Anxiety disorder: symptoms, forms and modern treatment

At a glance

FrequencyOne of the most common mental illnesses — many adults are affected over the course of their lives
FormsGeneralized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, agoraphobia
TreatableVery treatable — psychotherapy and/or medications considerably improve the symptoms in most of those affected
Therapy of choiceCognitive behavioral therapy (CBT) with exposure — the best-studied form of therapy
MedicationsSSRIs / SNRIs as first line; pregabalin with generalized anxiety; benzodiazepines only short-term
ICD-10F40 (phobic disorders), F41 (other anxiety disorders)

Table of contents

  1. What is an anxiety disorder?
  2. Forms
  3. Symptoms
  4. Causes
  5. Diagnosis
  6. Therapy: psychotherapy
  7. Therapy: medications
  8. Living with an anxiety disorder
  9. How brite helps you
  10. FAQ
  11. Related topics

1. What is an anxiety disorder?

Anxiety is a normal and vital feeling. It warns of danger and prepares the body for fight or flight. One only speaks of an anxiety disorder when the anxiety occurs inappropriately strongly, frequently or persistently, has no real cause and considerably impairs everyday life.¹

Anxiety disorders are among the most common mental illnesses of all. Nevertheless, many of those affected only seek help after years — out of shame, because they cannot classify the symptoms or because they believe they simply have to endure the anxiety.¹˒²

The good news: anxiety disorders are treatable well Psychotherapy — above all cognitive behavioral therapy (CBT) with exposure — is highly effective and is recommended by the guideline as a first-line therapy. In many of those affected, the symptoms can be considerably improved or completely overcome.¹

2. Forms

Generalized anxiety disorder (GAD)
Persistent, excessive worrying about various areas of life (health, work, family, finances) — on most days over at least six months. The worries cannot be controlled. Often accompanied by muscle tension, restlessness, sleep disturbances and irritability.
Panic disorder
Recurrent, unexpected panic attacks — sudden episodes of intense anxiety with physical symptoms (a racing heart, shortness of breath, sweating, dizziness, a fear of dying). Between the attacks often the fear of the next attack (anticipatory anxiety).
Agoraphobia
Fear of situations from which an escape would be difficult or in which no help would be available — public places, crowds, public transport, department stores. Can occur with or without panic disorder and often leads to avoidance behavior.
Social anxiety disorder (social phobia)
Pronounced fear of social situations in which one could be observed, judged or embarrassed — e.g. public speaking, eating in front of others, conversations with strangers. Goes beyond normal shyness.
Specific phobias
Intense, inappropriate fear of certain objects or situations — e.g. heights, flying, spiders, injections, blood, enclosed spaces. Generally leads to avoidance.

3. Symptoms

Psychological symptoms

  • intense, inappropriate anxiety or worries
  • a feeling of threat without a real cause
  • Avoidance behavior — anxiety-triggering situations are avoided, which intensifies the anxiety in the long term
  • difficulties concentrating
  • irritability, inner restlessness
  • catastrophic thinking — the worst is expected

Physical symptoms

Often the GP, cardiology or emergency room first Because of the physical symptoms, many of those affected first seek out the GP practice, cardiology or the emergency room — without knowing that an anxiety disorder is the cause. An open conversation about possible psychological triggers can shorten the path to the right therapy.

4. Causes

Anxiety disorders generally arise through an interplay of several factors.¹

  • Genetics: A familial predisposition plays a role — anxiety disorders occur more often in families.
  • Neurobiology: Changes in the balance of neurotransmitters (above all serotonin, noradrenaline, GABA) and in brain regions that process anxiety (amygdala, prefrontal cortex).
  • Learning history: Negative experiences, traumatic events, learned avoidance behavior, an overprotective upbringing.
  • Stress: Chronic stress, stressful life events, transitional phases (a job change, separation, loss).
  • Comorbidities: Anxiety disorders often occur together with depression, ADHD, addictive disorders or physical illnesses.

5. Diagnosis

  • Clinical conversation: The basis of the diagnosis. Recording the symptoms, the duration, the impairment and the avoidance behavior.
  • Standardized questionnaires: e.g. GAD-7 (generalized anxiety), PHQ-D (anxiety and depression) — help with screening and severity assessment.
  • Physical work-up: An overactive thyroid, cardiac arrhythmias, substance abuse and other physical causes generally have to be ruled out.
  • Differentiation: Anxiety disorders must be distinguished from normal anxiety, adjustment disorders, post-traumatic stress disorders and other mental illnesses.

More: Preparing for a doctor's appointment.

6. Therapy: psychotherapy

Psychotherapy is the first-line therapy with anxiety disorders — especially cognitive behavioral therapy (CBT) with exposure.¹

First line Cognitive behavioral therapy (CBT)
The two core elements of CBT
1. Cognitive restructuring: recognizing and changing anxiety-intensifying thoughts.
2. Exposure: consciously and step by step exposing yourself to the anxiety-triggering situations instead of avoiding them. The anxiety thereby becomes weaker in the long term.¹
Exposure — the heart of CBT
Can take place in vivo (in the real situation), in sensu (in the imagination) or via VR (virtual reality). Unpleasant at first, but highly effective. Experience shows: the feared catastrophe does not occur — and the brain learns to reassess.
Alternative Psychodynamic therapy

Can be used as an alternative when CBT is not available or not wanted.

Waiting times — what you can do The waiting times for a psychotherapy place are often long in Germany. A psychotherapeutic consultation (without a waiting list) can be the first step. Online programs — e.g. internet-based CBT — can also help to bridge the gap.

7. Therapy: medications

Medications are generally used when psychotherapy alone is not sufficient, with a severe course or when no psychotherapy is available promptly. They are often combined with psychotherapy.¹

SSRIs — the first-line medication
Active ingredients: escitalopram, sertraline, paroxetine and others.
Selective serotonin reuptake inhibitors. Generally work after a few weeks. Common initial side effects (nausea, restlessness, sleep disturbances) mostly subside. No risk of dependence.
SNRIs
Active ingredients: venlafaxine, duloxetine
Serotonin-noradrenaline reuptake inhibitors. An alternative to SSRIs with a similar effect profile.
Pregabalin
Approved for generalized anxiety disorder. Works faster than SSRIs/SNRIs. Can have a certain potential for dependence.
Buspirone
An alternative with generalized anxiety disorder. No risk of dependence. Onset of effect after weeks.
Benzodiazepines — only short-term, because of the risk of dependence Benzodiazepines (e.g. lorazepam, diazepam) work quickly and strongly to relieve anxiety. Because of the high risk of dependence, however, they are generally used only short-term and as emergency medication. The guideline does not recommend them as a long-term therapy with anxiety disorders.¹

More: Stopping medications — antidepressants and pregabalin should generally not be stopped abruptly (discontinuation phenomena). Also: Drug interactions.

8. Living with an anxiety disorder

  • Do not avoid: Avoidance behavior is the strongest maintainer of the anxiety. Facing the anxiety-triggering situations step by step is more effective in the long term than avoiding them — even when it is difficult in the short term.
  • Movement: Regular physical activity can measurably reduce anxiety symptoms and is recommended as a supplementary measure.
  • Sleep: Sleep disturbances and anxiety intensify each other. Good sleep hygiene is important.
  • Caffeine and alcohol: Caffeine can intensify anxiety symptoms. Alcohol relieves anxiety short-term, but worsens it in the long term and carries a risk of addiction.
  • Self-help: Self-help groups, anxiety guides and structured online programs (e.g. internet-based CBT) can support the therapy.

How brite helps you with an anxiety disorder

Escitalopram in the morning, pregabalin in the evening, maybe an emergency lorazepam in your pocket — and the CBT appointment in the calendar. brite holds the therapy together.

  • Intake reminder — SSRIs need weeks until they work — and only the regular intake brings the effect. brite reminds you reliably, even in crisis phases in which concentration is difficult. Set up a reminder
  • Interaction check — SSRIs plus triptans (migraine)? Plus St. John's wort? brite warns about risky combinations before they become a problem. Check now
  • Health history — document anxiety symptoms, avoidance behavior, panic attacks and therapy progress over time. Helps in the CBT conversation and with the therapy plan. Track your history
  • Digital medication plan — all medications clearly organized for psychiatry, psychotherapy and the GP — also helpful when several treating providers are involved. Go to medication plan
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FAQ: Common questions about anxiety disorders

Yes — anxiety is a normal and vital feeling. One only speaks of an anxiety disorder when the anxiety is inappropriately strong, has no real cause and considerably impairs everyday life.
A sudden episode of intense anxiety with physical symptoms (a racing heart, shortness of breath, dizziness, a fear of dying). Panic attacks are extremely unpleasant, but not dangerous. They generally last a few minutes and subside on their own again.
Yes — in many of those affected, the symptoms can be considerably improved or completely overcome through psychotherapy (CBT) and/or medications. The earlier the treatment begins, the better the prognosis.¹
The conscious and step-by-step seeking out of anxiety-triggering situations under therapeutic guidance. The anxiety thereby becomes weaker in the long term, because the brain learns: the feared catastrophe does not occur. Exposure is the most effective element of CBT with anxiety disorders.¹
No — SSRIs have no risk of dependence in the narrower sense. With abrupt stopping, however, discontinuation phenomena can occur (dizziness, tingling, irritability). That is why SSRIs should generally be tapered gradually under medical supervision. More: Stopping medications.
Benzodiazepines work quickly and strongly to relieve anxiety, but cause dependence with longer use. They are therefore generally used only short-term as emergency medication. The guideline does not recommend them as a long-term therapy with anxiety disorders.¹
Generally a few months (CBT typically 12 to 25 sessions, depending on the form and severity). First improvements can occur after just a few sessions — especially when active work is done with exposure.
A psychotherapeutic consultation (without a waiting list), the GP practice, the appointment service of the Association of Statutory Health Insurance Physicians (116 117 in Germany), the psychiatric emergency room with an acute crisis. Online programs (internet-based CBT) can bridge the waiting time. In an acute crisis (in the US): call or text the 988 Suicide & Crisis Lifeline. In Germany: Telefonseelsorge at 0800 111 0 111 (free, 24/7).

11. Related topics

Depression ADHD in adults Sleep disturbances Stopping medications Drug interactions Preparing for a doctor's appointment

Sources

  1. S3-Leitlinie Behandlung von Angststörungen (DGPPN, AWMF Reg-Nr. 051-028, V2, 2021). awmf.org
  2. gesundheitsinformation.de (IQWiG): Angststörungen. gesundheitsinformation.de
  3. Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN). dgppn.de
  4. Stiftung Deutsche Depressionshilfe: Angst. deutsche-depressionshilfe.de
Medical disclaimer: This article is for general information and does not replace medical or psychotherapeutic advice, diagnosis or therapy. Anxiety medications — especially SSRIs, SNRIs and pregabalin — should not be stopped on one's own. Benzodiazepines have a risk of dependence and should only be used short-term. In an acute crisis or with suicidal thoughts: go to a psychiatric emergency room, or (in the US) call or text the 988 Suicide & Crisis Lifeline; in Germany, Telefonseelsorge at 0800 111 0 111 (free, 24/7). Last updated: April 2026.