Anxiety: Symptoms, Causes, Diagnosis & Treatment

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Feelings of stress and anxiety can be very common in our everyday lives. These feelings are brought about by our mood hormones, such as adrenaline and cortisol, which are responsible for stimulating our ‘fight or flight’ response. This response occurs naturally and is supposedly evolutionary, allowing us to effectively react to danger or harmful situations.


Sometimes, feelings of anxiety can last for extensive periods and become overwhelming. When it interferes negatively with our lives, it requires special attention.


Here is a useful guide to help you understand more and, in time, learn how to manage it.


What is anxiety? 

Anxiety is our natural response to external stimuli that have developed with evolution, when humans lived in the wild and needed to be alert to their surroundings in order to survive.


Although we no longer need to deal with sabre-toothed tiger attacks, the natural responses have remained. In our everyday lives, we experience events that may cause our cortisol and adrenaline levels to spike, and result in a the ‘fight or flight’ response.


The increase in those two hormones brings about feelings of anxiousness, nervousness and stress. Those may be triggered by important events or decisions that cause us to feel stressed, for example exams, starting a new job, having a baby or having an interview, etc.


These manifestations of anxiousness are normal: stress is positive and necessary to spur us into action and to get through challenges but it should be brief and the magnitude of stress should be proportional to the stressor!


If you find that those feelings of stress and anxiety don’t subside even after overcoming specific events, and that you struggle to feel relaxed long after, it may be that anxiety becomes a disorder, so it may be necessary to seek professional help.

Is anxiety common in Hong Kong?

There are rising concerns in Hong Kong about the mental health of students and adolescents specifically. Studies have found that in every 10 students, more than half are reported to experience symptoms of anxiety. Yet outside of these studies, only a small proportion do actually reach out and receive the professional assistance and treatment they require.

Common symptoms of anxiety

You may feel a wide range of symptoms, including:

Physical sensations:

  • nausea (feeling sick)
  • tense muscles and headaches
  • dizziness
  • shortness of breath
  • sweating or hot flushes
  • irregular pulse rate
  • increased blood pressure
  • disturbed sleep
  • needing the toilet more frequently, or less frequently
  • churning in the pit of your stomach
  • possible experience of panic attack(s)

Psychological sensations:

  • sudden overwhelming fear
  • feeling tense, nervous
  • having a sense of dread, or fearing the worst
  • feeling like other people can see you’re anxious and are looking at you
  • feeling your mind overwhelmed with thoughts
  • dwelling on negative experiences, or thinking of a situation over again and again 
  • feeling restless and not being able to concentrate
  • feeling numb

Variations of anxiety disorders

Here are 6 common variations:

  • Generalised Anxiety Disorder (GAD) This is a condition that consists of an overall sense of worry and uncertainty for all areas in life e.g. money, health, family, work. GAD is characterised by the non-specificity of the worries, patients tend to find controlling their worries extremely difficult, and those will interfere with their daily activities.
  • Obsessive Compulsive Disorder (OCD) A chronic long-lasting disorder that involves recurring thoughts and behaviours that are uncontrollable; patients will experience intrusive and unwanted thoughts that form “obsessions”. Those will make them carry out specific actions such as washing their hands, repetitive checking, or rearranging to try to suppress the thoughts that are causing them anxiety.
  • Social anxiety Mainly involves an intense anxiety or fear of being judged or rejected in a social situation. When engaging in compulsory social interactions, they will likely showcase physical symptoms such as sweating, nausea, increased heart rate etc. Those with the condition will likely avoid social situations and gatherings for fear of others noticing their anxious behaviours. 
  • Specific phobias People with this condition will demonstrate strong irrational behaviour towards specific objects or circumstances e.g. heights, animals, driving, open spaces (agoraphobia), they will recognise the irrationality of the fear but have no control over their reactions. Having these phobias will likely cause patients’ lives to be limited as they may not experience the freedom to travel or even commute - depending on the specific phobia.
  • Post-Traumatic Stress Disorder (PTSD) A condition that stems from after having witnessed or experienced a traumatic event; which could be violence, natural disaster, or personal experience of abuse. Those who have PTSD will be greatly affected by their trauma and can easily be triggered in their everyday life, and feel anxious or fear flashbacks of the event(s) for months or even years.
  • Panic Disorder Panic disorder involves people who experience sudden panic attacks and have an overwhelming fear of recurring attacks. Panic attacks (also called anxiety attacks) involve symptoms such as rapid heart rate, shortness of breath, trembling or shaking, and nausea.
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Risk factors

  • Trauma – Past traumatic experiences such as abuse or witnessing traumatic events can place people at higher risks of developing anxiety at some point in life. This can occur in both adults and children.
  • Stress due to an illness – if a health condition or illness is causing significant worry or stress, it can contribute to developing anxiety.
  • Stress build up – big events or accumulated pressure in all areas of life can trigger excessive anxiety.
  • Personality – certain personality types are more prone to stress and feeling overwhelmed, this can increase chances of developing anxiety.
  • Other mental health disorders – anxiety disorders are often linked to other conditions, such as depression.
  • Hereditary - anxiety can run in the family.
  • Substance use – the use, misuse or withdrawal from drugs or alcohol can cause stress and anxiety to be heightened.
  • Gender – Women are reported to be at higher risks of developing anxiety disorders.

How is anxiety diagnosed?

For a clinical diagnosis of generalised anxiety disorder (GAD), according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), patients’ symptoms should fit the following criteria:


1. Experiencing excessive anxiety and worry, with anxiety on more days than not, for periods no shorter than 6 months, relating to a number of events and activities.


2. Difficulty in controlling anxious emotions and worries.


3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

a. Restlessness, feeling keyed up or on edge

b. Being easily fatigued

c. Difficulty concentrating or mind going blank

d. Irritability

e. Muscle tension

f. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)


4. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.


5. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).


6. The disturbance is not better explained by another medical disorder. (such as more specific symptoms that point towards the other variations of panic disorders.)

How is anxiety treated?

Specialists may prescribe at least one of the following treatment options:


1. Talk therapy (or Counselling)

Mainly involves working with a counsellor or psychologist to process through the causes of an individual’s anxiety and to find ways to readjust any thinking patterns, so that the way their anxiety is triggered can be made more manageable.

There are many types of therapy available, but the type most commonly used would be Cognitive Behavioural Therapy (CBT). Cognitive Behavioral Therapy is an effective combination of talk therapy and behavioral therapy, in which patients reframe negative thinking patterns into positive thoughts. Transforming one’s thoughts will ultimately result in positive actions and behaviors in difficult moments.


2. Medication

Doctors e.g. psychiatrists will commonly prescribe drugs from the following categories:

  • Selective serotonin reuptake inhibitors (SSRIs) - known for being safer, with fewer side effects, They are the most commonly prescribed type of antidepressant e.g. fluoxetine, paroxetine, sertraline and escitalopram
  • Serotonin and noradrenaline reuptake inhibitors (SNRIs) - an alternative to SSRIs, designed to function better than SSRIs but the comparison is still uncertain e.g. duloxetine, venlafaxine and desvenlafaxine
  • Benzodiazepines (tranquilizers) – these may be prescribed if symptoms of anxiety are quite severe; they serve to be of temporary relief until the effects of other forms of treatment are more prominent. e.g. alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium)
  • Pregabalin – an anticonvulsant (antiepileptic) drug, but also licensed to treat anxiety; it has effects of reducing the excitable signals released by the brain, and can treat pains and sleeping struggles caused by anxiety.
  • Tricyclic antidepressants (TCAs) - usually not the first-line of treatment prescriptions due to their tendency to induce numerous side effects such as dizziness, anxiety, dry mouth, and blurred vision e.g. amitriptyline, clomipramine, imipramine and nortriptyline
  • Beta-blockers – prescribed to treat the physical symptoms of anxiety, such as rapid heartbeat, tremor(s), high blood pressure etc. They do not reduce psychological symptoms but can be critical for when patients need to face triggering situations. e.g. propranolol (Inderal)

3. Exercise Prescription In some cases, specialists may prescribe that the patients carry out an exercise routine as part of the treatment process. This approach encourages patients to allocate time to carry out specific physical activities of various intensities, to stimulate them mentally and physically. 

List of professionals

There are many professionals available for you to see in Hong Kong. They are all professionally trained in counselling and can be very helpful and supportive. These may include:

Self-help methods to manage anxiety

  • Relaxation techniques – deep breathing, body scan (meditation) and muscular relaxation techniques can help calm the mind and release tension in the body
  • Reassure yourself – embrace how you feel and affirm your abilities. When facing problems, stay objective and calm, try to manage your worries by writing them down.
  • Take care of your physical health – try to maintain a regular sleep schedule, eat regularly, and stay active with some physical activity from time to time, this will promote stable levels of mood and energy.

Helpful Links

If you need instant support, here is a list of 24/7 Hotlines you can call:

Caritas Family Crisis Support Centre18288

Hotline Service (Family Crisis)

Hospital Authority2466 7350

Mental Health Direct

Social Welfare Department 2343 2255

Hotline Service: 24 hours

Suicide Prevention Services2382 0000

Hotline Service: 24 hours

The Samaritan Befrienders Hong Kong2389 2222

Hotline Service: 24 hours

The Samaritans2896 0000

Multi-Lingual Suicide Prevention Hotline: 24 hours


For a list of other useful mental health services, please click here.


What are the symptoms of anxiety?

People with anxiety may exhibit both physical and psychological symptoms. Physically speaking, nausea, dizziness, shortness of breath, irregular pulse rate and disturbed sleep are some examples of the symptoms. On a psychological level, people with anxiety may experience sudden overwhelming fear, dreadful feeling, numb feeling, restless feeling or difficulties in concentration.

What can anxiety do to your body?
What is the feeling of anxiety?
How can I get over my anxiety?
What are the types of anxiety disorders?

Dr. Frances Cheng is a Specialist in Psychiatry and is the Head of Mental Health at OT&P MindworX. She obtained her medical degree from the University of Hong Kong and her MSc. in Epidemiology at the London School of Hygiene & Tropical Medicine. She completed her specialist training in Psychiatry in Hong Kong and in the United Kingdom where she worked as an Academic Clinical Fellow at the University of Cambridge. She is a Member of the Royal College of Psychiatrists of the UK as well as a Fellow of the Hong Kong College of Psychiatrists. Prior to entering private practice, she was a Clinical Assistant Professor at the Department of Psychiatry at HKU. She is now an Honorary Assistant Professor at the same department.

This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.

Dr. Frances Cheng
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