Stress vs anxiety (and overwhelm): how to tell the difference

What is the difference between stress and anxiety?

So the difference is mostly about cause and timing. Stress “generally is a response to an external cause” and “goes away once the situation is resolved”. Anxiety “generally is internal” and “usually involves a persistent feeling of apprehension or dread that doesn’t go away”^[1]. Notice the word “generally”: the two overlap a lot, and many people feel both at once.

Neither is a problem in itself. The WHO says “a little bit of stress is good and can help us perform daily activities”^[4], and the NHS notes that some people find stress “helpful or even motivating”^[2]. In the same way, “occasional anxiety is a normal part of life”^[6]. It becomes a problem when it is intense, lasts or gets in the way of your life.

Stress vs anxiety vs overwhelm at a glance

This table puts the three side by side. It is a guide, not a way to diagnose yourself.

Based on NIMH, the NHS and NHS Every Mind Matters^{[1][2][3][5][8]}.

Symptoms of stress and anxiety

“Both stress and anxiety can affect your mind and body”^[1], and the official lists overlap almost completely. Either can bring:

• Worry, racing thoughts and trouble concentrating or making decisions^[2][5]
• Feeling irritable, tense, restless or tearful^[3][5]
• Headaches, muscle tension and other aches^[2][4]
• Stomach problems^[2][4]
• A faster or more noticeable heartbeat, or feeling short of breath^[5][7]
• Sleeping too much or too little^[2]
• Avoiding certain places or people, or drinking or smoking more^[2]

When you feel anxious or scared, your body releases stress hormones such as adrenaline and cortisol, which is why the physical signs feel so similar^[7]. Because the symptoms are shared, they will not tell you on their own which one you have. Physical symptoms can also have other causes, so it is worth seeing a doctor to rule out medical conditions^[6]. Get chest pain checked: call your local emergency number (999 in the UK, 911 in the US) if it comes on suddenly and does not go away, or comes with sweating, sickness, light-headedness or breathlessness^[28].

Am I stressed or anxious? Three questions

Ask yourself:

1. Is there a clear cause right now, such as a deadline, a move or a conflict?
2. Does the feeling ease when that situation ends, or carry on regardless?
3. Is it getting in the way of your life, making you avoid things, or always there?

The third question matters most. NIMH says you may be at risk of an anxiety disorder if you feel you cannot manage the stress and its symptoms “interfere with your everyday life”, “cause you to avoid doing things” or “seem to be always present”^[1].

There is no stress vs anxiety test that can diagnose you. Researchers measure stress by asking how unpredictable, uncontrollable and overloaded your life has felt in the past month^[14]. For anxiety, our post on high-functioning anxiety explains the short questionnaire many doctors use. Bliss Therapy also has a free anxiety self-test. A score can tell you whether to talk to someone, but only a professional can assess what is going on.

What does feeling overwhelmed mean?

“Overwhelm” is an everyday word, not a medical one. The NHS lists “feeling overwhelmed” among the signs of stress^[2], and NHS Every Mind Matters explains that stress typically happens “when we feel we do not have the resources to manage the challenges we face”^[3]. Overwhelm is what that feels like: too much at once, and no clear place to start. Stress questionnaires get close to it when they ask how often you felt you “could not cope with all the things that you had to do”^[14]. Anxiety can feel overwhelming too, when it is “really intense”^[5].

It is very common. In a 2018 UK survey, 74% of adults said that at some point in the past year they had felt so stressed they were overwhelmed or unable to cope^[13].

Overwhelm when you live abroad

Moving countries piles up exactly the kind of demands the NHS lists as causes of stress, such as pressure at work or home and “difficult or sudden life events”^[3]: a new job, paperwork in another language, finding a home. It often happens just as you are far from the friends and family who usually help, and official advice names keeping in touch with people you trust as one of the best ways to manage stress^[4][17]. Research on international students links the stress of adjusting to a new culture with more distress and depression, though it shows a link, not a cause^[29]. Many of our clients tell us the hardest part is not having anyone to talk it through with in their own language. See our page on therapy for expats.

When stress or anxiety becomes a problem

Short bursts of stress are part of life. But NIMH warns that if anxiety “doesn’t go away and begins to interfere with your life, it could affect your health”, including your sleep and your immune, digestive and heart health^[1]. Sleep is a good example: poor sleep and anxiety seem to feed each other, though the evidence is still limited^[12].

Lasting anxiety can also be a sign of generalised anxiety disorder (GAD), which “is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events”^[9]. In the UK, a GP may consider GAD if you often worry about many different things, find the worry hard to control, it affects your daily life, and you have felt anxious a lot of the time for at least 6 months^[8]. US criteria use the same 6 months, with symptoms such as restlessness, tiredness, poor concentration, irritability, muscle tension or sleep problems^[9]. The WHO’s manual adds that normal worry usually does not “interfere with functioning or cause marked distress”^[11]. Only a qualified professional can diagnose GAD.

How to manage stress

The advice from the NHS, the WHO and NIMH is consistent^[1][2][4]:

• Move more. Exercise “will not make your stress disappear”, but it can take the edge off^[17]. A large overview of trials found physical activity eases distress and anxiety, though many of the reviews were of low quality^[19].
• Talk to someone. Share how you feel with friends, family or colleagues you trust^[4][17].
• Break it down. Split big tasks into smaller steps, prioritise what makes a real difference, and do not try to do everything at once^[2][3][17].
• Plan ahead for days or events you know will be stressful^[2].
• Focus on what you can control, rather than on things you cannot change^[2][17].
• Protect your sleep and routine: regular meals, a sleep routine, and less caffeine^[1].
• Try breathing or relaxation exercises, or keep a journal^[1][2].
• Avoid relying on alcohol, cigarettes, gambling or drugs to cope^[2].

If self-help is not enough, structured help works. Stress-management programmes at work have had medium to large effects in trials, and programmes based on CBT did best^[18]. Eight-week mindfulness courses have reduced stress in healthy adults, although results varied a lot between studies^[20]. A review of CBT research found some of its strongest support for anxiety disorders and for general stress^[21].

How to manage anxiety

Start with self-help

NHS self-help for everyday anxiety suggests three things^[5][22]:

• Set a worry time: “a short period, say 10 or 15 minutes, every day or so” to write worries down and look for solutions^[22]. In a small trial, a fixed daily worry period reduced worry, anxiety and sleep problems, though other studies have been mixed^[23].
• Sort your worries: ask “Is there anything practical I can do about it?” to tell problems you can solve from what-ifs you cannot control^[22].
• Face fears gradually. Avoiding what makes you anxious can make anxiety worse^[5][7].

Bringing your attention back to the present moment can also calm anxiety^[5]. For more practical steps, see how to stop overthinking.

Therapy

If anxiety keeps coming back or may be GAD, talking therapy is usually the first step: a GP will usually suggest it before medicine^[10]. CBT is the “gold standard” therapy for GAD^[9], and the WHO says therapies based on CBT have the most evidence for anxiety disorders^[27]. In trials, psychological treatment for GAD, mostly CBT, helped much more than being on a waiting list^[25], and CBT also beat placebo, by a moderate margin^[26]. UK guidance recommends starting with the lightest option likely to work, such as CBT-based self-help, then CBT or applied relaxation, usually 12 to 15 weekly one-hour sessions^[24].

Medication

Medication is also a treatment for anxiety disorders, alone or with therapy^[1][9]. That is a decision to make with a doctor or psychiatrist.

On Bliss Therapy

UK guidance recommends offering anxiety treatment “in the preferred language of the person with GAD if possible”^[24], and in most studies of patients treated in their own language, at least one outcome was better^[30]. On Bliss Therapy you choose a therapist who speaks your language, by video, with no waitlist. 52 psychologists and counsellors list anxiety and stress, with sessions from €30 (about £25); 42 of them list CBT.

Our therapists are based outside the UK and the US, so they are unlikely to be on UK registers or covered by US health insurance. Ask any therapist about their training and their registration in the country where they practise.

What is a panic attack?

A panic attack is a sudden rush of “intense anxiety and fear”, often with a racing heart, breathlessness, shaking and a feeling that you are losing control. Most last 5 to 20 minutes, and although they feel frightening, they “should not harm you”^[7]. Because the symptoms can look like a heart problem, follow the chest-pain advice above and see a GP if you are not sure whether breathlessness is caused by anxiety^[5][28].

When to get help

Talk to a doctor or a therapist if you are struggling to cope, if what you are trying yourself is not helping, or if stress or worry is affecting your daily life or will not go away^[1][2][3]. In the UK you can see a GP, or adults can refer themselves to NHS talking therapies^[10]. You do not need to wait until it gets worse.