Agitation: More Than Just Anxiety

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The word “anxiety” is often used to describe vastly different experiences that have different underlying causes and require markedly differing treatments. Here we describe two distinct presentations of anxiety, and a third phenomenon that often masquerades as “extreme anxiety” but is a much different problem.

Anxiety triggered by frightening thoughts

This falls into categories of generalized, phobic, anticipatory, or obsessional anxiety. Many of us are used to waxing and waning periods of anxiety or what might be called “sensitization.” There are times when there is a heightened awareness of things to worry about, or your body just seems more tense and reactive to your thoughts than usual. You find yourself more worried than usual about mistakes, safety, or health, or you become hypervigilant about how you are perceived or treated. You are prone to overanalyzing, overplanning, and rumination.

Anticipatory anxiety arises as you consider and reconsider some decision, challenge, commitment, or upcoming event. Your mind goes forward in time and imagines scenarios where things go wrong as you catastrophize around what could possibly happen rather than what is likely to happen. You might believe that your anxiety is a signal to be more cautious, or you may go round and round about some question that is unanswerable or nonsensical.

You know what you are worrying about, even as you wish that you could stop worrying. The common thread in this form of anxiety is that it is about something. It may not be immediately obvious, but it has a focus. It is not about everything.

This type of anxiety is present in phobias, OCD, social and performance anxieties, chronic worries, perfectionism, and stressful situations. Traumatic experiences can also lead to increased anxiety, as mistrust of the world or yourself becomes a stimulus for vigilance and worry.

Panic attacks

A second presentation of anxiety is called a panic attack, and it is triggered by the fear of harmless sensations. It often occurs when you feel trapped or unable to get to safety. It is a false alarm of the body’s emergency response system—a sudden onset of high arousal that starts with a whoosh of sensations that include a rapid heart rate, over-breathing, sweating, feeling depersonalized, and being very frightened. It lasts for a few minutes and subsides on its own.

People often mistakenly believe that their panic episodes are caused by a place or situation. But it is the fear of sensations, or the experience of anxiety itself, that is the underlying fear.

During a panic attack, people are afraid of the attack itself, erroneously believing they are in danger of a medical catastrophe, a mental health breakdown, or a loss of control. It is a very distinct experience. When it is over, people are relieved but often then revert to worry or upset about what just happened and what it might mean.

Episodes of panic are not dangerous and are self-limiting. Treatment consists of learning how and why to not add fear or misunderstanding to the first whoosh of sensations. Panic attacks left alone and unresisted pass in a few minutes, and then, over time, as sensitization reduces, they reduce markedly in frequency.

Extreme anxiety

A third state, often described as “extreme anxiety,” is really quite a different experience. It is more correctly labelled agitation. Agitation is not “about" something. It is a changed state of being, in which you do not feel like yourself. You can’t concentrate, you lose your appetite, and you cannot focus your attention productively on anything. Often, you can’t sit still, and you feel tremulous shakiness throughout your body. You pace. You move from one thing to another seeking relief.

You are preoccupied with feeling ill or not yourself, and cannot carry on normal daily activities. You focus on ideas like “I am never going to feel alright,” or “what is happening to me?” or “I can’t function.” It is much more than worrying. It feels like a breakdown, a loss of control, a bewildering transformation. It can feel hopeless and overwhelming. Agitation can include anxiety, but it is more than that.

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Agitation is most often a symptom of a mood disorder—depression or bipolar disorder, or a “mixed state” mood. It can also be caused by medical illness, a medication reaction, or another biological cause. It is an all-day, all-night experience, often worse in the mornings, with a bit of relief in the evening. Sleep is not restorative, and there is often either too much or too little sleeping, early morning awakening, and a feeling of dread or doom that never leaves.

It can last for days or weeks and can be utterly debilitating. It is time to get professional help. It is not something that you are likely to be able to think yourself out of. And while compassionate friends and family can offer support, reassurance, and assistance, there is likely something needed from medical professionals. The underlying conditions that cause agitation are all treatable, and it will get better once the condition is treated.

Summary

Understanding these three distinct processes is important in knowing how to overcome them. Anxious worry is responsive to self-help, many kinds of psychotherapy, including cognitive behavioral therapies, and some medications. Panic can also respond very successfully to learning about it and changing your relationship to the experience, as well as some medications. But agitation is rarely responsive to self-help and support alone. If agitation is present, then there needs to be a professional diagnostic evaluation so that the underlying cause can be swiftly addressed.

To find a therapist, please visit the Psychology Today Therapy Directory.