Anxiety is a normal response that can help us face challenges, stay motivated, and defend ourselves from harm. However, when the anxiety response becomes too potent or frequent, it can affect our mental and physical health and, in some cases, signal the presence of an anxiety disorder. Below, we’re going to discuss what severe anxiety is, how symptoms of anxiety of this magnitude can manifest, and which treatment options are available for managing severe anxiety.
Anxiety can be difficult to manage regardless of its severity
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 diagnosable mental health condition. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines several different diagnosable anxiety disorders, such as 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 type of mental health condition in the US. Signs of an anxiety disorder can depend on the individual and the specific disorder, but they generally include both mental and physical symptoms like:
- Persistent nervousness, worry, and fear
- Muscle tension
- Rapid breathing
- Trouble sleeping
- Increased heart rate
- Difficulty concentrating
- Sweating
- Irritability
- Gastrointestinal distress
Symptoms of anxiety disorders exist on a spectrum from mild to severe. Symptoms of severe anxiety can also manifest as panic attacks, trouble breathing, extreme avoidance behaviors, and 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.
Causes of anxiety
While the exact cause of anxiety disorders is unknown, several factors—such as genetic and environmental influences—are thought to contribute to their development. Having a family history of anxiety disorders or other mental illnesses can increase one’s chance of developing an anxiety disorder. Additionally, certain personality traits, such as neuroticism, are associated with some types of anxiety disorders.
Some research also 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 that could increase one’s risk of anxiety 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 relate to symptoms of anxiety disorders.
Severe anxiety is not a clinical diagnosis. Instead, it’s a term that may be used to describe when certain anxiety disorders produce especially intense symptoms, or when a person experiences acute, extreme anxiety symptoms that don’t last long enough to qualify as a disorder.
When a healthcare professional diagnoses people with anxiety, they may sometimes describe the condition’s severity level as 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 intensity of anxiety based on an individual’s answers to a series of questions regarding their symptoms. Scores that are in the highest range suggest the presence of severe levels of anxiety.
Severe anxiety may involve feelings of overwhelming worry and nervousness that impair daily functioning to a greater extent than mild or moderate anxiety. A person with severe anxiety, may also 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 such intense self-consciousness that causes them to completely self-isolate, potentially avoiding even work, school, and time with close friends or family.
The physiological effects of severe anxiety could cause more serious physical health challenges as well. It may also require more intensive forms of treatment and increase the likelihood that an individual will develop
a comorbid condition—that is, other mental health conditions that co-occur at the same time.
Severe anxiety can manifest differently depending on the type of anxiety disorder an individual lives with. For example, some with severe social anxiety disorder may experience intense fear when even thinking about social situations, while someone with generalized anxiety disorder may experience extreme, nearly constant worry about daily life. 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 (DSM-5). Below are some common anxiety disorders and the severe symptoms they may produce.
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 and/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, potential 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 the individual’s life.
Panic disorder is a condition that causes a person to have panic attacks. A panic attack is an episode of severe anxiety characterized by sudden, intense fear and dread—even without an apparent cause—that can produce serious physical and emotional reactions. 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. Symptoms that may indicate severe panic disorder if they manifest frequently enough include those in which the individual experiences any of the following:
- 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”
- “needed help to cope with panic attacks”
Specific phobias are characterized by persistent, severe, and excessive anxiety or 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, or 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 certain animals, storms, or 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 (SAD) is characterized by symptoms of anxiety that arise in social situations. SAD is often related to a fear of being judged by others or embarrassed in front of others. According to the National Institute of Mental Health,
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, extreme behavioral inhibition, and even selective mutism.
Again, the American Psychiatric Association provides guidance on when social anxiety disorder is considered 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.
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 romantic partner. Separation anxiety disorder symptoms can include being persistently worried about losing the person closest to them, being reluctant to go out or sleep away from their home or without that person, and experiencing nightmares about separation. Symptoms often develop in childhood, but can carry over into 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-5, there are
five situations that may trigger agoraphobia:
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or being in a crowd
- Being outside the home alone
An individual must experience at least two of these to be diagnosed with the disorder. Symptoms of agoraphobia (nervousness and fear that are irrational given the actual danger present) may be severe if they occur in a wider variety of places, more frequently, or in combination with panic disorder.
Psychotherapy and medication are common treatments for anxiety disorders. Talk therapy—such as cognitive behavioral therapy (CBT)— can help participants reduce anxiety by talking through their feelings, identifying the sources of their symptoms, developing stress-management techniques, and learning about related health topics. Anti-anxiety medications—which are often reserved for symptoms of anxiety that are more frequent, persistent, or troublesome—can also be a crucial component of a treatment plan for severe anxiety in some cases.
There are several
lifestyle changes you can make that may also help reduce the severity of anxiety symptoms. These include things like exercising regularly, eating nutrient-dense foods often, limiting alcohol and caffeine, and getting plenty of sleep. Joining a support group can also be helpful for people living with severe anxiety, particularly social anxiety.
If you’re experiencing anxiety of any intensity that is causing you distress or interfering with your life, help is available. Seeking the support of a therapist is usually the recommended first step. However, some people experience increased anxiety symptoms at the prospect of calling therapy offices to find a provider, commuting to in-person appointments, and speaking about their symptoms with someone they don’t know face to face. In cases like these, online cognitive behavioral therapy can be a more approachable alternative. With a platform like BetterHelp, you can get matched with a licensed therapist and meet with them from anywhere you have an internet connection.
Online therapy
The results of a growing number of studies indicate that online cognitive behavioral therapy may help individuals alleviate or better manage anxiety—including symptoms that are more intense. For example, in one study, findings suggest that participants experienced significant improvements in symptoms of severe anxiety following an online cognitive behavioral therapy program. The study also mentions that online therapy “has the potential to increase reachability and availability” of CBT.
Takeaway
Severe anxiety can be difficult to live with and may potentially lead to serious mental, physical, and emotional effects. Understanding the symptoms of severe anxiety as well as how they may be managed may help you know when to seek out professional support.