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Understanding Anxiety and Anxiety Disorders Introduction

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D. Updated: Jun 4th 2019

What is Anxiety?

What is anxiety? Ask anyone to define anxiety and you will quickly realize there is no shortage of examples that people can provide. Although anxiety is a very common human experience, the descriptions that people provide are quite varied.

anxious manAnxiety is a human emotion. Everyone experience it. Yet, each person experiences this emotion in unique ways. The following case examples illustrate these various experiences of anxiety:

Sally is a 24-year-old sales associate in a highly prestigious pharmaceutical firm. She constantly works under a great deal of pressure. She says it's "no big deal." She even believes she thrives off this stress. However, she recently walked into her local grocery store and began to sweat. Her heart began to race. She felt like she was losing control. This happened on several occasions. She became so distressed she decided to order her groceries online to avoid another repeat episode.

Bill is a 47-year-old hardware store owner. Bill is constantly "worrying" about (what seems to him) just about everything. Whether he is concerned about his business not doing well…or, what if that mole on his back is not just a beauty mark?...or, how on earth is he ever going to drive to Michigan all by himself to see his son (even with the brand new navigation system)?…Bill just cannot seem to "control" his worry.

Kim is a 36-year-old, part-time, freelance web-designer. She is ordinarily calm and low-key. This is true until she has to go over a bridge, or travel in an airplane. For Kim, she hates places where she feels she cannot escape. She finds that she will often worry for days or even months in advance of these situations. As a result, she makes it a habit to avoid these situations at all costs; or, she "barely gets through them."

Lastly, we have Pete. He is a 32-year-old law student. Pete cannot quite explain why he is anxious; however, he wakes up every morning feeling a sense of "dread." His anxiety usually lingers until about mid-day. At that point, he finally gets into the swing of his normal, daily routine.

So who is right? Are they all describing the same thing? Simply stated, yes they are. The reason behind this paradox is that anxiety is best considered a complex, subjective experience. Anxiety is produced by multiple causes. It is expressed by a diverse set of symptoms. These symptoms include physical, emotional, behavioral, and cognitive components. This is why we can ask many different people about a very common experience; yet, get totally different definitions of what it means to be anxious.

People also differ in how often, and how intensely, they experience anxiety. For most people, anxiety is a normal and even adaptive occurrence. A normal degree of anxiety is part of the everyday human experience. Unfortunately, other people may experience anxiety to such a heightened degree that it causes them great distress. Sadly, this level of anxiety can interfere with people's ability to function well. It may affect many important areas of their lives such as work, school, and relationships. When anxiety reaches this level of distress, and results in impaired functioning, we begin to speak of an anxiety disorder.

Luckily, experts in the field have come a long way in understanding and treating anxiety problems. In the following article, we examine the many facets of anxiety. We will begin with a more in-depth understanding of both the beneficial and harmful aspects of anxiety. Next, we'll talk about what happens when anxiety becomes "pathological" or disordered. We describe and explain the many different types of anxiety disorders. We will present relevant research about what experts believe are the reasons behind the development, and maintenance of anxiety disorders. This same body of research has developed highly effective treatments for the different types of anxiety disorders. With this information, we confidently conclude there is hope and relief for the millions of people who struggle with anxiety.


Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute

Authors Statement: Established in 1979, the Bio Behavioral Institute is a psychological and psychiatric clinic dedicated to the treatment and research of anxiety and mood disorders. Based in Long Island, NY, USA, the institute serves both a local and international clientele. Our staff have over 40 years of experience treating anxiety and mood disorders and have been at the forefront of scientifically supported treatments for anxiety disorders for many years. We offer a variety of programs provided by a multidisciplinary team of professionals. For more information, please visit us online at or view Bio Behavioral Institute and author biographical information on this website.


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Dismantling My Anxiety Issues Over Time - Anonymous - Jan 31st 2015

I know people can overcome anxieties a little at a time. Sometimes with a therapist to help. I have been chipping away at my own for years. Here is one victory in my life.

One of the first realizations of where my anxiety came from was figuring out my mother had treated me differently than my siblings. She "shared" her feelings of discontent about people, situations, events, etc with me more often. Mostly when we were alone. She really wanted me to feel the same unhappiness she felt. I guess to reduce her own anxiety.

I tried to bring optimism to the situation. She didn't allow it. She was trying to get over things and she really needed a therapist. Not me. 

Sometime in my late thirties I realized what had happened. I began to mentally reject her burdens. In time I felt more balanced and happier. Now I let her talk for while. And if it is too much, I tell her I have to hang up or go. I am very nice to her. Why not? But I don't let it go on and on. She eventually figured out this wasn't working and stopped. 

That has been good for us both. I hope that helps someone.

anxiety, OCD or depression - Jamie W. Brown - Nov 19th 2014

Our son recently had an affair.  He has been married for over 25 years with two adult children, has a high stress job and often shows signs of OCD.  This affair is totally out of character for him.  He cannot express his feelings or why he had this affair.  Is he suffering from OCD, anxiety, depression or just selfishness?

You arent alone - - Sep 18th 2014

You didnt ask for these disorders.  The problem is is that you need help.  And money.  But your anxiety is likely to never go away unless you get the right meds.  We do not choose to feel this way.  If we could control our thoughts  then we wouldnt be depressed.  Their aint no easy way out.  If you made it out then you should thank your lucky stars.  The world is messed up and you need to follow the rules, which are constantly changing.  Dont do anything Illegal, no alcohol or drugs, but we need to be medicated.  Which places a stigma on us.  Pray to whatever.  What we need is a ww3 to give us all a sense of purpose.  I can guarantee it would help us.  If you have insomnia then fighting a war is the best cure for that.  I just wanted to be a soldier.  But we were born into a generation that encourages selfishness and laziness.  I dont see an easy way or a hard way out.

anxious/scared constantly. - lost - Aug 4th 2014

Hello I'm sorry all of you are having problems. I hope better things come to all of you. I have what I assume to be anxiety issues. I get to where I feel like I can't breathe for no reason usually when I'm driving or in a crowded place or if anyone says anything about death. I literally feel im I'm having a heart attack my chest tightens I start shaking and sweating.i have an irrational fear of death I guess. I think about it all the time I use to cry every night when I was young. I always just thought I was being stupid until I saw other people with these problems. It's comforting to know that I'm not just completely insane. It is horrible. I don't know what to do about it though! 

It's nice to know I'm not alone - - Jul 2nd 2014

I suffer with anexiety too, I've had it since I was about 14 (I'm 18 now) and I managed alright with it in school, but it has since spiralled out of control. I had to drop out of college because I had more panic attacks than homework assignments. When I'm in group with other people (queues, parties, classrooms...) I lose my vision and get room spin, I sweat uncontrollably and it feels like I've been punched in the gut and am suffocating. It's highly unpleasant. It has stopped me from being able to talk to people, answer the phone, see any friends, go to parties or family gatherings, find employment, buy groceries or even get help for the problem. My coping mechanisms have become ineffective and I'm just hoping now that I'll wake up and it'll have gone because I dont know what else to do.

But this helps, it really does.

anxiety since childhood. - arpita - Jun 5th 2014

hi.m anxietic to high level.its realy very hard for me to deal my normal daily life.

i am very nervous seeing or even knowing about any meeting with anyone may be even

my parents or friends or unknowns.i am 19now and i have eating disorder also.

due to anxiety i am unable to eat anything in front of others.every time i just keep on 

thinking rubbish.every second i feel like vomiting.due to these very reasons no 

one accepts me and i am always embarassed and insulted in front of others.

i feel to suicide because i am unable to hanfle myself.every day eating and meeting is an 

exam for me as if do or die.plz hlp.i vomit especially in front of others.

may be i am having social anxiety also

Anxiety - Azreuk - Jun 4th 2014

Well, I get anxious, that's true. When I visit the doctor, I get very nervous/anxious and they reprimand me, which makes me feel guilty. I sometimes get shots if adrenalin of when double checking I didn't forget anything and a cold sweat. I gave trouble breathing normally in crowds and it hurts from the anxiety I get when people are not happy with me. It's kinda tiring

IDK - Jacob - Nov 22nd 2013

Im a 16 , and im so fu**ed i've been streesed since age 6 worrying about school, home, life. I can't think straight. I kinda have always been a a freak all my life just did'nt really notice it since 3rd grade. I have anger issues. I used to be bullied untill I almost killed a boy that has been messing with me, and I was laughing while choking him i get into fights almost everday. I depreesed , angry and sick help.

health - John - Sep 16th 2013

I get so stressed about my health! Can't sleep ( more like im scared to go to bed incase my thoughts haunt me ) Worried about a knew thing each week and now think I have actually come across a pretty serious problem. So scared, and nervous. Feel literally sick with nerves and so tensed. 


Not so broken - Jo - Mar 25th 2013

Hello, last June I wrote in and basically just got the whole weight of my head. Now I want to say, It can get better. I know from my own personal experience just how annoying this can be for someone to say, but now I feel like my life is beginning to stitch itself back together again, and if you keep battling on one day you will get there. there is always hope. I do feel rather hypocritical though saying that, because on my bad days I will be right back to panic attacks and fear. the anxiety does not go, and you dont exactly learn how to cope. but gradually with determination you can learn not to let it effect you in the same ways. I am now in school full time. I will keep pushing forwards as far as i can, i will almost certainly have a fall along the way but i will just have to dust my knees of and start where i left off. Just please don't give up. And I will pray for you all (collectively I am afraid otherwise I will get no sleep) I know there are many who may find that irritating me saying that but i do care. And maybe if you know there are people praying for you even if you don't have a faith it may give you a little more fuel to keep you going in the future. I did not write this to say haha my life is okay now, I wrote this to say no matter your situation... you can get through with the right support. I am now 16, in school full time, my friends and family close beside me, i have been diagnosed with aspergers syndrome, I am recovering from pervasive refusal, and my life is now okay. I hope you will all find the help and care you need whether from family or friends or a mental health care service. BUt it is by for now. And stay strong. God Bless.


P.S Thankyou Sara for your kind, kind words. They mean a lot.

Anxiety Comment - Orange - Mar 24th 2013

Every time I go to a doctor, I get panic attacks and anxiety about having them examine me. It is weird for me and in the end, I'm in tears and the doctor is pitying me. Does someone has a suggestion to what I could do?

Someone to help - Sara - Oct 18th 2012

For all of you but particularly broken - Jo. Suppose for a minute there is a God and He cares about you. Just ask Him and see what He will do for you. Let Him in. You can't lose by trying this.

my life about anxiety - mckayla anderson - Oct 16th 2012

my anxiety happen when i was 10 years old i was in class when people started to look at me i didn't know what to do i wanted to run out of the room because i started to get hot and scared and i never wanted to do that again my mother took me to a  doctor and he said i have a anxiety disorder and he said that i needed to be cool and not think.

just making it worse - anton - Sep 5th 2012

i dont know how to explain it, but i will try to. It wasnt till i hit 25 i started to really suffer with anexity or cloustraphbia. But i started to have mild panic attacks when i was in crowded places i became very nervous and anxious when surrounded in small groups. Then i found a god send so to speak, i learnt i could take my mind off it for a bit then by playing on a one arm bandit and it would slowly calm me down. 

Then the next problem arrived i got addicted to the blasted things, so then i started losing money left right and center, which then got me worryig about money yet coudnt stop gambling, which lead to depression.

Now 3 years later i have become debt free thanks to having someone take a percentage of my wages and paying my debts off. but i still play on the blasted machines when ever i get in crowded situations. My depression is still there im not sure why granted i have no one in my life but other than been alone there is nothing to be depressed about and the way i am with people alone is probably the best thing.

The only reason im writing this is maybe if i vent it somewhere things might improve as i tend to bottle things up.

Finally I must apologise for my spelling.




Am I mentally unstable? - Sony - Jul 3rd 2012

Good evening.

When a kid behaves in a very bad way, parents often scold or beat him. I started to notice that I was beaten thrice- five times more than my brother, maybe because I seem to be a hyperactive brat- things didn't end right there; as I grew up, people began to notice I wasn't like any other girl from the rest... didn't make many friends in the elementary school, top to it off I became a target for the constant bullying I got stuck into, by myself. My parents always claim they've always loved thier 2 children. And by love.. have they meant humiliation? Ignoring me? Losing their patience when I failed at helping them at anything?

Looking back, I'm not the 'happy' girl I used to be- as I started to lose faith in myself, feeling guilty for everything I've done wrong... lost my interest at many things; kept myself shut from everyone, with the fear of getting blamed or rejected for bad things I didn't do, having buried deep inside that I've never been loved and that I don't deserve any mercy or inclussion from people. My self-esteem has dropped impressively low with the pass of years. It's true I still want to be someone in a future in a way, but when I turn around.. it seems likely to fail. I became sensitive at noises, voices and certain things which bring unpleasant memories. A few months back, I visited a doctor because I felt as if I got pinched with many needles all over my chest and arms, getting diagnosed with some type of anxiety. I hardly talk with anyone, it became useless trying to talk to anyone about my problems and they'll just keep on calling me 'crazy'. This went overboard and hurts so much... don't know if I'll manage to cope with anymore. I'm just sick of all this, and that it's just me the one who ends losing at everything.

I wish someone for once could just look at me and see what's inside. Thanks for your appreciation...

broken - Jo - Jun 3rd 2012

I am a 15 year old girl. People started noticing that i was NOT OKAY when i was 12. I believe it started a lot sooner then that. When I was probably about 6 or 7 years old and my mother was reading me a bedtime story i used to suddenly bolt upright and scream shae and whimper and get almighty tummy cramps and i used to sob myself to sleep because i was terrified of dyeing. Anyway when I was 12 I was put into a mental health unit after I had shut myself away in our playroom at home and screamed if ANYONE walked in. The only one i allowed in was my mother. I stopped eating and sleeping i got too thin and went crazy if anyone came near me. I was in hospital for 2 years. I was out of school for 3. I am just beggining to get back in. I got diagnosed with so many things but they were never certain. like aneorexia, schitzophrenia, severe anxiety, severe depression, severe separation anxiety, i was said to be phschotic, bipolar, traumatized and regression. Now they think I may have asbergers. They gave me medicine which made my chest blow up which deeply upsets me and it made me put on a lot of weight and then it made me hungry constantly so i got even bigger. then they tried me on a different medicine which made me feel unaware of my surroundings and made me feel like i was in a dream i ended up dropping myself from a window and broke my back. I self harmed still do. I banged my head against solid concrete walls over one thousand times a day till it bled. I used rough woolen cardigans to make massive friction burns. I bit myself and got massive bruises i pinched my skin and pulled it till the skin broke. i felt miserable constantly. but at the same time time numb. i felt almighty guilt.i was in agony. I couldnt trust anyone. i was terrified. i didnt believe any one loved loved me. the worst thing is that is still going on now only i feel worse. i left the unit on september the 29th last year. some of the nurses there became my family and i loved them as family. now i am in the worst pain imaginable. i had never had panic attacks till i left now when i think too hard about the people who became my family i have massive pannick attacks and i think i nearly had a heart attack. the worst part now is that i am fake. i have to hide myself and who i really am what i really believe inside. that really upsets me. i am constantly hideing. never showing the real me. i act. i am happy bouncy cheerful giggly very talkative. but that is not me inside i am petrified. i have to put it on though because i am extremely sensitive and terrified to be hurt again. but i am beginning to crumble. i wish someone for once could just look at me and see what is behind the shield. i also know that my family is on ther last feet. my mum is exhausted and cant cope with any more so i dont talk to her anymore, i am frightened of my father, my youngest sister is now aneorexic which is my fault because i have set a bad example and really disturbed her head. and my other brothers and sister are growing up and leaving home. i am sure that all this is not as bad as some people have it. but for those who are struggling i hope this helps them to know they are not alone and i hope it does not disturb or upset anyone. i wrote all this here because i feel like all of you might get me. and you wont be to disturbed because you get it. all your comments have really helped me thankyou. there is so so so much more but to be honest i am sick of it all and ii dont want people to get fed up of me. i am sorry. if anyone has any advise or think they can help please reply. I hope your lives get better and isnt as bad as mine is. good luck. thankyou. x  god bless.

KINESIOLOGY is very beneficial for Anxiety - Kerry Heritage - Jan 30th 2012

Hi to all,

I was doing some research for clients & found your forum : I wish to advise that KINESIOLOGY can make a HUGE difference to how you are feeling & the symptoms you are experiencing. (NO I am not wishing to  promote myself here - but give you a place to start researching kinesiology for yourself.) EVERY day I see MAJOR positive changes being made in people's lives who have lived with anxiety disorders for a number of years............... Consider giving kinesiology a go - what have you got to lose?

Best wishes Kerry

Anxiety and Aromasin - Bobbie - Jul 14th 2011

Had BC three years ago was prescribed Tamoxefin after finishing chemo & rads.  Three weeks ago Oncologist changed my medication to Aromasin.   I have suffered from.

Anxiety/Depression for years take Seroxat and Mirtazipine.

A few days after starting on Aromasin anxiety started again, that gut feeling in the morning. Has anyone had any experience of this on Aromasin.  ?


Im only 15 - Chrissy - Jul 1st 2011

Well i'm 15 right now but it started last year when I was 14 and  I started getting extremely painful stomach aches and we didn't know what it was so they diagnosed me with Chronic Funtional Abdominal Pain. But later we soom relized that it is anxiety so now we are trying to find a medicin tht works and I have to retake freshman year and I have no clue why I even get my attacks there seems to be nothing specific that trigers it. So if you have ideas to help me please email me at

Anxiety, depression, low self-esteem flowchart - Anna - Jun 1st 2011

I've had treatment for depression on and off for many years, but no one has specifically linked the depression with the tremendous paralysing anxiety, yet I know that one feeds the other till I get stuck in an emotional loop that seems inescapable. When I'm stuck, it's so hard to be rational and get myself out.

The time spent reading these 50 pages has been very worthwhile. I ended up drawing a 'mind map', describing as a flowchart: 1) how my anxiety, depression and low self-esteem relate to, depend on and feed each other, as a cycle; 2) how symptoms I experience of related disorders fit in (e.g. social phobia, compulsive behaviour, avoidance, self-maltreatment, panic, comfort eating); 3) how my efforts to get on with life, and to control the vicious emotional cycle, fit in with the cycle; 4) where the wild card I've called 'Echo' (shades of bad childhood experiences) fits in (highlighted red) and triggers emotional meltdown.

So, thanks. I have a clearer understanding of my problems, which hopefully will help me next time I start cycling round the loop.

My Anxiety - MySelf - Mar 28th 2011

i've been having panic and or anixety attacks for a couple of years now. it start when i was 18 going on 19 i believe and im almost 21 now. i get to the point where my heart is racing i feel like i cant breath and i get all paniced. i hate this feeling it drives me crazy and when it happens i feel so scared and once i calm down i feel so alone becasue noone understands how i just felt or what i go through and for a while my mom thought i was just faking or lieing till the doctor put me on meds for it . i get so antsy at times. im not on the meds anymore what am i suppose 2 do?? please email me with feed back.

what am i supposed to do? - - Mar 9th 2011

now i've been told that exercise is supposed to be good for anxiety, but not me! PE at school only makes it worse. we will be playing somwthing like netball and all i do is freeze up because i'm so nervous and then it gets even worse because i'm made to run around and play the game because people are counting on me. I've nearly thrown up three times because i'm so nervous in the middle of a netball or hockey match. what am i supposed to do wen i can't just stop pe all together at school?

if it were possible - Josh - Mar 1st 2011

You say "get up and do something about it."  Im 22 and stuck in a vicous cycle of anxiety witch stops me from getting a job and going to school.  This leaves me with no insurance and my parents are too broke to put me on theyre insurance.  Only hope is UofL and they declined me. What am i supposed to do? kill my self.  If anyone might be able to help me out I would repay you when ever possible. . Thanks.

please stop telling people to just pray - - Feb 11th 2011

People please stop telling people to just pray and that it will make all their problems go away. You have to take action. If you believe in a God then have the sense to know that he gives you the tools to help yourself you can't just sit around waiting for magic. You have to get up and help yourself. you can overcome this and you will if you get the proper therapy or medication. Don't suffer alone.

HOW TO OVER COME ANXIETY!! - - Jan 25th 2011



anxiety - - Dec 11th 2010

How do I stop my anxiety from bothering me? Its thoughts but who is giving me these thoughts?

Pulling her hair out ! - Chella - Nov 17th 2010

My 10 yr old daughter is ADHD, and has Tricotillomania. I'm wondering, do I add Anxiety Disorder to the list, or does the Tric fall under the AD? She's also a cutter,..what would that fall under?

anxiety sleep response - jazzy - Oct 11th 2010

I have been through more  than you guy been through you have to remember some one loves  you, at all times. this world have god people in it and not just for you  me too .I dont know what wrong with my mined I feel its worser then you people. know I dont you know but it was hard for me to type this. GOD BLESS YOU ALL 

Ending Insomnia and Busy minds - - Sep 6th 2010

To the above problem, I once suffered from the same sleepless nights but I have found a way to cure it.  If you are still having trouble sleeping because your mind is racing try this:

- Before you sleep, think of things that you are grateful for.  Writing a list of things you are grateful for is also helpful.

- Pray for things you wish for and come to a conclusion.  Do not go on and on with your prayers.

- Breath deep and slow.  Make sure you exhale the same amount that you inhale.  With your mind imagine inhaling the universe itself and breathing in its life force.  When you exhale, exhale all your negativity, imagine pushing it far from you, into another dimension.

- Make sure you do something you love to do at least once a day and do that as much as possible throughout your day.


I noticed my sleeplessness were due to some form of worry that I was unable to detect counsciously.  So, with careful studying and going back to my religious philosophies, I found that to cure a troubled mind is to remember what we are grateful for - to find that "happy thought" and hold on to it.  Once this is achieved and becomes automatic, the mind no loner needs to experience anything else.  What else is there to experience but happiness?  And so, it sleeps.  I hope that helps you in some way.  It took me about 1-2 weeks to be fully cured.  Take care.

About Dream - Dev - Jul 24th 2010

Hi Friend

My problem is that i cant sleep well.Whenever i get up from bed i dont feel mind is continuously thinking about something and something which i cant understand. i cant describe it what to say about it.

so anyone can help about it and where can i get help for it. what should i do for it.

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