Clinical Manifestations of Anxiety
Anxiety disorders present with a complex array of physical, cognitive, emotional, and behavioral symptoms that significantly impact quality of life and daily functioning. These manifestations can vary in intensity and presentation across different anxiety disorders but share common underlying features.
Physical Manifestations
Autonomic Nervous System Activation
- Trembling or shaking
- Sweating and sweaty palms
- Tachycardia (rapid heart rate)
- Tachypnea (rapid breathing)
- Hyperventilation
- Chest pain or discomfort 1
- Palpitations or pounding heart 2, 3
- Shortness of breath or smothering sensations 3
- Feeling of choking 3
Musculoskeletal Symptoms
- Muscle tension and stiffness
- Muscular cramps and twitching
- Fatigue and tiredness
- Weakness 1
Other Somatic Symptoms
- Dizziness, lightheadedness, or feeling faint 3
- Nausea or abdominal distress 3
- Paresthesias (numbness or tingling sensations) 3
- Chills or hot flushes 3
- Headaches 4
Cognitive Manifestations
- Excessive anxiety and worry about multiple events/activities
- Difficulty controlling worry
- Difficulty concentrating or mind going blank
- Memory impairment
- Cognitive confusion 1
- Fear of losing control 3
- Fear of dying 3
- Catastrophic thinking 1
- Derealization (feelings of unreality) 1, 2, 3
- Depersonalization (being detached from oneself) 2, 3
Emotional Manifestations
- Irritability
- Feeling on edge
- Feeling keyed up or restless
- Fear and apprehension
- Emotional distress
- Decreased interest in activities 1
Behavioral Manifestations
- Avoidance behaviors (avoiding anxiety-provoking situations)
- Restlessness or feeling keyed up
- Impaired coordination
- Decreased functioning in social, occupational, or other important areas 1
- Clinginess (especially in separation anxiety)
- Poor eye contact
- Shy demeanor
- Hypervigilance 4
- Selective mutism (absence of speech in certain social situations despite speaking in others) 4
Sleep Disturbances
- Difficulty falling asleep
- Difficulty staying asleep
- Restless and unsatisfying sleep
- Insomnia 1
Disorder-Specific Manifestations
Panic Disorder
- Recurrent unexpected panic attacks (discrete periods of intense fear reaching peak within 10 minutes)
- Concern about having additional attacks
- Worry about implications of attacks
- Significant change in behavior related to attacks 2, 3
Social Anxiety Disorder
- Excessive fear of social or performance situations
- Fear of negative evaluation by others
- Blushing, sweating in social situations 4
Generalized Anxiety Disorder
- Persistent worry across multiple domains for at least 6 months
- Worry is difficult to control
- At least 3 of 6 physical or cognitive symptoms 1, 5
Separation Anxiety Disorder
- Excessive fear about separation from attachment figures
- Distress when separated 4
Assessment Considerations
- Symptoms must cause clinically significant distress or impairment in functioning 4, 1
- Cultural variations in symptom presentation exist (e.g., somatic symptoms may predominate in some cultures) 1
- Symptoms may present differently across age groups 4
- Medical causes (thyroid disorders, cardiac conditions, respiratory disorders) must be ruled out 1, 6
- Substance-induced causes (caffeine, alcohol withdrawal, medication side effects) should be considered 1
Screening Tools
- Generalized Anxiety Disorder-7 (GAD-7) - scores ≥5,10, and 15 indicate mild, moderate, and severe anxiety 1, 5
- Hospital Anxiety and Depression Scale (HADS) - score ≥8 indicates possible anxiety disorder 4
- Screen for Child Anxiety Related Emotional Disorders (SCARED) 4
- Spence Children's Anxiety Scale (SCAS) 4
Recognizing these diverse manifestations is crucial for accurate diagnosis and effective treatment planning, ultimately improving outcomes related to morbidity, mortality, and quality of life for individuals with anxiety disorders.