Anxiety Disorders

Stories, signs to notice and what to do

The Night My Heart Raced

Arjun, twenty-nine, was in a crowded Mumbai local train when his heart suddenly pounded, his hands tingled, his chest tightened and he felt sure he was dying. He got off at the next station and sat on the platform, shaking. Doctors at the hospital did tests and found his heart was healthy.

Two weeks later it happened again, at home. Now Arjun lives in fear of the next attack. He avoids trains, then lifts, then crowded markets, and finally he starts refusing to leave the house without his brother. His world is shrinking, and he is ashamed of it.

His brother takes him to a psychologist who explains that these sudden waves are panic attacks: the body's alarm going off without real danger. They peak within minutes and then fall, though they feel terrifying. The fear of fear, and avoiding places, keeps the cycle alive. Arjun learns slow breathing, how to ride out a wave without running, and a step-by-step plan to return to the train, starting with one station. After some weeks he travels alone again. "The attacks did not kill me," he says. "Hiding from them nearly did."

Looking back, Arjun says the hardest part was the shame. Once he told his family honestly what was happening, they stopped guessing and started helping, and he no longer felt he was facing it alone.

How to recognise it

• Sudden surges of fear with pounding heart, breathlessness, dizziness, shaking or a sense of doom.
• The peak lasts minutes, but worry about another attack lingers for weeks.
• Medical checks find no heart or lung cause.
• Avoiding places where escape feels hard, such as trains, crowds or being alone.
• Life steadily narrowing because of avoidance.

What this story explains

This story shows panic disorder and agoraphobia, and the anxiety cycle where fear of the body's signals and avoidance keep the problem going.

Probable root causes

• A sensitive alarm system in the brain, sometimes running in families.
• Ongoing stress, poor sleep or too much caffeine.
• Misreading normal body sensations as danger.
• Avoidance that teaches the brain the places are unsafe.
• Earlier frightening experiences or a major life strain.

What to do

1. First get a medical check to rule out physical causes, then trust the result.
2. Stay where you are during an attack and breathe out slowly, longer than you breathe in.
3. Remind yourself: 'This is a panic wave. It will pass.'
4. Ground yourself by naming five things you can see.
5. Make a small ladder of avoided places and practise them step by step.
6. Reduce caffeine and keep regular sleep.

Whom to consult

• Family doctor to check heart, thyroid and other causes after the first attack.
• Clinical psychologist for talking therapy that treats panic well.
• Psychiatrist if attacks are frequent, severe or the person is housebound; in the case of chest pain that feels different or any emergency, go to the nearest hospital.

Do and don’t

How to behave and communicate

• Use a steady, quiet voice: "I am here. This will pass. Breathe out slowly with me."
• Do not argue about whether the fear is rational.
• Stay with them through the wave without crowding them.
• Afterwards ask: "What helped most just now?"
• Be consistent and patient across weeks.

What If Tonight Goes Wrong?

Meera is a forty-two-year-old mother in Hyderabad who cannot remember the last day she did not worry. What if her son fails? What if her husband's chest pain is serious? What if the cooking gas leaks? She checks the stove three times and phones the school twice a day.

Her body pays too. Her shoulders ache, she has stomach trouble, her mind will not slow down at bedtime and she wakes at four. Her family says, "You are just a worrier." Meera knows the worry feels beyond her control and has been there for more than a year.

A friend persuades her to see a doctor, who explains that this is not a character flaw but a long-lasting anxiety pattern called generalised anxiety. Meera learns to sort worries: those she can act on today, and those she can only let go. She writes the first kind in a notebook with one small action and practises putting the second kind aside with a slow breath. She also spots anxious thoughts such as 'something bad will certainly happen' and asks, "What is the evidence? What would I tell a friend?" With a counsellor's support, her sleep improves, and so does her laughter.

How to recognise it

• Excessive worry about many everyday things on most days for six months or more.
• Worry feels hard to control and jumps from one subject to the next.
• Restlessness, tense muscles, tiredness, poor concentration and disturbed sleep.
• Constant checking, reassurance seeking or over-planning.
• Real impact on work, family time or health.

What this story explains

This story shows generalised anxiety disorder, the worry decision tree and how to challenge anxious thoughts.

Probable root causes

• Family tendency toward anxiety and a naturally alert temperament.
• Years of responsibility with little time to rest.
• Habit of expecting the worst, which feeds the worry.
• Health or money uncertainty in the family.
• Poor sleep and little relaxation.

What to do

1. Ask of each worry: 'Can I do something about this today?' If yes, plan one small step; if no, practise letting it go.
2. Set a daily fifteen-minute 'worry time' and postpone worry to then.
3. Challenge thoughts by asking for evidence and a kinder view.
4. Practise grounding with the senses when your mind races.
5. Move your body daily and keep a calming bedtime routine.
6. Seek therapy rather than only self-help if it has lasted months.

Whom to consult

• Family doctor to check physical causes such as thyroid problems and to discuss options.
• Clinical psychologist for talking therapies, such as cognitive behaviour therapy.
• Psychiatrist if anxiety is severe, disabling or comes with low mood.

Do and don’t

How to behave and communicate

• Speak gently: "I can see how heavy this feels. Shall we look at what you can do today?"
• Reassure once, then help her use her own tools.
• Listen to the whole worry before commenting.
• Avoid 'don't worry'; try 'we will handle it step by step'.
• Share calm activities such as a walk.

The Back Row

Tomás, nineteen, studies engineering in Lisbon. He is clever, but he sits at the back of every class, never asks a question and hurries out. Eating in the canteen feels like being on stage. When a lecturer asked him to present a project, he stayed up all night, felt sick in the morning and told the group he was ill.

He is not shy by choice. Before any social situation his face burns, his voice shakes and a loud inner voice says, "Everyone will see how stupid you are." Afterwards he replays every word for hours. He has stopped going to parties and has lost two friends who stopped asking.

His cousin notices and tells him she felt the same until she saw a therapist. Tomás learns that this is social anxiety, an intense fear of being judged, and that avoidance keeps it strong. With his therapist he practises small, planned steps: saying hello to a classmate, asking one question in a seminar, then a short presentation to two friends. He also tests his predictions: "Did anyone really laugh?" Most of the time, nobody had even noticed.

Tomás still feels his heart race before a presentation, but he now knows it is a signal and not a verdict. He has even begun to enjoy the quiet jokes he shares with two classmates after lectures.

How to recognise it

• Strong fear of being judged, embarrassed or humiliated in social or performance situations.
• Blushing, trembling, a racing heart or a dry mouth before or during contact.
• Avoiding classes, meals, meetings or speaking up.
• Long replaying of conversations afterwards.
• This has gone on for months and limits study, work or friendships.

What this story explains

This story shows social anxiety disorder, how avoidance keeps fear alive and how gradual exposure and testing thoughts help.

Probable root causes

• A naturally sensitive temperament, sometimes in families.
• Past teasing, bullying or humiliation.
• Harsh or critical comments at home or school.
• Beliefs such as 'I must never look foolish'.
• Avoidance that stops the brain learning that it is safe.

What to do

1. Write down the feared situation and what you predict will happen.
2. Make a ladder from easiest to hardest social step, then try one a week.
3. After each step, compare what actually happened with what you feared.
4. Shift attention outward to the conversation, not to how you look.
5. Use slow breathing before and during hard moments.
6. Join a small group around a shared interest.

Whom to consult

• Clinical psychologist for cognitive behaviour therapy, usually very effective.
• Family doctor if physical symptoms or alcohol use are growing.
• Psychiatrist if anxiety is severe or comes with depression.
• College or school counsellor for support with presentations and adjustments.

Do and don’t

How to behave and communicate

• Use a friendly, low-key tone: "No hurry. What would feel like a small first step?"
• Listen to their fears without arguing.
• Avoid asking in front of others.
• Ask: "What did you notice afterwards?" instead of 'see, nothing happened'.
• Show warmth through consistent invitations.

The Lizard on the Wall

Sunita, thirty-eight, lives in a village near Nashik and cares for her family with great energy, except when a lizard appears. Last month one dropped near the kitchen door, and she screamed, dropped a pan and ran outside. She now checks every wall and corner before entering a room, and she has begun to sleep on the veranda.

Her husband laughs, "It is only a little lizard." Sunita knows it is small. She also knows she cannot stop the wave of terror, the sweating and the shaking. At the family wedding she refused to enter the old hall because it might have lizards, and she felt ashamed.

A health worker at the village clinic told her that a strong, out-of-proportion fear of a certain thing is a specific phobia, and that it is very treatable. The doctor referred her to a psychologist who taught her to relax her body, then to look at pictures, then a small toy, then a lizard in a jar from a distance. Each step was repeated until the fear dropped. After two months she could enter the kitchen calmly. "I did not become fond of lizards," she said, "but they no longer rule my house."

How to recognise it

• Intense, immediate fear of a specific object or situation such as animals, heights, injections, flying or blood.
• The fear is far stronger than the real danger and the person knows it, yet cannot control it.
• Heavy sweating, shaking, racing heart or even freezing when faced with it.
• Going out of the way to avoid it, which limits daily life.
• Fear has lasted months and causes shame or lost activities.

What this story explains

This story shows a specific phobia and how gradual, supported exposure treats it.

Probable root causes

• A frightening early experience with the object.
• Learning the fear from a parent or family member.
• A naturally sensitive alarm system.
• Avoidance that keeps the fear in place.
• Stress periods when fears feel stronger.

What to do

1. Understand that avoiding makes the fear grow, and facing it slowly shrinks it.
2. Learn slow breathing and muscle relaxation first.
3. Make a ladder of steps from pictures to the real thing.
4. Stay at each step until the fear falls before moving up.
5. Practise regularly, with a trusted person if helpful.
6. Reward each step you complete.

Whom to consult

• Clinical psychologist for exposure-based therapy, the best-evidenced approach.
• Family doctor if the phobia affects medical care, for example fear of injections.
• Psychiatrist if phobias are many, severe or come with panic or depression.

Do and don’t

How to behave and communicate

• Use a calm, respectful voice: "I know this feels huge. We will go one small step at a time."
• Believe the fear is real even if the danger is not.
• Let them set the pace.
• Say: "You did well. How was that for you?"
• Avoid jokes, even gentle ones, about the fear.

Aarav Who Would Not Speak

Aarav, six, is chatty and funny at home in Kolkata, but at school he does not say a single word. When the teacher asks him a question, he freezes and looks down. At the school gate he clings to his mother, cries and begs, "Don't go." Some mornings he complains of tummy aches.

His teacher wonders if he is rude or slow. His grandmother says he is spoilt. His mother, who has been dropping him later and later, feels guilty and exhausted. At a birthday party he whispered only to her.

The school counsellor met the family and explained that Aarav is not being stubborn. Two things are happening: strong fear of being apart from his mother, called separation anxiety, and an anxiety-based inability to speak in some places, called selective mutism. His parents and teacher worked together. Goodbyes became short and predictable, a small drawing from home went into his bag, and he was allowed to answer first with nods, then whispers, then words, without pressure. After a few months, he told his teacher, "My name is Aarav," and she smiled with tears in her eyes.

His mother also learned to take small steps herself, letting Aarav cope with a few minutes of discomfort. She says the change in her own worry was as important as the change in him.

How to recognise it

• Extreme distress at separation from a parent, with crying, clinging or tummy aches.
• Speaking freely at home but staying silent at school or with strangers for more than a month.
• Refusing school, sleepovers or being alone in a room.
• Worries about harm coming to parents.
• Lasting beyond usual early-childhood fears and affecting learning and friendships.

What this story explains

This story shows separation anxiety and selective mutism in children and how family and school support them.

Probable root causes

• A naturally shy or sensitive temperament.
• Family history of anxiety.
• Big change such as a new school or house move.
• Overprotection that unintentionally limits coping practice.
• Fear linked to an illness, loss or frightening event.

What to do

1. Tell the child that you understand and that school is safe and you will return.
2. Keep goodbyes short, warm and the same every day.
3. Work with the teacher on a gradual plan, starting with non-verbal answers.
4. Never pressure the child to speak; reward brave attempts.
5. Create low-pressure chances to talk with one friend at a time.
6. Keep routines predictable at home.

Whom to consult

• Paediatrician or family doctor to rule out health causes.
• School counsellor to plan support in class.
• Child psychologist or child psychiatrist if the problem lasts beyond a few weeks or school is being missed.

Do and don’t

How to behave and communicate

• Use a soft, warm voice and get down to the child's eye level.
• Say: "I know it feels scary. I will come back after school."
• Accept nods and gestures as answers.
• Avoid asking many questions at once.
• Notice and name bravery: "You waved goodbye today."

This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.