Synonyms

Fear

Definition

Anxiety is an unpleasant state characterized by affective, cognitive, and physiological elements such as fear, worry, apprehension, and tension.

Anxiety is similar to the emotion of fear, although the function of chronic anxiety is often to avoid or mask true fear through mechanisms of anxiety such as worry and anticipation of negative future outcomes. The physiological manifestations of anxiety include increased blood pressure; increased breathing rate (often shallow); increased heart rate; other cardiac symptoms (e.g., pain, “skipped” beats); gastrointestinal distress including nausea, stomach aches, increased motility of the gut, and diarrhea; and generalized bodily distress such as fatigue and pain. Cognitively, anxiety is frequently characterized by an overestimation of the probability of a negative future outcome and an exaggeration of the consequences of the negative outcome. For example, an anxious person may believe that it is likely that they will fail a test with catastrophic consequences.

Anxiety often occurs in response to external stressors. It can be a normal reaction to stress, in which case anxiety can help coping behavior by focusing attention, mobilizing energy, and increasing goal-directed behavior. However, anxiety can also be a reaction to internal (physiological) cues or a generalized and pervasive mood without identifiable precipitants. When anxiety is an excessive reaction, or present in the absence of any true challenges or dangers, it is considered pathological. Individuals with pathological levels of anxiety are typically high in “trait” anxiety, which is a stable and enduring tendency to respond with anxiety to a wide variety of situations. Individuals high in trait anxiety are often also high in neuroticism.

Historical Background

Anxiety is basic to human experience and has been documented and treated since the beginning of recorded history. The relation between anxiety and health complaints has been recognized since the seventeenth century, although psychiatric nosology did not become well developed until the last century. A number of anxiety disorders have been delineated in contemporary psychiatric writings and are described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

Current Knowledge

Although anxiety can be learned, it is thought to have a biological basis in the amygdala and hippocampus. When individuals are exposed to potentially dangerous or harmful stimuli, brain imaging often shows increased activity in the amygdala accompanied by participant reports of increased anxiety. Excessive anxiety can also compromise performance on neuropsychological tests, especially by interfering with attention and cognitive efficiency.

When suspected, the level of anxiety should be assessed. Anxiety is often measured using the Beck Anxiety Inventory or Hamilton Anxiety Scale. They do not diagnose anxiety disorders but give a dimensional measure of anxiety.

There are a number of recognized anxiety disorders in the contemporary psychiatric nosology (i.e., DSM 5). They are (alphabetically):

  • Agoraphobia

  • Generalized anxiety disorder

  • Panic disorder

  • Selective mutism

  • Separation anxiety disorder

  • Social anxiety disorder

  • Specific phobia

Additional anxiety-related disorders in the current diagnostic system such as obsessive compulsive disorder and posttraumatic stress disorder have been reclassified into new sections of the diagnostic and statistical manual of mental disorders (DSM-5®).

Effective treatment of anxiety almost always involves exposure to the feared stimulus. Treatments are based on the principles of classical conditioning, and the goal is to extinguish the fear response through exposure and habituation. Exposure can be in vivo or imaginal, and therapy frequently uses cognitive techniques to modify anxiety-generating cognitions. Anxiolytic medication is also often prescribed.

Cross-References