Anxiety Overview^[condition] and NIH Women's Health Research

Anxiety is a normal response to stress that is characterized by feelings of fear, worry, or uneasiness, but it becomes a disorder when these feelings are excessive, persistent, and interfere with daily functioning.¹ Anxiety disorders encompass several conditions, including generalized anxiety disorder, panic disorder, social anxiety disorder, and phobias. These conditions all involve excessive fear or worry that is disproportionate to actual circumstances, but they manifest in distinct ways:^{2 - 6}

• Generalized anxiety disorder involves pervasive, disproportionate worry about routine aspects of daily life, such as health, finances, work, or family matters.
• Panic disorder is characterized by abrupt episodes of overwhelming fear that arise in the absence of any real threat and a persistent fear of future panic attacks.
• Social anxiety disorders manifest as intense worry or fear about engaging in social situations, such as speaking in public or meeting new people.
• Phobias are characterized by intense, irrational fears triggered by objects or situations that pose little to no actual danger.

Other features of anxiety disorders include restlessness, difficulty concentrating, muscle tension, irritability, sleep disturbances, and physical symptoms such as a rapid heartbeat or nausea.^{1 , 2 , 5} These disorders often coexist with other mental or physical health disorders, such as depression, chronic pain syndrome, and eating disorders.^{3 , 4 , 6 - 9} They are also associated with alcohol use disorder and other substance use disorders.^{6 - 8}

The causes of anxiety disorders are multifactorial, involving interactions among genetics, hormones, brain biology and chemistry, stress, and environmental influences.^{2 , 4 , 10} Risk factors include a family history of anxiety or other mental disorders, traumatic experiences in childhood or adulthood, certain personality traits such as shyness, and underlying physical conditions such as thyroid problems.^{2 , 4 , 5} Environmental stressors, including adverse social factors or life events, may further contribute to symptom onset.^{10 , 11}

About one-third of U.S. adolescents and adults experience an anxiety disorder at some point in their lives,³ with women facing more than double the lifetime risk compared with men.^{4 , 5 , 12} Several biological and social factors contribute to this heightened vulnerability. Hormonal fluctuations across the menstrual cycle, pregnancy, and the postpartum period can precipitate or worsen anxiety disorders.^{4 , 10 , 13 - 15} Anxiety during pregnancy and the postpartum period presents unique risks, with untreated symptoms potentially impacting both maternal and child health.^{5 , 14} In addition, complications during pregnancy, childbirth, and the neonatal period can significantly increase the risk of perinatal anxiety.¹⁶ Menopause can also increase the risk of anxiety, possibly due to estrogen fluctuations, which can affect serotonin and gamma-aminobutyric acid signaling.¹¹ Perimenopausal symptoms, such as hot flashes and insomnia, can also increase stress and intensify anxiety symptoms.¹⁵ Additionally, women may disproportionately experience stressors, such as sexual abuse, that contribute to anxiety disorders, and they tend to demonstrate coping or cognitive patterns that are oriented toward rumination and worry.^{10 , 15}

Diagnosing anxiety disorders typically involves clinical evaluation, including an assessment of symptoms, medical history, and, when needed, physical exams to rule out other causes.^{2 , 4} Treatment often includes psychotherapy, especially cognitive behavioral therapy; medications, such as selective serotonin reuptake inhibitors or beta blockers; or a combination of both.^{2 , 4} Stress management techniques, such as exercise, yoga, music-based interventions, and mindfulness-based meditation, may also be helpful for anxiety disorders.^{4 , 7 , 17} Because managing mental health during pregnancy and lactation requires carefully weighing the potential risks of treatment against the risks of untreated conditions, pregnant and lactating women should seek guidance from a health care provider regarding treatment options.^{5 , 15} While many individuals achieve substantial improvement with appropriate care, anxiety disorders may recur over time.⁴

Ongoing research supported by the National Institute of Mental Health (NIMH) is investigating genetic, environmental, and developmental contributors to anxiety disorders.³ This research is also identifying the neuropsychological and cognitive mechanisms that underly anxiety disorders and the associated treatment targets; examining rates and symptoms of anxiety disorders after major life events, such as pregnancy or illness; and optimizing therapeutic interventions and treatments to improve outcomes. Because women experience anxiety at a higher rate than men, researchers are also studying how hormonal influences—especially the roles of estrogen changes and testosterone—and risk factors related to pregnancy and body weight affect the onset and exacerbation of anxiety.^{4 , 13 , 15 , 18} In addition, there is a pressing need for more rigorous and coordinated research on optimal anxiety treatments for women, especially during pregnancy and the postpartum period, and methods to increase access to those interventions.^{13 - 15} Complementary health approaches, such as yoga and meditation, as well as nutrition interventions for managing anxiety, also deserve further study.^{17 , 19}

The NIMH-funded Happy Mother–Healthy Baby clinical trial, which was conducted in Pakistan, investigated the efficacy of an early prenatal preventive intervention on the risk of postnatal major depression or generalized anxiety disorder. Developed with input from pregnant women in Pakistan, the intervention was a tailored form of cognitive behavioral therapy that was administered by nonspecialized providers to pregnant women with anxiety. The intervention reduced the risk of developing anxiety at 6 weeks postpartum by 74%.²⁰ Building on these findings, researchers are now working to identify optimal strategies for implementing the intervention and expanding its availability to the women who need it most.