As wildfires increasingly impact the global economy and public health, understanding their effects is crucial. Particularly, the relationship between wildfires and anxiety disorders remains unclear. In this study, we explore this association by analyzing 1,897,865 emergency department visits for anxiety disorders in the western United States. We examined records from 2007 to 2018, using a case-crossover design and conditional logistic regression to assess the impact of wildfire-related exposures on these visits. Here we show that exposure to wildfire smoke PM2.5 is positively linked with emergency department visits for anxiety disorders. This effect is more pronounced in women and girls and in older adults, highlighting their vulnerability. Notably, major smoke events (smoke PM2.5 contributed ≥75% of the total PM2.5) significantly amplify this risk. These findings underscore the psychological impacts of wildfires and their smoke, suggesting a need for targeted disaster risk reduction and climate risk management strategies, especially for vulnerable groups such as older adults and women. Our results call for increased climate awareness and tailored risk communication to mitigate these emerging health challenges.