | pages = 1068–1075 | date = February 2002 | pmid = 11826070 | doi = 10.1152/jn.00358.2001 | s2cid = 6278342 }}</ref> In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.

===Social===
Social risk factors for anxiety include a history of trauma (e.g., physical, sexual or emotional abuse or assault), bullying, early life experiences and parenting factors (e.g., rejection, lack of warmth, high hostility, harsh discipline, high parental negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behaviour, discouragement of emotions, poor socialization, poor attachment, and child abuse and neglect), cultural factors (e.g., stoic families/cultures, persecuted minorities including those with disabilities), and [[Social:Socioeconomic status and mental health|socioeconomics]] (e.g., uneducated, unemployed, impoverished although developed countries have higher rates of anxiety disorders than developing countries).<ref>{{cite book |chapter-url=http://books.nap.edu/openbook.php?record_id=12480&page=530 |chapter=Table E-4 Risk Factors for Anxiety |page=530 |veditors=O'Connell ME, Boat T, Warner KE |publisher=National Academies Press |title=Prevention of Mental Disorders, Substance Abuse, and Problem Behaviors: A Developmental Perspective |year=2009 |isbn=978-0-309-12674-8 |doi=10.17226/12480 |pmid=20662125 |vauthors=((National Research Council (Us) Institute Of Medicine (Us) Committee On The Prevention Of Mental Disorders Substance Abuse Among Children, Youth, and Young Adults)) |s2cid=142581788 |access-date=2014-04-19 |archive-date=2014-04-18 |archive-url=https://web.archive.org/web/20140418234307/http://books.nap.edu/openbook.php?record_id=12480&page=530 |url-status=live }}</ref> 
A 2019 comprehensive systematic review of over 50 studies showed that food insecurity in the United States is strongly associated with depression, anxiety, and sleep disorders.<ref>{{cite journal | vauthors = Arenas DJ, Thomas A, Wang J, DeLisser HM | title = A Systematic Review and Meta-analysis of Depression, Anxiety, and Sleep Disorders in US Adults with Food Insecurity | journal = Journal of General Internal Medicine | volume = 34 | issue = 12 | pages = 2874–2882 | date = December 2019 | pmid = 31385212 | pmc = 6854208 | doi = 10.1007/s11606-019-05202-4 }}</ref> Food-insecure individuals had an almost 3 fold risk increase of testing positive for anxiety when compared to food-secure individuals.

====Gender socialization====
Contextual factors that are thought to contribute to anxiety include [[Social:Socialization#Gender socialization|gender socialization]] and learning experiences. In particular, learning mastery (the degree to which people perceive their lives to be under their own control) and instrumentality, which includes such traits as self-confidence, [[Philosophy:Self-efficacy|self-efficacy]], independence, and competitiveness fully mediate the relation between gender and anxiety. That is, though gender differences in anxiety exist, with higher levels of anxiety in women compared to men, gender socialization and learning mastery explain these gender differences.<ref>{{cite journal |doi=10.1080/03634520009379205 |title=Anticipatory anxiety patterns for male and female public speakers |journal=Communication Education |volume=49 |issue=2 |pages=187–195 |year=2000 | vauthors = Behnke RR, Sawyer CR |s2cid=144320186 }}</ref>

==Treatment==
The first step in the management of a person with anxiety symptoms involves evaluating the possible presence of an underlying medical cause, the recognition of which is essential in order to decide the correct treatment.<ref name="WHO2009">{{cite book |publisher=World Health Organization |date= 2009 |title= Pharmacological Treatment of Mental Disorders in Primary Health Care |url= http://apps.who.int/iris/bitstream/10665/44095/1/9789241547697_eng.pdf |location= Geneva |isbn= 978-92-4-154769-7 |url-status= live |archive-url= https://web.archive.org/web/20161120132530/http://apps.who.int/iris/bitstream/10665/44095/1/9789241547697_eng.pdf |archive-date= November 20, 2016 |df= mdy-all}}</ref><ref name="TestaGiannuzzi2013partIII">{{cite journal | vauthors = Testa A, Giannuzzi R, Daini S, Bernardini L, Petrongolo L, Gentiloni Silveri N | title = Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases | journal = European Review for Medical and Pharmacological Sciences | volume = 17 | issue = Suppl 1 | pages = 86–99 | date = February 2013 | pmid = 23436670 | url = http://www.europeanreview.org/article/3087 | access-date = 2018-10-26 | archive-date = 2021-03-04 | archive-url = https://web.archive.org/web/20210304154235/https://www.europeanreview.org/article/3087 | url-status = live }}</ref> Anxiety symptoms may mask an [[Disease|organic disease]], or appear associated with or as a result of a medical disorder.<ref name="WHO2009" /><ref name="TestaGiannuzzi2013partIII" /><ref name="TestaGiannuzzi2013partII">{{cite journal | vauthors = Testa A, Giannuzzi R, Sollazzo F, Petrongolo L, Bernardini L, Dain S | title = Psychiatric emergencies (part II): psychiatric disorders coexisting with organic diseases | journal = European Review for Medical and Pharmacological Sciences | volume = 17 | issue = Suppl 1 | pages = 65–85 | date = February 2013 | pmid = 23436669 | url = http://www.europeanreview.org/article/3085 | access-date = 2018-10-26 | archive-date = 2021-05-05 | archive-url = https://web.archive.org/web/20210505213014/https://www.europeanreview.org/article/3085 | url-status = live }}</ref><ref name="TestaGiannuzzi2013partI">{{cite journal | vauthors = Testa A, Giannuzzi R, Sollazzo F, Petrongolo L, Bernardini L, Daini S | title = Psychiatric emergencies (part I): psychiatric disorders causing organic symptoms | journal = European Review for Medical and Pharmacological Sciences | volume = 17 | issue = Suppl 1 | pages = 55–64 | date = February 2013 | pmid = 23436668 | url = http://www.europeanreview.org/article/3083 | access-date = 2018-10-26 | archive-date = 2021-02-26 | archive-url = https://web.archive.org/web/20210226131355/https://www.europeanreview.org/article/3083 | url-status = live }}</ref>

[[Medicine:Cognitive behavioral therapy|Cognitive behavioral therapy]] (CBT) is effective for anxiety disorders and is a first line treatment.<ref name="NEJM2015">{{cite journal | vauthors = Stein MB, Sareen J | title = CLINICAL PRACTICE. Generalized Anxiety Disorder | journal = The New England Journal of Medicine | volume = 373 | issue = 21 | pages = 2059–2068 | date = November 2015 | pmid = 26580998 | doi = 10.1056/nejmcp1502514 }}</ref><ref>{{cite journal | vauthors = Cuijpers P, Sijbrandij M, Koole S, Huibers M, Berking M, Andersson G | title = Psychological treatment of generalized anxiety disorder: a meta-analysis | journal = Clinical Psychology Review | volume = 34 | issue = 2 | pages = 130–140 | date = March 2014 | pmid = 24487344 | doi = 10.1016/j.cpr.2014.01.002 | s2cid = 46188773 }}</ref><ref>{{cite journal | vauthors = Otte C | title = Cognitive behavioral therapy in anxiety disorders: current state of the evidence | journal = Dialogues in Clinical Neuroscience | volume = 13 | issue = 4 | pages = 413–421 | year = 2011 | pmid = 22275847 | pmc = 3263389 | doi = 10.31887/DCNS.2011.13.4/cotte }}</ref><ref>{{cite journal | vauthors = Pompoli A, Furukawa TA, Imai H, Tajika A, Efthimiou O, Salanti G | title = Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD011004 | date = April 2016 | issue = 4 | pmid = 27071857 | pmc = 7104662 | doi = 10.1002/14651858.CD011004.pub2 }}</ref><ref name="Ol2016">{{cite journal | vauthors = Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH | title = Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 3 | pages = CD011565 | date = March 2016 | pmid = 26968204 | pmc = 7077612 | doi = 10.1002/14651858.cd011565.pub2 }}</ref> CBT appears to be equally effective when carried out via the internet.<ref name="Ol2016" /> While evidence for mental health apps is promising, it is preliminary.<ref>{{cite journal | vauthors = Donker T, Petrie K, Proudfoot J, Clarke J, Birch MR, Christensen H | title = Smartphones for smarter delivery of mental health programs: a systematic review | journal = Journal of Medical Internet Research | volume = 15 | issue = 11 | pages = e247 | date = November 2013 | pmid = 24240579 | pmc = 3841358 | doi = 10.2196/jmir.2791 | doi-access = free }}</ref><ref>{{cite report | vauthors = Singh K, Severn M | title = e-Therapy Interventions for the Treatment of Anxiety: Clinical Evidence | date = 2018 | pmid = 30329251 | url = https://www.ncbi.nlm.nih.gov/books/NBK532212/ | access-date = 2022-12-28 | publisher = Canadian Agency for Drugs and Technologies in Health | series = CADTH Rapid Response Report: Summary with Critical Appraisal }}</ref>

Anxiety often affects relationships, and [[Medicine:Interpersonal psychotherapy|interpersonal psychotherapy]] addresses these issues by improving communication and relationship skills.<ref>{{Cite web |date=2023-11-08 |title=Can Therapy Help with Anxiety? Understanding the Benefits |url=https://totalmentalwellnessfl.com/does-therapy-help-with-anxiety-total-mental-wellness/ |access-date=2023-12-05 |website=totalmentalwellnessfl.com |language=en-US}}</ref>

Psychopharmacological treatment can be used in parallel to CBT or can be used alone. As a general rule, most anxiety disorders respond well to first-line agents. Such drugs, also used as anti-depressants, are the [[Chemistry:Selective serotonin reuptake inhibitor|selective serotonin reuptake inhibitor]]s and [[Chemistry:Serotonin–norepinephrine reuptake inhibitor|serotonin-norepinephrine reuptake inhibitors]], that work by blocking the reuptake of specific neurotransmitters and resulting in the increase in availability of these neurotransmitters. Additionally, benzodiazepines are often prescribed to individuals with anxiety disorder. Benzodiazepines produce an anxiolytic response by modulating GABA and increasing its receptor binding. A third common treatment involves a category of drug known as serotonin agonists. This category of drug works by initiating a physiological response at 5-HT1A receptor by increasing the action of serotonin at this receptor.{{citation needed|date=October 2022}} Other treatment options include [[Chemistry:Pregabalin|pregabalin]], tricyclic antidepressants, and moclobemide, among others.<ref name="Bandelow_2017">{{cite journal | vauthors = Bandelow B, Michaelis S, Wedekind D | title = Treatment of anxiety disorders | journal = Dialogues in Clinical Neuroscience | volume = 19 | issue = 2 | pages = 93–107 | date = June 2017 | pmid = 28867934 | pmc = 5573566 | doi = 10.31887/DCNS.2017.19.2/bbandelow }}</ref>

Anxiety is considered to be a serious psychiatric illness that has an unknown true pervasiveness due to affected individuals not asking for proper treatment or aid, and due to professionals missing the diagnosis.<ref name = "Chand_2022" />

==Prevention==
The above risk factors give natural avenues for prevention. A 2017 review found that psychological or educational interventions have a small yet statistically significant benefit for the prevention of anxiety in varied population types.<ref>{{cite journal | vauthors = Moreno-Peral P, Conejo-Cerón S, Rubio-Valera M, Fernández A, Navas-Campaña D, Rodríguez-Morejón A, Motrico E, Rigabert A, Luna JD, Martín-Pérez C, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Luciano JV, Bellón JÁ | display-authors = 6 | title = Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression | journal = JAMA Psychiatry | volume = 74 | issue = 10 | pages = 1021–1029 | date = October 2017 | pmid = 28877316 | pmc = 5710546 | doi = 10.1001/jamapsychiatry.2017.2509 }}</ref><ref>{{cite web |url=https://www.nationalelfservice.net/mental-health/anxiety/preventing-anxiety-with-psychological-and-educational-interventions/ |title=Preventing anxiety with psychological and educational interventions |vauthors=Pote I |website=National Elf Service |date=February 19, 2018 |access-date=December 12, 2019 |archive-date=December 16, 2021 |archive-url=https://web.archive.org/web/20211216143836/https://www.nationalelfservice.net/mental-health/anxiety/preventing-anxiety-with-psychological-and-educational-interventions/ |url-status=live }}</ref><ref>{{cite book |doi=10.1016/B978-0-12-813495-5.00008-5 |chapter=Targeting anxiety sensitivity as a prevention strategy |title=The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment |pages=145–178 |year=2019 | vauthors = Schmidt NB, Allan NP, Knapp AA, Capron D |isbn=978-0-12-813495-5 |s2cid=81782119 }}</ref>

==Pathophysiology==
Anxiety disorder appears to be a genetically inherited neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol.<ref>{{EMedicine|article|286227|Anxiety Disorders}}</ref>

In the [[Biology:Central nervous system|central nervous system]] (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms. Increased flow in the right parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients are the diagnostic factors for prevalence of anxiety disorder.

The amygdala is central to the processing of fear and anxiety,<ref>{{cite journal | vauthors = LeDoux J | title = The amygdala | journal = Current Biology | volume = 17 | issue = 20 | pages = R868–R874 | date = October 2007 | pmid = 17956742 | doi = 10.1016/j.cub.2007.08.005 | s2cid = 16348363 | doi-access = free }}</ref> and its function may be disrupted in anxiety disorders. Anxiety processing in the basolateral amygdala has been implicated with expansion of dendritic arborization of the amygdaloid neurons.<ref>{{cite journal | vauthors = Mitra R, Sapolsky RM | title = Acute corticosterone treatment is sufficient to induce anxiety and amygdaloid dendritic hypertrophy | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 105 | issue = 14 | pages = 5573–5578 | date = April 2008 | pmid = 18391224 | pmc = 2291109 | doi = 10.1073/pnas.0705615105 | doi-access = free | bibcode = 2008PNAS..105.5573M }}</ref> SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization.<ref>{{cite journal | vauthors = Mitra R, Ferguson D, Sapolsky RM | title = SK2 potassium channel overexpression in basolateral amygdala reduces anxiety, stress-induced corticosterone secretion and dendritic arborization | journal = Molecular Psychiatry | volume = 14 | issue = 9 | pages = 847–55, 827 | date = September 2009 | pmid = 19204724 | pmc = 2763614 | doi = 10.1038/mp.2009.9 }}</ref>

== See also ==
* List of people with an anxiety disorder
* {{annotated link|Philosophy:Angst}}
* {{annotated link|Philosophy:Fear}}
* {{annotated link|Medicine:Tripartite Model of Anxiety and Depression}}

== References ==
{{Reflist}}

== External links ==
{{Medical resources
| ICD11   = {{ICD11|MB24.3}}, <!-- Anxiety 
         -->{{ICD11|6B00}}–{{ICD11|6B05}}, <!-- Anxiety or fear-related disorders
         -->{{ICD11|6E63}} <!-- Secondary anxiety syndrome -->
| ICD10   = {{ICD10|F06.4}}, <!-- Organic anxiety disorder
         -->{{ICD10|F40}}, <!-- Phobic anxiety disorders
         -->{{ICD10|F41}}, <!-- Other anxiety disorders
         -->{{ICD10|F93.0}}–{{ICD10|F93.3}} <!-- Separation, Phobic, or Social anxiety disorder of childhood -->
| ICD10CM = {{ICD10CM|F43.22}}, <!-- Adjustment disorder with anxiety
         -->{{ICD10CM|F43.23}} <!-- Adjustment disorder with mixed anxiety and depressed mood -->
| eMedicineTopic =
| MeshID = D001007
| MedlinePlus = 003211
| MedlinePlus_mult = {{MedlinePlus2|000917}}
|OMIM=607834
}}
{{Library resources box|by=no|onlinebooks=no|about=yes|wikititle=anxiety}}

{{Emotion-footer}}


[[Category:Anxiety| ]]

{{Sourceattribution|Anxiety}}