The Bible has a lot to say about anxiety. Jesus tells us, "do not worry" (Matt.6:25). And everyone knows that Paul told the Philippian church: "Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God” (Phil. 4:6). We read about worry, anxiety, and fear so much in the Bible because it's such a common, human reaction to the unknown future. We've all been anxious--even Paul (2 Cor.11:28).

Everyone experiences anxiety on some level. Some may be more prone to becoming anxious than others, but no one is immune to it. The big question is when is anxiety considered a mental illness? Or to put it in other terms, when does worry develop into a pattern of overwhelming anxiety?

To better understand the issue, it might be easier to think of it on a spectrum. On one end of this spectrum is nervousness and concern, but it is manageable. On the far other extreme is outright fear and panic attacks. As anxiety moves along the spectrum it becomes more difficult to manage. Most everyone has been overwhelmed by anxiety at some point, but if this develops into a pattern that affects daily life, then it might have become a mental disorder. A disorder is just what it sounds like--normal functioning has been disrupted. Order has become disordered. With an anxiety disorder, our minds have been overloaded with stressors to the point that it disrupts our ability to function normally. Worry has become debilitating.

How do I recognize an anxiety disorder?

There are many types of anxiety disorders, but one of the most common is called generalized anxiety disorder. Here are the criteria:

1. Excessive anxiety and worry occurring most days of the week for at least six months.

2. The person finds it difficult to control the worry.

3. The anxiety is accompanied by at least three of the following symptoms:
   -Restlessness or feeling keyed up or on edge
   -Being easily fatigued
   -Difficulty concentrating or mind going blank
   -Irritability
   -Muscle tension
   -Sleep problems (difficulty falling asleep, staying asleep, or restless sleep)
   
   

What does this Bible say about this?

Because of the length of time (at least 6 months), it can be difficult to identify true anxiety disorders in the Bible. We simply don't have a record of six consecutive months of someone's life. We can, however, identify aspects of anxiety struggles. The Bible provides us more information on David than any other. It records his life from around twelve years old to his death. Of that time, we're given incredible details about a specific period lasting from four to seven years, before he became king of Israel.

During this time David’s life was characterized by running for his life from king Saul. After learning from Jonathan that King Saul was after him, David fled to Nob to get food and weapons. One of Saul’s servants called Doeg the Edomite saw him and reported it to the king. In his fear, David ran to the neighboring country of Gath, where King Achish ruled. David was “very much afraid of Achish king of Gath. So he pretended to be insane in their presence; and while he was in their hands he acted like a madman, making marks on the doors of the gate and letting saliva run down his beard” (1 Sam.21:11-12). Saul hunted David, almost capturing him a few times, and eventually chased him around a mountain.

It is most likely that David wrote many psalms during this period of his life. One of those is most likely Psalm 55, which is the most telling. In this vulnerable psalm, he reveals his mental state at the time. It appears that David is struggling with anxiety that is in line with anxiety disorder. He experiences:

Excessive anxiety and worry. “My thoughts trouble me and I am distraught because of what my enemy is saying, because of the threats of the wicked; for they bring down suffering on me and assail me in their anger” (vv.2-3).

Difficulty controlling the worry. “horror has overwhelmed me” (v.5)

Restlessness or feeling keyed up or on edge. “I am restless in my complaint (ESV)…I said, “Oh, that I had the wings of a dove! I would fly away and be at rest. I would flee far away and stay in the desert; I would hurry to my place of shelter, far from the tempest and storm” (vv.6-8).

Because this is a psalm, rather than a narrative, we can only work with what we’re given in understanding David’s experience. However, reading what he has already told us, it’s not difficult to imagine him also experiencing other symptoms, such as: fatigue, difficulty concentrating, and difficulty with sleep (either falling asleep or staying asleep).

What's more, his symptoms recount what appears to be an actual panic attack.
These are not mental illnesses, but instead occur as a result (or within the context) of an anxiety disorder. Panic attacks are a sudden surge of intense fear that overwhelms our system. The symptoms are:

• Heart palpitations or accelerated heart rate. David writes, “My heart is in anguish within me” (v.4)

• Sweating

• Trembling/shaking. He says, “Fear and trembling have beset me; horror has overwhelmed me” (v.5)

• Shortness of breath

• Feelings of choking

• Chest pain or discomfort. “My heart is in anguish within me” (v.4)

• Dizziness/light-headed

• Fear of dying. David admitted, "the terrors of death have fallen on me” (v.4)