What conditions can trigger an anxiety attack?

Conditions That Can Trigger Anxiety Attacks

Anxiety attacks can be triggered by underlying medical conditions (thyroid disease, cardiac disorders, hypoglycemia), substance use (caffeine, medications, drugs), psychiatric comorbidities (depression, PTSD), and psychosocial stressors (trauma, harassment, academic/social pressures), all of which must be systematically ruled out before diagnosing a primary anxiety disorder. 1

Medical Conditions That Mimic or Trigger Anxiety

When evaluating anxiety symptoms, you must exclude these specific medical conditions that can precipitate anxiety attacks:

Endocrine and Metabolic Disorders

• Hyperthyroidism - excessive thyroid hormone directly causes anxiety symptoms 1
• Hypoglycemia and diabetes - blood sugar fluctuations trigger panic-like symptoms 1

Cardiovascular Conditions

• Cardiac arrhythmias and other heart disorders - palpitations and chest discomfort can initiate or mimic panic attacks 1

Respiratory Disorders

• Asthma - shortness of breath and respiratory distress overlap with panic symptoms 1

Neurological Conditions

• Migraines - can present with anxiety and autonomic symptoms 1
• Chronic pain conditions - persistent pain is a known anxiety trigger 1

Substance-Induced Anxiety

Substance use must be systematically evaluated as a direct cause of anxiety symptoms:

• Caffeine excess (caféinisme) - stimulant effects directly provoke anxiety and panic 1
• Medications - various prescription drugs can induce anxiety as a side effect 1
• Illicit drug use - stimulants and withdrawal states trigger anxiety 1
• Alcohol and substance withdrawal - creates rebound anxiety and panic 1

The diagnosis requires that anxiety occurs specifically in the context of substance/medication use 1

Psychiatric Comorbidities as Triggers

Anxiety disorders rarely occur in isolation, and these comorbid conditions frequently trigger or exacerbate anxiety attacks:

Depression

• 56% of patients with major depressive disorder have comorbid anxiety 1
• The combination significantly increases suicide risk 1

Post-Traumatic Stress Disorder (PTSD)

• Sexual harassment, assault, and trauma are common underlying triggers in women 1
• PTSD frequently manifests as anxiety symptoms 1

Other Psychiatric Disorders

• Bipolar disorder, ADHD, obsessive-compulsive disorder, eating disorders, and substance use disorders all commonly co-occur with and trigger anxiety 1

Psychosocial and Environmental Triggers

In Adolescent Girls and Women

Specific triggers identified in this population include: 1

• School performance worries
• Concerns about physical appearance
• Earlier sexualization pressures
• Changing media and consumer culture exposure
• Poor self-esteem
• Social media comparison effects

Life Stressors

• Stressful or traumatic life events directly precipitate anxiety episodes 1
• Insecure attachment patterns increase vulnerability 1
• Peer rejection and social skills deficits trigger social anxiety 1

Parental and Family Factors

• Anxiogenic parenting behaviors - overprotective or controlling parenting styles perpetuate anxiety 1
• Family history - 30-50% heritability indicates genetic vulnerability 1

Developmental and Biological Vulnerabilities

Certain constitutional factors predispose individuals to anxiety attacks:

• Behavioral inhibition in childhood - temperamental fearfulness predicts later anxiety 1
• Autonomic hyperreactivity - exaggerated physiological stress responses 1
• Negative affectivity - tendency toward negative emotional states 1

Pregnancy and Postpartum Period

Anxiety disorders increase in both frequency and severity during pregnancy and postpartum, affecting the mother, infant, and family. 1 This represents a critical high-risk period requiring heightened vigilance.

Critical Clinical Pitfall

The most common error is attributing anxiety symptoms to a primary anxiety disorder without first systematically excluding medical causes. Always rule out thyroid disease and drug use before finalizing an anxiety disorder diagnosis. 1 This requires targeted laboratory testing (TSH, glucose) and detailed substance use history, not just a cursory review of systems.