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Can anxiety make you question everything?

Many of us regularly experience some degree of anxiety in our day-to-day lives. This is a normal human response when we encounter stressful situations or upcoming events that make us feel uneasy. However, for some people, anxiety can become excessive, persistent, and out of proportion to the actual circumstances they face. So much so that it causes significant emotional distress and interferes with daily functioning. This severe form of anxiety is what mental health professionals refer to as an anxiety disorder.

What are the signs of an anxiety disorder?

Anxiety disorders involve more than temporary worry or fear. For someone with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can be severe and upsetting. Anxiety disorders commonly cause people to avoid certain situations out of worry. Symptoms may include:

  • Feelings of panic, fear, and uneasiness
  • Uncontrollable, obsessive thoughts
  • Increased heart rate
  • Sweating
  • Trembling
  • Feelings of being out of control
  • Trouble sleeping
  • Gastrointestinal problems

People with anxiety disorders may avoid situations or environments that trigger or worsen their symptoms. For example, someone with social anxiety disorder may avoid social gatherings. Someone with agoraphobia may avoid places or situations where they feel trapped, helpless, or embarrassed.

What causes anxiety disorders?

Researchers are still trying to determine the underlying causes of anxiety disorders. There are likely multiple factors at play, including:

  • Brain chemistry – Anxiety disorders may be linked to an imbalance of neurotransmitters like serotonin and dopamine.
  • Genetics – Anxiety disorders tend to run in families, suggesting a genetic component.
  • Environmental factors – Trauma, abuse, stress, and other external factors may trigger or contribute to anxiety disorders.
  • Medical factors – Certain medical conditions, medications, and substance abuse may produce or worsen anxiety.

In many cases, anxiety disorders involve interactions between multiple factors rather than just one cause. It is also common for anxiety disorders to co-occur with other mental health conditions like depression or substance abuse disorders.

How do anxiety disorders affect thinking and behavior?

One of the major ways anxiety disorders impact people is through persistent irrational thoughts and worries. People with anxiety tend to catastrophize – envisioning worst case scenarios and exaggerating the possible consequences of minor problems. This swirling vortex of exaggerated “what if” thinking creates a constant state of unease, fear, and doubt.

Here are some common thought patterns associated with different anxiety disorders:

Anxiety Disorder Common Thought Patterns
Generalized Anxiety Disorder “What if something terrible happens?”
“I can’t stop worrying about everything going wrong.”
Social Anxiety Disorder “People will think I’m weird.”
“I won’t know what to say – I’ll embarrass myself.”
Panic Disorder “I’m going crazy.”
“I’m having a heart attack.”
Obsessive Compulsive Disorder “I have to check the locks 10 times or something bad will happen.”
“I can’t control my thoughts – what if I do something terrible?”

In addition to distorted thinking patterns, anxiety can also lead to unhelpful behavioral coping strategies. Avoidance behaviors are common, where people withdraw from anxiety-provoking people, places, activities, or situations. While avoidance provides temporary relief from anxiety, it reinforces the anxiety over the long-term. Other unhealthy coping behaviors may include compulsive behaviors like repeated hand washing, reassurance seeking from others, or self-medication through drugs or alcohol.

Can anxiety cause you to question reality?

In some cases, yes – severe or chronic anxiety absolutely can warp people’s sense of reality. Several specific ways this may happen include:

  • Depersonalization/derealization – Anxiety may make someone feel detached from themselves (depersonalization) or the world around them (derealization). Things seem unreal or dreamlike.
  • Dissociation – Someone may mentally “check out” as a coping mechanism to detach from an overwhelming situation. They may feel like an outside observer of their thoughts, feelings, and actions.
  • Hyper-vigilance – Anxiety causes some individuals to be on high alert constantly scanning for potential threats. This excessive wariness can make benign things seem ominous.
  • Paranoia – The persistent feeling of danger associated with severe anxiety can morph into paranoid thoughts. People may start to question if others have malicious intent.
  • Hallucinations – In very rare cases where anxiety is extreme, hallucinations may occur as the mind falters under intense stress. Auditory hallucinations of hearing voices or seeing illusions are most common.

The distorted thinking and perception that may accompany anxiety underscores the importance of professional help. With good treatment, most people with anxiety disorders can regain an accurate perspective and change their relationship to their anxiety and worries.

How are anxiety disorders treated?

Today, there are many effective treatment options available for anxiety disorders. A mental health professional can help create a treatment plan tailored to the specific type and severity of anxiety disorder. Treatment generally involves a combination of:

  • Medication – Antidepressants like SSRIs (e.g. Zoloft, Lexapro) are commonly prescribed to regulate brain chemistry. Anti-anxiety meds like benzodiazepines (e.g. Xanax, Klonopin) may also be used in the short-term.
  • Psychotherapy – Usually cognitive behavioral therapy (CBT) focused on identifying and changing thinking patterns and behaviors that reinforce anxiety.
  • Mind-body practices – Meditation, mindfulness, yoga, and controlled breathing can help calm the mind and body.
  • Support groups – Peer support provides help and decreases isolation/shame.
  • Lifestyle changes – More exercise, adequate sleep, healthy diet, and reduced caffeine/alcohol can lessen anxiety.

With continued commitment to treatment and personal self-care, significant improvement and recovery is within reach. While the questioning intensity of anxiety may obscure reality temporarily – the clouds can and do eventually lift.


Anxiety disorders severely impact a person’s thinking, emotions, and behaviors. Core features like excessive fear, irrational thoughts, avoidance, and hypervigilance can definitely cause someone to question the world around them and their own perceptions. Reality may appear distorted. However, anxiety disorders are treatable medical conditions. With professional help and lifestyle changes, most people can dramatically improve their mental health and regain a balanced perspective not so skewed by the lens of anxiety. There are better days ahead.