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The #1 Problem that Causes Severe Anxiety

The #1 Problem That Causes Severe Anxiety
One of the most common reasons why people seek out psychotherapy is because they struggle with anxiety. However, saying that someone has a problem with severe anxiety doesn’t really say much about what is it that the person is really struggling with. In my practice, I work with children, adolescents and adults, who experience anxiety to one degree or another, but the anxiety itself is rarely the main problem. Please, let me explain.

The presenting complaint

Often times in psychoanalysis and psychoanalytic psychotherapy, what we call the “presenting complaint” isn’t always the issue at stake in the treatment. For this reason, when I hear that a new client needs help for anxiety, I am often cautious not to take that statement at face value. As I reviewed in a previous post, from a psychoanalytic point of view “anxiety is the universal currency of affect, in a sense that every emotion can be converted into it” (Bruce Fink). So when I hear anxiety, I pretty much know that we’ll have some digging to do.

Anxiety is a symptom

People come for help because of a certain “symptom” that has been bothering them for awhile, and they’ve come to the point that they cannot deal with it on their own anymore. That symptom can be anything from anxiety and depression, to self-injurious or oppositional and defiant behaviors in kids and adolescents, to substance abuse, hypochondria, promiscuity or difficulty with relationships.

Notice how I frame all of these mental health issues as symptoms. That’s right, from a psychoanalytic point of view, anxiety, which is what we are talking about today, is a symptom, a symptom of something else. What this means is that the anxiety is NOT the problem itself, but rather, it’s a manifestation or a SYMPTOM of the problem.

The real problem

Okay, so what’s the real problem then? I am glad you asked. The real problem is usually something very specific to the individual’s psyche and personal history that is rarely easy to identify. I am saying this because I want to emphasize that it is not as simple as pointing your finger at this or that and saying “That’s the real problem!” It is very important not to put people in predetermined categories and in my opinion, we will be doing a disservice if we did that. The real problem is UNIQUE to every person.

The #1 problem underlying severe anxiety

However, there is one common problem that causes severe anxiety regardless of the specific shape or form it takes. That problem is generally defined as psychological TRAUMA. Oftentimes, people, who have experienced trauma in their past find themselves tormented by recurrent and severe anxiety, difficulty sleeping, fear, worry, uneasiness, difficulty trusting people and maintaining relationships, and occasional or periodic panic attacks.

Of course, anxiety is just one of the symptoms caused by the unbearable affect and emotional pain of traumatic experiences. But it doesn’t come as a surprise that the number one problem often underlying severe anxiety is a history of trauma. In psychoanalytic psychotherapy, once people are able to address the unspeakable, frightening and terrifying events that have lead to the anxiety, they can begin to make changes in their relationships for a happier and more fulfilling life.


I will leave the topic of trauma for another post but if you would like to learn more about common mental health issues affecting you and your family, subscribe to Mental Health Digest and get the latest issue emailed to you today by leaving your name and email address in the contact form here.

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The #1 Problem that Causes Severe Anxiety

Mihaela Bernard, MA, LCPC

Mihaela Bernard, MA, LCPC is a licensed clinical professional counselor and founder of Inside Family Counseling, LLC in Chicago. She is a Professional Member of the American Counseling Association and a member of Chicago Psychoanalytic Circle of the Freudian School of Quebec, Canada. She is the author of Mental Health Digest electronic magazine, your free, easy-to-read electronic resource on common mental health issues affecting you and your family, plus some suggestions on how to address them. She specializes in psychoanalytic psychotherapy for troubled children and adolescents, who face behavioral and emotional challenges at home and at school. Her mission is to empower, support and guide children, adolescents and their parents to a happy and healthy family. Mihaela also writes a Parenting Blog, where parents find helpful resources and practical tips on how to support their child and adolescent's behavioral and emotional development. You may find out more about her at

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APA Reference
, . (2019). The #1 Problem that Causes Severe Anxiety. Psych Central. Retrieved on April 6, 2020, from


Last updated: 28 Mar 2019
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