Stress can come from any sit­u­a­tion or thought that makes you feel frus­trated, angry, or anx­ious. What is stress­ful to one per­son is not nec­es­sar­ily stress­ful to another.

Anx­i­ety is a feel­ing of appre­hen­sion or fear. The source of this uneasi­ness is not always known or rec­og­nized, which can add to the dis­tress you feel.

Alter­na­tive Names

Anx­i­ety; Feel­ing uptight; Stress; Ten­sion; Jit­ters; Apprehension

Con­sid­er­a­tions

Stress is a nor­mal part of life. In small quan­ti­ties, stress is good — it can moti­vate you and help you be more pro­duc­tive. How­ever, too much stress, or a strong response to stress, is harm­ful. It can set you up for gen­eral poor health as well as spe­cific phys­i­cal or psy­cho­log­i­cal ill­nesses like infec­tion, heart dis­ease, or depres­sion. Per­sis­tent and unre­lent­ing stress often leads to anx­i­ety and unhealthy behav­iors like overeat­ing and abuse of alco­hol or drugs.

Emo­tional states like grief or depres­sion and health con­di­tions like an over­ac­tive thy­roid, low blood sugar, or heart attack can also cause stress.

Anx­i­ety is often accom­pa­nied by phys­i­cal symp­toms, including:

• Twitch­ing or trem­bling
• Mus­cle ten­sion, headaches
• Sweat­ing
• Dry mouth, dif­fi­culty swallowing
• Abdom­i­nal pain (may be the only symp­tom of stress, espe­cially in a child)

Some­times other symp­toms accom­pany anxiety:

• Dizzi­ness
• Rapid or irreg­u­lar heart rate
• Rapid breath­ing
• Diar­rhea or fre­quent need to urinate
• Fatigue
• Irri­tabil­ity, includ­ing loss of your temper
• Sleep­ing dif­fi­cul­ties and nightmares
• Decreased con­cen­tra­tion
• Sex­ual problems

Anx­i­ety dis­or­ders are a group of psy­chi­atric con­di­tions that involve exces­sive anx­i­ety. They include gen­er­al­ized anx­i­ety dis­or­der, spe­cific pho­bias, obsessive-compulsive dis­or­der, and social pho­bia.

Com­mon Causes

Cer­tain drugs, both recre­ational and med­i­c­i­nal, can lead to symp­toms of anx­i­ety due to either side effects or with­drawal from the drug. Such drugs include caf­feine, alco­hol, nico­tine, cold reme­dies, decon­ges­tants, bron­chodila­tors for asthma, tri­cyclic anti­de­pres­sants, cocaine, amphet­a­mines, diet pills, ADHD med­ica­tions, and thy­roid medications.

A poor diet – for exam­ple, low lev­els of vit­a­min B12 — can also con­tribute to stress or anx­i­ety. Per­for­mance anx­i­ety is related to spe­cific sit­u­a­tions, like tak­ing a test or mak­ing a pre­sen­ta­tion in pub­lic. Post­trau­matic stress dis­or­der (PTSD) devel­ops after a trau­matic event like war, phys­i­cal or sex­ual assault, or a nat­ural dis­as­ter. Peo­ple with gen­er­al­ized anx­i­ety dis­or­der expe­ri­ence almost con­stant worry or anx­i­ety about many things on more than half of all days for 6 months. Panic dis­or­der or panic attacks involve sud­den and unex­plained fear, rapid breath­ing, and increased heartbeat.

In very rare cases, a tumor of the adrenal gland (pheochro­mo­cy­toma) may be the cause of anx­i­ety. The symp­toms are caused by an over­pro­duc­tion of hor­mones respon­si­ble for the feel­ings of anxiety.

Home Care

The most effec­tive solu­tion is to find and address the source of your stress or anx­i­ety. Unfor­tu­nately, this is not always pos­si­ble. A first step is to take an inven­tory of what you think might be mak­ing you “stress out”:

• What do you worry about most?
• Is some­thing con­stantly on your mind?
• Does any­thing in par­tic­u­lar make you sad or depressed?
• Keep a diary of the expe­ri­ences and thoughts that seem to be related to your anx­i­ety. Are your thoughts adding to your anx­i­ety in these situations?

Then, find some­one you trust (friend, fam­ily mem­ber, neigh­bor, clergy) who will lis­ten to you. Often, just talk­ing to a friend or loved one is all that is needed to relieve anx­i­ety. Most com­mu­ni­ties also have sup­port groups and hot­lines that can help. Social work­ers, psy­chol­o­gists, and other men­tal health pro­fes­sion­als may be needed for ther­apy and medication.

Also, find healthy ways to cope with stress. For example:

• Eat a well-balanced, healthy diet. Don’t overeat.
• Get enough sleep.
• Exer­cise regularly.
• Limit caf­feine and alcohol.
• Don’t use nico­tine, cocaine, or other recre­ational drugs.
• Learn and prac­tice relax­ation tech­niques like guided imagery, pro­gres­sive mus­cle relax­ation, yoga, tai chi, or med­i­ta­tion. Try biofeed­back, using a cer­ti­fied pro­fes­sional to get you started.
• Take breaks from work. Make sure to bal­ance fun activ­i­ties with your respon­si­bil­i­ties. Spend time with peo­ple you enjoy.
• Find self-help books at your local library or bookstore.

Call your health care provider if

Your doc­tor can help you deter­mine if your anx­i­ety would be best eval­u­ated and treated by a men­tal health care professional.

Call 911 if:

• You have crush­ing chest pain, espe­cially with short­ness of breath, dizzi­ness, or sweat­ing. A heart attack can cause feel­ings of anxiety.
• You have thoughts of sui­cide.
• You have dizzi­ness, rapid breath­ing, or rac­ing heart­beat for the first time or it is worse than usual.

Call your health care provider if:

• You are unable to work or func­tion prop­erly at home because of anxiety.
• You do not know the source or cause of your anxiety.
• You have a sud­den feel­ing of panic.
• You have an uncon­trol­lable fear — for exam­ple, of get­ting infected and sick if you are out, or a fear of heights.
• You repeat an action over and over again, like con­stantly wash­ing your hands.
• You have an intol­er­ance to heat, weight loss despite a good appetite, lump or swelling in the front of your neck, or pro­trud­ing eyes. Your thy­roid may be overactive.
• Your anx­i­ety is elicited by the mem­ory of a trau­matic event.
• You have tried self care for sev­eral weeks with­out suc­cess or you feel that your anx­i­ety will not resolve with­out pro­fes­sional help.

Ask your phar­ma­cist or health care provider if any pre­scrip­tion or over-the-counter drugs you are tak­ing can cause anx­i­ety as a side effect. Do not stop tak­ing any pre­scribed med­i­cines with­out your provider’s instructions.

What to expect at your health care provider’s office

Your doc­tor will take a med­ical his­tory and per­form a phys­i­cal exam­i­na­tion, pay­ing close atten­tion to your pulse, blood pres­sure, and res­pi­ra­tory rate.

To help bet­ter under­stand your anx­i­ety, stress, or ten­sion, your doc­tor may ask the following:

• When did your feel­ings of stress, ten­sion, or anx­i­ety begin? Do you attribute the feel­ings to any­thing in par­tic­u­lar like an event in your life or a cir­cum­stance that scares you?
• Do you have phys­i­cal symp­toms along with your feel­ings of anx­i­ety? What are they?
• Does any­thing make your anx­i­ety better?
• Does any­thing make your anx­i­ety worse?
• What med­ica­tions are you taking?

Diag­nos­tic tests may include blood tests (CBC, thy­roid func­tion tests) as well as an elec­tro­car­dio­gram (ECG).

If the anx­i­ety is not accom­pa­nied by any wor­ri­some phys­i­cal signs and symp­toms, a refer­ral to a men­tal health care pro­fes­sional may be rec­om­mended for appro­pri­ate treatment.

Psy­chother­apy such as cognitive-behavioral ther­apy (CBT) has been shown to sig­nif­i­cantly decrease anx­i­ety. In some cases, med­ica­tions such as ben­zo­di­azepines or anti­de­pres­sants may be appropriate.

Ref­er­ences

Muller JE, Kohn L, Stein DJ. Anx­i­ety and med­ical dis­or­ders. Curr Psy­chi­a­try Rep. 2005 Aug;7(4):245–51.

White KS, Far­rell AD. Anx­i­ety and Psy­choso­cial Stress as Pre­dic­tors of Headache and Abdom­i­nal Pain in Urban Early Ado­les­cents. J Pedi­atr Psy­chol. 2005.

Lubit R, Rovine D, Defran­cisci L, Eth S. Impact of trauma on chil­dren. J Psy­chi­atr Pract. 2003; 9(2): 128–138.