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Normal and Abnormal Anxiety: What's the Difference?

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.

At the most basic level, anxiety is an emotion. Simply stated, an emotion is a subjective state of being. It is often associated with changes in feelings, behaviors, thoughts, and physiology. Anxiety, like all emotional states, can be experienced in varying degrees of intensity. For instance, we might say we are happy. A more intense expression of this same emotion might be an experience of joy. But unlike the emotion "happiness," which has several different words to convey these differing levels of intensity (e.g., intensity ranging from happiness to joy), anxiety is a single word that represents a broad range of emotional intensity. At the low end of the intensity range, anxiety is normal and adaptive. At the high end of the intensity range, anxiety can become pathological and maladaptive. While everyone experiences anxiety, not everyone experiences the emotion of anxiety with the same intensity, frequency, or duration as someone who has an anxiety disorder. Let's look more closely at some of the differences between the normal emotion of anxiety, and anxiety as a disorder.

anxious manThe normal emotions of anxiety and fear

Anxiety, and its close cousin fear, are both considered emotions. While there is considerable overlap between these two terms, there are some important differences. Fear is generally considered a primary emotion. In contrast, anxiety is considered a secondary emotion that represents the avoidance of fear (including the avoidance of fear-producing stimuli). Primary emotions refer to emotions that are recognizable through facial expressions. Primary emotions can easily be interpreted by an observer and exist across different cultures. These primary emotions are: happiness, anger, sadness, fear, surprise, disgust. Secondary emotions, such as anxiety, are not readily recognizable to an outside observer. Secondary emotions are generally considered an internal, private experience.

The most important distinction between fear and anxiety is the timeframe. Fear is the response to a danger that is currently detected in the immediate, present moment of time. In contrast, anxiety refers to the anticipation of some potential threat that may, or may not, happen in the future. In other words, fear is a response to an immediate danger in the present moment of time, while anxiety is associated with a threat that is anticipated in a future moment of time. Anxiety reflects the anticipation of fear and represents an adaptive attempt to prevent the fear-provoking circumstance from occurring. In an anxious state, people are readying themselves and preparing themselves to cope with a future problem or dilemma that they anticipate will cause some kind of harm if not prevented from occurring. In this respect, anxiety is a normal, beneficial emotion.

Emotions are simply a normal part of the human experience. As such, they are neither good nor bad. What happens afterwards determines whether we experience a particular emotion as good or bad; i.e., the changes in our feelings, behaviors, thoughts, and physiology. At this point, you may be wondering, "What could possibly be good about fear and anxiety? Don't these emotions just make people feel miserable?" Well, the answer may come as a quite a shock, but fear and anxiety are actually very important emotions. When it comes to human survival and achievement, anxiety and fear actually motivate us to take necessary action. For example, picture a young mother and her child are crossing the street. The mother suddenly realizes they are in the direct path of an oncoming car. Imagine what would happen if she did not feel the least bit afraid. Now imagine a law student preparing to take his bar exam so that he can become an attorney. What if he didn't have any anxiety over whether he passed or failed his bar exam? Clearly, without fear and anxiety to prepare their minds and bodies for automatic action, these individuals would be at risk for some very serious, negative consequences. So, while the experience of fear or anxiety may at times be an unpleasant one, we can see that without these important emotions we'd actually be far worse off.

Fear and survival: The fight-or-flight response

When people speak of fear, they are often referring to the body's physiological response to fear. This is known as the fight-or-flight response. More specifically, when we are in the presence of an immediate danger, our bodies will automatically begin to prepare us to either attack the threat (i.e., fight) or more often, to escape from the danger (i.e., flight). Clearly, the ability to perform these necessary actions ensures our survival. This ability is made possible by the fight or flight response. For example, when we are faced with danger our hearts begin to beat very fast. The reason behind this increased heart rate is that the emotion of fear signaled our body and mind to prepare for action. The nervous system responds to the signal of danger by attempting to increase blood flow throughout the body. This increased blood flow ensures extra oxygen is delivered to our muscles. This extra oxygen is needed for energy during a fight or an escape from danger (e.g., running really fast). This increased blood flow requires the heart to work harder, and beat faster. Similarly, because increased oxygen is beneficial when faced with danger, there is a natural tendency for people to begin breathing more rapidly and more deeply to meet the demand for extra oxygen. This extra oxygen enables the body to rise to the challenge of fight-or-flight. These physical responses are discussed in more detail in the section, Biological Explanations of Anxiety.

Like many adaptive mechanisms, the fight-or-flight response has evolved over time to help ensure our survival. In ancient times, our ancestors came into constant contact with many types of very real dangers in their environment (lions and tigers and bears, OH MY!). Over time, with repeated exposure to these threats, our ancestors' nervous systems began to evolve in a manner that made the fight-or-flight response automatic and immediate. This adaptation was very beneficial. It ensured the necessary physical responses, (such as increased heart rate and respiration) would occur without wasted time (immediate) and without having to think about it (automatic). This adaptation makes sense because human beings would be at a significant disadvantage if they had to stop and rationally determine best course of action whenever they were in danger. Consider again the example of the mother and her child crossing the street when she realizes they are in the direct path of an oncoming car. Clearly, she does not have time to stop and weigh out all her options. Her response must be immediate.

In modern times, we may not encounter the same sorts of danger our ancestors had to face. Nonetheless, we still encounter threats in our daily lives that make the fight-or-flight response useful. Present day examples include physical threats (being attacked by a mugger); social threats (being ridiculed or embarrassed); and mental threats ("blanking-out" on a difficult exam). Unfortunately, a problem arises when the fear response is triggered but there is no actual threat in our environment. Thus, the response serves no useful purpose. This is called a false alarm. False alarms are discussed in more detail in another section. For now, it is simply important to recognize that without a certain amount of fear in our lives, our survival becomes more difficult.