Anxiety disorders: symptoms, causes and treatment

Key points

• An anxiety disorder is diagnosed when anxiety is persistent, out of proportion to the situation and disrupts daily life [1][4].
• The Adult Psychiatric Morbidity Survey 2023/4 found that 7.5% of adults in England met the criteria for generalised anxiety disorder [3].
• Types include generalised anxiety disorder, panic disorder, social anxiety disorder, phobias, agoraphobia and health anxiety [4][5][6][7][8].
• Physical symptoms such as palpitations, dizziness and chest tightness often bring people to a GP [5][6].
• NICE recommends lower-intensity psychological help before medication, and for generalised anxiety disorder offers a choice between therapy and medication at the same step [1][2].
• Adults in England can refer themselves to NHS Talking Therapies without a GP [4][9].

What an anxiety disorder is

An anxiety disorder is a mental health condition in which anxiety is persistent, out of proportion to the situation, and interferes with everyday life. Anxiety itself is normal, the body’s response to threat. It becomes a disorder when it continues without clear reason, lasts months, and limits what a person can do [1][4].

If you need help now. Samaritans: call 116 123, free, 24/7. Shout: text 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.

The Adult Psychiatric Morbidity Survey 2023/4 reported that 20.2% of adults in England had a common mental health condition, the group covering depression and the anxiety disorders [3]. It measured symptoms in the previous week, so the figure describes one point in time [3].

Symptoms

Psychological and physical symptoms occur together. The physical ones reach a GP first more often, because they feel like a heart or breathing problem [5].

Psychological and behavioural symptoms:

• worry that is hard to control, often about several things at once [1][4]
• feeling tense, restless or irritable, with poor concentration and disturbed sleep [4]
• dread, fear of dying or detachment from the body, during a panic attack [5]
• avoiding places and activities linked to the anxiety, or seeking reassurance [6][7][8]

Physical symptoms:

• a fast, pounding or unusual heartbeat [4][5]
• shortness of breath, a choking sensation, chest pain or tightness [5][6]
• sweating, trembling, hot flushes, chills or numbness [5]
• dizziness, faintness, nausea or diarrhoea [4][6]

Panic attacks are often mistaken for heart problems, and NICE notes that people attend A&E with chest pain before panic disorder is identified [1]. Social anxiety disorder is often put down to shyness, though NICE frames it as fear, avoidance and lost functioning [2].

Types

Anxiety disorders are separate diagnoses, not one condition.

• Generalised anxiety disorder (GAD). Worry about many things, most days, that is hard to control and has lasted at least 6 months [4].
• Panic disorder. Repeated, unexpected panic attacks, most lasting 5 to 20 minutes, and worry about having more [5].
• Social anxiety disorder. Intense fear of social situations, including of blushing, sweating or appearing boring [2].
• Specific phobias. Strong fear of one object or situation: animals, heights, flying, enclosed spaces or blood [6].
• Agoraphobia. Fear of situations where escape is hard or help unavailable, such as public transport or leaving home [7].
• Separation anxiety disorder. Severe distress at being apart from an attachment figure, which ICD-11 moved into this grouping [10].
• Health anxiety. Persistent worry about illness, with body checking and reassurance seeking, which the NHS describes as related to OCD [8].

ICD-11, the classification the NHS uses, places OCD and PTSD in separate groupings rather than with the anxiety disorders: obsessive-compulsive or related disorders, and disorders specifically associated with stress [10].

Causes and risk factors

There is no single cause. The NHS states that GAD usually has no obvious cause, and that panic disorder involves several factors [4][5].

Factors linked to higher risk include:

• another anxiety disorder, or depression [4]
• close relatives with anxiety, depression or other conditions [4][6]
• stressful or traumatic experiences, including abuse or bullying [4]
• a frightening event tied to an object or situation, in phobias [6]
• a painful long-term physical condition, or drug or alcohol misuse [4]

Two popular explanations go beyond the evidence. Family history raises risk but does not determine it, and no single gene has been identified [4]. The NHS lists neurotransmitter imbalance as one factor in panic disorder, not the whole explanation, so calling anxiety a chemical imbalance overstates it [5].

How it is diagnosed

In England a GP usually makes the first diagnosis, starts treatment and refers on [4][5]. Psychiatrists, registered with the GMC, and practitioner psychologists, registered with the HCPC, diagnose in specialist services [2].

Assessment is a conversation, not a test. NICE states it should weigh distress and lost functioning, not just the number, severity and duration of symptoms [1]. Questionnaires support it:

• GAD-2 and GAD-7. NICE suggests the two-item GAD-2 when an anxiety disorder is suspected [1]. The seven-item GAD-7 is the standard anxiety measure in NHS Talking Therapies, recorded at appointments to track change [9].
• Mini-SPIN and SPIN. NICE recommends the three-item Mini-SPIN to identify possible social anxiety disorder, then the SPIN or Liebowitz scale [2].

In England, adults aged 18 and over can refer themselves to NHS Talking Therapies without seeing a GP [4]. The service manual states that nine out of ten people were seen within 6 weeks of referral, though waits vary by area [9]. A diagnosis names a pattern and opens access to treatments. It is not a description of character, and not a permanent label.

Treatment

NICE sets out stepped care for generalised anxiety disorder, offering the least intrusive effective option first. Step 1 is education and active monitoring. Step 2 is low-intensity psychological help: CBT-based self-help, guided self-help, or a psychoeducational group. Step 3 is a choice between CBT or applied relaxation, usually 12 to 15 weekly sessions of 1 hour, and drug treatment, guided by the person’s preference because there is no evidence either works better. Step 4 is specialist services [1].

For panic disorder, NICE recommends self-help for mild to moderate cases, and CBT of 7 to 14 hours for moderate to severe cases, or an antidepressant if the disorder is long-standing or CBT is declined [1].

For social anxiety disorder, NICE recommends individual CBT developed for the condition, on the Clark and Wells or Heimberg model, then supported self-help, an SSRI, or short-term psychodynamic psychotherapy if earlier options are declined [2].

Decisions about medicines are for a prescriber. Where a person with GAD chooses drug treatment, NICE suggests sertraline first, then an alternative SSRI or an SNRI if that is ineffective. It advises against benzodiazepines for GAD except short-term in a crisis, and against them for panic disorder [1].

The evidence is not uniformly strong. NICE advises against routinely offering group CBT ahead of individual CBT for social anxiety, because it is less clinically and cost effective [2].

Living with an anxiety disorder

Avoidance is the pattern most worth watching. The NHS advises against avoiding situations that make you anxious, and suggests building up time in them gradually [4].

Practical steps the NHS recommends [4][5]:

• keep caffeine down, since tea, coffee, cola and energy drinks disturb sleep
• avoid using alcohol, cigarettes or drugs to take the edge off
• exercise regularly, which can reduce tension and improve sleep
• learn slow breathing or relaxation techniques for panic attacks

If anxiety affects your work or studies, you can tell an employer or university what you find difficult and what would help, such as changes to presentations or travel. UK charities offering information and peer support include Mind, Rethink Mental Illness, Anxiety UK and No Panic [4][5].

When to speak to a professional

Speak to a GP if:

• you think you may have an anxiety disorder, or treatment is not helping [4]
• a fear, phobia or health worry is affecting your everyday life [6][8]
• you are having panic attacks regularly, or using alcohol or drugs to manage anxiety [1][5]

If you are 18 or over and in England, you can refer yourself to NHS Talking Therapies without a GP [4][9]. A GP appointment is still worth having if physical symptoms need checking or you want to discuss medication.

Get help straight away if you are struggling to keep yourself safe. Samaritans: call 116 123, free, 24/7. Shout: text 85258. NHS 111, then the mental health option. Call 999 if anyone is in immediate danger.

Common questions

Is an anxiety disorder the same as anxiety?

No. Anxiety is a normal response that everyone has. An anxiety disorder is diagnosed when it is persistent, out of proportion to the situation and disrupts daily life [1][4]. The dividing line is duration, control and lost functioning.

Are OCD and PTSD anxiety disorders?

Not in ICD-11, the classification used by the NHS. OCD sits in a grouping of obsessive-compulsive or related disorders, and PTSD in one of disorders specifically associated with stress [10]. Both were once classed as anxiety disorders.

How long does treatment take?

It varies. NICE describes CBT or applied relaxation for GAD as usually 12 to 15 weekly sessions of 1 hour, and CBT for panic disorder as 7 to 14 hours [1]. CBT for social anxiety runs up to 14 sessions [2].

Clinical review pending

References

1. National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management. NICE clinical guideline CG113, published 26 January 2011, last updated 15 June 2020. https://www.nice.org.uk/guidance/cg113/chapter/Recommendations
2. National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment. NICE clinical guideline CG159, published 22 May 2013. https://www.nice.org.uk/guidance/cg159/chapter/1-Recommendations
3. NHS England Digital. Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. Chapter 1: Common mental health conditions, published 27 November 2025. https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/survey-of-mental-health-and-wellbeing-england-2023-24/common-mental-health-conditions
4. NHS. Generalised anxiety disorder (GAD). nhs.uk, page last reviewed 22 October 2024. https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder-gad/
5. NHS. Panic disorder. nhs.uk, page last reviewed 22 August 2023. https://www.nhs.uk/mental-health/conditions/panic-disorder/
6. NHS. Phobias. nhs.uk, page last reviewed 11 March 2026. https://www.nhs.uk/mental-health/conditions/phobias/
7. NHS. Overview: Agoraphobia. nhs.uk, page last reviewed 31 October 2022. https://www.nhs.uk/mental-health/conditions/agoraphobia/overview/
8. NHS. Health anxiety. nhs.uk, page last reviewed 8 November 2023. https://www.nhs.uk/mental-health/conditions/health-anxiety/
9. NHS England. NHS Talking Therapies for anxiety and depression Manual, version 7.1. https://www.england.nhs.uk/wp-content/uploads/2018/06/nhs-talking-therapies-manual-v7.1-updated.pdf
10. Stein DJ, Szatmari P, Gaebel W, et al. Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine, 2020, volume 18, article 21. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-1495-2