Marla Genova had resigned herself to a career in dry cleaning. The then-teenager couldn't imagine doing anything less isolating or mundane than what she did at that post-high school job: sitting at the dry cleaner's, mostly alone, until the one time each day the clothes were delivered. "Basically, I just sat there," says Genova, who's now in her 40s and lives in Connecticut. "I could have seen myself sitting there forever."
Genova may have looked apathetic, unambitious or even unintelligent, but what she really was, was anxious. She didn't receive an official diagnosis – social anxiety disorder – until she was screened for anxiety during an awareness event at college, even though she'd always known something was wrong.
Soon after the diagnosis, she enrolled in a social phobia group research study that taught cognitive behavioral therapy. There, Genova began trusting she could do a lot more with her life than sit.
How Anxiety Affects You
The therapy program "changed my entire way of thinking, and I was able to apply it to other parts of my life as well," says Genova, who spent 20 years conducting clinical research on anxiety disorders and other behavioral and public health issues before launching Socially Speaking, a social performance and anxiety coaching business.
Anxiety – as it refers to a set of disorders including social anxiety disorder and generalized anxiety disorder, which Genova also has – affects more than 18% of the U.S. adult population each year. That makes it the most common mental illness in the country, according to the Anxiety and Depression Association of America.
"Anxiety is definitely becoming more common. Chances are, you know someone who suffers from it," says Angelique Mason, a family nurse practitioner with Penn Medicine at Woodbury Heights in New Jersey, who often sees patients with a range of anxiety disorders.
Incidence of anxiety was on the rise prior to the COVID-19 pandemic, but that global health crisis and attendant financial and social disruptions just threw gas on the anxiety fire for a majority of Americans. An October 2020 poll from the American Psychiatric Association found 62% of Americans feel more anxious than they did at the same time the previous year, a sizable increase over APA polls over the preceding three years, in which the number had ranged between 32% and 39%.
Moe Gelbart, director of behavioral health at Torrance Memorial Medical Center in Torrance, California, notes that "we're experiencing the highest rates of anxiety we have ever seen. Reasons include fear of the unknown and feelings of helplessness and lack of control."
Lawrence Lovell, a licensed mental health counselor based in New York City, and founder of Breakthrough Solutions, points to a 2021 report from the Kaiser Family Foundation that found during the pandemic 4 in 10 adults in the U.S. reported symptoms of anxiety or depressive disorder, up from 1 in 10 who reported those symptoms from January to June 2019.
Despite these staggering numbers, just over a third of people with anxiety get treatment, ADAA reports. This is in part because many of its manifestations are so ubiquitous – lack of sleep or feeling overwhelmed – and not initially – or even ever – associated with anxiety.
For example, feelings of apathy, fatigue, irritability and even anger – not just worry – can signal anxiety issues, says Kristina Hallett, a clinical psychologist and executive coach in Suffield, Connecticut. Problems that seem strictly physical like headaches, chest pain, numbness, rashes, hair loss and more can be linked to anxiety disorders too.
That's not to say these symptoms are always due to anxiety, or that anxiety as an emotion rather than a psychiatric diagnosis is a bad thing. "Anxiety is a normal part of the human experience and, in many ways, evolutionarily valuable, helping us to survive and thrive" by keeping us alert to potential dangers, explains Dr. Zachary Kelm, an osteopathic psychiatry resident at Ohio State University in Columbus.
But anxiety disorders can disrupt your daily life. Lawrence Needleman, a psychologist at the Ohio State University Wexner Medical Center in Columbus, says "anxiety, when extreme, can be extremely debilitating. It can contribute to job and relationship loss, poor health, social isolation and depression. For example, people with agoraphobia, OCD (obsessive-compulsive disorder) or PTSD (post-traumatic stress disorder) might be afraid to leave their home or will only do so with a safe person."
Gelbart agrees that sometimes, anxiety can be really problematic. "People with anxiety disorders avoid activities, avoid people and gatherings, cannot function at school or work and are very misunderstood by those around them."
Anxiety Is Treatable
Despite these challenges and anxiety's prevalence, "the good news is that anxiety is the most treatable mental health disorder," Gelbart says. "The general goal is to help a person change their negative, irrational thinking and replace it with rational thought. It's important to identify catastrophic thinking and to adjust it; to learn to live in the present instead of the future or past; and to control the things you can and let go of things you have no control of."
Treatment can be highly effective and may include cognitive behavioral therapy and medication, Needleman adds.
The first step is recognizing that you have anxiety, and for that, you need to understand the symptoms of anxiety. While panic attacks and episodes of very intense anxiety might be instantly identifiable as being associated with an anxiety disorder, there can be a lot of other subtler symptoms.
Symptoms of Anxiety
Here are some of those lesser-known signs that what you're experiencing may, in fact, be more than run-of-the-mill nervousness:
Even though she's learned how to expertly manage her anxiety, Genova still catches herself clenching her jaw, neck and other muscles – a common experience for people with anxiety whose bodies are trying to prepare them to take on a perceived threat.
"I'm always gripping the steering wheel – I have sore muscles, I can feel it," says Genova, who wears a mouth guard at night to help treat her anxiety-aggravated temporomandibular joint disorder.
People with anxiety can also experience muscle twitching or weakness for the same reason: Their muscles are recovering from the tension, Hallett explains. Outside of practical solutions like mouth guards when necessary, becoming aware that you're tensing is key to combating this symptom and anxiety in general, Genova says. Exercises like yoga can also be helpful to ease anxiety-related sore, tight muscles, she finds.
If the idea of chilling out stresses you out, you may have an anxiety disorder. "When I'm trying to get in relax mode and watch TV, it's hard," says Genova, who also catches herself clenching her teeth in that situation.
"Relaxing" – like sleeping – can be tough for people with anxiety since the lack of cognitive distraction can free up their minds to ruminate, which only reinforces those negative thought patterns.
"If I'm ruminating or worrying because I'm anxious about something, what I'm literally doing is increasing the speed and accessibility of that particular anxiety pathway," Hallett says. That's why anxiety treatment often involves practice recognizing and replacing those negative thought patterns with less-threatening ones.
When Genova, for one, feels anxiety symptoms coming on, she may tell herself, "I recognize this is anxiety, my body is trying to protect me, but I've experienced this before and it's not going to harm me."
Yawning can be triggered by plenty of things including, of course, a poor night's sleep. And a poor night's sleep can be caused by anxiety. "Anxiety causes the mind to race, often leading to sleepless nights. Then, not getting enough sleep can exacerbate the [daytime] symptoms," Mason says.
But anxiety-related yawning can also be unrelated to sleep: "Yawning is one of the body's relaxation methods to go the other way from the physiological stress response," Hallett says. She recommends people with anxiety practice "square breathing," or breathing in for four counts, holding for four, exhaling for four and holding for four.
During each four count, "draw" one side of a square – your finger making the shape on your leg or a table will do – to occupy your mind just enough to center you, suggests Hallett, who also endorses the free app Breathe2Relax for folks who want a digital tool to guide them through deep breathing relaxation techniques.
Kelm says some research suggests when patients show up to the hospital or doctor's office with dizziness, up to 15% of them may have a psychiatric disorder – particularly an anxiety disorder.
That may be because the areas of the brain that cause anxiety tell the vestibular system – the system that senses where your body is in space – that something is wrong, and dizziness results to try to "correct" your perceived ill-positioning, the American Physical Therapy Association's Section on Neurology reports.
In addition to other anxiety management techniques like cognitive behavioral therapy and breath work, support groups can help with this symptom, which is often brought on in social situations like public speaking, finds Genova, who's been running anxiety support groups for years.
"You need to be facing your fear," she says. "Being in front of a small audience (helps), and you're also working on it together."
While facing your feats can increase anxiety in the short term, it can help you "have less anxiety in the future," Needleman says.
"Anxiety is usually tied to stress, which can affect the digestive system," Mason says. That's because when anticipating a threat, your body can't be bothered with digesting food. That's why conditions like dry mouth, irritable bowel syndrome, loss of appetite, nausea, bloating and bellyaches can all be related to anxiety.
As with all symptoms of anxiety, it's important to identify and treat any serious medical conditions anxiety may or may not be related to before assuming they can all be chalked up to anxiety.
But if anxiety seems to at least play a role in some of your life-disrupting symptoms, Mason recommends exercise, meditation and trying to find joy in activities you used to enjoy – say, reading a good book or calling an old friend.
She also encourages people to work on eliminating the stressors that may be causing the anxiety in the first place, be that ending a toxic relationship or setting boundaries at work. "These are all good first steps," she says, "and then other treatment options, like medication, can be considered."
If you find that you're misplacing your keys all the time or having trouble remembering important tasks and responsibilities, it could be related to anxiety, Lovell says. Many people "don't realize how much stress can impact cognitive function and decision making."
This can make it difficult to remember all the little things we have to do each day, from which internet passwords to use on which site to when to pick up the kids from school.
What to Do if You're Struggling
If you find that you're struggling with anxiety, know that help is available. Needleman says in addition to working with a mental health professional for targeted treatment, you can also make lifestyle changes to help ease anxiety including:
Gelbart adds that "meditation and mindfulness are excellent ways to calm down, and with today's technological advances, many mindfulness apps are available at very low cost, with excellent results. Engaging in this type of meditation/mindfulness has proven to be extremely helpful in coping with anxiety."