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For other uses of "Anxiety" and "Anxious", see Anxiety (disambiguation).
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 v
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Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often

accompanied by nervous behavior such as pacing back and forth, somatic complaints,
and rumination.[1] It includes subjectively unpleasant feelings of dread
over anticipated events.[2][need quotation to verify]
Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as
an overreaction to a situation that is only subjectively seen as menacing. [3] It is often
accompanied by muscular tension,[4] restlessness, fatigue and problems in
concentration. Anxiety is closely related to fear, which is a response to a real or
perceived immediate threat; anxiety involves the expectation of future threat. [4] People
facing anxiety may withdraw from situations which have provoked anxiety in the past. [5]
Anxiety disorders differ from developmentally normative fear or anxiety by being
excessive or persisting beyond developmentally appropriate periods. They differ from
transient fear or anxiety, often stress-induced, by being persistent (e.g., typically lasting
6 months or more), although the criterion for duration is intended as a general guide
with allowance for some degree of flexibility and is sometimes of shorter duration in
children.[4]

Contents

 1Anxiety vs. fear

 2Symptoms
 3Types
o 3.1Existential
o 3.2Test and performance
o 3.3Stranger, social, and intergroup anxiety
o 3.4Trait
o 3.5Choice or decision
o 3.6Panic disorder
o 3.7Anxiety disorders
o 3.8Short- and long-term anxiety
 4Co-morbidity
 5Risk factors
o 5.1Neuroanatomy
 5.1.1The gut-brain axis
o 5.2Genetics
o 5.3Medical conditions
o 5.4Substance-induced
o 5.5Psychological
 5.5.1Evolutionary psychology
o 5.6Social
 5.6.1Gender socialization
 6Treatment
 7Prevention
 8Pathophysiology
 9See also
 10References
 11External links

Anxiety vs. fear[edit]

A job applicant with a worried facial expression

Anxiety is distinguished from fear, which is an appropriate cognitive and emotional

response to a perceived threat.[6] Anxiety is related to the specific behaviors of fight-or-
flight responses, defensive behavior or escape. It occurs in situations only perceived as
uncontrollable or unavoidable, but not realistically so. [7] David Barlow defines anxiety as
"a future-oriented mood state in which one is not ready or prepared to attempt
to cope with upcoming negative events,"[8] and that it is a distinction between future and
present dangers which divides anxiety and fear. Another description of anxiety is agony,
dread, terror, or even apprehension.[9] In positive psychology, anxiety is described as the
mental state that results from a difficult challenge for which the subject has
insufficient coping skills.[10]
Fear and anxiety can be differentiated in four domains: (1) duration of emotional
experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction.
Fear is short-lived, present-focused, geared towards a specific threat, and facilitating
escape from threat; anxiety, on the other hand, is long-acting, future-focused, broadly
focused towards a diffuse threat, and promoting excessive caution while approaching a
potential threat and interferes with constructive coping. [11]
Joseph E. LeDoux and Lisa Feldman Barrett have both sought to separate automatic
threat responses from additional associated cognitive activity within anxiety. [12][13]

Symptoms[edit]
Anxiety can be experienced with long, drawn-out daily symptoms that reduce quality of
life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts
with sporadic, stressful panic attacks, known as acute anxiety.[14] Symptoms of anxiety
can range in number, intensity, and frequency, depending on the person. While almost
everyone has experienced anxiety at some point in their lives, most do not develop
long-term problems with anxiety.
Anxiety may cause psychiatric and physiological symptoms. [15][16]
The risk of anxiety leading to depression could possibly even lead to an individual
harming themselves, which is why there are many 24-hour suicide prevention hotlines. [17]
The behavioral effects of anxiety may include withdrawal from situations which have
provoked anxiety or negative feelings in the past. [5] Other effects may include changes in
sleeping patterns, changes in habits, increase or decrease in food intake, and increased
motor tension (such as foot tapping).[5]
The emotional effects of anxiety may include "feelings of apprehension or dread, trouble
concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness,
watching (and waiting) for signs (and occurrences) of danger, and, feeling like your
mind's gone blank"[18] as well as "nightmares/bad dreams, obsessions about
sensations, déjà vu, a trapped-in-your-mind feeling, and feeling like everything is
scary."[19] It may include a vague experience and feeling of helplessness [20]
The cognitive effects of anxiety may include thoughts about suspected dangers, such as
fear of dying. "You may ... fear that the chest pains are a deadly heart attack or that the
shooting pains in your head are the result of a tumor or an aneurysm. You feel an
intense fear when you think of dying, or you may think of it more often than normal, or
can't get it out of your mind."[21]
The physiological symptoms of anxiety may include:[15][16]

 Neurological,
as headache, paresthesias, fasciculations, vertigo,
or presyncope.
 Digestive, as abdominal
pain, nausea, diarrhea, indigestion, dry mouth,
or bolus.
 Respiratory, as shortness of breath or sighing
breathing.
 Cardiac, as palpitations, tachycardia, or chest pain.
 Muscular, as fatigue, tremors, or tetany.
 Cutaneous, as perspiration, or itchy skin.
 Uro-genital, as frequent urination, urinary
urgency, dyspareunia, or impotence, chronic pelvic
pain syndrome. Stress hormones released in an
anxious state have an impact on bowel function and
can manifest physical symptoms that may contribute
to or exacerbate IBS.

Types[edit]

Painting entitled Anxiety, 1894, by Edvard Munch

There are various types of anxiety. Existential anxiety can occur when a person

faces angst, an existential crisis, or nihilistic feelings. People can also
face mathematical anxiety, somatic anxiety, stage fright, or test anxiety. Social
anxiety refers to a fear of rejection and negative evaluation by other people. [22]
Existential[edit]
Further information: Angst, Existential crisis, and Nihilism
The philosopher Søren Kierkegaard, in The Concept of Anxiety (1844), described
anxiety or dread associated with the "dizziness of freedom" and suggested the
possibility for positive resolution of anxiety through the self-conscious exercise of
responsibility and choosing. In Art and Artist (1932), the psychologist Otto Rank wrote
that the psychological trauma of birth was the pre-eminent human symbol of existential
anxiety and encompasses the creative person's simultaneous fear of – and desire for –
separation, individuation, and differentiation. [citation needed]
The theologian Paul Tillich characterized existential anxiety[23] as "the state in which
a being is aware of its possible nonbeing" and he listed three categories for the
nonbeing and resulting anxiety: ontic (fate and death), moral (guilt and condemnation),
and spiritual (emptiness and meaninglessness). According to Tillich, the last of these
three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times
while the others were predominant in earlier periods. Tillich argues that this anxiety can
be accepted as part of the human condition or it can be resisted but with negative
consequences. In its pathological form, spiritual anxiety may tend to "drive the person
toward the creation of certitude in systems of meaning which are supported
by tradition and authority" even though such "undoubted certitude is not built on the rock
of reality".[23]
According to Viktor Frankl, the author of Man's Search for Meaning, when a person is
faced with extreme mortal dangers, the most basic of all human wishes is to find
a meaning of life to combat the "trauma of nonbeing" as death is near. [24]
Depending on the source of the threat, psychoanalytic theory distinguishes the following
types of anxiety:

 realistic
 neurotic
 moral[25]
Test and performance[edit]
Main articles: Test anxiety, Mathematical anxiety, Stage fright, and Somatic anxiety
According to Yerkes-Dodson law, an optimal level of arousal is necessary to best
complete a task such as an exam, performance, or competitive event. However, when
the anxiety or level of arousal exceeds that optimum, the result is a decline in
performance.[26]
Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have
a fear of failing an exam. Students who have test anxiety may experience any of the
following: the association of grades with personal worth; fear of embarrassment by a
teacher; fear of alienation from parents or friends; time pressures; or feeling a loss of
control. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting,
uncontrollable crying or laughing and drumming on a desk are all common. Because
test anxiety hinges on fear of negative evaluation,[27] debate exists as to whether test
anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia.
[28]
 The DSM-IV classifies test anxiety as a type of social phobia. [29]
While the term "test anxiety" refers specifically to students, [30] many workers share the
same experience with regard to their career or profession. The fear of failing at a task
and being negatively evaluated for failure can have a similarly negative effect on the
adult.[31] Management of test anxiety focuses on achieving relaxation and developing
mechanisms to manage anxiety.[30]
Stranger, social, and intergroup anxiety[edit]
Main articles: Stranger anxiety and Social anxiety
Humans generally require social acceptance and thus sometimes dread the disapproval
of others. Apprehension of being judged by others may cause anxiety in social
environments.[32]
Anxiety during social interactions, particularly between strangers, is common among
young people. It may persist into adulthood and become social anxiety or social phobia.
"Stranger anxiety" in small children is not considered a phobia. In adults, an excessive
fear of other people is not a developmentally common stage; it is called social anxiety.
According to Cutting,[33] social phobics do not fear the crowd but the fact that they may
be judged negatively.
Social anxiety varies in degree and severity. For some people, it is characterized by
experiencing discomfort or awkwardness during physical social contact (e.g. embracing,
shaking hands, etc.), while in other cases it can lead to a fear of interacting with
unfamiliar people altogether. Those suffering from this condition may restrict their
lifestyles to accommodate the anxiety, minimizing social interaction whenever possible.
Social anxiety also forms a core aspect of certain personality disorders,
including avoidant personality disorder.[34]
To the extent that a person is fearful of social encounters with unfamiliar others, some
people may experience anxiety particularly during interactions with outgroup members,
or people who share different group memberships (i.e., by race, ethnicity, class, gender,
etc.). Depending on the nature of the antecedent relations, cognitions, and situational
factors, intergroup contact may be stressful and lead to feelings of anxiety. This
apprehension or fear of contact with outgroup members is often called interracial or
intergroup anxiety.[35]
As is the case the more generalized forms of social anxiety, intergroup anxiety has
behavioral, cognitive, and affective effects. For instance, increases in schematic
processing and simplified information processing can occur when anxiety is high.
Indeed, such is consistent with related work on attentional bias in implicit memory. [36][37]
[38]
 Additionally recent research has found that implicit racial evaluations (i.e. automatic
prejudiced attitudes) can be amplified during intergroup interaction. [39] Negative
experiences have been illustrated in producing not only negative expectations, but also
avoidant, or antagonistic, behavior such as hostility. [40] Furthermore, when compared to
anxiety levels and cognitive effort (e.g., impression management and self-presentation)
in intragroup contexts, levels and depletion of resources may be exacerbated in the
intergroup situation.
Trait[edit]
Anxiety can be either a short-term 'state' or a long-term personality "trait". Trait anxiety
reflects a stable tendency across the lifespan of responding with acute, state anxiety in
the anticipation of threatening situations (whether they are actually deemed threatening
or not).[41] A meta-analysis showed that a high level of neuroticism is a risk factor for
development of anxiety symptoms and disorders. [42] Such anxiety may be conscious or
unconscious.[43]
Personality can also be a trait leading to anxiety and depression. Through experience,
many find it difficult to collect themselves due to their own personal nature. [44]
Choice or decision[edit]
Anxiety induced by the need to choose between similar options is increasingly being
recognized as a problem for individuals and for organizations. [45] In
2004, Capgemini wrote: "Today we're all faced with greater choice, more competition
and less time to consider our options or seek out the right advice." [46]
In a decision context, unpredictability or uncertainty may trigger emotional responses in
anxious individuals that systematically alter decision-making. [47] There are primarily two
forms of this anxiety type. The first form refers to a choice in which there are multiple
potential outcomes with known or calculable probabilities. The second form refers to the
uncertainty and ambiguity related to a decision context in which there are multiple
possible outcomes with unknown probabilities.[47]
Panic disorder[edit]
Main article: Panic disorder
Panic disorder may share symptoms of stress and anxiety, but it is actually very
different. Panic disorder is an anxiety disorder that occurs without any triggers.
According to the U.S Department of Health and Human Services, this disorder can be
distinguished by unexpected and repeated episodes of intense fear. [48] Someone who
suffers from panic disorder will eventually develop constant fear of another attack and
as this progresses it will begin to affect daily functioning and an individual's general
quality of life. It is reported by the Cleveland Clinic that panic disorder affects 2 to 3
percent of adult Americans and can begin around the time of the teenage and early
adult years. Some symptoms include: difficulty breathing, chest pain, dizziness,
trembling or shaking, feeling faint, nausea, fear that you are losing control or are about
to die. Even though they suffer from these symptoms during an attack, the main
symptom is the persistent fear of having future panic attacks. [49]
Anxiety disorders[edit]
Main article: Anxiety disorder
Anxiety disorders are a group of mental disorders characterized by exaggerated
feelings of anxiety and fear responses.[50] Anxiety is a worry about future events and fear
is a reaction to current events. These feelings may cause physical symptoms, such as
a fast heart rate and shakiness. There are a number of anxiety disorders:
including generalized anxiety disorder, specific phobia, social anxiety
disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective
mutism. The disorder differs by what results in the symptoms. People often have more
than one anxiety disorder.[50]
Anxiety disorders are caused by a complex combination of genetic and environmental
factors.[51] [52]To be diagnosed, symptoms typically need to be present for at least six
months, be more than would be expected for the situation, and decrease a person's
ability to function in their daily lives.[citation needed] Other problems that may result in similar
symptoms include hyperthyroidism, heart disease, caffeine, alcohol, or cannabis use,
and withdrawal from certain drugs, among others. [citation needed]
Without treatment, anxiety disorders tend to remain. [50][53] Treatment may include lifestyle
changes, counselling, and medications. Counselling is typically with a type of cognitive
behavioural therapy.[54] Medications, such as antidepressants or beta blockers, may
improve symptoms.[53]
About 12% of people are affected by an anxiety disorder in a given year and between
5–30% are affected at some point in their life. [54][55] They occur about twice as often in
women than they do in men, and generally begin before the age of 25. [50][54] The most
common are specific phobia which affects nearly 12% and social anxiety disorder which
affects 10% at some point in their life. They affect those between the ages of 15 and 35
the most and become less common after the age of 55. Rates appear to be higher in
the United States and Europe.[54]
Short- and long-term anxiety[edit]
Anxiety can be either a short-term "state" or a long-term "trait". Whereas trait anxiety
represents worrying about future events, anxiety disorders are a group of mental
disorders characterized by feelings of anxiety and fear.[50]

Co-morbidity[edit]
Anxiety disorders often occur with other mental health disorders, particularly major
depressive disorder, bipolar disorder, eating disorders, or certain personality disorders.
It also commonly occurs with personality traits such as neuroticism. This observed co-
occurrence is partly due to genetic and environmental influences shared between these
traits and anxiety.[56][57]
Anxiety is often experienced by those with obsessive–compulsive disorder and is an
acute presence in panic disorder.

Risk factors[edit]
A marble bust of the Roman Emperor Decius from the Capitoline Museum. This portrait "conveys an
impression of anxiety and weariness, as of a man shouldering heavy [state] responsibilities". [58]

Anxiety disorders are partly genetic, with twin studies suggesting 30-40% genetic
influence on individual differences in anxiety.[59] Environmental factors are also important.
Twin studies show that individual-specific environments have a large influence on
anxiety, whereas shared environmental influences (environments that affect twins in the
same way) operate during childhood but decline through adolescence. [60] Specific
measured ‘environments’ that have been associated with anxiety include child abuse,
family history of mental health disorders, and poverty.[61] Anxiety is also associated
with drug use, including alcohol, caffeine, and benzodiazepines (which are often
prescribed to treat anxiety).
Neuroanatomy[edit]
Neural circuitry involving the amygdala (which regulates emotions like anxiety and fear,
stimulating the HPA Axis and sympathetic nervous system) and hippocampus (which is
implicated in emotional memory along with the amygdala) is thought to underlie anxiety.
[62]
 People who have anxiety tend to show high activity in response to emotional stimuli in
the amygdala.[63] Some writers believe that excessive anxiety can lead to an
overpotentiation of the limbic system (which includes the amygdala and nucleus
accumbens), giving increased future anxiety, but this does not appear to have been
proven.[64][65]
Research upon adolescents who as infants had been highly apprehensive, vigilant, and
fearful finds that their nucleus accumbens is more sensitive than that in other people
when deciding to make an action that determined whether they received a reward.
[66]
 This suggests a link between circuits responsible for fear and also reward in anxious
people. As researchers note, "a sense of 'responsibility', or self-agency, in a context of
uncertainty (probabilistic outcomes) drives the neural system underlying appetitive
motivation (i.e., nucleus accumbens) more strongly in temperamentally inhibited than
noninhibited adolescents".[66]
The gut-brain axis[edit]
The microbes of the gut can connect with the brain to affect anxiety. There are various
pathways along which this communication can take place. One is through the major
neurotransmitters.[67] The gut microbes such as Bifidobacterium and Bacillus produce the
neurotransmitters GABA and dopamine, respectively. [68] The neurotransmitters signal to
the nervous system of the gastrointestinal tract, and those signals will be carried to the
brain through the vagus nerve or the spinal system. [67][68][69] This is demonstrated by the
fact that altering the microbiome has shown anxiety- and depression-reducing effects in
mice, but not in subjects without vagus nerves. [70]
Another key pathway is the HPA axis, as mentioned above. [69] The microbes can control
the levels of cytokines in the body, and altering cytokine levels creates direct effects on
areas of the brain such as the hypothalmus, the area that triggers HPA axis activity. The
HPA axis regulates production of cortisol, a hormone that takes part in the body's stress
response.[69] When HPA activity spikes, cortisol levels increase, processing and reducing
anxiety in stressful situations. These pathways, as well as the specific effects of
individual taxa of microbes, are not yet completely clear, but the communication
between the gut microbiome and the brain is undeniable, as is the ability of these
pathways to alter anxiety levels.
With this communication comes the potential to treat anxiety. Prebiotics and probiotics
have been shown to reduced anxiety. For example, experiments in which mice were
given fructo- and galacto-oligosaccharide
prebiotics[71] and Lactobacillus probiotics[70] have both demonstrated a capability to
reduce anxiety. In humans, results are not as concrete, but promising. [72][73]
Genetics[edit]
Genetics and family history (e.g. parental anxiety) may put an individual at increased
risk of an anxiety disorder, but generally external stimuli will trigger its onset or
exacerbation.[57] Estimates of genetic influence on anxiety, based on studies of twins,
range from 25–40% depending on the specific type and age-group under study. For
example, genetic differences account for about 43% of variance in panic disorder and
28% in generalized anxiety disorder.[citation needed] Longitudinal twin studies have shown the
moderate stability of anxiety from childhood through to adulthood is mainly influenced
by stability in genetic influence.[74][75] When investigating how anxiety is passed on from
parents to children, it is important to account for sharing of genes as well as
environments, for example using the intergenerational children-of-twins design. [76]
Many studies in the past used a candidate gene approach to test whether single genes
were associated with anxiety. These investigations were based on hypotheses about
how certain known genes influence neurotransmitters (such as serotonin and
norepinephrine) and hormones (such as cortisol) that are implicated in anxiety. None of
these findings are well replicated,[citation needed] with the possible exception of TMEM132D,
COMT and MAO-A.[77] The epigenetic signature of BDNF, a gene that codes for a protein
called brain derived neurotrophic factor that is found in the brain, has also been
associated with anxiety and specific patterns of neural activity. [citation needed] and a receptor
gene for BDNF called NTRK2 was associated with anxiety in a large genome-wide
investigation.[78] The reason that most candidate gene findings have not replicated is that
anxiety is a complex trait that is influenced by many genomic variants, each of which
has a small effect on its own. Increasingly, studies of anxiety are using a hypothesis-
free approach to look for parts of the genome that are implicated in anxiety using big
enough samples to find associations with variants that have small effects. The largest
explorations of the common genetic architecture of anxiety have been facilitated by the
UK Biobank, the ANGST consortium and the CRC Fear, Anxiety and Anxiety Disorders.
[78][79][80]

Medical conditions[edit]
Many medical conditions can cause anxiety. This includes conditions that affect the
ability to breathe, like COPD and asthma, and the difficulty in breathing that often
occurs near death.[81][82][83] Conditions that cause abdominal pain or chest pain can cause
anxiety and may in some cases be a somatization of anxiety;[84][85] the same is true for
some sexual dysfunctions.[86][87] Conditions that affect the face or the skin can cause
social anxiety especially among adolescents, [88] and developmental disabilities often lead
to social anxiety for children as well.[89] Life-threatening conditions like cancer also cause
anxiety.[90]
Furthermore, certain organic diseases may present with anxiety or symptoms that mimic
anxiety.[15][91] These disorders include certain endocrine diseases
(hypo- and hyperthyroidism, hyperprolactinemia),[91][92] metabolic disorders (diabetes),[91][93]
[94]
 deficiency states (low levels of vitamin D, B2, B12, folic acid),[91] gastrointestinal
diseases (celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease),[95][96]
[97]
 heart diseases, blood diseases (anemia),[91] cerebral vascular accidents (transient
ischemic attack, stroke),[91] and brain degenerative diseases (Parkinson's
disease, dementia, multiple sclerosis, Huntington's disease), among others.[91][98][99][100]
Substance-induced[edit]
Several drugs can cause or worsen anxiety, whether in intoxication, withdrawal or as
side effect. These include alcohol, tobacco, cannabis, sedatives (including
prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs
like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens,
and inhalants.[101] While many often report self-medicating anxiety with these substances,
improvements in anxiety from drugs are usually short-lived (with worsening of anxiety in
the long term, sometimes with acute anxiety as soon as the drug effects wear off) and
tend to be exaggerated. Acute exposure to toxic levels of benzene may cause euphoria,
anxiety, and irritability lasting up to 2 weeks after the exposure. [102]
Psychological[edit]
Poor coping skills (e.g., rigidity/inflexible problem solving, denial, avoidance, impulsivity,
extreme self-expectation, negative thoughts, affective instability, and inability to focus
on problems) are associated with anxiety. Anxiety is also linked and perpetuated by the
person's own pessimistic outcome expectancy and how they cope with feedback
negativity.[103] Temperament (e.g., neuroticism)[42] and attitudes (e.g. pessimism) have
been found to be risk factors for anxiety. [101][104]
Cognitive distortions such as overgeneralizing, catastrophizing, mind reading, emotional
reasoning, binocular trick, and mental filter can result in anxiety. For example, an
overgeneralized belief that something bad "always" happens may lead someone to
have excessive fears of even minimally risky situations and to avoid benign social
situations due to anticipatory anxiety of embarrassment. In addition, those who have
high anxiety can also create future stressful life events. [105] Together, these findings
suggest that anxious thoughts can lead to anticipatory anxiety as well as stressful
events, which in turn cause more anxiety. Such unhealthy thoughts can be targets for
successful treatment with cognitive therapy.
Psychodynamic theory posits that anxiety is often the result of
opposing unconscious wishes or fears that manifest via maladaptive defense
mechanisms (such as suppression, repression, anticipation, regression, somatization,
passive aggression, dissociation) that develop to adapt to problems with
early objects (e.g., caregivers) and empathic failures in childhood. For example,
persistent parental discouragement of anger may result in repression/suppression of
angry feelings which manifests as gastrointestinal distress (somatization) when
provoked by another while the anger remains unconscious and outside the individual's
awareness. Such conflicts can be targets for successful treatment with psychodynamic
therapy. While psychodynamic therapy tends to explore the underlying roots of anxiety,
cognitive behavioral therapy has also been shown to be a successful treatment for
anxiety by altering irrational thoughts and unwanted behaviors.
Evolutionary psychology[edit]
An evolutionary psychology explanation is that increased anxiety serves the purpose of
increased vigilance regarding potential threats in the environment as well as increased
tendency to take proactive actions regarding such possible threats. This may
cause false positive reactions but an individual suffering from anxiety may also avoid
real threats. This may explain why anxious people are less likely to die due to accidents.
[106]
 There is ample empirical evidence that anxiety can have adaptive value. Within a
school, timid fish are more likely than bold fish to survive a predator. [107]
When people are confronted with unpleasant and potentially harmful stimuli such as foul
odors or tastes, PET-scans show increased blood flow in the amygdala.[108][109] In these
studies, the participants also reported moderate anxiety. This might indicate that anxiety
is a protective mechanism designed to prevent the organism from engaging in
potentially harmful behaviors.
Social[edit]
Social risk factors for anxiety include a history of trauma (e.g., physical, sexual or
emotional abuse or assault), bullying, early life experiences and parenting factors (e.g.,
rejection, lack of warmth, high hostility, harsh discipline, high parental negative affect,
anxious childrearing, modelling of dysfunctional and drug-abusing behaviour,
discouragement of emotions, poor socialization, poor attachment, and child abuse and
neglect), cultural factors (e.g., stoic families/cultures, persecuted minorities including the
disabled), and socioeconomics (e.g., uneducated, unemployed, impoverished although
developed countries have higher rates of anxiety disorders than developing countries).
[101][110]
 A 2019 comprehensive systematic review of over 50 studies showed that food
insecurity in the United States is strongly associated with depression, anxiety, and sleep
disorders.[111] Food-insecure individuals had an almost 3 fold risk increase of testing
positive for anxiety when compared to food-secure individuals.
Gender socialization[edit]
Contextual factors that are thought to contribute to anxiety include gender socialization
and learning experiences. In particular, learning mastery (the degree to which people
perceive their lives to be under their own control) and instrumentality, which includes
such traits as self-confidence, self-efficacy, independence, and competitiveness fully
mediate the relation between gender and anxiety. That is, though gender differences in
anxiety exist, with higher levels of anxiety in women compared to men, gender
socialization and learning mastery explain these gender differences. [112][medical citation needed]

Treatment[edit]
See also: Fear §  Management
The first step in the management of a person with anxiety symptoms involves evaluating
the possible presence of an underlying medical cause, whose recognition is essential in
order to decide the correct treatment. [15][91] Anxiety symptoms may mask an organic
disease, or appear associated with or as a result of a medical disorder. [15][91][113][16]
Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first line
treatment.[114][115][116][117][118] CBT appears to be equally effective when carried out via the
internet.[118] While evidence for mental health apps is promising, it is preliminary. [119]
Psychopharmacological treatment can be used in parallel to CBT or can be used alone.
As a general rule, most anxiety disorders respond well to first-line agents. First-line
drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine
reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other
treatment options include pregabalin, tricyclic antidepressants, buspirone,
moclobemide, and others.[120]

Prevention[edit]
The above risk factors give natural avenues for prevention. A 2017 review found that
psychological or educational interventions have a small yet statistically significant
benefit for the prevention of anxiety in varied population types. [121][122][123]

Pathophysiology[edit]
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Anxiety disorder appears to be a genetically inherited neurochemical dysfunction that

may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of
the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function;
increased cortisol.[124]
In the central nervous system (CNS), the major mediators of the symptoms of anxiety
disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric
acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing
factor, may be involved. Peripherally, the autonomic nervous system, especially the
sympathetic nervous system, mediates many of the symptoms. Increased flow in the
right parahippocampal region and reduced serotonin type 1A receptor binding in the
anterior and posterior cingulate and raphe of patients are the diagnostic factors for
prevalence of anxiety disorder.
The amygdala is central to the processing of fear and anxiety, and its function may be
disrupted in anxiety disorders. Anxiety processing in the basolateral amygdala has been
implicated with dendritic arborization of the amygdaloid neurons. SK2 potassium
channels mediate inhibitory influence on action potentials and reduce arborization. [125]

See also[edit]
  List of people with an anxiety disorder
 Angst – Intense feeling of apprehension, anxiety, or
inner turmoil
 Fear – Basic emotion induced by a perceived threat
 Tripartite Model of Anxiety and Depression
 Uncanny

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 External links[edit]
Classification D

 ICD-10: F06.4, F40, F41, F93.0

 ICD-10-CM: F06.4, F40, F41, F43.22, F43.23, F93.0

 OMIM: 607834

 MeSH: D001007

External resources  MedlinePlus: 003211

Library resources about
Anxiety

 Resources in your library

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Anxietyat Wikipedia's sister projects

 Definitions from Wiktionary

 Quotations from Wikiquote

  Media related to Anxiety at Wikimedia Commons

 Anxiety at Curlie
hide

Emotions (list)

ceptance

oration

sthetic emotions

ection

itation

ony

musement

ger
gst

guish

noyance

ticipation

xiety

athy

ousal

raction

redom

mness

mpassion

nfidence

ntempt

ntentment

urage

uelty

riosity

feat

pression

sire

spair

appointment

gust

trust

tasy

barrassment 
o Vicarious

pathy

hrallment

husiasm

vy

phoria

citement

r
w (psychology)

stration

atification

atitude

eed

ef

ilt

ppiness

red

aeth

mesickness

pe

rror

stility

miliation

gge

steria

ulgence

atuation

ecurity

piration

erest

tation

lation

lousy

ndness

neliness

nging

ve 
o Limerence

st

no no aware

glect

stalgia
trage

nic

sion

y 
o Self-pity

asure

de 
o Grandiosity

o Hubris

o Insult

o Vanity

ge

gret

cial connection

ection

morse

sentment

dness 
o Melancholy

udade

adenfreude

nsucht

f-confidence

ntimentality

ame

ock

yness

row

te

ess

fering

prise

mpathy

nseness

st
 nder

rry

nicism

featism

hilism

timism

simism

clusion

ltschmerz

ect 
o consciousness

o in education

o measures

o in psychology

ective 
o computing

o forecasting

o neuroscience

o science

o spectrum

ectivity 
o positive

o negative

peal to emotion

otion 
o and art

o and memory

o and music

o and sex

o classification

o evolution

o expressed

o functional accounts

o group
 o homeostatic

o perception

o recognition 

 in conversation
o in animals

o regulation 

 interpersonal
o work

otional 
o aperture

o bias

o blackmail

o competence

o conflict

o contagion

o detachment

o dysregulation

o eating

o exhaustion

o expression

o intelligence 

 and bullying
o intimacy

o isolation
o lability

o labor

o lateralization

o literacy

o prosody

o reasoning

o responsivity

o security

o selection

o symbiosis

o well-being
otionality 
o bounded

otions 
o and culture

o in decision-making

o in the workplace

o in virtual communication

o history

o moral

o self-conscious

o social

o social sharing

o sociology

ling

nder and emotional expression

oup affective tone

eractions between the emotional and executive brain systems

ta-emotion

hognomy

hos

cial emotional development

ic passions

eory 
o affect
o appraisal

o discrete emotion

o somatic marker

o constructed emotion

 BNF: cb11938918z (data)

 GND: 4002053-8

 LCCN: sh85005835

 NDL: 00563573

 SUDOC: 040664368
Categories: 
 Anxiety
  Emotions
 Mental states in Csikszentmihalyi's flow model
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