Anxiety is an emotion characterized by an unpleasant state of inner
turmoil, often accompanied by nervous behavior, such as pacing back
and forth, somatic complaints, and rumination. It is the
subjectively unpleasant feelings of dread over anticipated events,
such as the feeling of imminent death.
Anxiety is not the same as
fear, which is a response to a real or perceived immediate threat,
whereas anxiety is the expectation of future threat.
Anxiety is a
feeling of uneasiness and worry, usually generalized and unfocused as
an overreaction to a situation that is only subjectively seen as
menacing. It is often accompanied by muscular tension,
restlessness, fatigue and problems in concentration.
Anxiety can be
appropriate, but when experienced regularly the individual may suffer
from an anxiety disorder.
People facing anxiety may withdraw from situations which have provoked
anxiety in the past. There are various types of anxiety.
Existential anxiety can occur when a person faces angst, an
existential crisis, or nihilistic feelings. People can also face
mathematical anxiety, somatic anxiety, stage fright, or test anxiety.
Social anxiety and stranger anxiety are caused when people are
apprehensive around strangers or other people in general. Furthermore,
anxiety has been linked with physical symptoms such as IBS and can
heighten other mental health illnesses such as OCD and panic disorder.
The first step in the management of a person with anxiety symptoms is
to evaluate the possible presence of an underlying medical cause,
whose recognition is essential in order to decide its correct
Anxiety symptoms may be masking an organic disease,
or appear associated or as a result of a medical disorder.
Anxiety can be either a short term "state" or a long term "trait".
Whereas trait anxiety represents worrying about future events, anxiety
disorders are a group of mental disorders characterized by feelings of
anxiety and fear.
Anxiety disorders are partly genetic but may
also be due to drug use, including alcohol, caffeine, and
benzodiazepines (which are often prescribed to treat anxiety), as well
as withdrawal from drugs of abuse. They often occur with other mental
disorders, particularly bipolar disorder, eating disorders, major
depressive disorder, or certain personality disorders. Common
treatment options include lifestyle changes, medication, and therapy.
Metacognitive therapy seeks to rid anxiety through reducing worry,
which is seen as a consequence of metacognitive beliefs.
2.2 Test and performance
2.3 Stranger, social, and intergroup
2.5 Choice or decision
3 Risk factors
3.3 Medical conditions
3.5.1 Evolutionary psychology
3.6.1 Gender socialization
4 See also
6 External links
A job applicant with a worried facial expression
Anxiety is distinguished from fear, which is an appropriate cognitive
and emotional response to a perceived threat.
Anxiety is related to
the specific behaviors of fight-or-flight responses, defensive
behavior or escape. It occurs in situations only perceived as
uncontrollable or unavoidable, but not realistically so. David
Barlow defines anxiety as "a future-oriented mood state in which one
is not ready or prepared to attempt to cope with upcoming negative
events," and that it is a distinction between future and present
dangers which divides anxiety and fear. Another description of anxiety
is agony, dread, terror, or even apprehension. In positive
psychology, anxiety is described as the mental state that results from
a difficult challenge for which the subject has insufficient coping
Fear and anxiety can be differentiated in four domains: (1) duration
of emotional experience, (2) temporal focus, (3) specificity of the
threat, and (4) motivated direction.
Fear is defined as short lived,
present focused, geared towards a specific threat, and facilitating
escape from threat; anxiety, on the other hand, is defined as
long-acting, future focused, broadly focused towards a diffuse threat,
and promoting excessive caution while approaching a potential threat
and interferes with constructive coping.
Anxiety can be experienced with long, drawn out daily symptoms that
reduce quality of life, known as chronic (or generalized) anxiety, or
it can be experienced in short spurts with sporadic, stressful panic
attacks, known as acute anxiety. Symptoms of anxiety can range in
number, intensity, and frequency, depending on the person. While
almost everyone has experienced anxiety at some point in their lives,
most do not develop long-term problems with anxiety.
Anxiety may cause psychiatric and physiological symptoms.
The behavioral effects of anxiety may include withdrawal from
situations which have provoked anxiety or negative feelings in the
past. Other effects may include changes in sleeping patterns,
changes in habits, increase or decrease in food intake, and increased
motor tension (such as foot tapping).
The emotional effects of anxiety may include "feelings of apprehension
or dread, trouble concentrating, feeling tense or jumpy, anticipating
the worst, irritability, restlessness, watching (and waiting) for
signs (and occurrences) of danger, and, feeling like your mind's gone
blank" as well as "nightmares/bad dreams, obsessions about
sensations, déjà vu, a trapped-in-your-mind feeling, and feeling
like everything is scary."
The cognitive effects of anxiety may include thoughts about suspected
dangers, such as fear of dying. "You may ... fear that the chest
pains are a deadly heart attack or that the shooting pains in your
head are the result of a tumor or an aneurysm. You feel an intense
fear when you think of dying, or you may think of it more often than
normal, or can't get it out of your mind."
The physiological symptoms of anxiety may include:
Neurological, as headache, paresthesias, vertigo, or presyncope.
Digestive, as abdominal pain, nausea, diarrhea, indigestion, dry
mouth, or bolus.
Respiratory, as shortness of breath or sighing breathing.
Cardiac, as palpitations, tachycardia, or chest pain.
Muscular, as fatigue, tremors, or tetany.
Cutaneous, as perspiration, or itchy skin.
Uro-genital, as frequent urination, urinary urgency, dyspareunia, or
Painting entitled Anxiety, 1894, by Edvard Munch
Further information: Angst,
Existential crisis, and Nihilism
The philosopher Søren Kierkegaard, in
The Concept of Anxiety
The Concept of Anxiety (1844),
described anxiety or dread associated with the "dizziness of freedom"
and suggested the possibility for positive resolution of anxiety
through the self-conscious exercise of responsibility and choosing. In
Art and Artist (1932), the psychologist
Otto Rank wrote that the
psychological trauma of birth was the pre-eminent human symbol of
existential anxiety and encompasses the creative person's simultaneous
fear of – and desire for – separation, individuation, and
Paul Tillich characterized existential anxiety as
"the state in which a being is aware of its possible nonbeing" and he
listed three categories for the nonbeing and resulting anxiety: ontic
(fate and death), moral (guilt and condemnation), and spiritual
(emptiness and meaninglessness). According to Tillich, the last of
these three types of existential anxiety, i.e. spiritual anxiety, is
predominant in modern times while the others were predominant in
earlier periods. Tillich argues that this anxiety can be accepted as
part of the human condition or it can be resisted but with negative
consequences. In its pathological form, spiritual anxiety may tend to
"drive the person toward the creation of certitude in systems of
meaning which are supported by tradition and authority" even though
such "undoubted certitude is not built on the rock of reality".
According to Viktor Frankl, the author of Man's Search for Meaning,
when a person is faced with extreme mortal dangers, the most basic of
all human wishes is to find a meaning of life to combat the "trauma of
nonbeing" as death is near.
Test and performance
Main articles: Test anxiety, Mathematical anxiety, Stage fright, and
According to Yerkes-Dodson law, an optimal level of arousal is
necessary to best complete a task such as an exam, performance, or
competitive event. However, when the anxiety or level of arousal
exceeds that optimum, the result is a decline in performance.
Test anxiety is the uneasiness, apprehension, or nervousness felt by
students who have a fear of failing an exam. Students who have test
anxiety may experience any of the following: the association of grades
with personal worth; fear of embarrassment by a teacher; fear of
alienation from parents or friends; time pressures; or feeling a loss
of control. Sweating, dizziness, headaches, racing heartbeats, nausea,
fidgeting, uncontrollable crying or laughing and drumming on a desk
are all common. Because test anxiety hinges on fear of negative
evaluation, debate exists as to whether test anxiety is itself a
unique anxiety disorder or whether it is a specific type of social
phobia. The DSM-IV classifies test anxiety as a type of social
While the term "test anxiety" refers specifically to students,
many workers share the same experience with regard to their career or
profession. The fear of failing at a task and being negatively
evaluated for failure can have a similarly negative effect on the
adult. Management of test anxiety focuses on achieving relaxation
and developing mechanisms to manage anxiety.
Stranger, social, and intergroup
Stranger anxiety and Social anxiety
Humans generally require social acceptance and thus sometimes dread
the disapproval of others. Apprehension of being judged by others may
cause anxiety in social environments.
Anxiety during social interactions, particularly between strangers, is
common among young people. It may persist into adulthood and become
social anxiety or social phobia. "Stranger anxiety" in small children
is not considered a phobia. In adults, an excessive fear of other
people is not a developmentally common stage; it is called social
anxiety. According to Cutting, social phobics do not fear the
crowd but the fact that they may be judged negatively.
Social anxiety varies in degree and severity. For some people, it is
characterized by experiencing discomfort or awkwardness during
physical social contact (e.g. embracing, shaking hands, etc.), while
in other cases it can lead to a fear of interacting with unfamiliar
people altogether. Those suffering from this condition may restrict
their lifestyles to accommodate the anxiety, minimizing social
interaction whenever possible.
Social anxiety also forms a core aspect
of certain personality disorders, including avoidant personality
To the extent that a person is fearful of social encounters with
unfamiliar others, some people may experience anxiety particularly
during interactions with outgroup members, or people who share
different group memberships (i.e., by race, ethnicity, class, gender,
etc.). Depending on the nature of the antecedent relations,
cognitions, and situational factors, intergroup contact may be
stressful and lead to feelings of anxiety. This apprehension or fear
of contact with outgroup members is often called interracial or
As is the case the more generalized forms of social anxiety,
intergroup anxiety has behavioral, cognitive, and affective effects.
For instance, increases in schematic processing and simplified
information processing can occur when anxiety is high. Indeed, such is
consistent with related work on attentional bias in implicit
memory. Additionally recent research has found that
implicit racial evaluations (i.e. automatic prejudiced attitudes) can
be amplified during intergroup interaction. Negative experiences
have been illustrated in producing not only negative expectations, but
also avoidant, or antagonistic, behavior such as hostility.
Furthermore, when compared to anxiety levels and cognitive effort
(e.g., impression management and self-presentation) in intragroup
contexts, levels and depletion of resources may be exacerbated in the
Anxiety can be either a short-term 'state' or a long-term personality
'trait'. Trait anxiety reflects a stable tendency across the lifespan
of responding with acute, state anxiety in the anticipation of
threatening situations (whether they are actually deemed threatening
or not). A meta-analysis showed that a high level of neuroticism
is a risk factor for development of anxiety symptoms and
disorders. Such anxiety may be conscious or unconscious.
Choice or decision
Anxiety induced by the need to choose between similar options is
increasingly being recognized as a problem for individuals and for
organizations. In 2004,
Capgemini wrote: "Today we're all faced
with greater choice, more competition and less time to consider our
options or seek out the right advice."
In a decision context, unpredictability or uncertainty may trigger
emotional responses in anxious individuals that systematically alter
decision-making. There are primarily two forms of this anxiety
type. The first form refers to a choice in which there are multiple
potential outcomes with known or calculable probabilities. The second
form refers to the uncertainty and ambiguity related to a decision
context in which there are multiple possible outcomes with unknown
Anxiety disorders are a group of mental disorders characterized by
exaggerated feelings of anxiety and fear responses.
Anxiety is a
worry about future events and fear is a reaction to current events.
These feelings may cause physical symptoms, such as a fast heart rate
and shakiness. There are a number of anxiety disorders: including
generalized anxiety disorder, specific phobia, social anxiety
disorder, separation anxiety disorder, agoraphobia, panic disorder,
and selective mutism. The disorder differs by what results in the
symptoms. People often have more than one anxiety disorder.
The cause of anxiety disorders is a combination of genetic and
environmental factors. Risk factors include a history of child
abuse, family history of mental disorders, and poverty. Anxiety
disorders often occur with other mental disorders, particularly major
depressive disorder, personality disorder, and substance use
disorder. To be diagnosed symptoms typically need to be present at
least six months, be more than would be expected for the situation,
and decrease functioning. Other problems that may result in
similar symptoms including hyperthyroidism, heart disease, caffeine,
alcohol, or cannabis use, and withdrawal from certain drugs, among
Without treatment, anxiety disorders tend to remain. Treatment
may include lifestyle changes, counselling, and medications.
Counselling is typically with a type of cognitive behavioural
therapy. Medications, such as antidepressants or beta blockers,
may improve symptoms.
About 12% of people are affected by an anxiety disorder in a given
year and between 5-30% are affected at some point in their
life. They occur about twice as often in females as males, and
generally begin before the age of 25. The most common are
specific phobia which affects nearly 12% and social anxiety disorder
which affects 10% at some point in their life. They affect those
between the ages of 15 and 35 the most and become less common after
the age of 55. Rates appear to be higher in the United States and
A marble bust of the Roman Emperor
Decius from the Capitoline Museum.
This portrait "conveys an impression of anxiety and weariness, as of a
man shouldering heavy [state] responsibilities".
Neural circuitry involving the amygdala (which regulates emotions like
anxiety and fear, stimulating the HPA Axis and sympathetic nervous
system) and hippocampus (which is implicated in emotional memory along
with the amygdala) is thought to underlie anxiety. People who have
anxiety tend to show high activity in response to emotional stimuli in
the amygdala. Some writers believe that excessive anxiety can lead
to an overpotentiation of the limbic system (which includes the
amygdala and nucleus accumbens), giving increased future anxiety, but
this does not appear to have been proven.
Research upon adolescents who as infants had been highly apprehensive,
vigilant, and fearful finds that their nucleus accumbens is more
sensitive than that in other people when deciding to make an action
that determined whether they received a reward. This suggests a
link between circuits responsible for fear and also reward in anxious
people. As researchers note, "a sense of 'responsibility', or
self-agency, in a context of uncertainty (probabilistic outcomes)
drives the neural system underlying appetitive motivation (i.e.,
nucleus accumbens) more strongly in temperamentally inhibited than
Genetics and family history (e.g., parental anxiety) may predispose an
individual for an increased risk of an anxiety disorder, but generally
external stimuli will trigger its onset or exacerbation. Genetic
differences account for about 43% of variance in panic disorder and
28% in generalized anxiety disorder. Although single genes are
neither necessary nor sufficient for anxiety by themselves, several
gene polymorphisms have been found to correlate with anxiety: PLXNA2,
SERT, CRH, COMT and BDNF. Several of these genes influence
neurotransmitters (such as serotonin and norepinephrine) and hormones
(such as cortisol) which are implicated in anxiety. The epigenetic
signature of at least one of these genes BDNF has also been associated
with anxiety and specific patterns of neural activity.
Many medical conditions can cause anxiety. This includes conditions
that affect the ability to breathe, like
COPD and asthma, and the
difficulty in breathing that often occurs near death.
Conditions that cause abdominal pain or chest pain can cause anxiety
and may in some cases be a somatization of anxiety; the same
is true for some sexual dysfunctions. Conditions that affect
the face or the skin can cause social anxiety especially among
adolescents, and developmental disabilities often lead to social
anxiety for children as well. Life-threatening conditions like
cancer also cause anxiety.
Furthermore, certain organic diseases may present with anxiety or
symptoms that mimic anxiety. These disorders include certain
endocrine diseases (hypo- and hyperthyroidism,
hyperprolactinemia), metabolic disorders (diabetes),
deficiency states (low levels of vitamin D, B2, B12, folic acid),
gastrointestinal diseases (celiac disease, non-celiac gluten
sensitivity, inflammatory bowel disease), heart diseases,
blood diseases (anemia), cerebral vascular accidents (transient
ischemic attack, stroke), and brain degenerative diseases
(Parkinson's disease, dementia, multiple sclerosis, Huntington's
disease), among others.
Several drugs can cause or worsen anxiety, whether in intoxication,
withdrawal or from chronic use. These include alcohol, tobacco,
cannabis, sedatives (including prescription benzodiazepines), opioids
(including prescription pain killers and illicit drugs like heroin),
stimulants (such as caffeine, cocaine and amphetamines),
hallucinogens, and inhalants. While many often report
self-medicating anxiety with these substances, improvements in anxiety
from drugs are usually short-lived (with worsening of anxiety in the
long-term, sometimes with acute anxiety as soon as the drug effects
wear off) and tend to be exaggerated. Acute exposure to toxic levels
of benzene may cause euphoria, anxiety, and irritability lasting up to
2 weeks after the exposure.
Poor coping skills (e.g., rigidity/inflexible problem solving, denial,
avoidance, impulsivity, extreme self-expectation, affective
instability, and inability to focus on problems) are associated with
Anxiety is also linked and perpetuated by the person's own
pessimistic outcome expectancy and how they cope with feedback
negativity. Temperament (e.g., neuroticism) and attitudes
(e.g. pessimism) have been found to be risk factors for
Cognitive distortions such as overgeneralizing, catastrophizing, mind
reading, emotional reasoning, binocular trick, and mental filter can
result in anxiety. For example, an overgeneralized belief that
something bad "always" happens may lead someone to have excessive
fears of even minimally risky situations and to avoid benign social
situations due to anticipatory anxiety of embarrassment. In addition,
those who have high anxiety can also create future stressful life
events.  Together, these findings suggest that anxious thoughts
can lead to anticipatory anxiety as well stressful events, which in
turn cause more anxiety. Such unhealthy thoughts can be targets for
successful treatment with cognitive therapy.
Psychodynamic theory posits that anxiety is often the result of
opposing unconscious wishes or fears that manifest via maladaptive
defense mechanisms (such as suppression, repression, anticipation,
regression, somatization, passive aggression, dissociation) that
develop to adapt to problems with early objects (e.g., caregivers) and
empathic failures in childhood. For example, persistent parental
discouragement of anger may result in repression/suppression of angry
feelings which manifests as gastrointestinal distress (somatization)
when provoked by another while the anger remains unconscious and
outside the individual's awareness. Such conflicts can be targets for
successful treatment with psychodynamic therapy. While psychodynamic
therapy tends to explore the underlying roots of anxiety, cognitive
behavioral therapy has also been shown to be a successful treatment
for anxiety by altering irrational thoughts and unwanted behaviors.
An evolutionary psychology explanation is that increased anxiety
serves the purpose of increased vigilance regarding potential threats
in the environment as well as increased tendency to take proactive
actions regarding such possible threats. This may cause false positive
reactions but an individual suffering from anxiety may also avoid real
threats. This may explain why anxious people are less likely to die
due to accidents.
When people are confronted with unpleasant and potentially harmful
stimuli such as foul odors or tastes, PET-scans show increased
bloodflow in the amygdala. In these studies, the participants
also reported moderate anxiety. This might indicate that anxiety is a
protective mechanism designed to prevent the organism from engaging in
potentially harmful behaviors.
Social risk factors for anxiety include a history of trauma (e.g.,
physical, sexual or emotional abuse or assault), early life
experiences and parenting factors (e.g., rejection, lack of warmth,
high hostility, harsh discipline, high parental negative affect,
anxious childrearing, modelling of dysfunctional and drug-abusing
behaviour, discouragement of emotions, poor socialization, poor
attachment, and child abuse and neglect), cultural factors (e.g.,
stoic families/cultures, persecuted minorities including the
disabled), and socioeconomics (e.g., uneducated, unemployed,
impoverished (although developed countries have higher rates of
anxiety disorders than developing countries)).
Contextual factors that are thought to contribute to anxiety include
gender socialization and learning experiences. In particular, learning
mastery (the degree to which people perceive their lives to be under
their own control) and instrumentality, which includes such traits as
self-confidence, independence, and competitiveness fully mediate the
relation between gender and anxiety. That is, though gender
differences in anxiety exist, with higher levels of anxiety in women
compared to men, gender socialization and learning mastery explain
these gender differences.[medical citation needed] Research has
demonstrated the ways in which facial prominence in photographic
images differs between men and women. More specifically, in official
online photographs of politicians around the world, women's faces are
less prominent than men's. Interestingly enough, the difference in
these images actually tended to be greater in cultures with greater
institutional gender equality.
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