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The first step to properly diagnosing an anxiety disorder is to rule out another medical condition. Because anxiety accompanies so many medical conditions, some serious, it is extremely important for your health care professional to uncover any physiological medical problems or medications that might underlie or be masked by an anxiety attack.

Thus, a physical examination and medical and personal history is essential. You should describe any history of anxiety disorders or depression in your family and mention any other contributing factors, such as excessive caffeine use, recent life changes or stressful events. It is very important to be honest with your health care professional about all conditions, including substance abuse, or other psychological or mood states that might contribute to or result from the anxiety disorder.

Anxiety attacks can mimic or accompany nearly every acute disorder of the heart or lungs, including heart attacks and angina. Asthma attacks and panic attacks have similar symptoms and can also coexist. In addition, anxiety-like symptoms are seen in many other medical problems, including epilepsy, hypoglycemia, adrenal-gland tumors and hyperthyroidism. Women can also experience intense anxiety attacks with hot flashes during menopause. Many drugs, including some for high blood pressure, diabetes and thyroid disorders, can produce symptoms of anxiety, as can withdrawing from certain drugs like those used to treat sleep disorders or anxiety.

Panic disorder often coexists with depression, and sometimes the two conditions are difficult to distinguish because anxious feelings, agitation, insomnia and problems with concentration often accompany depression.

Thus, your health care professional will use a medical evaluation to rule out alternative explanations of anxiety symptoms.

Health care professionals can use various tests to determine the causes, type, severity and frequency of your anxiety. Most are written, multiple-choice tests that can be administered on paper or verbally. Among the most common:

The Hamilton Anxiety Rating Scale. It consists of 14 items, each defined by certain symptoms. This was one of the first rating scales developed to quantify the severity of anxiety symptoms. Since its introduction by Max Hamilton in 1959, it has become a widely used and accepted test for the evaluation of anxiety.

The Beck Anxiety Inventory measures the severity of anxiety in adults and adolescents and to differentiate between anxiety and depression, giving professionals a firm basis upon which to make diagnostic decisions.

A variety of other tests are available to health care professionals via the American Psychiatric Association and other professional organizations. Most are centered on defining the kinds of symptoms you experience as part of your anxiety.

Specific anxiety disorders are diagnosed based on the severity and duration of symptoms and on additional behavioral characteristics that accompany the symptoms of anxiety. Specifically:

• Generalized anxiety disorder (GAD) is confirmed if you experience excessive anxiety and worry on most days for at least six months and if three or more of the following symptoms are present (only one for children):

• edginess or restlessness

• tiredness and fatigue

• difficulty concentrating

• irritability

• muscle tension

• sleep disturbances

Symptoms should cause significant distress, impair normal functioning and not be due to a medical condition or other mood disorder or psychosis.

• Panic attacks are diagnosed if you experience recurrent unexpected panic attacks or have at least one unexpected panic attack followed by at least one month of fear that another will occur; this fear can be as disabling as the panic attack itself. If you associate the harmless circumstances surrounding the original attack with fear, similar circumstances later may recall the anxiety and trigger another attack. During a panic attack, you feel intense fear or discomfort, with at least four or more of the following symptoms:

• rapid heartbeat

• sweating

• shakiness

• shortness of breath

• a choking feeling

• dizziness

• nausea

• feelings of unreality

• numbness

• either hot flashes or chills

• chest pain

• fear of dying

• fear of going insane

Panic attacks that include only one or two symptoms, such as dizziness and heart pounding, are known as limited-symptom attacks; these may be either residual symptoms after a major panic attack or precursors to full-blown attacks. Panic attacks occur with other anxiety disorders, including phobias and post-traumatic stress disorder.

• Phobias. If you have a specific phobia, you may experience the following symptoms around the phobic object or situation:

• panicky feelings

• sweating

• rapid heartbeat

• avoidance behavior

• difficulty breathing

• Social phobia. Symptoms vary in intensity, ranging from mild and tolerable anxiety to a full-blown panic attack. Sometimes social phobia is manifested by extreme shyness and discomfort in social settings; frequent blushing, trembling, sweating, palpitations, diarrhea and confusion are typical symptoms.

• Agoraphobia: In its severest form, agoraphobia is characterized by a paralyzing terror of being in places or situations from which you feel there is no escape or accessible help in case of a panic attack. As a result, you might confine yourself to places in which you feel safe, usually at home. You may often make complicated plans to avoid confronting feared situations and places.

• Obsessive-compulsive disorder (OCD) is diagnosed if obsessions and compulsions interfere with your normal activities or cause emotional distress or anxiety, especially if the ritualistic behavior cannot be carried out. Adults with this condition usually recognize their obsessions or compulsions as excessive and unreasonable, yet feel compelled to engage in them. The obsessive thoughts or images can range from mundane worries about whether one has locked a door to bizarre and frightening fantasies of behaving violently toward a loved one. The compulsive acts triggered by such obsessions might include repetitive checking for locked doors or unlit stove burners or calls to loved ones at frequent intervals to be sure they are safe. Some people are compelled to wash their hands every few minutes or spend inordinate amounts of time cleaning their surroundings in order to subdue the fear of contagion.

  Certain other obsessive disorders, including body dysmorphic disorder (BDD), trichotillomania and Tourette's syndrome, may be part of the OCD spectrum. In BDD, people are obsessively preoccupied with an imagined defect in their appearance. People with trichotillomania continually pull out their hair, leaving bald patches. Symptoms of Tourette's syndrome include jerky movements, tics and uncontrollably uttering obscene words.

• Post-traumatic stress disorder (PTSD) symptoms can occur weeks, months, or even years after the traumatic event. If you suffer from PTSD, you may have the following symptoms:

• recurrent and distressing memories or dreams during which you feel you are reliving the event and feel separated from your surroundings or body

• sleeplessness

• depression

• agitation

• feelings of being "on alert" at all times

• emotional withdrawal

• hopelessness

• mood swings

• guilt over surviving the event

• inability to concentrate

• an excessive startle response to noise

Because of widespread lack of understanding and the stigma associated with anxiety disorders, many people with these disorders—an estimated one-third—don't receive a diagnosis, and so don't receive treatments proven effective through research. Yet anxiety disorders, like other mental illnesses, reflect specific dysfunctions within the brain and should not be faced with shame or fear. Enormous progress has been made in the scientific understanding of the underlying causes and mechanisms of anxiety disorders.

To be a smart health care consumer, you need to ensure the health care professional you see is able to recognize an anxiety disorder. While mental health treatment can be received from a wide range of professionals, including primary care physicians, psychiatrists, psychologists and social workers, you may want to consider seeking out an anxiety specialist, particularly someone who can offer the treatments found to be most successful, such as cognitive behavioral therapy and medications.

You can contact the Anxiety Disorders Association of America (www.adaa.org) or the Association for Behavioral and Cognitive Therapies (www.aabt.org) to find professionals specializing in anxiety. Make sure you follow the steps for seeking treatment as outlined in your health insurance plan. You may be required, for example, to see a primary care physician first. Some health insurance plans cover mental health services; some don't. Check your policy or ask your plan administrator so you can determine what your out-of-pocket expenses might be. Don't overlook the simple fact that you should like your treating professional. If you can't develop a rapport within the first or second session, your therapy won't be successful, so keep searching for someone with whom you're comfortable.