Helpful anxiety protects you — clinical anxiety can be treated.

Not everyone with anxiety has the same symptoms, or with the same intensity. Clinical anxiety is almost always felt first in the body:

• Racing heart or palpitations with no cardiac cause to explain them.

• Shortness of breath or tightness a sense of choking or pressure in the chest.

• Constant muscle tension neck, jaw, shoulders; aches that do not let up.

• Dizziness or a sense of unreality vertigo, depersonalization or derealization.

• Digestive discomfort nausea, abdominal pain, irritable bowel.

• Difficulty falling asleep the mind will not switch off at bedtime.

• Ruminative worry anticipating the worst, going in circles without resolution.

• Avoidance and safety behaviors no longer going places, carrying medication "just in case", over-checking.

Anxiety often does not come alone: it frequently coexists with depression, a history of trauma or an unrecognized underlying ADHD. Identifying what lies beneath changes the treatment — addressing only the visible symptom tends to give partial results.

It is worth a formal evaluation when:

1. 1

   Anxiety interferes with your work, studies, social life or sleep in a sustained way.

2. 2

   You have had one or more panic attacks and started avoiding places or situations for fear they will return.

3. 3

   You regularly use medication to "function" or to sleep, even without a clear prescription.

4. 4

   The anxiety appeared after a specific event (work, family, medical) and does not resolve on its own.

5. 5

   Other professionals have already ruled out medical causes, but the pattern of symptoms persists.

Asking for an evaluation is not overreacting — it is clinical information that opens up specific, well-studied treatment options.

These contrasts show why a professional makes the diagnosis — they are not a checklist for self-diagnosis. And several of these conditions can also coexist with an anxiety disorder: part of the evaluation is telling apart what explains what.

• A panic attack or a heart problem?

  The symptoms of a panic attack —palpitations, chest pain or tightness, shortness of breath— overlap with those of a cardiac event, which is why a first attack should be medically evaluated to rule out organic causes. Once ruled out, the pattern (peaks that reach their maximum within minutes and then subside, with normal tests) points to panic disorder. That distinction is not made over the web: it is made through evaluation.

• Clinical anxiety or normal stress?

  Feeling anxious before an exam or an important decision is normal and adaptive. It becomes clinical when it is out of proportion to the threat, persists even after the stressor has passed, and starts to narrow your life: what you avoid, how you sleep, how you function.

• Anxiety or a medical cause (thyroid, caffeine, arrhythmia)?

  Some medical conditions —such as hyperthyroidism or certain arrhythmias— and caffeine or other substances produce symptoms that mimic anxiety. That is why the evaluation includes ruling out organic causes before attributing everything to an anxiety disorder; sometimes they also coexist.

• Anxiety or depression?

  Anxiety and depression coexist very frequently and are not always easy to tell apart. Anxiety revolves around anticipation and fear; depression, around low mood and loss of interest. Working out which predominates —or whether both are present— changes the treatment plan.

• Anxiety or an unrecognized underlying ADHD?

  In some people, especially women, anxiety is the visible layer of an ADHD that was never diagnosed: the disorganization and the sense of always running behind generate a secondary anxiety. Treating only the anxiety, without seeing the underlying attentional pattern, tends to give partial results.

Frequently asked questions

1. Is a panic attack dangerous?

   A panic attack is an intensely unpleasant and frightening experience, but in a person without an underlying condition that would contraindicate it, the episode itself is time-limited —it usually peaks within minutes— and reversible. Understanding what happens in your body during the attack reduces the fear and is part of the treatment. If you have a known medical or cardiac condition, or it is your first attack, a medical evaluation to rule out other causes is the sensible step.

2. I have physical symptoms and the tests come back normal — could it be anxiety?

   It is very common. Anxiety produces real —not "imaginary"— physical symptoms because it activates the autonomic nervous system. If your medical tests are normal but the symptoms persist, a psychiatric evaluation is reasonable and is often the missing piece.

3. Will I depend on medication forever?

   Not necessarily. Core treatment combines psychotherapy and, when indicated, medication —which is generally kept for a defined period after improvement and then withdrawn in a planned way. Dependence-risk medications, when used, are handled in a limited way and with a withdrawal plan agreed from the start. If you already arrive using them daily, we assess a safe withdrawal together.

4. What medication will I take?

   It depends on each case —there is no single answer and I do not decide it in advance. Treatment is individualized to your presentation, your comorbidities and your tolerance, and not everyone needs medication. As a safety principle, I do not start medication at the first consultation, nor do I turn first to restricted medications.

5. Does social anxiety have a treatment, or is it part of my personality?

   It has a treatment. Being shy or introverted —a normal part of temperament— is one thing; clinical social anxiety, which stops you from doing things you want to do, is another. Exposure therapy and, when indicated, medication have good evidence.

6. Can I do the first consultation by video?

   Yes. The first evaluation of an anxiety presentation can be done perfectly well by telepsychiatry. What matters is that you have a quiet space free of interruptions during the hour-long consultation.

7. Do you see people who prefer care in English?

   Yes. I see patients in English with the same fluency as in Spanish, which is relevant for expatriates living in Lima, executives at multinational companies, or people who simply prefer to talk about intimate matters in English.

References

1. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022;9(2):137-150.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: APA; 2022.
3. National Institute for Health and Care Excellence (NICE). Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline CG113; 2011 (updated 2020).
4. Carpenter JK, Andrews LA, Witcraft SM, et al. Cognitive behavioral therapy for anxiety and related disorders: a meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018;35(6):502-514.
5. Cuijpers P, Sijbrandij M, Koole SL, et al. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13(1):56-67.