How to recognise the signs of anxiety

Almost nobody arrives at the first consultation saying “I think I have anxiety”. People come because they no longer sleep, because their heart beats too fast, because they went to the cardiologist and nothing was found. Anxiety shows up in the body first, and it is the body that sends us to the doctor.

The signs that appear in the body

These are the most common reasons people end up with other specialists first:

• Palpitations or the feeling that the heart beats irregularly, especially in the evening
• A lump in the throat or difficulty breathing deeply
• Tension in the shoulders and jaw, headaches that do not respond to painkillers
• Digestive problems without an identified cause
• Sweating, trembling, dizziness

When medical investigations find nothing, it does not mean the symptoms are imagined. It means they have another cause.

The signs that appear in thinking

Here things get harder to notice, because they seem to be just “the way you are”:

• You constantly anticipate what could go wrong
• You replay conversations that ended long ago
• You find it hard to concentrate because your mind jumps from one scenario to another
• You postpone decisions for fear of choosing wrongly
• You repeatedly ask the people around you for reassurance

The signs that appear in behaviour

The most important signal is avoidance. It starts discreetly: you skip an event with lots of people, you take a detour when driving, you turn down a presentation at work. Every avoidance brings immediate relief, but strengthens the mechanism: next time it will be even harder.

Anxiety is not cured by avoiding the situations that trigger it. That is exactly how it is maintained.

When to ask for help

There is no threshold of suffering above which you “deserve” an appointment. But there are a few situations in which waiting costs more than the consultation:

• The symptoms have lasted more than a month and show no sign of improving
• You have started avoiding situations that used to be natural for you
• You use alcohol or other substances to calm down
• Your sleep has broken down and does not recover even at the weekend
• The people close to you noticed the change before you did

What happens at the first consultation

We talk about what you are experiencing, since when and in what context. We rule out the medical causes that can mimic anxiety: the thyroid, anaemia, certain medications. Only then do we establish whether you need psychotherapy, treatment or both.

Anxiety is one of the conditions with the best treatment outcomes. Most people feel a difference within the first few weeks.