Anxiety: Meaning, Symptoms and Treatment in Nigeria

Anxiety is the uneasy, worried feeling we get when we face a threat or a problem, often felt in the body as a racing heart, tight chest or upset stomach. It's normal and usually passes. It becomes an anxiety disorder when it's out of proportion, hard to control, lasts for months and gets in the way of life. Anxiety disorders are common and treatable.

What anxiety means

Anxiety is part of being human. A little of it before an exam or an interview helps you prepare. Your body is getting ready to act: stress hormones such as adrenaline speed up your heart and breathing and make you sweat. Our glossary has a short definition of anxiety.

Fear is about a danger in front of you now; anxiety looks ahead, to something that might happen. Stress is your response to pressure from outside, such as a demanding job or an illness, and anxiety can carry on even when the pressure has gone. Our stress page covers that side.

Anxiety becomes a problem when it's very strong, there most of the time, out of proportion to the situation, or stopping you from living your life.

Worry that fits your situation is not a disorder. Many people in Nigeria have real reasons to worry about money, jobs or safety, and being anxious about them makes sense. What matters is whether the worry has taken over: whether it runs all day, spreads to everything, and won't switch off even when you try. Our piece on financial anxiety deals with money worries in particular.

Symptoms

Anxiety shows up in the body, the mind and how you behave:

• In the body: a fast or pounding heartbeat, dizziness, headaches, chest tightness, breathlessness, sweating, shaking, feeling hot, stomach upset, loss of appetite, and trouble sleeping.
• In the mind: feeling tense or on edge, being unable to relax, worrying about the past or future, fearing the worst, poor concentration, and irritability.
• In what you do: avoiding places and situations, checking things again and again, seeking reassurance, and pulling back from people or things you used to enjoy.

Many people notice the body symptoms first, sometimes without realising they're anxious. Our guide to the physical signs of anxiety goes through them. Some medical problems, such as an overactive thyroid, and too much caffeine or coming off alcohol can cause similar symptoms, so it's worth seeing a doctor rather than diagnosing yourself.

Anxiety attack or panic attack?

"Anxiety attack" is an everyday phrase, not a medical diagnosis. People use it for two different things, so it helps to know both:

• A panic attack is a sudden surge of intense fear that peaks within minutes, with strong body symptoms: a racing heart, breathlessness, chest pain, shaking, dizziness, tingling, feeling unreal, and a fear of losing control or dying. Most last 5 to 20 minutes. They can come out of the blue.
• An episode of high anxiety usually builds more slowly, lasts longer and feels less intense in the body, often tied to a worry or situation.

Panic attacks are common: across World Health Organization surveys in 25 countries, about 1 in 8 adults had had one. Having panic attacks doesn't mean you have panic disorder. Panic disorder means attacks keep coming, at least some of them unexpectedly, with weeks of worry about the next one. Our guides on anxiety and panic attacks and panic disorder go further.

Chest pain is never something to assume is "just anxiety". If you have chest pain, breathlessness that doesn't settle, or you faint, or if it's your first attack or it feels different from before, get urgent medical help: call 112, or 767 in Lagos, or go to the nearest hospital emergency unit. Don't drive yourself.

Types of anxiety disorder

• Generalised anxiety disorder (GAD): excessive worry about many everyday things, such as work, money, health and family, on most days for months, with tension, restlessness, poor sleep and poor concentration. See what GAD is.
• Panic disorder: repeated, unexpected panic attacks and constant fear of the next one.
• Social anxiety disorder: intense fear of being judged or embarrassed in social situations or when performing, which is more than shyness. See social anxiety.
• Phobias: strong fear of a particular thing or situation, such as heights, enclosed spaces, animals or blood, out of proportion to the danger.
• Agoraphobia: fear of places where escape or help might be hard, such as crowds, markets or public transport. See our glossary entry on agoraphobia.
• Separation anxiety: excessive fear about being apart from the people you're closest to. It affects adults too, usually about a partner or children. See separation anxiety.
• Health anxiety: a persistent fear of having a serious illness, with repeated checking or seeking reassurance. Doctors now group it with obsessive-compulsive problems. See health anxiety.

Some people have more than one, and anxiety often comes with depression. Our depression page covers that.

How anxiety can show up in Nigeria

For many people, anxiety is first described through the body: dizziness, palpitations, a "hot" or "heavy" head, crawling feelings or stomach trouble. The World Health Organization's diagnostic manual notes that complaints like "heat in the head" are common ways of expressing anxiety in some cultures. These are real symptoms and worth taking to a doctor, along with how you've been feeling.

Some people explain anxiety through outside causes, such as spiritual attack or envy. Faith can be a real support, and a pastor or imam can be the trusted person who helps you get care. What doesn't help is being told to pray instead of getting treatment.

Students may have heard of "brain fag": headaches, poor concentration and trouble studying under exam pressure, first described among Nigerian students in 1960. In a 2015 survey, most Nigerian psychiatrists said they now diagnose these symptoms as anxiety or a mood problem instead, which is good news, because both respond to treatment. Our exam stress guide has practical help.

How common it is

Anxiety disorders are the most common mental health problems in the world. About 470 million people had one in 2023, according to the World Health Organization, and women are affected more than men. Only about 1 in 4 people with an anxiety disorder gets any treatment.

Nigerian figures vary with how they were measured:

• Nigeria's national mental health survey (interviews in 21 states, 2002 to 2004) found low rates: about 4 in 100 adults had an anxiety disorder in the past year. The researchers and WHO collaborators think rates like these are underestimates, partly because people may not tell interviewers how they feel.
• Lagos State Mental Health Survey (more than 11,000 adults, 2015): 3.5% had current symptoms of generalised anxiety, measured with a questionnaire.

Studies of particular groups, such as students and doctors in training, have found much higher rates.

What causes it

There's rarely one cause. Anxiety comes from a mix of stressful or traumatic experiences, ongoing pressure, your temperament, your health and your genes. Caffeine, alcohol and drugs can make it worse, and so can coming off them. Avoiding what you fear brings relief in the moment but tends to make anxiety stronger over time.

Treatment that works

Anxiety disorders are very treatable. Guidelines from the World Health Organization and the UK's National Institute for Health and Care Excellence (NICE) put talking therapy first.

Talking therapy

• Cognitive behavioural therapy (CBT) has the strongest evidence for generalised anxiety, panic, social anxiety and phobias. You learn how anxious thoughts, body sensations and avoidance feed each other, and you practise facing what you fear in small, planned steps.
• Guided self-help, a CBT-based course or workbook with short support sessions, is a good start for milder anxiety.
• Applied relaxation is another option for generalised anxiety.

How long it takes depends on the problem. For generalised anxiety, a course of CBT or applied relaxation is usually 12 to 15 weekly sessions. For panic disorder, NICE suggests 7 to 14 hours of CBT in total, finished within about four months. In practice, many people have around three to four months of weekly sessions. Guided self-help is shorter.

Therapy by video works about as well as therapy in person, so you can start from home. You can find a therapist who works with anxiety and panic and book by video, voice or chat.

Medicines

A doctor may offer medicine, usually an SSRI-type antidepressant, especially for generalised anxiety or panic disorder. For generalised anxiety, NICE treats therapy and medicine as equal choices at that stage, so your preference matters. Medicine takes a few weeks to work, and some people feel more anxious at first, so stay in touch with your doctor. Tell them straight away if you have any thoughts of suicide.

Sedatives that "calm your nerves" are not recommended for anxiety, except very briefly in a crisis, because people can become dependent on them and they don't help in the long run. If you already take one, don't stop suddenly; talk to your doctor.

The therapists on Mytherapist.ng provide talking therapy and don't prescribe. If you might need medication, see a doctor or psychiatrist. Our guide to therapy or medication can help you decide.

What you can do today

These are part of what therapists teach:

• Don't avoid what makes you anxious. Build up the time you spend in those situations a little at a time.
• Cut down on caffeine, including energy drinks and strong tea, and don't use alcohol or drugs to cope.
• Move your body, and keep regular sleep and meal times.
• Breathe slowly, in through your nose and out through your mouth.
• Try "worry time". Set aside 10 to 15 minutes a day to write your worries down. When one pops up at other times, note it and save it for later. In worry time, sort the problems you can act on from the ones you can't.
• Catch, check and change anxious thoughts. Notice a thought like "this will go badly", ask what you'd say to a friend who thought it, and try a fairer version.

During a panic attack, stay where you are if you can, breathe slowly, and remind yourself it will pass. Don't breathe into a paper bag. Our guide to handling a panic attack has more.

Helping someone with anxiety

• Notice the signs: worrying far more than seems reasonable, avoiding places, cancelling plans, headaches or stomach aches, or being on edge and irritable.
• Listen and take them seriously. Their fear is real to them, even if the danger isn't. You don't have to agree with the worry to show you care.
• Be patient with cancelled plans and irritability, and notice small steps forward.
• Encourage help, whether that's self-help or professional support.
• During a panic attack, stay with them, speak calmly, and breathe slowly with them. If they have chest pain or can't catch their breath, treat it as an emergency.

Anxiety tests

The most widely used anxiety check is the GAD-7: seven questions about how often symptoms have bothered you over the last two weeks. It's free to use, but it's a screening tool, not a diagnosis. In a large review, it missed about a third of people with generalised anxiety, and about half of people with anxiety disorders overall, because it wasn't built to pick up panic, phobias or social anxiety. A low score doesn't rule anxiety out, and a high one needs a proper conversation with a professional.

Getting help in Nigeria

You can go to any health facility, and by law, if it can't help you, it should refer you to one that can. A common route is a primary health centre, family doctor or general hospital first, then a psychiatry clinic at a teaching hospital or one of about eight federal neuropsychiatric hospitals.

Talking therapy is also available from clinical psychologists, therapists and counselors, including online. You can find a therapist who works with anxiety and panic on Mytherapist.ng and see their prices before you book.

Most people in Nigeria pay for mental health care themselves. Health insurance cover varies, so ask your HMO or NHIA provider exactly what's covered: psychiatrist visits, medicines and talking therapy. Our guides to the cost of therapy and free and low-cost options can help.

When it's urgent

Get urgent medical help for chest pain, breathlessness that doesn't settle, fainting, or a first panic attack or one that feels different: call 112, or 767 in Lagos, or go to the nearest hospital emergency unit.

Anxiety can also bring thoughts of suicide, especially alongside depression. If you're thinking about ending your life, you're not alone, and help is available now. To talk to someone at any hour, Safe Place Nigeria is on 0800 800 2000. It's toll-free and answered 24 hours a day. More numbers are on our helplines page.