Back to Blog Anxiety & The Body
July 15, 2025
Anxiety & The Body

Anxiety & The Body (by Dr Sean David)

Fight or Flight?

Anxiety refers to a state of anticipation of alarming future events. Anxiety is usually a normal transient response to stress and may be a necessary cue for adaption and coping, the body’s protective mechanism known as the ‘fight or flight response’.

Image 1 – Anxiety & […]

Anxiety & The Body (by Dr Sean David)

Fight or Flight?

Anxiety refers to a state of anticipation of alarming future events. Anxiety is usually a normal transient response to stress and may be a necessary cue for adaption and coping, the body’s protective mechanism known as the ‘fight or flight response’.

Image 1 – Anxiety & The Body (Blog Article by Dr Sean David), image source: https://cbt4panic.org/anxiety-symptoms-stem-from-the-very-helpful-fight-or-flight-response/

However, anxiety can become pathologic, where it is excessive and inappropriate to the reality of the current situation. It is often described by many as a distressing experience of dread and foreboding.

Anxiety is manifested in the affective, cognitive behavioural and physical domains. The affective states could range from edginess and unease to terror and panic. Cognitively, the experience is one of worry, apprehension and thoughts concerned with emotional or bodily danger. Behaviourally, anxiety triggers a multitude of responses concerned with diminishing or avoiding the distress.

Physical Manifestations of Anxiety

The stimulation of the autonomic nervous system results in an array of bodily perturbations.

Image 2 – Anxiety & The Body (Blog Article by Dr Sean David), image source: https://www.anxietycentre.com/anxiety-disorders/symptoms/

Several nervous system structures are involved in fear and pathologic anxiety.

Image 3 – Anxiety & The Body (Blog Article by Dr Sean David), image source: https://www.xcode.life/genes-and-health/how-anxiety-affects-brain/

The amygdala is responsible for initiating the fight-or-flight response. When activated, the amygdala triggers a series of changes in brain chemicals and hormones that puts the entire body in anxiety mode.

Image 4 – Anxiety & The Body (Blog Article by Dr Sean David), image source: https://cbt4panic.org/the-fight-or-flight-response-symptoms/

Left untreated, over time the affected individual’s body physically responds more frequently and intensely to worries. Co-morbid depression often sets in. One’s ability to meaningfully function academically, occupationally and socially gets hampered, leading to a deterioration in quality of life.

Treatment of Pathologic Anxiety

The first point of contact for many patients would be their general practitioners or even the hospital Accident & Emergency department. It is important to evaluate and rule out underlying medical illnesses that may mimic an anxiety disorder such as thyroid disorders, heart rhythm disturbances, gastrointestinal diseases or alcohol withdrawal.

The doctor may order some basic investigations such as a thyroid function blood test or an electrocardiogram (to check one’s heart rhythm). Once medical causes have been excluded or identified and treated, persisting anxiety symptoms would warrant a psychiatric consultation.

A prescription of anti-depressants such as Selective Serotonin Re-Uptake Inhibitors (SSRIs) to aid in balancing of brain neurotransmitters may be suggested. Anxiolytics such as benzodiazepines e.g. Clonazepam may be used in the initial phase of treatment, and thereafter only short courses being prescribed to reduce the risk of dependency.

Cognitive-Behavioural Therapy (CBT) involves cognitive re-structuring and anxiety symptom management. Cognitive interventions are aimed at challenging and correcting the inaccurate and maladaptive thought patterns that maintain anxiety disorders. Symptom management techniques e.g. relaxation and breathing re-training procedures help to eliminate anxiogenic bodily reactions.

Image 5 – Anxiety & The Body (Blog Article by Dr Sean David), image source: https://www.psychreg.org/anxiety-disorders-causes-treatments/

Lifestyle adjustments to one’s hectic pace of life need to be made to break the vicious cycle of stress and worry. Developing a healthy routine with regularly scheduled self-esteem raising activities, ensuring adequate rest and nutrition as well as maintaining social connections are pivotal for mental wellness.

References

  1. Massachusetts General Hospital, Handbook of General Hospital Psychiatry, seventh edition, chapter 13: Anxious Patients.
  2. Kaplan & Sadock’s Concise Textbook Of Clinical Psychiatry, fourth edition, chapter 6: Anxiety Disorders.

Dr. Sean David Vanniasingham
Consultant Psychiatrist

Dr Sean David Vanniasingham is a consultant psychiatrist experienced in general psychiatry, addiction medicine, and neurostimulation treatment.Dr David graduated from the National University of Singapore with a Bachelors in Medicine and Surgery and subsequently attained his post-graduate degree from the Royal College of Psychiatrists. After completing his psychiatry residency training, he practiced as a psychiatrist at the Institute of Mental Health (IMH) and the National Addictions Management Service (NAMS).Dr David has a vast experience in treating patients from both inpatient and outpatient settings. He has treated a wide variety of conditions including depression, anxiety, OCD, ADHD, psychosis, addictions, stress-related conditions and insomnia. He is also trained in in the practice of neurostimulation treatment modalities such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). Dr David is a firm believer of practicing a bio-psycho-social model approach in the holistic and recovery-oriented care of his patients.Dr David is passionate about the education of young doctors. He was awarded the National Healthcare Group teaching recognition award for medical educators. He has also presented at conferences and given public education talks. He is an examiner for the MRCPsych (UK) examinations held in Singapore. Dr David is a fellow at the Academy of Medicine Singapore and is currently serving as an executive committee member of the Singapore Psychiatric Association.