Anxiety: a guide to symptoms, types and treatment

Anxiety is the body's alarm system. In the right amount it keeps you alert and helps you prepare. With an anxiety disorder, the alarm goes off too often, too strongly, or when there's no real danger, and it's hard to switch off.

It shows up in the body as much as the mind, which is why many people first wonder if something is physically wrong:

• In your body: a racing or pounding heart, tight muscles, headaches, stomach upset, shortness of breath, or feeling tired all the time
• In your thoughts: worry that's hard to control, "what if" thinking, replaying conversations, or a mind that won't switch off at night
• In your mood: feeling restless, irritable or on edge
• In your sleep: trouble falling or staying asleep
• In what you do: avoiding places, people or tasks, asking for reassurance, or over-preparing to feel safe

These signs are a general guide, not a checklist for diagnosis.

Read more: when anxiety becomes physical, when anxiety shows up in your body, anxiety and the nervous system, feeling constantly on edge, hypervigilance, why you can't turn your mind off, supporting a sensitive nervous system.

Worrying about health, money, work or family is a normal part of life, and stress is a natural response to a real pressure. What sets an anxiety disorder apart is that the anxiety doesn't ease when the situation does, shows up in many situations, and starts to shape your choices.

Read more: the difference between stress and anxiety, when overthinking becomes a problem, why you keep replaying conversations.

Many people aren't sure which kind fits them, and they often overlap. Sorting that out is part of the evaluation. You don't need to know before you come in.

A note on OCD and PTSD

Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) involve a lot of anxiety and were once grouped with the anxiety disorders. Today they're classified separately, and each has its own treatment approach. See our OCD page, our complete OCD guide and our PTSD page.

Panic attacks and panic disorder

A panic attack is a sudden wave of intense fear with strong physical symptoms, such as a pounding heart, sweating, trembling, shortness of breath or a feeling of doom. A panic attack on its own is a symptom, not a diagnosis, and it can happen with other conditions. Panic disorder is the diagnosis when attacks keep coming unexpectedly and the fear of the next one starts to change your life. What panic attacks are, and are not.

Generalized anxiety and social anxiety

Read understanding generalized anxiety disorder, social anxiety: more than shyness, why you feel drained after social interaction and how to recover after social interaction.

Other anxiety disorders and related concerns

• Specific phobias: intense fear of a particular thing or situation, such as heights, flying, needles or animals, that's out of proportion to the actual danger and leads to avoidance.
• Agoraphobia: intense fear of places or situations where it might be hard to get away or get help if panic symptoms started, such as crowds, public transport or being far from home. It sometimes develops alongside panic disorder.
• "Health anxiety": a common term, not a formal diagnosis, for worrying so much about having a serious illness that it takes over: frequent checking of your body, searching symptoms online, or seeking reassurance that doesn't last. Clinicians may diagnose it as illness anxiety disorder or somatic symptom disorder, depending on the picture.

• Work: perfectionism, overworking and trouble switching off can hide anxiety for years. Read anxiety in working professionals, anxiety in finance and consulting and layoff anxiety in tech.
• Relationships: anxiety can show up as reassurance-seeking, conflict avoidance or constant checking in. Read working with anxiety in relationships and when anxiety affects your relationships.
• After having a baby: anxiety is common during pregnancy and after birth, and it's often missed. Read postpartum anxiety and see our women's mental health page.
• Alcohol: a drink can take the edge off for a while, but alcohol can make anxiety worse afterward and over time. Read how alcohol affects anxiety and depression.
• Cannabis: some people use cannabis to try to take the edge off anxiety. For others, it can cause or worsen anxiety, fear or panic, especially with stronger, high-THC products or larger amounts. If it's part of your life, it's worth talking about openly with your provider, without judgment.
• When it's hard to tell what's what: anxiety, ADHD, burnout and depression can look alike. Read ADHD, anxiety or burnout?.

It's worth reaching out if:

• Worry, fear or panic is there most days, or keeps coming back
• You're avoiding things you need or want to do
• It's affecting your sleep, work, school or relationships
• You're relying on alcohol, cannabis or reassurance to get through
• You've tried to manage it on your own and it isn't enough

You don't need to wait until things are at their worst. If you've been looking for a psychiatrist for anxiety in New Jersey, our board-certified psychiatric nurse practitioners can evaluate what's going on and talk through your options.

Anxiety can sometimes come with thoughts of suicide, especially alongside depression. If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.

There's no single test for anxiety. A careful evaluation looks at the whole picture, and we take the time to hear it:

• What you're experiencing, when it started, how often it happens and how it affects your life
• Your physical health and medications, because some medical problems (such as an overactive thyroid or heart rhythm problems), some medications, and caffeine or other substances can cause similar symptoms. Sometimes that means checking in with your primary care provider.
• Conditions that often come with anxiety, such as depression, PTSD, OCD, ADHD, or alcohol and substance use
• What you've tried before, and how it worked for you
• Your goals, and what you'd like to be different

This is part of a comprehensive psychiatric evaluation. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available. You'll leave understanding what we think is going on, and why. Read the questions you'll be asked at a first psychiatric evaluation.

Anxiety disorders are treatable. Treatment usually involves therapy, medication, or both, along with practical changes, and finding the right fit can take some time. The goal isn't to remove every anxious feeling. It's to make anxiety manageable, so it no longer runs your decisions.

Therapy

Cognitive behavioral therapy (CBT) is the best-studied therapy for anxiety disorders, often called the gold standard. It helps you notice and change anxious thinking patterns and gradually face what you've been avoiding, which is called exposure. Depending on your clinician, visits may draw on supportive, motivational interviewing, CBT-based, or DBT-based skills. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.

Medication

Several antidepressants, mainly SSRIs and SNRIs, are FDA-approved for specific anxiety disorders, and buspirone is approved for anxiety. They usually take several weeks to start working, and side effects are often mild, especially when the dose starts low and goes up slowly. Medication isn't right for everyone, and the decision is yours. Your provider will explain what each option can and can't do, and you'll decide together. This is part of our medication management. You can browse the options in the medication quick facts below, and read what to expect when starting medication for anxiety.

Everyday steps that help

These don't replace treatment, but they support it: regular sleep, physical activity (exercise has been shown to ease anxiety symptoms), cutting back on caffeine, and going easy on alcohol and cannabis. Slowing down and building tolerance for uncertainty help too, and so does noticing when reassurance-seeking keeps anxiety going.

Read more: evidence-based anxiety treatment, why reassurance doesn't help long-term, building tolerance for uncertainty, how to slow down without getting overwhelmed.

Regular follow-ups

We check how you're doing, watch for side effects and adjust carefully over time, one change at a time. Please don't stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly.

We're in network with Horizon BCBS NJ and most other BCBS plans, Aetna, Cigna, UHC, Optum, Oscar, Oxford and Curative. Coverage can vary by plan and by provider, so after you submit your intake packet, we'll verify your benefits and let you know what to expect before your first appointment. We don't accept Medicare or Medicaid (NJ FamilyCare). Because of Medicare and Medicaid rules, we also can't see patients with these plans on a private-pay basis.

Self-pay rates, superbills and the Good Faith Estimate are on our insurance and fees page.