Most of us have coped with worry and stress to some extent. We attribute it to a busy life, going through a difficult period, or even part of our personality. However, there is a boundary between the normal stress of life and anxiety that gradually takes over a large part of daily life; a boundary many people cross before they realize it.
The hard part is that anxiety, when it appears, often seems entirely reasonable. For almost every symptom there is a convincing explanation, and that makes serious signs often ignored under labels like "it's just stress and simple fatigue" or "this too shall pass"; until they can no longer be ignored.
To pinpoint exactly where that boundary lies, Robin Raven spoke with Dr. Gil Lichtstein, a board-certified psychiatrist in Boca Raton, Florida. Relying on evidence-based treatments, he treats a wide range of psychiatric disorders in children, adolescents, and adults.
In this interview Lichtstein discussed signs that should be taken seriously; from physical symptoms many misinterpret to the point where continuing to push through is no longer an appropriate solution. He also explained how anxiety gradually casts a shadow over people’s decisions, relationships, and quality of life without them initially noticing the change.
Key points
Anxiety that occurs almost daily and disrupts your daily functioning is more than ordinary stress.
Physical symptoms such as stomach upset, chest pain, teeth grinding, and poor sleep are often mistakenly attributed to other problems.
Withdrawing from people, certain places, and activities is a warning sign that anxiety is gradually shrinking your world. According to Dr. Lichtstein, an anxiety disorder is like situational anxiety that never ends.
Alcohol, marijuana, and cigarettes usually worsen anxiety rather than reduce it.
Anxiety is treatable, and treatment can include psychotherapy, medication, or a combination of both.
When everyday stress becomes something more
Stress usually comes and goes, but clinical-level anxiety tends to persist. When asked how to distinguish the two, Dr. Gil Lichtstein said the most important criterion is the recurrence of symptoms and the extent of their impact on a person’s life.
He explained: "When anxiety occurs almost every day, or for most hours of the day, nearly every day, engages you, and affects your ability to do daily tasks, you are no longer dealing with ordinary stress."
In other words, the issue is not just that you sometimes feel anxious. The main question is whether anxiety has gradually taken control of your daily schedules, sleep, decisions, and choices.
Physical symptoms many are unaware are linked to anxiety
Anxiety is often thought of as a purely mental state, but in many people its first signs appear in the body. Lichtstein says this stems from the body's biological mechanisms. According to him, anxiety is closely linked to the body's "fight-or-flight" response. This response triggers the release of stress hormones; hormones that, to aid survival, produce various physical symptoms.
This survival mechanism means the list of physical symptoms of anxiety is long and many are easily mistaken for other illnesses. Lichtstein says gastrointestinal problems are among the most common of these symptoms, including nausea, diarrhea, vomiting, stomach discomfort, and a vague feeling of tightness or pressure in the abdomen.
The consequences of anxiety may also appear as chest pain or pressure, sudden sweating, or palpitations. Sleep is another early victim of anxiety and the disturbance is not limited to insomnia. Very vivid dreams, chronic fatigue, muscle tension, teeth grinding, temporomandibular joint (TMJ) disorder, and restless legs syndrome are also part of these consequences. However, Lichtstein emphasizes one important point: "Before attributing these symptoms to anxiety, we must first investigate and rule out possible physical causes."
Subtle signs that are easily overlooked
One reason anxiety is hard to diagnose is that it often makes sense. There is almost always a justification for each symptom. When asked about signs people usually ignore, Dr. Gil Lichtstein said these symptoms are often rationalized with phrases like "it’s just stress and simple fatigue" or "this is part of my personality."
He says many people do not take anxiety seriously until it leads to more serious problems such as panic attacks, burnout, chronic physical conditions, strained relationships, or reduced job performance. In such circumstances, these rationalizations seem reasonable and even responsible, but the cost is giving anxiety the opportunity to take root and worsen.
Situational anxiety or an anxiety disorder?
Almost everyone feels anxious before a big presentation, an exam, or a tough interview, but this type of anxiety is temporary and resolves after the situation ends. An anxiety disorder, however, is not like that.
Lichtstein says: "An anxiety disorder is a pathological condition. It disrupts a person's daily functioning, occurs almost every day, and instead of being a fleeting moment in life, it becomes persistent and intrusive." To explain the difference he uses a simple metaphor: "An anxiety disorder is like situational anxiety that never goes away."
How anxiety slowly shrinks your world
According to Lichtstein, some of the most important signs of anxiety do not appear as physical or psychological symptoms but in a person's behavior. He says anxiety has a very prominent behavioral component. People gradually distance themselves from anything that causes them discomfort or anxiety, and over time these small avoidances change the course of their lives.
Lichtstein describes this pattern with the phrase "out of sight, out of mind." Invitations are declined one after another, some places are no longer destinations, and connections with certain people are quietly severed. Each of these decisions may seem reasonable at the moment, but eventually a person may realize the world they live in has become much smaller than before.
When anxiety fuels unhealthy habits
For some people, anxiety gradually leads to substance use or behaviors that appear to be calming. Lichtstein says many people turn to alcohol, marijuana, or cigarettes to reduce anxiety, but these strategies usually have the opposite effect in the long term.
He explains: "These substances may create a sense of calm in the short term, but they usually exacerbate anxiety in the long term."
He says the cycle can form quickly; a person turns to a substance or behavior to escape anxiety, feels better, but when the effect fades, the anxiety returns more intensely, reinforcing dependence on that behavior. Lichtstein emphasizes that breaking this cycle is usually difficult without treating the root cause of the anxiety.
When to seek help from a professional?
If anxiety has reached the point where it affects your relationships, work, education, or daily quality of life, you should no longer consider it merely part of your personality or a result of life's pressures.
Lichtstein says many people live with anxiety for years because they believe they must endure it or that the situation will never change. The reality is different. He says: "Anxiety can be treated."
According to this psychiatrist, treatment can include psychotherapy, medication, or a combination of both depending on each person's circumstances. The key point is that people should know they do not have to cope alone with anxiety that has disrupted their daily lives.
Lichtstein emphasizes at the end that the earlier treatment begins, the more likely a person is to return to normal life and prevent anxiety from becoming chronic.
Different types of anxiety and why recognizing their differences matters
Anxiety is not a single condition and appears in various forms. Dr. Gil Lichtstein explains the different types of anxiety and mentions several distinct disorders.
He says generalized anxiety disorder is characterized by persistent worry about almost all aspects of life. Social anxiety occurs more in social situations, and specific phobias involve intense fear of particular stimuli or conditions. He also referred to panic attacks, which are short but very intense periods of fear and helplessness.
Lichtstein stresses that correctly diagnosing the type of anxiety is not merely theoretical or academic but directly affects the choice of treatment method. He says: "Identifying the type of anxiety matters because the best treatment depends on its underlying cause."
He says two people may appear to have very similar symptoms, but for recovery they may need two completely different treatment paths.
When to stop enduring and see a specialist?
Many people view endurance as a strength and try for months or even years to continue life despite anxiety. But Lichtstein believes this approach is not always helpful or correct.
He says there is a clear boundary; when the impact of anxiety on daily functioning, physical health, relationships, or the ability to maintain a job becomes evident, it is no longer time to endure.
He explains: "Generally, when the harm of anxiety is apparent in daily life, it is time to get help from a professional."
According to this psychiatrist, seeking treatment is not a sign of failure or inability but a step to prevent a problem from deepening and affecting various aspects of a person's life if ignored.
What does effective treatment look like?
The good news, and perhaps the part many do not expect to hear, is that anxiety treatment is both accessible and highly effective. When asked what people should expect when starting treatment, Dr. Gil Lichtstein explained that there are multiple treatment options and the choice depends on each person's circumstances.
He said: "Effective treatment can include cognitive psychotherapy, behavioral therapies, and medication; each alone or in combination, depending on the individual's situation." He added there is no one-size-fits-all prescription and the treatment plan should be tailored to each patient's needs.
Lichtstein also explained that signs of successful treatment usually appear in a particular order. He said: "When you feel your way of thinking has changed and that change leads you to act differently and ultimately feel differently, it means treatment is on the right track."
He says the first change occurs in thinking patterns, then behavior changes, and finally emotions follow.
Habits that inadvertently worsen anxiety
Many people resort to available solutions to escape anxiety, but those solutions sometimes deepen the problem. When asked what people usually do that instead of reducing anxiety actually worsens it, Lichtstein pointed to three: "alcohol, marijuana, and cigarettes."
He explained that while these substances may produce a sense of calm in the short term, in the long term they usually exacerbate anxiety and lead a person into a cycle that is hard to break.
If shame prevents you from seeking help
For many people the biggest barrier to treatment is not the anxiety itself but the shame of asking for help. When asked what he tells someone who feels embarrassed or worried about seeing a specialist, Lichtstein explained: "Anxiety is no different from diabetes or high blood pressure. It is an illness that can be treated." He said seeking help for anxiety should be as normal as going to a doctor for physical illnesses.