Anxiety: symptoms, causes, treatment and self-help

The NHS says anxiety can cause many different symptoms and may affect how you feel physically, mentally and how you behave. It is not always easy to recognise when anxiety is the reason you are feeling or acting differently.

The main symptom of generalised anxiety disorder (GAD) is feelings of stress or worry that affect your daily life and are difficult to control. The NHS lists the symptoms below.

The NHS explains that when you feel anxious or scared, your body releases stress hormones such as adrenaline and cortisol, which can be helpful in some situations but can also cause physical symptoms such as an increased heart rate and sweating. In some people it might cause a panic attack. The NHS also says regular anxiety, fear or panic can be the main symptom of several health conditions, so it advises not to self-diagnose and to speak to a GP if you are worried.

Most people feel anxious sometimes, and the NHS says it does not always mean you have GAD. It is more likely to be GAD if you feel anxious most of the time and it affects your everyday life. The NHS says there are also other types of anxiety disorder, and it is common to have more than one, for example panic disorder (sudden attacks of anxiety and panic) and phobias (an overwhelming fear of something specific).

The NHS says treatment for GAD can help you manage your symptoms, but it may take time. A GP will usually advise you to try talking therapies before they prescribe medicine or refer you to a specialist.

NICE describes a stepped-care approach for GAD: education and active monitoring first, then low-intensity psychological interventions such as individual self-help, then high-intensity psychological interventions or drug treatment for those with marked impairment or whose symptoms have not improved. For drug treatment NICE says to offer an SSRI, and to consider sertraline first.

The NHS suggests the following. It also says to avoid using alcohol, cigarettes, gambling or drugs to relieve anxiety, as these can contribute to poor mental health.

• Talk about your feelings to a friend, family member, health professional or counsellor.

• Use recommended self-help therapies such as books, online tools or courses.

• Learn to relax with calming breathing exercises or activities such as yoga or pilates.

• Try to get enough sleep.

• Exercise regularly. Running, walking, swimming and yoga can reduce anxiety and stress and help you sleep better.

• Eat a healthy diet with regular meals to keep your energy levels stable.

• Do not drink lots of coffee, tea, cola or energy drinks, as caffeine can disrupt sleep and make anxiety harder to control.

• Do not avoid situations that make you anxious; try slowly building up time spent in worrying situations to gradually reduce anxiety.

The NHS says that if you experience sudden, intense anxiety and fear, it might be a panic attack. Symptoms can include a racing heartbeat, feeling faint, dizzy or light-headed, feeling that you are losing control, sweating, trembling or shaking, shortness of breath or breathing very quickly, tingling in the fingers or lips, and feeling sick.

A panic attack usually lasts 5 to 20 minutes. The NHS says they can be frightening, but they are not dangerous and should not harm you. Chest pain and breathlessness can also have other causes, so see a GP if you are unsure or are worried.

The NHS says children and young people feel worried and anxious at times, and many worries are a normal part of growing up. It says separation anxiety is very common from around 6 months to 3 years and should stop at around age 2 to 3, and that preschool children often develop specific fears that usually go away gradually on their own.

Anxiety becomes a problem when it is very strong or getting worse and does not go away, or gets in the way of daily activities and stops a child doing things they enjoy. In young children the NHS lists signs such as being irritable, tearful or clingy, difficulty sleeping, waking in the night, bedwetting and bad dreams. In older children it lists lacking confidence to try new things, finding it hard to concentrate, problems with sleeping or eating, angry outbursts, lots of negative thoughts and avoiding everyday activities such as school.

The NHS suggests talking to your child and listening carefully, helping them find solutions, keeping to routines, preparing them for change and working with the school. If your child is really struggling and it is affecting everyday life, it suggests talking to your GP or school nurse.

The NHS says some people can get depression or anxiety for the first time during pregnancy, and that if you have had anxiety before pregnancy your symptoms may come back. Depression and anxiety in pregnancy can often be helped with a talking therapy such as CBT.

If you are pregnant or have given birth within the last 12 months, the NHS says your midwife, doctor or health visitor can help you get support. Tell them how you are feeling rather than waiting to see whether it passes.

The NHS says there are many different causes of anxiety, fear or panic and it is different for everyone. For GAD, it says there is not usually an obvious cause, but some things can increase the chance of having it.

• Having another anxiety disorder, such as panic disorder or social phobia.

• Having close relatives with anxiety disorders, depression or other mental health conditions.

• A history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying.

• A painful long-term health condition, such as arthritis.

• A history of drug or alcohol misuse.

• GAD is also more common in women than men.

The NHS says a GP will ask you questions about your worries and physical symptoms, and it is important to be honest even if it is difficult to talk about your emotions. A GP may diagnose GAD if you have typical symptoms and you often worry about a wide range of things, feelings of anxiety are affecting your daily life, you are finding it hard to control your feelings and you have felt anxious a lot of the time for at least 6 months.

The NHS says treatment can help you manage symptoms but it may take time. There is no fixed length of time for anxiety; it varies from person to person, and a GP can review how treatment is working.

The NHS says to see a GP if you think you might have GAD, if you are struggling to cope with anxiety, fear or panic, if the things you are trying yourself are not helping, or if you have been diagnosed and treatments are not helping.

The NHS says support is available if you or someone you know is having a mental health crisis or emergency, and points to where to get urgent help for mental health. The Samaritans can be called on 116 123 at any time, day or night. In an emergency, call 999.

On the NHS, adults can self-refer to NHS talking therapies for anxiety and depression, or see a GP, who may offer therapies, medicines or referral to a community mental health team. Children and young people are supported through school nurses, GPs and children and young people's mental health services.

Some people choose a private therapist or psychiatrist for faster access or more choice of therapy. Check the practitioner's professional registration, ask what approach they use and make sure your GP is told about any medicines so your care is joined up.