Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Anxiety Disorder

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In one line

·Anxiety disorders (generalized anxiety disorder, panic disorder, social anxiety disorder, agoraphobia, specific phobia) all cause too much fear and avoidance, but each one has different triggers, different time patterns, and different first-line treatments proven to work.

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Normal physiology

·The amygdala (the brain's alarm bell, buried deep near the center) watches for danger every second. When it spots a threat, it sends instant signals to the prefrontal cortex (the thinking and planning part behind your forehead), which decides 'Is this danger real?' and 'What should I do?' Then the autonomic nervous system (a network of nerves controlling heartbeat, breathing, sweating, and muscle tension without you thinking about it) kicks the body into high gear—heart rate climbs, breathing speeds up, and muscles tense—so you can fight the danger or run away. This system evolved over millions of years to keep humans alive.

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What goes wrong

·In anxiety disorders, the amygdala becomes too sensitive (it fires at shadows and safe situations as if they were tigers) or the prefrontal cortex loses its ability to calm the amygdala down (the brake stops working), so the alarm stays on even when there is no danger. The result: your body stays in fight-or-flight mode hour after hour, day after day, and you feel terrified, exhausted, and trapped. Different anxiety disorders break the circuit in different places. Generalized anxiety disorder keeps baseline worry high all the time—you worry about work, health, money, and family every day for months, and you cannot turn it off even when everything is objectively fine. Panic disorder fires sudden, intense false alarms—your heart races, you cannot breathe, you feel like you are having a heart attack or dying, and the surge peaks in minutes then fades, but the fear of the next attack keeps you on edge. Social anxiety disorder misfires whenever other people might judge you—speaking in a meeting, eating in public, or making small talk feels unbearable, and you see every glance or facial expression as proof you are being evaluated and found lacking. Agoraphobia links fear to specific places where escape feels hard or help might not come—buses, bridges, crowds, wide-open parking lots, or even leaving your house alone—so you avoid those places and your safe zone shrinks. Specific phobia locks all the fear onto one trigger (heights, needles, dogs, blood, flying)—the fear is out of proportion to real danger, you know it does not make logical sense, but you cannot override it and you rearrange your life to avoid that one thing.

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Hallmark signs

·Excessive worry that is hard to control, happening more days than not for at least 6 months (generalized anxiety disorder)
·Sudden panic attacks that peak in under 10 minutes, with chest pain, racing heart, trouble breathing, dizziness, and fear of dying
·Intense fear in social situations where others might judge you—like speaking in public, eating in front of people, or being watched (social anxiety disorder)
·Avoiding places where you feel trapped or unable to escape—buses, crowds, malls, open spaces, or leaving home alone (agoraphobia)
·Extreme fear of one specific thing—heights, needles, flying, animals, or blood (specific phobia)
·Restlessness, constant fatigue, trouble focusing, irritability, tight muscles, or broken sleep
·Physical symptoms that mimic serious illness—chest pain, shortness of breath, dizziness, nausea, or diarrhea
·Thoughts of suicide or hurting yourself

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Red flags · escalate now

·Suicidal thoughts or a plan to harm yourself—screen at every visit; risk jumps when depression and substance use are also present
·New anxiety or panic starting after age 45—rule out overactive thyroid (hyperthyroidism), irregular heartbeat (cardiac arrhythmia), adrenal tumor (pheochromocytoma), or side effects from stimulants or steroids
·Substance use disorder or needing higher and higher doses of benzodiazepines—tolerance and rebound anxiety signal dependence; safe taper or addiction treatment is required
·Total social withdrawal or inability to work—severe functional loss predicts worse outcomes and may require intensive outpatient or inpatient psychiatric care
·Hallucinations or delusions (psychotic symptoms)—anxiety alone does not cause psychosis; consider schizophrenia, bipolar disorder, or drug-induced psychosis

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Workup

·Thyroid-stimulating hormone (TSH) to rule out hyperthyroidism (overactive thyroid)
·Fingerstick blood glucose to rule out low blood sugar (hypoglycemia) (low blood sugar)
·12-lead electrocardiogram (ECG) and troponin if chest pain is present or patient is older or has cardiac risk factors
·Urine drug screen if substance use is suspected
·Complete blood count (CBC) to rule out anemia
·Serum cortisol (morning level) if Cushing syndrome is suspected
·Electroencephalogram (EEG) if seizure activity is suspected
·Caffeine intake history and review of medications and supplements

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Treatment

·Cognitive-behavioral therapy (CBT) or exposure therapy
·Selective serotonin reuptake inhibitor (SSRI) such as sertraline or escitalopram
·Serotonin-norepinephrine reuptake inhibitor (SNRI) such as venlafaxine or duloxetine
·Benzodiazepine (such as lorazepam or alprazolam) only for acute panic or severe distress, short-term use only
·Beta-blocker (such as propranolol) for physical symptoms of panic or performance anxiety
·Screen for and treat comorbid conditions: major depressive disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and substance use disorder (alcohol, cannabis, stimulants)
·Sleep hygiene, regular aerobic exercise, and reduce or eliminate caffeine intake

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NCLEX trap

·Benzodiazepines are only for very short-term help — 2 to 4 weeks at most, per the American Psychiatric Association. The first-choice treatment is cognitive-behavioral therapy (a type of talk therapy that teaches you to change anxious thoughts and face your fears safely) plus an SSRI (a medicine that raises serotonin, a brain messenger that steadies mood and calms fear). If you use benzodiazepines every day for a long time, your brain becomes dependent (it needs the drug just to feel normal), and anxiety actually gets worse because your brain never learns how to calm itself down on its own.
·Always rule out dangerous causes first. Do a 12-lead EKG (a tracing of the heart's electrical rhythm) and check troponin (a blood protein that spills out when heart muscle is damaged) if the person has chest pain, per American College of Cardiology and American Heart Association guidelines. Only after you prove the heart is fine can you say the symptoms are from anxiety. Missing a real heart attack or dangerous rhythm in a young person is a deadly mistake.
·Avoiding the feared thing makes anxiety worse over time because it teaches the brain the danger is real. The proven treatment is exposure therapy (slowly and safely facing the feared situation) combined with cognitive-behavioral therapy. This retrains the amygdala (the brain's fear alarm deep in the middle of your head) to recognize there is no real threat. Avoidance keeps the alarm stuck in the 'on' position.
·SSRIs take 4 to 6 weeks to start working for anxiety, per American Psychiatric Association guidelines. The medicine has to build up serotonin slowly in the tiny gaps between brain cells, and then the brain has to grow new receptors to use that serotonin. Stopping the medicine after one week because nothing changed yet is a common mistake. Teach the patient this timeline and combine medicine with therapy so they stick with the plan long enough for it to work.
·Anxiety disorders come in different types: generalized anxiety disorder, panic disorder, social anxiety disorder, agoraphobia (fear of places where escape feels hard), and specific phobias (fear of one thing like heights or needles). The correct diagnosis drives the treatment — social anxiety needs an SSRI plus exposure to social situations, while a specific phobia often needs exposure therapy alone. Treating the wrong type means the treatment fails. Always screen for all types because they often happen together.
·Always screen for depression (persistent sad mood, loss of interest in things you used to enjoy, thoughts of ending your life) and alcohol or drug use. Up to 60% of people with anxiety disorders also have depression, per the National Institute of Mental Health. Using alcohol or drugs can mimic or worsen anxiety — alcohol quiets GABA (the brain's main calming signal) over time, making anxiety worse when it wears off. You must treat both problems or neither one gets better.

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