Stress Vs. Anxiety: How to Tell the Difference and Why it Matters?

Stress and Anxiety: What's the Difference?

Both stress and anxiety are the body's responses to threats. Stress is the body's response to the perceived or actual emotional or physical stressors, e.g., financial concerns, relationship issues and excessive workload. It is a short-term reaction to a particular event or a situation and helps the individuals to cope with the stress and challenge. On the other hand, anxiety is a prolonged state of excessive worrying and uneasiness without any visible or clear cause. It is mostly due to over-thinking the actual or perceived future threats and causes fear and apprehension. Anxiety is a chronic condition not linked to any particular stressor and triggers and interferes with daily functioning.

The stress causes symptoms, e.g., urgency, poor concentration, irritability, muscular tension and increased heart rate. Symptoms of anxiety are more generalised, e.g., a constant fear of dread or doom, sleeping issues, fatigue, muscular tension, excessive worrying and restlessness. Despite many similarities, there are various key differences in both. Stress is typically a short-lived response, and the symptoms last as long as the stressor is there. The symptoms are easily attributable to a known stressor, even in the case of chronic stress. On the other hand, anxiety is a chronic state of uneasiness and apprehension that sometimes occurs without known stressors. 

Stress is not always harmful and is often motivating and results in better performance, particularly if healthy coping mechanisms are developed. The anxiety only impairs various functional and emotional aspects of life. The acute stress is over as soon as the cause is removed. Symptoms of anxiety persist for a long time as there is no defined cause. The treatment and management are different. Although both conditions improve with medications, relaxation techniques and management, anxiety is deeply rooted and needs more specialised treatment and care. Understanding the similarities and differences between stress and anxiety is important for better awareness, effective management and prevention and improving performance and productivity.  

What is Stress?

Stress is defined in many ways. The World Health Organization (WHO) defines it as a state of mental tension and worries experienced due to a difficult situation. It is a natural and normal response to stressful events that allows a person to cope with the challenge. It is a problem only when a person is unable to cope with the stress, and it becomes a chronic challenge. It is a state of worry that develops in response to everyday pressures and stresses according to the Cambridge Dictionary. It becomes unhealthy only when it begins to disturb the normal functioning of life. Chronic stress results in negative changes experienced in all body systems. 

It is a very common phenomenon. 74% of the adults in the UK in 2018 experienced being overwhelmed by stress in the last year, while 32% experienced suicidal thoughts, according to the Mental Health Foundation. 

How does stress work?

Stress involves complex psychological and physiological interactions among different organs and systems, impacting mental and physical health. The working mechanism of stress is explained by Brianna Chu and co-workers at Campbell University and Touro University as follows; 

Stress perception: The stress starts with identifying causative agents known as stressors. The stressors are either actual or perceived and present inside or outside the body. An example of a physical stressor is experiencing or witnessing a car accident, and an example of a psychological stressor is preparing for a job interview. The limbic system of the brain is involved in the perception of stress. The five senses help in the task. 

Activation of hypothalamus-pituitary axis (HPA): The body initiates a fight or flight mechanism in response to stress. The brain sends signals to the hypothalamus, which secretes chemicals that work on the pituitary gland to release chemicals that work on the adrenal gland situated on the kidneys.

Production of dress hormones: The adrenal gland primarily secretes two stress hormones: adrenaline and Cortisol. Cortisol levels as many as 9 times in stressful situations. Both hormones prepare the body for stressful situations by increasing physical readiness and alertness. 

Physiological responses: Both stress hormones induce various changes in the body, e.g., increased muscular tension, higher blood pressure, higher respiration rate and rapid heartbeat. The body mobilises its energy reserves to be used in stressful situations.

Increased energy metabolism: The stress hormones cause the mobilisation of energy reserves in the body. The first reserve to be mobilised is the glycogen stored in the liver. The liver converts it into glucose and releases it into the bloodstream. The glucose is converted into energy and is used by the body to respond better to the stresses. 

Suppression of leisure activities: The leisure activities, e.g., reproductive functions, digestion and immune functions, are not needed in an emergency. The body suppresses such activities to allocate all available resources to the fight-and-flight response.

Emotional and psychological responses: Stress affects cognitive and behavioural functions. It results in anger, fear and anxiety and causes poor concentration and decision-making. 

End of stress response: Once the actual or perceived threats are over, the body reverts to the initial position. The parasympathetic nervous system is activated, causing lower blood pressure, heart rate and lower levels of stress hormones. In the case of chronic and prolonged stress, the stress response persists for a long time. It is detrimental to physical and psychological health and results in poor immunity, high risk of infections, anxiety disorders, depression and increased risk of cardiovascular diseases. 

What are the Causes of Stress?

Stress is a response to physical or psychological factors known as triggers. The triggers are different for different people. Some common causes of stress are;

Workplace stressors: Many surveys at the London School of Medicine and Dentistry and BPP University London have noted that issues related to the workplace are among the major causes. Some related factors that cause stress are being unhappy with the nature of the job, having high responsibilities or too high workload, very long working hours, poor top management, unrealistic expectations from the top management, harmful or dangerous working conditions, job insecurity, always working under the risk of termination, dim prospect of future growth, low wages, nature of the job, e.g., jobs involving engaging a large crowd, facing harassment or discrimination at the workplace and non-supportive attitudes of the top management. 

Daily life stressors: A lot of daily life stresses have a role. They include a loss in business or loss of job, divorce or relationship break-up, death of a loved one, financial pressure and high financial obligations, shifting to a new home or a new area, emotional issues e.g., low self-esteem, low self-worth, guilt, anger, anxiety and depression, getting married, having chronic injury or illness, having a sick or elderly family member that needs special care and experiencing traumatic events e.g., rape, theft, natural disaster or violence against self or the loved ones.

Sometimes, the cause of stress is not outside but the psychological factors inside the body. Some important psychological factors are; 

Uncertainty and fear: The uncertainty and fear associated with issues like ingestion of toxins, working in an environment having dangerous chemicals, global warming, terrorist attacks and economic meltdown results in stress. Chronic stress leads to anxiety disorders as a person feels powerless over such events. Natural disasters are rare events. However, their extensive media coverage spread fear and panic. Some other issues are fear that a person cannot meet the monthly expenses or fear that a person cannot complete a given project. 

Perceptions and attitudes: Stress depends on how a person views a situation or the world. For example, robbery attracts two types of responses. Some people think that it's okay and insurance companies are going to pay, while others think that they are not going to recover from the loss and experience stress. Likewise, a person who thinks himself competent is less stressed and enthusiastic about the incoming project than someone who is not confident and sure about his performance. 

Unrealistic expectations: Expecting everything to be right always results in stress. Likewise, some people harbour unrealistic expectations from their co-workers or staff and get stressed when the expectations are frustrated. 

Inability to cope with the change: Some people find it challenging to adjust events to happy events, e.g. job promotions or weddings. The unpleasant events, e.g., the death of a family member or friend, a major financial setback, loss of employment and divorce, are too hard to be handled by such people. 

Financial strains: Financial issues, e.g., having a large debt, facing unexpected expenses, and failing to meet financial obligations, are major sources of stress for financially active people. The economic recession and downturns cause anxiety and stress in the business class.

Relationship issues and family conflicts: The family conflicts with the spouse, children, and parents are emotionally taxing. Relationship breaks and divorces are among the major stressors. Such situations cause a person to experience a lack of social support and social isolation. 

Health issues: Disease and death are normal experiences of life. However, dealing with a chronic illness or experiencing a close person undergoing such agonies is troublesome. Likewise, managing a chronic health condition, e.g., diabetes and hypertension, becomes a source of stress. Experiencing accidents and injuries causes emotional and physical stress.

Cultural and social factors: Experiencing prejudices, discriminatory attitudes, being subjected to unbearable cultural and religious expectations, and facing social pressure on certain issues result in stress. It particularly happens if the personal beliefs or values conflict with the social norms and values. For example, transgender and other people with sexual orientation problems experience prejudices and societal pressures in traditional societies. 

Environmental factors: Industrialisation, pollution, urbanisation, and climate change have added many new factors to the list. Living in an unsafe, polluted and noisy area is stressful. The other factors, e.g., natural disasters and extreme weather conditions, are among other causes, particularly for the farming community, which is more linked to the climate and soil.

Can Stress cause anxiety?

Yes, stress causes or exacerbates the already present anxiety. Both are closely linked conditions, and one triggers or worsens the other. The studies have noted that the prevalence of both conditions is nearly the same, and both often exist as co-morbidities. The physiological response in both situations is the same, i.e., the release of adrenaline and Cortisol. 

Persistent or chronic stress causes generalised anxiety disorder (GAD) or exacerbates it if already present. Chronic stress sensitises the mind and body to stressful situations and makes the body more prone to such situations in future, leading to anxiety. Continuously experiencing stressful situations reduces a person's ability to cope, which is essential for preventing the stress from changing into anxiety. Chronic stress results in sleep disturbances, which cause feelings of anxiety.

What are the Signs and Symptoms of Stress?

Stress causes both physical and psychological signs. The intensity and duration of signs vary from person to person. The signs of stress are categorised into two types: physical and psychological. 

Physical signs

Stress causes several physical signs, e.g., 

Muscle pain and tension: One common physical sign of stress is muscle tension and pain. Stress causes tension and pain in the back, shoulder and neck muscles. Such pains result in stiffness, headaches and aches. 

Digestive signs: Stress affects the digestive system, causing signs, e.g., constipation, diarrhoea, nausea, indigestion and stomach ache.

Sleep disturbances: Stress disturbs the sleep cycle, causing issues, e.g., difficulty falling asleep, frequent wakeups during the night and insomnia.

Appetite changes: Stress influences appetite, resulting in loss or excessive appetite in unhealthy food cravings. The appetite changes ultimately result in changes in body weight. Stress causes the release of dopamine, which increases appetite and results in weight gain. 

Fatigue: A person with chronic stress experiences fatigue even after a full night's sleep. It is due to the physical tensions and disturbances of sleep patterns.

Rapid heartbeat: The stressful situations cause palpitations and a rapid heartbeat. It is an attempt by the body to increase the blood flow towards the vital organs. 

High frequency of illnesses: Stress, particularly chronic ones, causes progressive immune system weakening. It makes people more prone to common issues, e.g., infections and colds.

Skin problems: Stress and the resulting immune weakness exacerbate the skin conditions, e.g., psoriasis, eczema and acne. 

Shallow breathing: Stress causes rapid and shallow breathing, creating anxiety and tension. 

Psychological symptoms

Besides the physical symptoms, there are many psychological and emotional symptoms, e.g., 

1. Irritability: Excessive stress causes impatience, mood swings and irritability, which becomes problematic for the people around the patient. 
2. Depression: Prolonged high-stress levels cause signs of depression, e.g., low energy, hopelessness and sadness. Chronic depression is difficult to treat. 
3. Anxiety: Chronic and long-term stress leads to anxiety symptoms, e.g., uneasiness, restlessness, and fear of impending doom. 
4. Cognitive impairments: Stress negatively influences cognitive functions, causing issues like loss of concentration, poor decision making and forgetfulness. 
5. Social withdrawal: Stressed people tend to withdraw from social situations and gatherings, leading to more severe signs and social isolation.
6. Emotional reactions: The stress, particularly chronic ones, causes heightened emotional reactions, e.g., tearfulness, frustration and anger. 
7. Negative thoughts: Stress debates self-worth and self-esteem, resulting in pessimism, self-criticism and negative thoughts. 
8. Feeling overwhelmed: Chronic stress causes a person to become overwhelmed and unable to manage routine life responsibilities. 
9. Loss of interest in life: A stressed person loses interest in hobbies and other activities that were once very enjoyable.

Behavioural signs

Some behavioural signs associated with stress are;

1. Substance and drug abuse: Some people resort to unhealthy coping mechanisms to cope with stress, e.g., substance use, drinking and drug abuse. 
2. Procrastination: Stress causes people to hide from the situation. People tend to delay or hide from the tasks they find stressful. 
3. Teeth grinding and nail-biting: Stress causes poor habits, e.g., teeth grinding (bruxism) or nail biting in some people. 
4. Social isolation: Stressed people often isolate themselves from social events and gatherings, resulting in social isolation.
5. Changing sleep patterns: The stress disturbs sleep patterns, leading to insomnia or oversleeping. 
6. Restlessness: Facing difficulty sitting and experiencing restlessness are common signs of stress.

What are the Treatments for Stress?

Various treatments are available for stress. Stress management must address both the body and mind, as both mind and body are involved in stress. First, the healthcare providers use psychological and alternative treatments. The medications are used if the psychological and alternative treatments are ineffective or to supplement the psychological treatments. Common treatment options are; 

Mindfulness and meditation-based techniques: Meditation and mindfulness-based stress reduction (MBSR) involve techniques that help manage depression and stress. Meditation is a centuries-old technique that allows a person to reach a relaxed state of mind by focusing on breathing and paying attention to the body. The MBSR relies on the principle of meditation to make people get rid of negative feelings. The benefits of MBSR are reduced worrying and stress, better focus and sharp memory, lower frequency of emotional ups and downs, better emotional resilience and better relationships. 

Talk therapy: Talking to an experienced professional is a way to manage stress and control thoughts and emotions better. Talk therapy is recommended if the stress is causing various other mental health issues. Many types of talking therapies are available, e.g., cognitive behavioural therapy (CBT), psychoanalytic therapy, humanistic therapy, dialectical behaviour therapy (DBT), interpersonal therapy (IPT), psychodynamic therapy, gestalt therapy, family therapy, group therapy, existential therapy, solution-focused brief therapy (SFBT), art therapy and animal assistant therapy. The choice of therapy depends upon signs and professional recommendations. The CBT is described below.

Cognitive behavioural therapy (CBT): CBT is a talk therapy that focuses on questioning and pinpointing the negative and mistaken thoughts associated with mental health problems, e.g., stress and anxiety. Some experts combine CBT with medications, and research supports the benefits of combined use. However, research in 2019 noted that a combination of medications and CBT is no more effective than CBT alone. CBT uses different techniques, e.g., cognitive reframing or restructuring, exposure therapy, guided discovery, thought records and journaling, behavioural experiments, etc. All such techniques are safe and are associated with no side effects. Sometimes, a motivated person is able to self-practice such techniques. 

Acupuncture: It is an old Chinese practice in which fine needles are used to stimulate the immune and nervous systems. During the process, a licensed acupuncturist inserts very fine needles at specific points in the body, known as the acupoints. If performed correctly, it is a painless technique, and there is evidence that it aids the traditional treatments of stress, anxiety, digestive disorders and chronic pain.  Some experts have found it to be practically effective for insomnia. 

Massage: Massage is a part of Asian culture and has shown benefits in treating different stress-related disorders, e.g., insomnia and anxiety. Adding various massage treats to the routine is very effective for different types of stress. The massage techniques effective in relieving stress are Swedish, deep tissue, Shiatsu, hot stone, Thai, and reflexology. All types of massages are not good for all people, and it is essential to talk to the doctor.

Aromatherapy: It is a complementary therapy which uses aromatic plant-based essential oils to promote psychological and physical well-being. Although not a substitute for medical therapy, there is proof that it helps manage stress symptoms. It involves inhaling aromas of different essential oils, which activate the olfactory system, which is further linked to the limbic system associated with regulating stress responses and emotions. A clinical review by Ashley J. Farrar (Mayo Clinic Hospital, USA) has found that it causes a relaxation response, lowers the levels of stress hormones, improves sleep and has a placebo effect.

Hypnotherapy: Hypnotherapy involves guiding people in a deeply focused and relaxed state of consciousness known as a hypnotic or trance state. In the hypnotic state, the hypnotism therapist helps the patients to address and explore the causes of stress. A person in the trans-state is able to access the subconscious mind where memories and emotions are stored and are more open to suggestions. The therapists use relaxation techniques, e.g., positive suggestions and imagery, to help individuals refrain from negative thoughts, develop healthy coping mechanisms and reduce anxiety. 

Meditation and yoga: Both meditation and yoga are useful mindfulness techniques that help reduce stress by various mechanisms, e.g., by improving mind-body connection, causing relaxation response, reducing stress, improving cognitive functions, better emotional regulation, improving sleep, allowing better self-care and by equipping with healthier coping mechanisms. Incorporating yoga and meditation into daily routine is a useful stress management technique. 

Herbal treatments: The demand for herbal treatments and products is increasing as they are free from the side effects of traditional medicines and don't need time, as in the case of psychological therapies. Some herbs known to reduce stress are; 

Ashwagandha: It is a member of the adaptogen group of herbs that influences the stress response. Using Ashwagandha extract, liquid tincture, or tablets reduces Cortisol levels and improves sleep. 

Chamomile: It is a flowering herb. Two available forms are German chamomile and Roman chamomile. It is used as a skin cream, extract, tablet or tea. The research has found that it reduces the symptoms of generalized anxiety disorder (GAD). It, however, interacts with various medicines, and the people using Medications must consult the doctor.

Valerian: It is a plant native to Asia and Europe. Its root is used in traditional medicine to treat depression, anxiety and sleeping problems. It is generally safe. However, the safety information for children and pregnant women is not established, and such people must use it cautiously. 

Galphimia glauca: It is a herb found in Mexico. The local people were using it to reduce anxiety and stress. It is useful for treating anxiety, but sufficient data is unavailable.  

Lavender: It belongs to the mint family of flowering plants. It is used to alleviate anxiety and calm the nerves. It is used as an essential oil or as tea. Lavender essential oil is rich in terpenes, which the studies have found that have calming effects on different chemical receptors in the brain. Its benefits for short-term treatment of anxiety are known, but long-term effects are little understood. 

Passionflower: It is a family of herbs containing more than 500 plant species. Some species, e.g., P. incarnata, are useful to treat anxiety, nervousness and restlessness. It is taken in the form of liquid tincture or tablet. 

Cannabidiol: It is among the active ingredients of the Cannabis plant, and various studies have found that it has a calming effect on the nervous system. Some evidence suggests that it is beneficial for anxiety-related disorders. It is available in topical creams, vape liquids, liquid extracts and tablets. 

Kava Kava: It is native to different Pacific islands, and there are reports that it helps treat anxiety and stress. Some reports suggest it causes liver damage and must be used after consulting a professional. 

Miscellaneous supplements: Other supplements that reduce anxiety and stress are magnesium, vitamin C and essential fatty acids. Such supplements must be used after consultation with the nutritionist. 

Medications: The medications do not treat the underlying cause but only help manage the signs and symptoms. The doctors prescribe various types of medications, e.g., mild tranquillizers or sleeping pills, e.g., alprazolam (Xanax), diazepam (Valium) and lorazepam (Ativan) that help treat the sleeping issues, and antidepressants (e.g., SSRIs and SNRIs) that help treat signs of depression. The medicines are prescribed to treat stress complications, e.g., hypertension and irritable bowel syndrome (IBS). 

What is Anxiety?

Anxiety is an emotional disorder characterized by worried thoughts, feelings of tension and physical signs like hypertension, rapid heartbeat, shallow breathing, shaking and trembling, sweating, muscle tension, fatigue, gastrointestinal upsets, headaches and sleep disturbances. Merriam-Webster medical dictionary defines it as anxiousness, nervousness and uneasiness about an anticipated or impending I'll. People with anxiety disorders experience intrusive and recurrent concerns and thoughts and tend to avoid certain situations out of worry. Just like stress is the body's response to stressors, anxiety is the body's response to stress. 

It is a feeling of apprehension or fear about what is going to happen. Experiencing anxiety is normal, but the symptoms lasting for more than 6 months disturb life, leading to anxiety disorders, e.g., phobias, panic disorders, social anxiety disorder, obsessive-compulsive disorder, illness anxiety disorder and separation anxiety disorder. Anxiety is a symptom of many other psychological disorders, e.g., chronic diseases, posttraumatic stress disorder (PTSD), major depressive disorders, chronic inflammatory conditions and pains and different substance abuse disorders. 

How does anxiety work?

Anxiety is a complex physiological and physiological response that occurs when a person feels apprehension about a future event or perceives a threat. It involves a variety of physical, emotional and cognitive responses. Different steps in the processing of anxiety are;

Threat perception: The start of anxiety is just like stress. However, exposure to multiple stresses over time sensitises the body to the stress, resulting in anxiety. The anxiety starts as a person perceives a real or imaginary threat. It is either physical (preparation for a public presentation or job interview) or psychological (worries about the future). 

Amygdala activation: Amygdala is a part of the brain that has a role in processing anxiety, fear and emotions. It is responsible for the processing of aggression and fear and the development of defensive behaviours. It develops fear and emotion-related memories (Elizabeth Martin, PhD, Emory University, USA). As soon as a person perceives a threat, the amygdala is activated. It activates the hypothalamus, which initiates a complex process to prepare the body for a fight-or-flight situation. 

Stress hormone release: The hypothalamus causes the activation of the sympathetic nervous system that causes the release of street hormones Cortisol and adrenaline. The stress hormones prepare the body for the coming situation. 

Physical responses: The elevated levels of stress hormones result in many physical signs, e.g., a state of alertness, muscle tension, sweating, increased heart rate and rapid breathing. Such changes enable the body to cope with stressful situations. The pupils of the eyes dilate to have a clear view of the danger.

Cognitive responses: Anxiety influences cognition, leading to signs, e.g., fear or feeling of impending doom, excessive worrying and racing thoughts. It results in poor decision-making and loss of or poor concentration. Poor cognition over some time results in a heightened state of emotions.

Emotional responses: Anxiety causes various emotions, e.g., uneasiness, apprehension and fear. Such emotional responses vary from person to person depending upon the individual situation and the intensity and duration of triggers. The exposure of triggers for a long time results in progressive degradation of the emotional responses.

Coping mechanisms: Ultimately, people resort to different coping mechanisms to handle anxiety. Some positive coping strategies are seeking medical or social support, practising different problem-solving skills, exercises and outings. The negative coping strategies are substance abuse and social avoidance. Resorting to negative strategies causes stress to persist and anxiety to develop. 

Feedback loop: Negative coping strategies trigger more stress, and the self-perpetuating cycle continuous, resulting in conditions like social anxiety disorder, panic disorder or generalised anxiety disorder (GAD). The causative factors involve various environmental issues, e.g., brain chemistry, traumas and genetic factors. 

What are the Causes of Anxiety?

The experience of anxiety is different for different people. So, it is difficult to determine the exact cause of anxiety, and many factors are involved. Some common factors are; 

1. Genetic factors: Recent research suggests that having a close relative with anxiety disorders increases the risk of experiencing anxiety and related disorders. Some genetic factors increase the risk of so-called 'anxiety sensitivity'. A researcher from Freiberg, Germany, found in 2002 that nearly 50% of variance in the anxiety factors is attributed to genetics. The exact evidence in the form of inheritance of certain anxiety-causing genes is not available. Identifying such causes is difficult as the behaviour is influenced by many factors learnt from the environment. 
2. Childhood or past experiences: Experiencing difficult situations in childhood, adulthood, and adolescence is a risk factor for anxiety and related conditions. Experiencing trauma and stress in the youth years has a bigger impact than such experiences in adulthood. Some experiences associated with anxiety are experiencing racism, being socially excluded or bullied, losing one or both parents, neglect and emotional and physical abuse. Carelessness or overprotective attitude of the parents is an important factor. 
3. Experiencing challenges in life: Some routine life issues that cause a person to experience anxiety are a gradual build-up of stress, exhaustion, uncertainty, experiencing a lot of life changes, pressures related to work or study, being unemployed or out of work for a long time, very long working hours, homelessness and other housing problems, financial strains, worries about the natural disasters or environment (eco-anxiety), grief due to the loss of a loved one, feeling isolated or lonely, disease outbreak e.g., during COVID-19 and being a subject of sexual violence and harassment. The bigger life changes are particularly associated with stress and anxiety. 
4. Problems related to mental and physical health: Many physical and mental health issues cause anxiety. These are having a life-threatening condition, e.g., cancer, hepatitis or liver failure, suffering from chronic illnesses, e.g., arthritis, gout, etc. and having mental health issues, e.g., depression. 
5. Medications and drugs: Anxiety is among the side effects of many commonly used medications and drugs, e.g., alcohol, psychotic medications and recreational drugs and the medications used for Parkinson's disease, thyroid diseases and seizures, and medications containing caffeine and corticosteroids.
6. Heart problems: Heart health problems, e.g. heart failure and coronary artery disease, are linked to an increased risk of anxiety. A 2016 research by Christopher M. Celano, M.D. and colleagues noted that the risk of GAD is higher in people diagnosed with heart failure (13%) and coronary artery disease (11%). The association between anxiety and heart disease is two-way. People experiencing anxiety disorders are at higher risk of heart disease and vice versa. Increased levels of stress hormones and the lower blood supply to the heart for a long time are the contributing factors. 
7. Weight loss supplements: Some over-the-counter weight loss supplements cause anxiety as a side effect. For example, St. John's Wort causes insomnia, and the green tea extract has a lot of caffeine, which increases alertness and reduces sleep. Likewise, Guarana, an ingredient in some diet products, has 4 times more caffeine than coffee beans. Ephedra, present in some products, increases heart rate and causes anxiety. Dietary supplements containing Ephedra have been banned in the USA since 2004. 
8. Thyroid diseases: The thyroid is a small gland in the neck that secretes thyroid hormones, which are important for energy levels and metabolism. The secretion of excessive thyroid hormones (hyperthyroidism) causes anxiety symptoms, e.g., a lack of sleep, heart palpitations, irritability and nervousness. The opposite condition, hypothyroidism, is linked to anxiety disorders too. So, a person with anxiety, neck swelling, heat intolerance, fatigue, and weight loss must get tested for thyroid diseases. 
9. Stress: Stress and anxiety are closely linked together. Stress causes the symptoms of anxiety, which exacerbates the symptoms of stress. An overly stressed person resorts to unhealthy coping mechanisms, which increase the risk of developing anxiety disorders. 
10. Anxiety triggers: Some other factors that are known to trigger anxiety are high caffeine intake, a messy environment at home, self-neglect, sleeping issues, stress, hazardous working environment and social, family and workplace conflicts.

Can anxiety cause stress?

Yes, anxiety is one of the causes of stress. Anxiety is heightened uneasiness, worrying, and fear triggered by future uncertainties and perceived threats. A chronic state of anxiety causes increased stress levels due to the continuous activation of the stress response system and the release of stress hormones. With time, anxiety's emotional and physical toll contributes to a greater stress burden. In short, anxiety and stress go hand in hand, contributing to the other. In short, anxiety develops in response to stress but causes more severe signs of stress.

What are the Signs and Symptoms of Anxiety?

The feeling of anxiety is different for different people. Here is a list of physical and mental signs of anxiety. It is important to note that not all signs are experienced by all people. The signs and symptoms are related to the physical, mental, pathological and behavioural domains. 

1. Physical signs: The physical signs are related to the disturbance of physiological parameters. They include a churning feeling in the stomach, dizziness and light-headedness, feeling needles and pins on the skin, inability to sit still and restlessness, aches and pains, particularly backache and headache, rapid breathing, irregular, thumping and fast heartbeat, hot flashes, sweating, sleeping disorders, grinding the teeth, particularly at night, nausea, digestive disturbances, panic attacks and changes in sexual desire. 
2. Mental Health effects: The signs and symptoms related to mental health are tension, inability to relax, nervousness, fearfulness of the worst outcome, sense of dread, feeling as if the world is slowing down or speeding, feeling as if other people are aware of a person’s anxiety, inability to stop worries, fears that stop worrying is likely to result in poor outcomes, extreme worries about the anxiety itself, e.g., fear of a panic attack, wishes to have reassurances from others, thoughts that the others are upset or angry, a feeling of losing touch with the reality, depression, low mood, overthinking about a particular situation and derealisation in which a person feels disconnected from the world or feels as of the world is not real.
3. Behavioural signs: The patient shows different behavioural signs, e.g., avoiding the places and situations that trigger the anxiety symptoms, procrastination, i.e., putting off tasks due to fear of not completing them on time, pacing, nail-biting, constantly seeking support and reassurances from others and withdrawal from relationships and social activities. 
4. Emotional symptoms: Some emotional symptoms noted are panic or excessive fear that is totally out of proportion from the actual situation, having unfounded and irrational fears of objects, people or things, feeling keyed up or on the edge and a feeling that something terrible is inevitable and is going to happen (fear of impending doom). 
5. Sleep disturbances: A person with a chronic anxiety disorder experiences various sleep disturbances, e.g., difficulty falling or staying asleep, intense, frequent and anxiety-themed nightmares and frequent wakeups during night sleep. The sleep disturbances ultimately increase the stress burden, leading to a poor prognosis. 
6. Pathological signs: Stress invites several other diseases with their respective signs. They are digestive system issues, e.g., diarrhoea, stomachache and irritable bowel syndrome (IBS), migraine headaches, frequent tension headaches and immune system weakness, resulting in a high frequency of illnesses. Having symptoms on and off is normal. However, when the symptoms become chronic and are strong enough to disturb the routine life, it indicates anxiety disorders. 

What are Treatments for Anxiety?

Before treating anxiety, the other associated problems, e.g., alcoholism, smoking, depression, etc., must be treated first as they complicate the treatment. The treatment options for anxiety disorders are grouped into psychological and medical treatments. 

Psychological treatments 

Psychological treatments are provided before the use of medications. Psychological therapies include talk therapies, e.g., cognitive behavioural therapy (CBT) and relaxation techniques. Expert psychologists deliver such therapies. 

1. Cognitive behavioural therapy (CBT): It is given by the psychologist. However, a determined person must be able do it by himself. CBT works by changing how a person behaves or thinks and is very effective for treating anxiety disorders. Several methods of CBT are self-working using a CBT computer course or workbook, taking the help of a therapist after a few weeks while working on s computer course or workbook, engaging in a group course where people with similar conditions meet and exchange their experiences and consulting the psychological to find better ways to handle the signs. If self-therapy is ineffective, the patients must engage in an intensive treatment course where regular sessions with the professionals are done for 3-4 months. 
2. Relaxation techniques: The relaxation skills train a patient to relax the muscles during stress and anxiety. The expert therapists train the patients on different relaxation skills, e.g., deep breathing, progressive muscle relaxation, guided imagery, mindfulness meditation, yoga, Tai Chi, autogenic training, aromatherapy, listening to music, hot shower or bath, journaling, reading a good magazine or book and visualisation. The relaxation techniques involve learning how to relax muscles and quickly respond to stress triggers. As in CBT, practising relaxation skills requires a person to consult the therapist for several weeks or months. 

Medical treatments

Medical treatment is offered if the psychological treatments are ineffective or don't work. Different types of medications are prescribed to treat anxiety disorders. Some medications work short-term and must be taken for some days, while others must be taken for a long time. The physician considers different factors before prescribing medication, e.g., medication available, duration and severity of symptoms, interactions with other drugs, side effects, pregnancy, and breastfeeding status. 

At least every month, regular doctor appointments are needed to review the situation regularly. Different types of medications available for GAD are,

Selective serotonin reuptake inhibitors (SSRIs): The SSRIs are the first class of medications for GAD patients. SSRIs increase the level of serotonin in the brain. Different examples are paroxetine, escitalopram and sertraline. The SSRIs must be taken for weeks to observe the improvement, and the treatment is started from a lower dose, which is increased depending upon need. Most of the side effects improve within a few days of regular use. 

The common side effects of SSRIs are agitation, the feeling of sickness, constipation, diarrhoea, indigestion, poor appetite, weight loss, blurred vision, dizziness, excessive sweating, dry mouth, insomnia, low sex drive, erectile and orgasm dysfunction. 

Serotonin and noradrenaline reuptake inhibitors (SNRIs): The SNRIs are prescribed if the SSRIs don't work. These medications increase both the adrenaline and serotonin levels in the brain and are more effective than SSRIs. Common examples are duloxetine and venlafaxine. The side effects reported are dizziness, drowsiness, headaches, feelings of sickness, constipation, hypertension, sweating, insomnia, dry mouth and sexual problems, e.g., low sex drive and erectile dysfunction.

Benzodiazepines: These sedatives are used for short-term treatment during severe anxiety. They work immediately within 30-90 minutes of taking. The most common example is the diazepam. Due to the risk of addiction, such drugs are not used for long, and their effectiveness decreases with time. The side effects are poor sexual desire, trembling or shaking in the body (tremors), vertigo, loss of concentration, headache and drowsiness. As drowsiness is very common, it is not recommended to drive after taking diazepam. The use of alcohol must be avoided with benzodiazepines due to the risk of reactions.

Pregabalin: It is prescribed if SSRIs and SNRIs don't work. It is an anticonvulsant medication used to treat nervous system illnesses, e.g., epilepsy and is beneficial for the treatment of anxiety too. The patient must be careful about side effects, e.g., vertigo, dry mouth, headaches, blurred vision, weight gain due to increased appetite, drowsiness, and dizziness. 

Alternative medications: If the antidepressants are not working despite months of regular use or are causing severe side effects, alternative medications are recommended. The antidepressants are withdrawn slowly to avoid the issues associated with drug withdrawal. 

If continuous treatment with antidepressants and relaxation techniques is ineffective, the patients are advised to consult s team of professionals, including psychiatrists, psychiatric nurses, occupational therapists, clinical psychologists and social workers. The professionals review the situation regularly and provide solutions. It is important to be patient as anxiety and related disorders take time to recover. 

What does Stress and Anxiety feel like?

Stress and anxiety are complicated emotional, psychological and physical experiences and are experienced differently by different people. Stress causes feelings of being overwhelmed, worrying and uneasiness. The physical feelings experienced by the patients are stomach discomfort, rapid heartbeat, headaches, muscular tension and sleep and appetite changes. A person experiences poor thinking, loss of concentration and racing thoughts. The ultimate sum of such feelings is irritability and restlessness, resorting to healthy or unhealthy coping mechanisms and seeking reassurance from the people around, says L. Robinson (School of Nursing, University of Maryland). 

Excessive fear and avoidance of perceived threats are the main features of anxiety disorder, according to Brenda Penninx (Amsterdam University Medical Centre). Anxiety is experienced as a state of constant and persistent worries about the potential dangers of future events and thinking about different worst-case scenarios. The concerns are mostly not real and are difficult to control. The patient experiences various physical symptoms of stress, e.g., light-headedness, trembling, sweating and shortness of breath. Sometimes, the feelings are just like a panic attack. A strong fear of a dreadful event or impending doom prevails, which causes a person to become helpless and out of control for some time.

Just like stress, anxiety interferes with routine life as the patients tend to avoid actual or perceived triggers. Some people engage in negative self-talk in response to stress and anxiety, doubt their judgements or abilities and become overly self-critical. The patients experience as if it is impossible to control or calm down worrisome thoughts, emotions or feelings. Persistent headaches are among the major hallmarks of chronic anxiety. So, both stress and anxiety have many things in common, except that stress is a short-term response to a trigger while anxiety is a more profound and long-term issue. 

How to determine if you are experiencing Stress or Anxiety?

As there are many common signs, distinguishing between two conditions is difficult. However, some differences allow a person or a healthcare provider to differentiate. A paper published in the Neurobiology of Stress in 2019 has noted the following major differences between stress and anxiety;

Cause: Stress is triggered by a specific situation or event, e.g., an upcoming exam, a work deadline or a sudden financial loss. It is most often a response to demands or external pressures. On the other hand, anxiety is a generalised state of worrying about things like the future, safety, health and career. Most often, the cause is not a specific thing or situation. 

Proportion to the situation: Stress is often in proportion to the stressors. It means the stress level matches the degree or severity of the trigger or challenge to some degree. Conversely, anxiety is a disproportionately high response to a trigger or threat. For example, some stress about exams is normal. However, excessive fear and dread is not normal and is a sign of anxiety. 

Time-bound: Stress is time-bound and subsides as soon as the cause or trigger is resolved. For example, the stress associated with an exam or a job interview is over as soon as the event is complete. The anxiety is very persistent and continues even after the trigger is over. The signs of anxiety continue for days, weeks or months unless treated. The signs persist even after the situation has been resolved. 

Symptoms: The symptoms of stress and anxiety are similar but slightly different. Stress causes signs like stomach upsets, headaches and muscular tension, which are linked to the cause of stress. Anxiety causes symptoms like trembling, sweating and a rapid heartbeat, experienced without any known cause. 

Influence on daily life: The effects of anxiety on daily life functions are more significant than stress, affecting relationships and work performance. It causes irrational fears and intrusive thoughts that are difficult to impossible to control.

How can Stress and Anxiety be used together in medical terms?

In medical terminology, the street and anxiety are related but different concepts. Despite differences, both terms are often used together due to co-occurrence, shared signs and co-morbidity. They do sometimes coexist together and exacerbate each other. For example, a major stress of a chronic nature, e.g., suffering from or having a close family member with a deadly and chronic disease, causes stress and anxiety together. A person always suspects a piece of dreadful news and experiences signs of anxiety. Any chronic stress contributes to or exacerbates the already existing anxiety disorder. Chronic stress affects a person's coping ability, leading to severe signs of anxiety.

Moreover, the health consequences of chronic stress and anxiety are very similar. The interplay between stress and anxiety is apparent during treatment, and managing one condition helps manage the other. Stress and anxiety often co-occur in the same patients. So, although stress and anxiety are different concepts, they have many things in common, and their co-morbidity, presence of similar signs, and similar treatment protocols confuse them. 

How can Stress and Anxiety affect Men's Health?

Stress is a regular thing in life. The effects and signs are very similar for both genders. However, there are some gender-specific differences. Here are some issues which are unique to men only. 

Prostate health: Prostate enlargement is a common issue experienced by older and middle-aged men; nearly 50% of men above 50 are diagnosed with it. The number exceeds 70% after 60 years. The condition called benign prostatic hyperplasia (BPH) has some link to stress and anxiety, and many times, both conditions occur in the form of a vicious cycle, with stress and anxiety exacerbating the signs of BPH and the presence of BPH causing signs of anxiety and stress. The enlarged prostate is s painful and stressful condition as the patient has to urinate repeatedly, causing embarrassment and stress during social events and travelling. Needing to urinate at night disrupts sleep, causing father severe signs. A lack of sleep weakens the immune system, resulting in a higher risk of diseases and anxiety disorders. 

Mental Health: Stress and anxiety negatively affect the mental health of both men and women and cause several emotional signs, e.g., depression, low mood and anxiety. In extreme cases, the signs become unmanageable. The effects are experienced irrespective of gender, but researchers like Rohit Sharma Shekar Gupta (Ram Manohar Lohia Hospital, India) found that men fared worse in stress and anxiety as they experienced additional risk factors, e.g., traditional norms of masculinity, workplace stresses, financial strains, more reluctance to seek professional help and substance abuse.

Consequently, the risk of complications of chronic stress and anxiety, e.g., depression major, is much higher in men than in women. 

Heart health: Stress and anxiety cause a more pronounced risk of heart disease in men than women. It is attributed to different coping mechanisms in both genders. Men are more likely to hide emotions than women and experience more severe signs. There is a lack of clarity that stress and anxiety are themselves the cause of heart diseases. Women are more likely to talk about their emotions and thoughts than men due to various cultural regions, particularly in traditional societies. It results in a bigger impact of common stresses in men than women. 

Weight and obesity: Chronic stress and anxiety disturb the appetite and body weight. It depends upon the nature of coping mechanisms. Some people lose their appetite, while others experience a heightened appetite and resort to unhealthy eating patterns.

Stress causes a fight and flight response in the body, creating an urge to eat more to generate more energy for the upcoming crisis. Dealing with the fight or flight response consumes much energy and attention; consequently, people must eat more to meet the deficit. It particularly happens if the type of challenge faced is physical. However, most people face psychological stress in which the response is not physical, and no more food intake is needed. Still, some people consume more food to handle the stress, resulting in overeating and weight gain. 

Sleeping disorders: Stress causes a lack of sleep due to high Cortisol levels. A clinical trial study published by the Department of Medicine, University of Chicago found that people taking 4 hours of night sleep have 37-45% higher Cortisol levels the next morning. Higher Cortisol levels, in turn, depress sleep. A minority of men experience loss of appetite and consequent weight loss in response to stress. 

Fertility: Stress influences several parameters related to fertility and sexual health. A research finding suggests that men experiencing many stressful events in the past years have less mobile sperms. Stress increases the occurrence of abnormally shaped sperms, which disturbs the fertilizing potential. Chronic stress causes oxidative stress, which is responsible for poor sperm quality. High-stress levels increase the risk of other sexual health issues, e.g., erectile dysfunction, poor libido and premature ejaculation. 

How Do Anxiety and Stress Impact the Health of Women?

Stress affects women differently than men, and women are more likely to show the symptoms of stress than men. Women are more likely to experience depression and anxiety than men. The reason is not fully clear. However, some experts think it is related to the female body's different processing of stress hormones. Different impacts of stress on women's health are;

Poor fertility: One major effect of stress on women's health is on fertility. Stress always reduces fertility, and women find it difficult to achieve or maintain pregnancy. Some experts like C.D. Lynch have linked it to high alpha-amylase levels, a stress-associated enzyme. The stress and its associated high alpha-amylase levels result in a 12% reduction in the chances of conception than women with normal enzyme levels, as noted by.

Irregular periods: It is easy to recall a stressful period when a change in the menstrual cycle leads to missing periods or a severe period. Chronic and long-term stress affects the hormone balance in the body, resulting in shorter or longer, more painful, irregular and heavier periods. Some women experience the symptoms of premenstrual syndrome (PMS). 

Digestive disturbances: The gut-brain axis controls the interaction between the brain and the digestive organs. Short-term stress causes issues like butterfly feelings, churning, nausea and diarrhoea. Chronic and prolonged stress causes an increase in acid production in the stomach, resulting in acid reflux, heartburn burn and indigestion. Poor digestion due to the activation of the sympathetic nervous system and decreased secretion of digestive enzymes causes poor digestion, vomiting, bloating, gas production, constipation, diarrhoea, obesity and flare-ups of chronic diseases, e.g., IBS.

Higher risk of heart diseases: The elevated levels of stress hormones and the resulting stress response cause the constriction of blood vessels and increase the blood pressure to cope with the situation. The heart rate increases to increase blood flow and nutrients into the muscles. Long-term and chronic stress causes the long-term elevation of the blood pressure and heart rate. It increases the risk of heart diseases, e.g., heart attack, stroke, platelet aggregation, cardiac arrhythmias, acute coronary syndrome and heart failure (Barry A. Franklin, 2021).  

Poor immunity: Stress hormones weaken immunity and increase the risk of chronic illnesses and infections. A stressed woman is more likely to experience flare-ups of chronic conditions like inflammatory bowel disease and arthritis and experience more episodes of cold and flu. A weakened immunity causes delayed recovery from common diseases. 

Compromised mental health: Stress and anxiety for a long time results in the development of anxiety, depression and other chronic mental health issues. Women are twice as likely to experience the symptoms of depression when exposed to stress and anxiety for a long time as men, says Rachel H. Salk, University of Wisconsin. It is associated with a constant elevation of Cortisol levels. 

Pregnancy: Feeling anxiety and stress is normal in pregnancy as the hormonal levels and physiology are changing regularly. However, too much stress and anxiety during pregnancy harms the health of mother and baby alike. Stress and anxiety during pregnancy result in discomfort, body aches and the development of other serious issues, e.g., depression, eating disorders, gestational diabetes and hypertension (preeclampsia). Some severe complications result in premature birth, low birth weight and even abortion in chronic cases. 

Hair and skin: Stress is associated with hair thinning and skin issues, e.g., acne in women. Stress causes telogen effluvium, in which more hair follicles enter the telogen or resting phase of the hair cycle. The stress hormones cause increased oil production from the sebaceous glands that clog the pores, leading to the development of acne. The compromised immunity and the disruption of skin barrier integrity increased the risk of skin flare-ups. 

Weight gain: Some women eat emotionally to cope with the stress. It results in excessive food intake and weight gain. It is not gender specific and is experienced by men, too. 

Can Stress and Anxiety be prevented?

Yes, stress and anxiety are preventable. Stress and anxiety occur due to various physical and psychological causes, and prevention needs the avoidance of such factors. Some proven ways to prevent stress and anxiety are taking care of the body and mind by eating a healthy and well-balanced diet, limiting the intake of sugary drinks, caffeinated products, alcohol and smoking, making a flexible schedule of daily activities, reducing the hectic schedule and avoiding the boring and stressful activities, maintaining an anxiety journal, spending some time with family friends, managing the finances and spending some time for physical activities daily. 

It is important to treat such issues if the causes of stress are illnesses or physical and mental health conditions. The success of the preventive measures is a subjective matter and varies from person to person. The people have experienced different levels of improvement. The key to success is to strictly follow the preventive protocols and take the help of healthcare and psychological professionals in case of any complexities. 

Does Stress and Anxiety have health benefits?

Yes, although the street and anxiety are viewed as negative things and are associated with harmful consequences, there are certain contexts in which some people experience benefits. Some benefits are;

Stress motivates a person: A moderate and mild stress level motivates a person to achieve certain goals, perform well in certain situations and meet certain deadlines. Helen Pluut and other Leiden University, Netherlands experts have called it useful stress or the eustress. 

Better alertness: Moderate alertness and anxiety results in improved focus and alertness. Anxiety and stress increase vigilance and improve reactions, particularly when dealing with potential threats and emergencies. 

Better performance: Some people observe that moderate levels of stress help improve performance in certain situations, e.g., during a sports competition, job interview or public speaking. Sometimes, a heightened state of alertness is beneficial. 

Better adaptive response: Stress induces a fight or flight response, which is very useful to survive in certain situations, e.g., while facing a deadly threat. Stress and anxiety prepare the body to quickly and accurately respond to actual or perceived threats and increase the chance of survival. 

Increased resilience: Regularly dealing with a moderate level of stress and anxiety and working to develop healthy coping mechanisms improve resilience to stress. A person learns how to cope with the stressful situation healthily and develop coping strategies that help in the long run. 

The potential benefits mentioned above depend on certain contexts and are only experienced if a person experiences lower to moderate stress levels. Experiencing a high-stress level for a long time is not good for overall health and has several negative health consequences. It all depends on how a person perceives or views a particular situation. 

Are Stress and Anxiety different from depression?

Stress, anxiety and depression are closely related yet different things. Stress is a short-term reaction to a particular stressor, and anxiety means excessive fears and worries even without known triggers. Depression, on the other hand, is a mood disorder which is characterised by persistent feelings of hopelessness, sadness and a lack of pleasure or interest in routine life activities. Depression is not entirely a response to external stressors, although stress or anxiety trigger or exacerbate the depression. The key differences in the three conditions are; 

Time frame: Stress is associated with a particular stressor and is short-lived and time-bound. The depression and anxiety are not related to specific triggers, are not time-bound, and are ongoing. Emotions: Stress causes pressure and tension, while anxiety causes excessive fear and worry. Depression, on the other hand, is characterised by persistent feelings of sadness. 

Physical symptoms: Depression and anxiety cause many similar symptoms, e.g., disturbances of appetite, sleep and energy levels. The symptoms of stress, particularly the chronic ones, are very similar. However, they are more time-bound and are related to a particular stressor. 

Diagnosis: Stress is not identified as a diagnosable health condition unless it becomes debilitating and chronic, e.g. generalised anxiety disorder (GAD). Depression and anxiety, on the other hand, are diagnosable mental health conditions which disrupt the quality of life and daily functioning. Treatment options: Depression and anxiety need specific treatment, while stress resolves easily with moderate care. 

All three conditions coexist and often overlap; the people experiencing chronic stress and anxiety experience or are at a higher risk of developing depression. Seeking support from a doctor or psychologist is important to handle complicated situations.