Self

27 Things No One Ever Tells You About Anxiety

It’s not the same thing as stress.

Anxiety is not a choice.
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There's no need to sugarcoat it: Dealing with an anxiety disorder can be downright confusing, whether you were recently diagnosed with one, or you've been living with it for a long time. Even people who have lived with conditions ranging from generalized anxiety disorder to post-traumatic stress disorder (PTSD) for many years still find themselves scouring Google with questions about their mental health disorders, coping skills, and new symptoms of anxiety that seem to crop up. While most people could give you a cookie-cutter definition, in terms of what to know about anxiety, there are a lot of practical things no one ever tells you.

"Anxiety disorders have the highest prevalence of any mental health disorder in the U.S., impacting nearly 20% of adults each year," Sarah Greenberg, the lead coach and program design lead at BetterUp, tells Bustle. To be more precise, anxiety disorders affect 40 million adults in the U.S., or 18.1% of the population, according to the Anxiety and Depression Association of America (ADAA). While anxiety is common, there are so many different ways it can manifest — and it could take a while to learn the ins and outs of how to best manage your own mental health.

Knowing your diagnosis can be informative, but that is often just the first step in a long journey of learning how to live with a chronic mental health condition. Regardless of whether anxiety flaring up is new or all too familiar to you, here are 27 things you should know about anxiety, according to experts.

1

Anxiety Is Not A Choice

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When you're first diagnosed with an anxiety disorder, there will undoubtedly be some well-intended person in your life who insists "happiness is a choice." Sigh. "Experts agree that the cause [of anxiety disorder] is truly a combination of nature (genetics) and nurture (lived experience)," Greenberg says. In fact, a 2010 study conducted by researchers at Johns Hopkins Children's Center found that, perhaps unsurprisingly, children with anxious parents were more anxious themselves.

2

Everyone's Experience With Anxiety Is Unique

Though anxiety is one of the most common mental health conditions in the world, every single person's experience with anxiety is unique. "There are so many interrelated factors that influence your experience, and thus your path forward," Greenberg says. "I am wary of any 'one-size-fits-all' treatment approach, and instead favor an approach that takes into account both the decades of important research from social science, as well as the nuances that make each person’s journey unique."

3

Anxiety Can Often Go Unnoticed

Anxiety can manifest itself in varying degrees, sometimes to the point where it might go unnoticed if you don’t know what to look for. "Low grade or 'hidden' anxiety might not significantly interfere with your ability to function," Dr. Jamie Long, Doctor of Psychology (Psy.D.), licensed clinical psychologist at The Psychology Group Fort Lauderdale, tells Bustle. "Nonetheless, it's still important to recognize the signs because living in a heightened state of tension is harmful to your health in the long run,” she says. “It's also helpful to recognize the early warning signs of anxiety before it worsens and eventually does interfere with daily functioning." These early warning signs can include nervousness, increased heart rate, trouble sleeping, persistent worry, and difficulty concentrating.

4

Anxiety Is Highly Treatable

When you're first diagnosed with an anxiety disorder, it's more than OK to feel afraid, overwhelmed, or unsure of what the next steps forward will look like. Fortunately, Dr. Scott Symington, Ph.D., licensed clinical psychologist and author of Freedom from Anxious Thoughts and Feelings: A Two-Step Mindfulness Approach for Moving Beyond Fear and Worry, says anxiety is "one of the most treatable mental health conditions," and that there are "an array of evidenced-based treatments that are highly effective in alleviating debilitating anxiety." With the right team of mental health professionals, it's more than possible to manage your anxiety with treatments like cognitive behavioral therapy (CBT), mind-body approaches, and prescription medication.

5

You Can Search For Therapists Until You Find The Right One

Finding a therapist you connect with can be a huge step towards healing when you're living with an anxiety disorder. "When it comes to choosing a therapist, too often people feel obligated to keep working with the first practitioner they meet,” Greenberg says. “If it feels like a good fit, great! If not, it’s important to know it’s OK to keep shopping around."

6

Talk Therapy Isn't The Right Approach For Everyone With Anxiety

There's no question that seeing a therapist on a regular basis can make your anxiety much more manageable. However, traditional talk therapy might not be the right approach for everyone. If you find your sessions aren't as productive as you'd like, you can ask your therapist if it would be helpful to try a treatment with a touch on the creative side, such as art therapy, movement therapy, or music therapy. "Treatment works, but it’s not a simple path," says Amy Cirbus, a licensed therapist at Talkspace. And not everyone is going to find success within the same model.

7

Complementary Therapies Can Help

Mind-body therapies — such as yoga and meditation — have been shown help reduce anxiety. According to the National Institutes of Health, research suggests these practices may help lessen anxiety, improve coping strategies, alleviate pain and fatigue, and boost overall wellness. What's more, studies have found that mind-body therapies can greatly improve mental and physical health specifically among marginalized communities who might have difficulty accessing traditional treatments. Though mind-body practices don't replace therapy (or minimize the urgent need for better access to therapy for everyone), they are often effective when used as a complementary treatment option.

8

Being Stressed Is Not The Same Thing As Being Anxious

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Feeling nervous or worried is a totally normal response to stress, but anxiety is a chronic mental health disorder that can be debilitating. However, often people conflate the two — even the people experiencing them — since symptoms such as uneasiness, tension, high blood pressure, headaches, and loss of sleep overlap, according to Kristin Wilson, MA, LPC, vice president of clinical outreach for Newport Academy, an adolescent mental health treatment facility.

Still, there are notable differences between stress and anxiety. "Generally, stress is a reaction to pressure or a threat, meaning a response to an external cause, such as a tight deadline at work or having an argument with a friend, and typically subsides once the situation has been resolved," Wilson previously told Bustle. "In contrast, anxiety disorders are characterized by persistent feelings of uneasiness, fear, worry, or unease that do not usually end after a concern has passed. Ultimately, anxiety disorders can cause disruption in everyday life and routines."

9

You're Not Alone In Your Anxiety

"We don't talk about [anxiety] enough," Cirbus tells Bustle. "It's so common, and yet often goes undisclosed and undiscussed." Being able to find a trusted friend to openly discuss your anxiety with can make a huge difference when you're struggling. If you feel like you can't talk to a friend or loved one, there is no shame calling or texting a hotline to reach a mental health professional or trained crisis counselor. Contact the National Alliance on Mental Illness (NAMI) HelpLine at 1-800-950-NAMI (6264) for help Monday through Friday from 10 a.m. to 10 p.m. ET.

10

There Are Many Different Symptoms Of Anxiety Disorders

People with anxiety disorders may experience uncontrollable worry, feelings of restlessness, intense fear, and racing or intrusive thoughts. But anxiety can also manifest as physical symptoms like chronic headaches and body aches. Moreover, doctors have reported memory problems, heart palpitations, excessive sweating, and diarrhea.

People with panic disorder may experience even more severe physical symptoms. There have been a number of reports of folks confusing panic attacks with heart attacks. As a 2016 study in Psychiatric Services revealed, over 1.2 million emergency room visits in the U.S. between 2009 and 2011 were anxiety-related. A 2019 study in the Journal of Health Psychology found that over 77% of non-cardiac chest pain ER patients reported having chest pain following a panic attack.

11

Anxiety Disorders Are Linked To Other Common Health Conditions

"Anxiety disorders often co-occur with other challenges such as depression, significant life stressors, or insomnia,” Greenberg says. In fact, the ADAA reports that close to half of people diagnosed with depression are also diagnosed with anxiety. Sleep disorders may be linked to anxiety — a 2020 study in Psychiatry Research found that people with anxiety were five times more likely to experience lack of sleep — and anxiety disorders can also have a negative impact on digestion.

12

Your Memory Might Be Affected

Anxiety has also been known to cause memory problems in some cases, especially in those with undiagnosed anxiety disorders. "Another common physical presentation involves attention and concentration, which logically leads to memory problems," Kevin Gilliland, Psy.D. and executive director of outpatient therapy practice Innovation360, previously explained to Bustle. "If you can’t concentrate and stay present in a conversation, you might end up thinking you have dementia.”

Thinking you might be dealing with dementia can be very scary, but if your memory problems are actually a result of an anxiety disorder, chances are speaking with a mental health professional can help address the problem.

13

Anxiety Can Look Like Anger

While you might typically think of an anxious person as looking fearful — shaking, crying, or sweating — that's not always the case. It's not unusual for someone experiencing anxiety to lash out or seem irritable rather than worried. "[Anger] is rooted in fear, and fear is just another word for anxiety," therapist Kayce Hodos, LPC, previously told Bustle. "When we feel threatened, we react with our natural stress response — fight or flight. Those of us who end up fighting often get angry when things don’t go our way. To figure out how to manage your anger, you need to be able to name your fear and learn to take control of what’s lying beneath: anxiety."

14

Anxiety Can Impact Your Work Productivity

Greenberg explains that your mental health can greatly impact your satisfaction and productivity at work. In fact, as reported by the American Psychiatric Association’s Center for Workplace Mental Health, anxiety disorders can lead to an average of 4.6 work days lost and 5.5 days of reduced productivity each month. It's up to employers to make workplaces accessible for people with mental illness and other disabilities, but doing things like learning new skills to manage your anxiety disorder at work and prioritizing work-life balance may help you cope with your anxiety.

15

Medication Can Help

According to the CDC’s 2019 National Health Interview Survey, 15.8% of adults in the U.S. take prescription medication for their mental health. While antidepressants and other psychiatric medications are not right for everyone, your physician or psychiatrist may recommend taking medication to help manage your anxiety disorder.

"It takes the vigilance of finding the right (and affordable) doctor, then the right medication for you, [and] then the right dosage of that medication," Greenberg explains. "For most people, it’s the combination of medication and counseling together that provides the best results."

16

Your Brain Is Teachable

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Anxiety may feel all-consuming sometimes, but Symington says with the right therapist and skills, you can retrain your brain to relax when you begin to feel anxious or feel a panic attack coming on. (Yes, our brains are that cool!)

"The fear response (fight or flight) can show up in spaces where it doesn’t belong, such as driving over bridges or going to the dentist. When this happens, you have the ability to teach your brain that the perceived threat is not dangerous," explains Symington. "While driving over the feared bridge, for example, you would relax your grip on the steering wheel, take deep breaths, and place your attention on the radio, or some other external stimuli. [...] As you do this, the anxiety gradually dissipates."

17

Ignoring Your Anxiety Won't Make It Go Away

Hyper-focusing on your anxiety or intrusive thoughts can be harmful, but trying to avoid your anxiety altogether can also be unhelpful. "Avoiding sources of fear and anxiety is natural, but it invites more anxiety into your life,” explains Symington. “It reinforces the threat status of whatever is being avoided.”

It’s all about finding a balance. "Heightened self-consciousness or hyper-vigilance of one's environment can be a negative symptom [of anxiety]," Greenberg says. "But harnessing that awareness and applying it strategically can actually be a real asset.”

18

Anxiety Can Affect Your Relationships

Having an anxiety disorder can impact every aspect of your life, including your relationships — both platonic and romantic. "Anxiety can cause strain on a relationship, and often will if it is not treated properly,” Alana Barlia, LMHC, previously told Bustle. However, she says that learning to communicate with your partner about your mental health needs is key. It's important to remember that while anxiety may present unique challenges in a relationship (which every relationship has, BTW), that doesn't make you unlovable or undateable.

19

You Cannot Always Control Or Predict Your Anxiety

There may be times when your anxiety seems to flare up out of nowhere — even when you have a strong support system, a routine in place, and therapist-approved coping skills. Cirbus says that while it's typical to feel a little fearful or hopeless when this happens, "staying the course does work." It's important to keep seeing your therapist, practicing the coping skills you've learned, and for some, taking prescribed anxiety medication.

Cirbus explains that, like with any chronic illness, living with an anxiety disorder takes a lot of effort and patience. Being aware of your anxiety triggers may help you manage your symptoms better. But accepting that you will have bad mental health days from time to time, and that your anxiety will not always be predictable, can make living with it easier.

20

Learning About Your Anxiety Disorder Can Help

It may be overwhelming, but taking small steps toward learning about your mental health may help you feel encouraged to seek help, try new coping skills, and make small strides towards recovery. "When you’re first diagnosed with anxiety, it can feel extremely vulnerable and frightening to claim this diagnosis as your own, [but] gathering information helps," Cirbus says. This may mean consistently seeing your therapist, picking up a book about mental health, or reading about what has worked for others with anxiety disorders.

21

Tracking Your Symptoms Can Help You Be More Aware Of Your Anxiety

On a similar note, gathering information about your unique anxiety triggers and symptoms can help you better manage your mental illness over time. "It’s important to track symptoms closely over a period of time. Doing so, without judgment, will help you recognize and interrupt unhelpful patterns," says Greenberg. "Practicing self-awareness in this way can make what once felt impossible well within reach." Downloading a mental health app is an easy way to start keeping track of how your anxiety impacts you on a regular basis.

22

Lifestyle Choices Can Impact Your Anxiety In Sneaky Ways

Your daily routine can have a huge impact on your overall mental and physical wellness — especially when you have an anxiety disorder. Skipping meals, scrolling on social media too often, staying up late, and sitting at home all day are a few habits that can worsen your anxiety. Caffeine, in particular, can have a negative effect when combined with anxiety, according to Jennifer Weaver, LMHC, CRC, psychotherapist in private practice in Rhode Island. "Caffeine raises your heart rate and causes [you] to have that nervous feelings and to feel agitation," Weaver previously told Bustle.

23

Exercising Can Help With Anxiety

Exercise is not a cure for anxiety. However, it’s a go-to coping skill for many when they’re feeling super anxious — and for good reason. Studies have shown that physical activity and exercise can help with anxiety and really boost your mood. So, even if exercising might seem like the last thing you want to do, consider putting on your sneakers anyway. Even something as simple as going for a brisk 20-minute walk releases endorphins — which, in turn, can quell some of the mental and physical symptoms associated with anxiety disorders.

24

Anxiety Can Affect Your Sex Drive

Just as anxiety can affect many day-to-day activities, it can also significantly affect your libido. “Your anxious body prioritizes creating stress hormones like cortisol at the expense of sex hormones like estrogen, progesterone, and testosterone,” Erica Zellner, a health coach at medical provider Parsley Health, previously explained to Bustle. Those sex hormones are responsible for regulating your sex drive, as well as aiding in lubrication and arousal. So, when people with anxiety produce those hormones in low quantities, their desire to engage in sexual activities will be low, too. Not to mention, anxiety disorders can make you feel less comfortable and relaxed overall.

25

Anxiety Can Weaken Your Immune System

When cortisol, the hormone associated with anxiety and stress, is increased in your system on a regular basis, it can affect your immune system, wearing you down and making you more susceptible to illness. "Cortisol, in this form, takes a toll on the body’s systems and functioning, causing them ... [to] break down faster than normal," therapist Emily Cosgrove, LMFT, previously told Bustle. "This means the immune system is weakened and may struggle to fight illnesses that enter your body." When you are feeling run down, you’re more likely to catch illnesses like colds and flus.

26

Breathing Can Help With Anxiety

Believe it or not, the simple act of breathing and focusing on your breath can help with anxiety. While it certainly won’t get rid of your anxiety altogether, studies do show that breathing mindfully will make an impact. According to a 2019 study published in the International Journal of Yoga, yogic breathing techniques prove beneficial in reducing anxiety and depressive symptoms in patients. Likewise, a 2018 study from Frontiers of Human Neuroscience found that slow breathing techniques may increase comfort, relaxation, pleasantness, vigor, and alertness, and reduced symptoms of arousal, anxiety, depression, anger, and confusion.

27

Your Anxiety Can Be Used For Good

Yes, you read that right: There is such a thing as good anxiety (aka very small amounts of it), and this type of anxiety may actually boost your cognitive health. "Anxiety is energy,” Symington says. “Nervous, anxious energy can be used as an internal reminder — and energy source — to express the best parts of who you are.”

"Nobody wishes for anxiety," Greenberg says. "But, what some people find is that the work they do to recover from symptoms, such as adopting healthy habits, exploring thought patterns, or improving relationships, doesn’t just alleviate symptoms. It actually leads them to emerge from the journey stronger than ever." This doesn’t mean you shouldn’t seek treatment, but it does mean you can learn to reframe your anxious thoughts in a healthier way.

Navigating an anxiety disorder can be tricky, and you'll probably always run into obstacles you've not faced before. However, the more you understand about your mental illness, the better you can be prepared to handle it in the future.

If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Illness (NAMI) website, or call 1-800-950-NAMI (6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP (4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or call 911.

Studies referenced:

Schmidt, L. (2008). Social anxiety disorder: A review of environmental risk factors. Neuropsychiatric Disease and Treatment, 123. https://doi.org/10.2147/ndt.s1799

Burstein, M., Ginsburg, G. S., & Tein, J. Y. (2010). Parental anxiety and child symptomatology: an examination of additive and interactive effects of parent psychopathology. [corrected]. Journal of abnormal child psychology, 38(7), 897–909. https://doi.org/10.1007/s10802-010-9415-0

Bandelow, B., Wedekind, D., & Michaelis, S. (2017). Treatment of anxiety disorders. Generalized Anxiety Disorders, 19(2), 93–107. https://doi.org/10.31887/dcns.2017.19.2/bbandelow

Burnett-Zeigler, I., Schuette, S., Victorson, D., & Wisner, K. L. (2016). Mind-Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review. Journal of alternative and complementary medicine (New York, N.Y.), 22(2), 115–124. https://doi.org/10.1089/acm.2015.0038

Dark, T., Flynn, H. A., Rust, G., Kinsell, H., Harman, J. S. (2016). Epidemiology of Emergency Department Visits for Anxiety in the United States: 2009–2011. Psychiatric Services, 68(3), 238-244. https://doi.org/10.1176/appi.ps.201600148

Foldes-Busque, G., Denis, I., Poitras, J., Fleet, R. P., Archambault, P., & Dionne, C. E. (2019). A closer look at the relationships between panic attacks, emergency department visits and non-cardiac chest pain. Journal of health psychology, 24(6), 717–725. https://doi.org/10.1177/1359105316683785

Serdari, A., Manolis, A., Tsiptsios, D., Vorvolakos, T., Terzoudi, A.,Nena, E., Tsamakis, K., Steiropoulos, P., Tripsianis, G. (2020) Insight into the relationship between sleep characteristics and anxiety: A cross-sectional study in indigenous and minority populations in northeastern Greece. Psychiatry Research, Volume 292, 113361, ISSN 0165-1781. https://doi.org/10.1016/j.psychres.2020.113361

Anderson, E., & Shivakumar, G. (2013). Effects of exercise and physical activity on anxiety. Frontiers in psychiatry, 4, 27. https://doi.org/10.3389/fpsyt.2013.00027

Lukasik, K. M., Waris, O., Soveri, A., Lehtonen, M., & Laine, M. (2019). The relationship of anxiety and stress with working memory performance in a large non-depressed sample. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00004

Tiwari, N., Sutton, M., Garner, M., & Baldwin, D. S. (2019). Yogic Breathing Instruction in Patients with Treatment-Resistant Generalized Anxiety Disorder: Pilot Study. International journal of yoga, 12(1), 78–83. https://doi.org/10.4103/ijoy.IJOY_22_18

Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Frontiers in human neuroscience, 12, 353. https://doi.org/10.3389/fnhum.2018.00353

Morey, J. N., Boggero, I. A., Scott, A. B., & Segerstrom, S. C. (2015). Current directions in stress and human immune function. Current Opinion in Psychology, 5, 13–17. https://doi.org/10.1016/j.copsyc.2015.03.007

Experts:

Sarah Greenberg, lead coach and program design lead at BetterUp

Scott Symington, licensed clinical psychologist and author of Freedom from Anxious Thoughts and Feelings: A Two-Step Mindfulness Approach for Moving Beyond Fear and Worry

Amy Cirbus, licensed therapist at Talkspace

Kristin Wilson, MA, LPC, Vice President of Clinical Outreach at Newport Academy

Kayce Hodos, LPC, certified therapist

Alana Barlia, LMHC, therapist at Intuitive Healing Psychotherapy NYC

Jennifer Weaver, LMHC, CRC

Erica Zellner, health coach at medical provider Parsley Health

Dr. Jamie Long, licensed clinical psychologist at The Psychology Group Fort Lauderdale

Kevin Gilliland, PsyD and executive director of Innovation360

Emily Cosgrove, LMFT

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