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 Symptoms

• Trembling or shaking
• Sweating and sweaty palms
• Tachycardia/palpitations (reported in 7.7% of anxiety patients) 2
• Hyperventilation
• Chest pain
• Shortness of breath
• Dizziness and light-headedness (reported in 20.8% of anxiety patients) 2

Gastrointestinal Symptoms

• Nausea/vomiting (reported in 9.6% of anxiety patients) 2
• Abdominal distress
• Dry mouth (reported in 14.7% of anxiety patients) 2
• Constipation (reported in 10.4% of anxiety patients) 2
• Diarrhea (reported in 10.1% of anxiety patients) 2
• Changes in appetite (both increased and decreased)

Musculoskeletal Symptoms

• Muscle tension and stiffness
• Muscular cramps and twitching
• Fatigue and tiredness (reported in 48.6% of panic disorder patients) 2
• Weakness
• Tremor (reported in 4.0% of anxiety patients) 2

Cognitive and Emotional Symptoms

Cognitive Symptoms

• Excessive anxiety and worry about multiple events/activities
• Difficulty controlling worry
• Difficulty concentrating or mind going blank
• Memory impairment (reported in 33.1% of panic disorder patients) 2
• Cognitive disorder/confusion (reported in 9.9% of anxiety patients) 2
• Racing thoughts

Emotional Symptoms

• Irritability (reported in 33.1% of panic disorder patients) 2
• Feeling on edge or keyed up
• Fear and apprehension
• Emotional distress
• Depression (reported in 13.9% of anxiety patients) 2
• Decreased interest in activities
• Feeling overwhelmed

Sleep Disturbances

• Difficulty falling asleep
• Difficulty staying asleep
• Restless and unsatisfying sleep
• Insomnia (reported in 8.9% of anxiety patients) 2
• Nightmares

Behavioral Changes

• Avoidance behaviors
• Restlessness or feeling keyed up
• Impaired coordination (reported in 40.1% of panic disorder patients) 2
• Decreased functioning in social, occupational, or other important areas
• Increased startle response
• Social withdrawal

Severity Assessment

The GAD-7 scale is commonly used to assess anxiety severity with scores indicating:

• 0-4: Minimal anxiety
• 5-9: Mild anxiety
• 10-14: Moderate anxiety
• 15-21: Severe anxiety 2, 3

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

• Symptoms that interfere moderately to markedly with functioning
• Persistent symptoms not responding to initial interventions
• Multiple physical symptoms occurring simultaneously
• Significant impairment in social, occupational, or other important areas of functioning 1

Special Considerations

Perceived vs. Actual Physical Symptoms

Research shows that perceived heart rate changes are more strongly associated with anxiety intensity than actual heart rate changes during stress 4. This highlights how the perception of physical symptoms often contributes more to anxiety than the physiological changes themselves.

Risk Factors to Consider

• Family history of anxiety disorders
• Comorbid psychiatric disorders
• History of alcohol or substance use/abuse
• Presence of other chronic illnesses 2

Warning Signs Requiring Immediate Attention

• Thoughts of self-harm or suicide
• Severe agitation
• Confusion or psychosis
• Inability to care for basic needs 2

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, and cause clinically significant distress or impairment in functioning 1, 5.

Medical and substance-induced causes of anxiety symptoms should always be ruled out before attributing symptoms to primary anxiety disorder 1.