What are the symptoms of severe stress and anxiety?

Symptoms of Severe Stress and Anxiety

Severe stress and anxiety manifest through multiple physical, psychological, and behavioral symptoms including restlessness, feeling keyed up or on edge, excessive worry, difficulty controlling worry, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. 1

Physical Symptoms

• Autonomic nervous system activation:

  • Trembling or shaking
  • Sweating
  • Tachycardia (rapid heartbeat) and palpitations
  • Tachypnea (rapid breathing)
  • Sweaty palms 1
  • Hyperventilation 1
  • Chest pain 1

• Musculoskeletal symptoms:

  • Muscle tension and stiffness 1
  • Muscular cramps and twitching 1
  • Fatigue and tiredness 1
  • Weakness 1

• Gastrointestinal symptoms:

  • Nausea/vomiting 1, 2
  • Abdominal distress 1
  • Changes in appetite (increased or decreased) 1
  • Diarrhea or constipation 2
  • Dry mouth 2

Psychological Symptoms

• Cognitive symptoms:

  • Excessive anxiety and worry about multiple events/activities 1
  • Difficulty controlling worry 1
  • Difficulty concentrating or mind going blank 1
  • Memory impairment 1, 2
  • Cognitive disorder/confusion 1, 2
  • Racing thoughts 3
  • Catastrophic thinking 3

• Emotional symptoms:

  • Irritability 1
  • Feeling on edge 1
  • Nervousness 2
  • Feeling keyed up or restless 1
  • Fear and apprehension 1
  • Emotional distress 1
  • Decreased interest in activities 1

Behavioral Symptoms

• Sleep disturbances:

  • Difficulty falling asleep 1
  • Difficulty staying asleep 1
  • Restless, unsatisfying sleep 1
  • Insomnia 1, 2

• Other behavioral changes:

  • Avoidance behaviors 1
  • Restlessness or feeling keyed up 1
  • Impaired coordination 1
  • Social withdrawal 3
  • Decreased functioning in social, occupational, or other important areas 1

Severity Indicators

Symptoms of severe anxiety (GAD-7 score of 15-21) include:

• Symptoms that interfere moderately to markedly with functioning 1
• Persistent symptoms not responding to initial interventions 1
• Multiple physical symptoms occurring simultaneously 1
• Significant impairment in social, occupational, or other important areas of functioning 1
• Symptoms occurring more days than not for at least 6 months (for GAD diagnosis) 1

Important Clinical Considerations

• Anxiety symptoms may present differently across cultures, with some individuals experiencing predominantly somatic symptoms rather than psychological ones 4
• Medical causes of anxiety (e.g., unrelieved pain, fatigue, infection, electrolyte imbalance) should be ruled out before attributing symptoms to primary anxiety 1
• Risk assessment for self-harm is essential when evaluating severe anxiety, as these patients may be at increased risk for suicide 5
• Substance-induced causes of anxiety should be considered, including caffeine, alcohol withdrawal, or medication side effects 1
• Anxiety symptoms often overlap with other conditions like depression, post-traumatic stress disorder, and adjustment disorders 1, 6

Diagnostic Thresholds

For Generalized Anxiety Disorder diagnosis, symptoms must:

• Persist for at least 6 months
• Include excessive anxiety and worry that is difficult to control
• Be accompanied by at least 3 of 6 physical or cognitive symptoms
• Cause clinically significant distress or impairment in functioning 1, 5

Recognizing these comprehensive symptoms of severe stress and anxiety is crucial for proper assessment and management to improve morbidity, mortality, and quality of life outcomes.