Understanding The Symptoms And Signs Of Severe Anxiety

Medically reviewed by Laura Angers Maddox, NCC, LPC
Updated April 23, 2024by BetterHelp Editorial Team

Anxiety is a normal response that can help us face challenges, stay motivated, and defend ourselves from harm. When this response becomes too potent or frequent, however, it can affect our mental and physical health and, in some cases, signal the existence of a mental health disorder. Severe anxiety may arise out of a variety of situations and anxiety disorders, potentially leading to serious complications. Below, we’re going to discuss what severe anxiety is, how its symptoms can manifest, and which treatment options are available for managing it.   

Anxiety can be difficult to manage regardless of its severity

What is anxiety?
Anxiety refers to feelings of nervousness, fear, and worry that often arise out of uncertainty. Most people experience anxiety occasionally, whether it’s related to work, relationships, or other aspects of life. Some individuals, however, live with anxiety that rises to the level of a mental health condition. Several different anxiety disorders exist in the Diagnostic and Statistical Manual of Mental Disorders. These include panic disorder, generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, and specific phobias. According to the Anxiety and Depression Association of America, anxiety disorders are the most prevalent mental health conditions in the US

Symptoms of anxiety include:

  • Nervousness, worry, and fear
  • Muscle tension
  • Rapid breathing
  • Trouble sleeping
  • Increased heart rate
  • Difficulty concentrating
  • Sweating
  • Irritability
  • Gastrointestinal distress
  • Thoughts of self-harm

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

While the exact cause of these mental illnesses is unknown, several factors—primarily genetic and environmental influences—are thought to contribute to their development. Having a family history of anxiety disorders or other mental health conditions can increase one’s chance of developing an anxiety disorder. Additionally, certain personality traits, such as those encompassed by the behavioral inhibition temperament, are associated with anxiety disorders. 

Research suggests that anxiety is linked to abnormalities in brain chemistry that affect the function of certain regions, including the amygdala, insular cortex, and cingulate cortex. Environmental factors can include negative life events like trauma in early childhood or the loss of a loved one. Physical health concerns, like thyroid problems and irritable bowel syndrome, can also be the source of symptoms of anxiety disorders. 
What is severe anxiety?
Severe anxiety is not a clinical diagnosis. Instead, different anxiety disorders can produce severe symptoms, or an individual may experience anxiety that is severe but not persistent enough to constitute a disorder. 
When a healthcare professional diagnoses an individual with anxiety, they may also describe the condition’s severity level. Commonly, this means categorizing anxiety as either mild, moderate, or severe. 

Anxiety can be categorized as severe based on a variety of measures. For example, the Beck Anxiety Inventory is a scale that assesses the severity of anxiety based on an individual’s answers to a series of questions regarding their symptoms. Scores that are in the highest range indicate the presence of severe levels of anxiety. 

Severe anxiety may involve feelings of overwhelming worry and nervousness that interfere with daily activities, relationships, and other aspects of daily life. The excessive fear of severe anxiety can impair functioning to a greater extent than mild or moderate anxiety. Because of the challenges associated with severe anxiety, a person may go to greater lengths to avoid places or situations in which such feelings often arise. For example, an individual with severe social anxiety may experience intense self-consciousness that causes them to self-isolate in extreme ways. 

The physiological effects of severe anxiety could cause more serious physical health challenges. Additionally, excessive anxiety may require more intensive forms of treatment and increase the likelihood that an individual will develop a comorbid condition.  
Types of severe anxiety and their symptoms
Severe anxiety can manifest differently depending on the type of anxiety disorder an individual lives with. For example, an individual with social anxiety disorder may experience intense fear in social situations, while someone with generalized anxiety disorder may experience extreme, nearly constant worry that is unrelated to a specific scenario. To understand how severe anxiety may manifest across different situations, it can help to know the various types of anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders. Below are some common anxiety disorders and the severe symptoms they may produce.

Generalized anxiety disorder 
One of the most common mental health conditions, generalized anxiety disorder (GAD) can lead to intense feelings of fear and worry. Severe symptoms of GAD may include frequent or extreme nervousness, gastrointestinal distress, fatigue, irritability, and tension. With GAD, severe anxiety may be related to specific sources, or it could arise for no discernible reason. 

As discussed above, the Beck Anxiety Inventory is one example of an evaluation that can assess the severity of anxiety symptoms. According to this 21-question scale, symptoms—which include numbness or tingling, fear of losing control, indigestion, and 18 others—may be severe based on the extent to which they impact an individual’s life. 

Panic disorder

Panic disorder is a condition in which panic attacks regularly occur. A panic attack is an episode of severe anxiety characterized by sudden, intense fear that can produce serious physical and emotional reactions, even without an apparent cause. Severe panic attacks often happen unexpectedly, potentially causing an individual to experience extreme fear, rapid breathing, chest pain, and an elevated heart rate.

Severe panic disorder may be diagnosed based on various assessments. For example, the American Psychiatric Association (APA) developed a scale for measuring the severity of panic disorder that is based on the frequency of common symptoms. Examples of symptoms that may indicate severe panic disorder if experienced frequently enough include those in which the individual “had thoughts of losing control, dying . . . or other bad things happening because of panic attacks”; “left situations early, or participated only minimally, because of panic attacks”; or “needed help to cope with panic attacks”.  


Phobias are characterized by excessive, persistent, and severe fears of a specific object, situation, or activity that is generally not harmful. For the most part, the individual knows their fear is irrational, but it can still trigger anxiety symptoms. Specific phobias can cause severe distress and worry—to the point that some people go to extreme lengths to avoid what they fear. Examples of phobias include the fear of spiders, heights, and needles. 

As with panic disorder, the APA has developed a scale for measuring the severity of phobias that is based on the frequency of symptoms felt in response to common fears like animals, storms, and enclosed areas. According to this inventory, symptoms like sudden fear, avoidance, and tension may be severe if they’re experienced more often than not. 

Anxiety can be difficult to manage regardless of its severity

Social anxiety disorder
Social anxiety disorder (SAD) is marked by symptoms of anxiety that arise in social settings. SAD is often related to a fear of being judged by others or embarrassed. According to the APA, 7% of US adults live with social anxiety disorder. Severe symptoms of social anxiety disorder can include serious physical symptoms (e.g., rapid heart rate), social isolation, and even selective mutism.

Again, the American Psychiatric Association provides guidance on when social anxiety disorder is severe. According to the APA’s scale, the Severity Measure for Social Anxiety Disorder, if an individual experiences certain symptoms more than half the time, they may have severe social anxiety. 
Separation anxiety disorder
A person with a severe separation anxiety disorder will typically feel anxious and fearful about separating from those with whom they are attached, such as a parent or caretaker. Separation anxiety disorder symptoms include being persistently worried about losing the person closest to them, having a reluctance to go out or sleep away from their home or without that person, or experiencing nightmares about separation. Signs of distress often develop in childhood, but symptoms can carry through adulthood.


Agoraphobia is a fear of situations from which it would be difficult to escape if a person were to experience panic or other challenging feelings. According to the DSM-V, there are five situations that may lead to agoraphobia—"using public transportation,” “being in open spaces,” “being in enclosed spaces,” “standing in line or being in a crowd,” or “being outside the home alone”—and an individual must experience two of them to be diagnosed with the disorder. Symptoms of agoraphobia (nervousness and fear that are irrational given the danger present) may be severe if they occur in a wider variety of places, more frequently, or in combination with panic disorder.
Managing severe anxiety
Psychotherapy and medications are common treatments for anxiety disorders. Talk therapy can help participants reduce anxiety by talking through their feelings, identifying the sources of their symptoms, and developing stress-management techniques. Anti-anxiety medications—which are often reserved for symptoms of anxiety that are more frequent, persistent, or troublesome—can be a crucial component of a treatment plan for severe anxiety. 

There are also several lifestyle changes you can make to help reduce the severity of anxiety symptoms. These include exercising regularly, eating a balanced diet, and getting plenty of sleep. Joining a support group can also be helpful for people living with severe anxiety, particularly excessive social anxiety.  
Help with symptoms of severe anxiety with online therapy
The results of a growing number of studies show that online therapy can help individuals alleviate anxiety that is experienced more intensely. In one such study, researchers found that participants experienced significant improvements in symptoms of severe anxiety following an online cognitive behavioral therapy (CBT) program. The study also mentions that online therapy “has the potential to increase reachability and availability” of CBT.  

If you’d like guidance and emotional support as you address an anxiety disorder or a similar concern, know that help is available. Utilizing an online therapy platform like BetterHelp, you can work through symptoms of severe anxiety remotely, through video call, voice call, or in-app messaging. You can also reach out to your therapist outside of sessions, which can be helpful if you have a question or want to clarify a point made during therapy. 


Severe anxiety can be difficult to live with, potentially leading to serious mental, physical, and emotional effects. Understanding the symptoms of severe anxiety, as well as how anxiety disorders can be managed, may help you alleviate them when they arise in your life. If you’d like to learn more about severe anxiety, consider reaching out to a licensed therapist online. With the right guidance, you can reduce the severity of your anxiety symptoms and thrive.
Regulate anxiety in a compassionate environment
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