All of us has experienced anxiety and fear. To live without them is impossible. Anxiety can be a wearing stress or a stimulating tonic. Fear can be protective d lead to appropriate escape from danger. Fear can be overcome with bravery or be overwhelming. The English language is full of words to describe the many shades of anxiety and fear: aghast, agitation, alarm, anguish, apprehension, concern, consternation, disquiet, distress, dread, guts, horror, misgiving, nervousness, panic, qualm, scare, terror, threatened, trepidation, troubled, unease, unnerved, unsettled, upset, wary.
The Overlap Between Anxiety And Fear
These terms (anxiety and fear) have been defined in various ways, some of which are specific and scientific and others of which are vague and overlapping.
We feel that it would be futile to try to impose a rigid definition on either term and that to do so would be more confusing than enlightening. Anxiety and fear are often used interchangeably without any loss of understanding. For example, a phobia is one of the many types of anxiety yet is defined as a “persistent or irrational fear.” Or a person may complain of being anxious in anticipation of a specific external event such as public speaking or may have an “ill-defined fear” that something unpleasant will happen.
If any distinction is to be made, it is that the causes of fear tend to be more external to the individual and thus more easily identified, such as when our car skids out of control on a patch of ice or we are threatened by a hoodlum. Anxiety, by contrast, can be viewed as a response to a less obvious, ill-defined, irrational, distant, or unrecognized source of danger. Anxiety describes an unpleasant state of mental (or psychological) tension often accompanied by physical (or physiological) anxiety symptoms in which we may feel both physically and mentally helpless, exhausted by being always on guard against an unidentifiable danger. Fear also causes unpleasant mental tension and physical changes.
Phobias are recognized by the sufferer as irrational fears that do not frighten most people and that cause the sufferer to avoid the frightening situation or even thoughts about it.
Anxious people have some of the following common complaints: shakiness, jumpiness, jitteriness, trembling, tension, muscle aches, fatigue, and inability to relax. There may also be eyelid twitch, furrowed brow, strained face, fidgeting, restlessness, easy startle, and sighing.
Other indications of anxiety are sweating, racing or pounding heart, cold, clammy hands, dry mouth, dizziness, lightheadedness, numbness and/or tingling in the hands or feet or other parts of the body, upset stomach, hot or cold spells, frequent need to urinate, diarrhea, discomfort in the pit of the stomach, lump in the throat, flushing, pallor, and a high pulse and respiration rate, even while resting.
An anxious person is apprehensive and continually feels anxious, worries, ruminates, and anticipates that something bad will happen to himself or herself (such as fainting, losing control, or dying) or to others (such as family members becoming ill or being injured in an accident).
The individual feels “on edge,” impatient, or irritable even while trying to cope with anxiety. There may be complaints of being easily distracted or having difficulty concentrating and sleeping.
Different Kinds Of Anxiety And Panic
Anxiety has many gradations of intensity. It can be a mere qualm, rise to marked trembling, or become complete panic. Panic is extremely intense anxiety attack.
The onset and duration of anxiety (or panic) also varies. It may come on gradually over minutes or hours, or strike like lightning out of the blue. And it may last for only a few seconds or for hours or even days, although severe panic does not usually last longer than half an hour or so.
If we feel anxious or panicky regardless of where we are, that is called spontaneous anxiety (or spontaneous panic if it is very intense). Anxiety which occurs only in particular situations is called situational or phobic anxiety (or phobic panic if it is severe). And if our anxiety is triggered even by merely thinking of particular situations, that is a variety of phobic anxiety (or phobic panic) which is called anticipatory anxiety (or anticipatory panic).
As far as we can tell, the feelings are similar whether the anxiety (or panic) is spontaneous or phobic. Research has found that the type of phobia also makes little difference to the feelings that are experienced: People with agoraphobia, social anxiety disorder, and animal phobia all report similar feelings when in the phobic situation.
Intensity, however, can pull out more stops, depending on the type of anxiety or panic. In experiencing mild tension we might have no more than an unpleasant feeling in the pit of our stomach. The extreme anxiety we call panic brings out a greater orchestration of feelings—we are more likely then to feel rapid heartbeat, sweating, and trembling and to think that we are going mad or losing control.
Panic and anticipatory anxiety can usually be differentiated, and most individuals grow in their ability to do so as their experience with anxiety/panic increases. Figure 1 symbolically displays the subjective difference patients often describe between the two anxieties (this illustration was prepared by Dr. David Sheehan, who has kindly allowed us to reproduce it here). Other patients report little, if any, difference in the subjective experience or signs of panic and anticipatory anxiety.
All in all, it is simply not necessary to make a big fuss about distinguishing between anxiety and fear.
Theories Of Anxiety
In psychoanalytic theory, anxiety is thought to represent a conflict hidden beneath the level of conscious awareness. These anxieties are thought by psychoanalysts to have early origins related to discomfort (as when children are sick, soiled, hungry, or frightened), sex (classically involving feelings of the infant and child for its parents), or aggression (sometimes in the various forms of child abuse). Quite logically, this theory led to psychotherapies whose purpose was to first uncover and then resolve the hidden conflict with the expectation that the symptoms symbolizing the conflict would then disappear.
Later it became clear that understanding and resolving less conscious conflicts did not always relieve phobic and obsessive-compulsive anxiety or restore individuals to normal functioning. Learning theorists proposed that anxiety is a learned behavior and, therefore, could be unlearned. Simply put, if a person feels anxious in a situation, avoids it, and so decreases his anxiety, this makes it more likely that the person will try to switch off the anxiety the next time by avoiding again. This anxiety relief is bought at a cost of avoiding the feared situation and all the handicaps such avoidance brings on. However, if anxiety-provoking situations are persistently confronted rather than avoided, people “learn” that their anxiety dies down even without avoidance. Learning theory does not explain why persistent expo¬sure to the feared situation causes the anxiety to subside.
Recently, scientists have focused attention on biochemical mechanisms that may underlie Anxiety Disorders. Their theories suggest that certain types of biochemical imbalances are responsible for these disorders and that treatment directed at correcting such imbalances will be clinically beneficial. While treatment based on this model is often assumed to be accomplished only with anxiety medication, it is important to recognize that psychological and behavioral influences can cause changes in brain chemistry, and that the biochemical model favors no single therapeutic approach. To the adage, “For every twisted thought a twisted molecule,” we might add, “For every straightened thought a straightened molecule.”
Of these theories of anxiety (psychodynamic, learning, and biochemical), as well as genetic (dealing with inheritance) and developmental (issues regarding maturation) theories, each has something to contribute to our understanding of Anxiety Disorders and anxiety causes. The origins of fears are sometimes identifiable in a patient’s past; fears are probably maintained, in part, by learned avoidance behavior; and Generalized Anxiety Disorders have biochemical underpinnings that govern the kind and extent of anxiety experienced. Some anxieties are clearly influenced by genetic factors, and some anxieties appear and disappear at common stages in human development. It is unlikely that any one theory can explain the origins and maintenance of anxiety. However, theories often generate sectarian beliefs that introduce and maintain bias in what should be broad and objective scientific thinking. Sir Rabindranath Tagore defined a sectarian as “one who thinks he has the whole sea ladled into his own private pond.” Theorists who become sectarians resemble dogmatists everywhere. When theory ma reality are in conflict, dogmatists impose theory and mistakenly proclaim a fit.
Theory suggests leads that have to be explored and carefully evaluated in rigorous scientific studies and anxiety articles.
Modesty is appropriate at this stage in our quest for knowledge about the causes of Anxiety Disorders and the mechanisms through which they become manifest, for there still remains much to learn. While theories guide practice and may be helpful to doctors and their patients in providing a rationale for a treatment approach, rationales are often mere rationalizations, theories are often wrong (at least in part), and treatments based on theories can be ineffective (as in some psychoanalytic anxiety treatment of Phobic and Obsessive-Compulsive Disorders) or even harmful (when clinicians who believe too strongly in a single theory advocate an ineffective treatment and fail to refer patients for an alternative treatment that could be more effective).
The origins of Anxiety Disorders are complex and still largely beyond our present knowledge. We know, however, how to help many people who have the disorders. Often, effective treatments in medicine are based on experience, as is true for behavioral and drug treatments of anxiety. The explanation for why they are helpful often come after they have been developed rather than before. Practically speak¬ing, we would rather have a treatment that works and not understand why than know the cause of an illness but not be able to effectively treat it.