Severe anxiety symptoms: what bad anxiety looks like, and what to do right now

Everyone feels anxious sometimes. But severe anxiety is different. It’s there when you wake and when you try to sleep. It makes eating, working and leaving the house feel impossible. It can feel like you’re drowning.

If that’s where you are, here’s what severe anxiety looks like, what to do right now, and how to get the help that works.

Get help right away if you’re thinking about ending your life (call or text 988 in the US), or if you have chest pain that spreads to your arm, jaw, neck or back, severe trouble breathing, or you faint (call 911).

What severe anxiety looks like

In your mind

• constant worry or dread that you can’t switch off
• feeling something terrible is about to happen
• racing thoughts, or your mind going blank
• being unable to concentrate on anything
• feeling detached, unreal or “not there”
• hopelessness, or feeling you can’t go on like this

In your body

• frequent or back-to-back panic attacks
• a racing heart, chest tightness or pain
• breathlessness or feeling you can’t breathe
• shaking, sweating, dizziness
• nausea, vomiting or diarrhoea
• exhaustion, but unable to sleep

In your life

• unable to work, study or look after yourself
• not eating, or eating very little
• avoiding more and more places and people
• relying on alcohol or other drugs to cope
• being unable to be alone, or unable to be with people

On the GAD-7, the questionnaire many doctors use, a score of 15 to 21 out of 21 falls in the severe range.

Right now: getting through the next hour

1. Get someone with you, in person or on the phone, if you can.
2. Breathe out slowly. In through your nose for 4, out through your mouth for 6. Keep going for a few minutes.
3. Ground yourself. Press your feet into the floor. Name 5 things you can see, 4 you can feel, 3 you can hear.
4. Use cold. Splash cold water on your face or hold something cold. Skip this if you have a heart condition.
5. Sip water and, if you can, eat something small.
6. Let the wave pass. Remind yourself: “This is anxiety. It’s awful, but it will ease.” Panic attacks peak within about 10 minutes.
7. Make one call: to your doctor, a crisis line or someone you trust.

When it needs urgent help

Call 911 (or your local emergency number) if:

• you have chest pain that spreads, severe breathlessness or you faint
• you’re thinking about harming yourself and feel you might act on it
• you’re having seizures, severe confusion or seeing or hearing things that aren’t there

Call or text 988 (US) if you’re in crisis or thinking about ending your life.

Get medical help the same day if:

• you haven’t been able to eat or drink properly for a day or more
• you’re stopping or cutting down alcohol, sleeping pills or anti-anxiety medicines and your anxiety has become severe
• anxiety has suddenly become much worse, or feels different

Causes to rule out

Some things can cause or worsen severe anxiety, and need medical attention:

• Alcohol withdrawal. MedlinePlus lists anxiety, shakiness, sweating and insomnia among the symptoms, usually starting within 8 hours of the last drink and peaking in 24 to 72 hours. It can become dangerous, with seizures, fever, severe confusion or hallucinations. Don’t stop heavy drinking suddenly without medical advice.
• Stopping sedatives or benzodiazepines suddenly, which can also be dangerous. Talk to your doctor about reducing them safely.
• Stimulants, like high amounts of caffeine, energy drinks or some medicines and drugs.
• Medical conditions, like an overactive thyroid or heart rhythm problems.

Getting help that works

Severe anxiety usually needs more than self-help. Tell your doctor clearly: “My anxiety is severe and it’s stopping me from living my life.” Options include:

• Cognitive behavioural therapy (CBT), the most researched treatment for anxiety
• Medicine, often an SSRI or SNRI, which can take a few weeks to work
• Both together, which helps many people most
• More intensive support, like specialist mental health services, if anxiety is very severe or you’re not safe

Our post on anxiety therapy explains how to find the right help.

Frequently asked questions

What is severe anxiety?

Anxiety that’s intense, constant and gets in the way of daily life, like working, eating, sleeping or leaving the house. On the GAD-7 questionnaire, a score of 15 or more is in the severe range.

Can severe anxiety make you physically ill?

It can cause real physical symptoms, like vomiting, diarrhoea, chest pain, exhaustion and weight loss from not eating. It’s important to get these checked, both to rule out other causes and to get support for the anxiety.

Should I go to the ER for severe anxiety?

Go if you have chest pain that spreads, severe breathlessness, fainting, or you’re not safe from harming yourself. You can also go if you’re in crisis and can’t get other help. Otherwise, contact your doctor urgently or call or text 988.

Can severe anxiety be cured?

Many people recover fully, and most improve a great deal with treatment. Severe anxiety often responds well to CBT, medicine or both.

How Breatheasy can help

When anxiety is at its worst, Breatheasy gives you something to hold on to. Tap “I’m feeling anxious” and Luma walks you through it: rate how strong it feels, breathe slowly as your phone pulses gently, ground yourself with 5-4-3-2-1, then see how far the anxiety came down. Crisis help and your emergency contact are always one tap away. A two-week anxiety check using the GAD-7 helps you and your doctor track how you’re doing. Breatheasy can’t replace urgent care: if you’re not safe, call 988 or 911. Breatheasy is coming soon to iPhone and Android.

Sources

• A brief measure for assessing generalized anxiety disorder: the GAD-7, Spitzer and others, Archives of Internal Medicine, 2006
• Alcohol withdrawal, MedlinePlus, US National Library of Medicine
• Generalised anxiety disorder in adults, NHS
• Panic disorder, NHS
• Anxiety disorders, National Institute of Mental Health
• 988 Suicide and Crisis Lifeline