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What is Anxiety, What is an Anxiety Disorder, and Why Defining It Matters

what is anxiety

As a practicing psychologist for over 20 years, the question of “what is anxiety” is one that has led many conversations in my office. People often want to know what is an anxiety disorder and if they could have one. What I have learned is that most of us have a sense of what we mean when we talk about anxiety. But, we get confused when we start trying to define what anxiety actually is.

Ask yourself: when you feel anxious, is it something normal, or something you should, well, worry about?

Answers aren’t as straightforward as you might think.

Working definitions hold that some anxiety is normal, whereas too much anxiety is too much. But few discuss the quality of anxiety, and how moderate anxiety and stress can correlate with optimal functioning.

More is needed about what anxiety actually means, and further tools are needed to understand the broad scope of anxiety beyond simply whether too much is too much. A severity model of anxiety, while useful in understanding pathology, is no longer sufficient in understanding the range of anxiety as it pertains to mental health and wellness, not just mental illness.

As science evolves, we are learning more about the experience and purpose of emotions in general, and importantly, how we can enact control.

Keep reading to understand more about anxiety, and what you need to know to define what it might be for you.

Worry, Stress, Fear, or Panic?

Getting at what anxiety really is isn’t as straightforward as one might think. Our increasingly colloquial synonyms of anxiety don’t help either. Many of us use anxiety synonyms to describe a range of anxiety experiences adding to potential confusion. For example, what do we mean when we talk about worry? Is it the same thing as anxiety? And what’s the difference between stress and anxiety?  And what is the relationship between anxiety, fear, and panic?

Worry is defined as, “a state of anxiety and uncertainty over actual or potential problems.” Worry is the cognitive part of anxiety, the thinking part necessary to imagine potential solutions. At its best, worry can be active and purposeful in driving solutions. At its worst, worry can become obsessive overthinking that leads to rumination.

Stress on the other hand has to do with our experience of a demand to change. A term originally coined by Hans Selye in the 1930’s, stress captured the motivation to adjust our behavior to what is required, and could be an experience that was either good or bad.

Reflecting a more clinical understanding of these terms, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) defines stress as:

“the pattern of specific and nonspecific responses a person makes to stimulus events that disturb his or her equilibrium and tax or exceed his or her ability to cope.”

Fear is simply defined as, “the emotional response to real or perceived imminent threat,” and anxiety as the “anticipation of future threat.”

Panic reflects the most extreme form of clinical experience of anxiety, and is thus categorized by the presence of a panic attack, or, “an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes,” and includes a variety of physical and cognitive symptoms.

These symptoms can include but are not limited to palpitations, pounding heart, accelerated heart rate, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, chills, numbness, feelings of detachment, and an intense fear of losing control or dying.[1]

I practice, these feelings can exist separately, but when it comes to anxiety, you can feel one or all of these emotions at the same time.

What is Anxiety Like?

When describing what is anxiety like for any of us, it can be harder than it may seem since the experience of anxiety varies for each of us. How we define our experience turns out to be an important part of our what anxiety feels like for all of us. We get to decide how, and what, we feel.

While there are some key differences in the above definitions of anxiety, stress, worry, fear and panic, there is still considerable overlap and blurred lines separating them. Individual differences in how we think about these terms, and our own experience of angst, may determine more of the difference than the terms themselves.

Like with all emotions, how we define our anxiety has as much to do with who we are and how we feel about it, as it does our experience itself. Our experience shapes the labels we use to describe them, and our labels shape our experience as well. Turns out how we label our emotions can actually co-constructwhatthey are, and howwe experience them.

To learn more about how defining our experience defines it, check out Lisa Feldman Barrett’s pioneering work on emotional construction.

While there are common definitions ofstress, worry, fear, and anxiety, how we think about each of these experiences is colored by our experience, values, and upbringing, andis as individual as we are. Your experience of stress might be my experience of anxiety, which might be another person’s worry, and yet another person’s sense fear.

How we define anxiety is as individual as our own unique perspective. The experience of discomfort and anxiety are all pretty similar experiences, but how we label them defines what they are, and makes them ours – to define and use.

This is important because it underscores what science is proving that we are in more control than we may think. More on this idea a bit later.

Defining Anxiety: An Emotion AND a Disorder

Anxiety is a fairly broad word that is used to describe a broad range of experiences to include normal emotional experiences as well as problematically symptomatic ones. Understanding what is the emotion of anxiety and what is anxiety disorder can help.

Google dictionary defines anxiety as:

  • feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.
  • desire to do something, typically accompanied by unease.
  • In PSYCHIATRY: a nervous disorder characterized by a state of excessive uneasiness and apprehension, typically with compulsive behavior or panic attacks.

The American Psychological Association (APA) defines anxiety as, “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”

The Anxiety and Depression Association of America (ADAA) describes anxiety this way:

“Anxiety is a normal part of living. It’s a biological reaction—the body’s way of telling us something isn’t right. It keeps us from harm’s way and prepares us to act quickly in the face of danger. But if your anxiety becomes overwhelming and persistent, or if it interferes with your regular daily activities, or even makes them impossible, you may have an anxiety disorder.”

Both the Mayo Clinic and National Institutes of Mental Health (NIH) cite similar descriptions, noting occasional anxiety as an expected part of normal life, but distinguishing persistent and worsening anxiety as something more serious. Beyond temporary worry or fear, anxiety disorders are marked by intense and excessive worry about everyday situations that is difficult to control, interferes with daily activities, and persists for long periods of time.

When anxiety doesn’t feel controllable, it tends to persists and worsen, leading to further symptoms and distress.

What is an Anxiety Disorder?

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) represents the diagnostic classification system for mental disorders to which mental health clinicians predominantly ascribe. While it is a manual defining agreed-upon standards and diagnostic classifications reflecting our most current scientific and clinical understanding of mental disorders, it is also an evolving resource, forever under review and revision to reflect ongoing progress in our field. It was last revised in 2013.

According to the DSM-5, anxiety disorders must meet certain thresholds of severity and persistence. Specifically, these mental disorders, “differ from developmentally normative fear or anxiety by being excessive or persisting beyond developmentally appropriate periods. They differ from transient fear or anxiety, often stress-induced, by being persistent.”

Likewith all mental disorders, diagnostic criteria require that symptoms cause, “clinically significant distress or impairment in social, occupational, or other important areas of functioning,” and not be better explained by another psychologically or medically based disorder.[2]

What is Social Anxiety?

Social anxiety refers to anxiety that is most often related to social interactions or the anticipation of them. Not only is it the most common form of anxiety, but its incidence has been steadily rising especially in young people.  Not to be confused with introversion – a need to be alone to restore energy and focus – or a lack of social interest, social anxiety is about caring so much about relationships that one’s fears of judgment and rejection can outweigh one’s desire to connect.[3]

Social anxiety is a more clinical term for what we might colloquially call shyness.  Marked by deep discomfort and anxiety around social situations in general, social anxiety can occur in social settings, or simply by anticipating them. And like other forms of anxiety can present along a continuum from mild to severe.

Social anxiety becomes a social anxiety disorderwhen anxiety about social situations, and being scrutinized in them, causes marked distress and impairment in daily life. In addition to fearing judgment by others, a socially anxious person fears their social anxiety will additionally contribute to a risk of social humiliation or rejection. Importantly, the anxiety is out of proportion to the actual threat given the social context, and persistently interferes with a person’s life.[4]

What is Generalized Anxiety Disorder?

Generalized anxiety disorder (GAD) is characterized by persistent and excessive anxiety about a variety of events and activities, that is accompanied by physical symptoms and not easily controlled. Like with other anxiety disorders, the intensity, duration and frequency of the anxiety and worry is out of proportion to the actual likelihood of the anticipated event. Affecting approximately 3% of the U.S. population in any given year, women’s risk of the disorder is double that of men. The disorder develops gradually and symptoms tend to be chronic, though severity may wax and wane across the life span.[5] 

What is Separation Anxiety?

 Often a description used to address anxiety in children, separation anxiety has to do with the feelings of distress and fear that come from being separated from people to whom the person is attached. This form of anxiety can occur across the life span and relate to a variety of important people. But in children, separation anxiety often manifests in separation from caregivers and other key adults in a child’s life.

According to the DSM-V, separation anxiety becomes separation anxiety disorder when the anxiety is excessive, developmentally inappropriate, and significantly interferes with life. Separation from attachment figures or home produces consistent distress, and situations where this might occur are often actively avoided. Fears of untoward events or situations where separation could occur tend to be likewise intrusive and persistent, as well as fears of simply being alone without important attachment figures. Clingy behavior, sleep refusal, school or travel avoidance, and separation nightmares are common symptoms of separation anxiety disorder. While this disorder is more common in childhood, affecting 4% of US children, it can also affect adults with up to 2% of US adults reporting symptoms.

What is an Anxiety Attack?

Often used synonymously with a panic attack described above, an anxiety attack refers to an acute onset of severe anxiety often marked by the physiological symptoms of a threat response. Though descriptive and popularly employed, the term “anxiety attack” is nonetheless colloquial and not recognized by the DSM-V as a clinical syndrome. Its popular use continues to shape its use and meaning, and in general an anxiety attack refers to severe anxiety with an abrupt onset.

Battling Stigma

Stress is something we routinely admit, sometimes even wear as a badge of honor, conveying we are busy, engaged, and needed. We aren’t that concerned about admitting a penchant for worry either.

Who hasn’t disclosed worry about something important

But when it comes to talking about anxiety, the word is heavier, and for most brings a bit of pause. Perhaps because anxiety disorders are called anxietydisorders, and not worry, fear, or stress disorders, we have tainted the word – and experience – of anxiety for the worse. Or maybe we have simply become more educated about the signs and symptoms of anxiety disorders in general, and worry any anxiety is clinical anxiety.

I’m not sure the many variables that make anxiety stigma such a steep hill to climb. But anxiety remains an emotion first and foremost. Anxiety itself is NOT a disorder. Nor is anxiety an abnormal, unhealthy emotion. Anxiety can be a completely normal part of human life. 

What is Normal Anxiety?

While key mental health organizations reference occasional normal anxiety, none specifically elaborate on normal anxiety, orhow anxietycan be a useful, constructive emotion. In its focus on mental disorders, the DSM-5 aims to define anxiety disorders, offering no specific definition of normal anxiety, worry, fear, or stress.  Given that clinical psychology has evolved from the medical model of studying of mental illness, normal anxiety has seldom been studied or defined. Like with other emotions, normal anxiety has had to be inferred by the absence of diagnostic criteria.

In canvasing various definitions and in researching the neurobiology of this emotion, here is my best working definition of anxiety:

Anxiety is both the feeling of realizing something we care about may be at risk and the resources we need to protect it.[6]

Fundamentally anxiety is a powerful hardwired emotion, often tied to physiological arousal, that we all can experience from time to time. It is a complicated emotional energy that gets aroused when something we care about is at risk. Both a signal of a problem, and the elements of its solution, anxiety is a normal human emotion that can guide us toward our best selves, or be the catalyst to miserable discomfort.  There are many different voices of anxiety, as well as attitudes toward these experiences that can shape our overall experience of anxiety. 

Defining the Voices of Anxiety: Yell, Chatter, Whisper

“Yelling” anxiety is what most of us tend to think about anxiety at its most severe. This is the place where symptoms are unmistakable, disruptive, deeply uncomfortable and scary.

I call this kind of anxiety “yelling” anxiety because of how loudly it disrupts our life. In some cases, causing physical distress or panic and limiting our ability to manage our everyday life.

Yelling anxiety is usually physical in some way. It activates our physiological threat response, causing us to feel feelings of fear, dread and a sense that things outside of our control are happening.

As we begin to feel the physical symptoms, (shallow breathing, pit in the stomach, tremor in the knees), yelling anxiety demands our attention; it will not be ignored. Often it feels so escalated that it can spur you to fight, freeze, or flee thinking.

It’s also a cycle in many ways- the more anxiety we feel, the more scared we become. And fear about anxiety is often the accelerant that fuels anxiety into panic, the thing most people wish to avoid.

When yelling anxiety strikes, it is anxiety that exceeds what’s best for our wellbeing. It is super scary. So scary in fact that all we want to do is Make. It. Go. Away.This 100% understandable.

Anxiety is miserable, and when it feeds on itself, it can leave us feeling paralyzed and that feeling in and of itself, is crippling. But if you don’t want yelling anxiety to rule your life, you have to know that when it appears, resisting it is very likely the exact thing that is keeping it alive.

Pulling anxiety back into a more moderate range is critical to being able to use if effectively.

This starts with facing it, and knowing you can handle it. No matter how uncomfortable, intense, and scary anxiety can be, it still remains a feeling that cannot fundamentally hurt you. You can handle anxiety – even the most intense symptoms of it – so long as you know you can.

Almost counterintuitively, managing your fear about anxiety is one of the most effective things you can do to quiet your anxiety’s volume. If you are experiencing acute feelings of panic, click here for resources to stop it.

“Chatter” anxiety is the most common form of anxiety – the kind of constant anxiety that motivates and nudges us along to pay attention, stay on task, and keep going. It’s too loud to be ignored, but soft enough not to be deafening or debilitating.

In many ways, this is the best kind of anxiety to work with because it’s tangible, but not out of control.

Stress is the other name we use to describe this kind of “chatter” anxiety. For most of us, some form of stress is a constant in our lives. We are aware of it and feel its immense pressure all the time, tugging is to do more, perform better, accomplish more etc. At its best, stress motivates us to stay on task and keep pushing forward.

Anxiety, whether positive or negative, works very much in the same way.

Originally coined by Hans Selye in the 1930’s, stress is technically defined as the body’s response to any demand for change. Anxiety is much the same, but it is mental and in our heads. Anxiety is the response to our perception of what will be demanded and how we anticipate coping with that pressure.

Another way to think about it is that anxiety is largely an internal calculation of stress. We evaluate the potential impact of an event and how we anticipate feeling about it.

What might happen? 

Can I handle it? 

What if it isn’t ok?

While clinical definitions of anxiety focus on the emotional distress surrounding a potential danger, how we metabolize stress doesn’t have to be negative or work against us. There really is such a thing as “good stress” that can be leveraged to help us live a more satisfying life.

“Whisper”anxiety is a quieter anxiety that often gets mistaken for other things. This is the kind of anxiety that often lurks in the shadows but is always there nagging you, sometimes irritating you, urging you to pay attention and take notice….

Often experienced in quiet moments or masquerading as other emotions, “whisper anxiety” includes those feelings that remind you that something you care about just isn’t right. Like other forms of anxiety, “whisper anxiety’s” job is to keep bugging you until you pay attention and start focusing on solutions. But unlike other forms of anxiety, “whisper anxiety” isn’t urgent. It doesn’t carry a rapid heart rate or an obsessive thought you just can’t let go of.

Whisper anxiety often attaches itself to things you care about that can be delayed for now, but not indefinitely. It’s the nagging phone call you need to make or the bill that needs paying that you plan to “get around to.”

It is a subtle reminder that other priorities are awaiting your attention.

In this way, “whisper anxiety” can be stealthy in its manifestations, and that makes it harder to identify. Whisper anxiety comes in the form of panic’s lesser known cousins. Things like procrastinationdreaming, worrying, irritability, and waiting. 

Differentiating Healthy Versus Unhealthy Anxiety

Knowing the difference between healthy and unhealthy anxiety isn’t always straightforward, but there are three key questions to ask:

  1. How much is anxiety affecting your life all around?
  2. How afraid do you feel about your anxiety?
  3. What are you doing with your anxiety?

These three questions help describe your experience with anxiety, and in turn determine how well you are coping with it.

There is anxiety with a small “a,” and Anxiety with a capital “A.” Imbedded in the emphasis is how severely we experience anxiety, and also how scared we are of our experience. How we describe anxiety can provide important clues about how we are managing anxiety; whether it’s bearable, or truly a problem in our lives.

How we feel about anxiety can also give clues as to how much difficulty it causes in our lives. When we say we feel anxiety, and are rather matter or fact about it, we are obviously talking about tolerable, hopefully useful, anxiety. But when we talk about feeling anxiety with an expression of fear or sadness, we are talking about anxiety we’re afraid of, that is taking a toll on us.

How we feel about anxiety turns out to powerfully determine how we experience anxiety, and in turn how we can best cope. 

The more afraid we are of anxiety, the more severe it will be, and thus the scarier it will become. The more emphasis we put on anxiety’s discomfort, the more uncomfortable it will be.

Positive Psychology Meets Anxiety

With the advent of positive psychology, more focus has been paid to understanding mental health and wellness in recent decades. A growing body of research has emerged underscoring the powerful contribution physical health, mental attitude, and behavior can have on mental wellness overall.  Particularly with regards to stress and anxiety, we are developing a clearer understanding of how powerfully our attitudes can shape our experience in almost every way.

For example, according to a large scale study, if we can view stress and anxiety as helpful resources we can harness to be our best, rather than detriments to our functioning, we can make it so. Likewise, if we believe that anxiety and stress are dangerous to us, and that we can’t handle these experiences, we will limit their effectiveness and increase their overall negative impact. How we think about anxiety matters.

How we label anxiety matters a great deal too. Simply naming how we are feeling has been long understood to deliver a powerful sense of emotional control. But science has now uncovered that how we label our emotions can have a powerful impact as well. Thanks to the science of emotional co-construction, we now understand that emotional labeling defines our experience to a large extent.

If we label anxiety as something positive – like excitement or a readiness to do something – then we experience it so. If we label it as something scary and dangerous, we increase our distress. Simply defining our experience can deliver a great deal of control over our experience.

It turns out that we have a whole lot more control over our experience of anxiety than we may have ever thought possible. This is particularly good news when it comes to anxiety, since a sense of control helps mitigate and reduce feelings of anxiety in general. A sense of control also delivers needed coping resources and problem solving when discomfort strikes.

Anxiety and control can work together to fuel our best efforts if we can keep our attitude positive and maintain a focus on doing something positive. Simply naming anxiety in a more positive way can be a powerful first step in harnessing positive psychology’s latest science. 

Online Resources

Crisis Call Center/National Suicide Prevention Lifeline: This 24/7/365 crisis line provides safe, non-judgmental professional support for individuals in any type of emotional crisis. Support resources are also available for help in supporting a loved one, as well as best practices for professionals. For phone support in the US, including special support for Veterans, call 1-800-273-8255. Text support can be accessed by texting “ANSWER” to 839863. Online options for chat in English, Spanish, and for Deaf and Hard of Hearing at http://www.suicidepreventionlifeline.org/.

Anxiety and Depression Association of America, (ADAA): Whether you are looking for online information, or the help of a trained professional in your area, this international nonprofit is a leader in education, training, and research for anxiety, depression and related disorders. https://adaa.org/finding-help

American Psychological Association (APA): APA is the leading scientific and professional organization representing psychology in the United States, with 115,700+ researchers, educators, clinicians, consultants and students as its members. It set and governs professional standards of conduct, and offers online public information about anxiety and mental health, as well as a directory of psychologists searchable by location. http://www.apa.org/helpcenter/anxiety.aspx

National Alliance of Mental Illness (NAMI): The largest American grassroots mental health organization, NAMI provides information, educational programs, and advocacy dedicated to building better lives for those affected by mental illness. Online support in accessing help can be found at https://www.nami.org/Find-Support, or by calling the NAMI Helpline at 800-950-NAMI (1-800-950-6264). For email support, M-F, 10 AM – 6 PM ET or TEXT “NAMI” TO 741741.

PsychCentral: The Internet’s largest and oldest independent mental health online resource run by mental health professionals provides trusted information and over 250 support groups to consumers. https://psychcentral.com/

Psychology Today:This popular psychology media outlet offers a large, searchable network of therapists in the US, Canada, and UK that can be searched by location, expertise, insurance, types of therapy, age groups, and more. https://www.psychologytoday.com/us/therapists

 

For more help managing anxiety, check out my new book, Hack Your Anxiety, register for my free mini-ecourse by signing up for book bonuses here, or check-out my anxiety and relationships blogs.  

Photo by Jamie Street on Unsplash

 

[1]American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

[2]American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

[3]Importantly, introverts don’t tend to fear social situations so much as they are emotionally drained by them.

[4]American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

[5]American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

[6]Clark, A H (2018). Hack Your Anxiety: How to Make Anxiety Work for You in Life, Love, and All that You Do. Chicago: Sourcebooks

Alicia H. Clark, PsyD

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