Anxiety is useful until it stops switching off

Anxiety has a job. Before a difficult conversation at work, before an exam,
before a decision that matters, it raises your heart rate, narrows your
attention and hands you a burst of energy. That is the system working. People
describe it as unpleasant, and it is, but a person who felt nothing before a
deadline would miss more deadlines.

The useful question is therefore not "am I anxious" but **"does it switch
off"**. A normal alarm stops when the threat passes. An anxiety disorder is
one that does not: the worry persists, gets worse over time, and begins to
interfere with job performance, schoolwork and relationships. That
interference — not the intensity of the feeling — is what turns a normal
reaction into a medical condition.

The three shapes it takes

Generalised anxiety and phobias are more common in women. Social anxiety, by
contrast, affects men and women equally — a difference worth knowing, because
the assumption that anxiety is a women's condition keeps men out of treatment.

What raises the risk

The cause is unknown, which is an honest answer rather than an evasive one.
Genetics, brain biology and chemistry, stress and environment all appear to
contribute, and no single one explains a case. The risk factors that recur
across every type are: personality traits such as shyness or withdrawal in
new situations, traumatic events in early childhood or adulthood, a family
history of anxiety or other mental disorders, and physical conditions such as
thyroid problems or arrhythmia.

That last one matters more than its position in the list suggests. A racing
heart and shortness of breath are symptoms of anxiety and of a thyroid
disorder, which is why a diagnosis starts with a physical exam and lab tests
to rule out another health problem before any psychological evaluation is
made. The evaluation comes second on purpose.

What treatment actually consists of

Two things, often together: psychotherapy and medicine.

Cognitive behavioural therapy teaches different ways of thinking and
behaving, changing how you react to what frightens you. It may include
exposure therapy, which is the counter-intuitive half — you confront the
fear deliberately, in order to do the things you have been avoiding.
Acceptance and commitment therapy takes a different route, using mindfulness
and goal setting rather than confrontation. Therapy only works when it is
aimed at your specific anxieties; a general course of talking is not the
treatment.

Medicines are anti-anxiety drugs and certain antidepressants. Expect to try
more than one: different types work better for different disorders, and
finding the right one is normal rather than a sign of failure.

One thing you can change today, at no cost: caffeine, other substances and
certain medicines make the symptoms worse. Support groups and stress
management help alongside the rest.

Source: National Institute of Mental Health, via MedlinePlus.