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Anxiety

disorders fear believe neurotic

Anxiety is an unpleasant emotional state characterized by an often vague apprehension, uneasiness, or dread. Anxiety is often accompanied by physical sensations similar to those of fear such as perspiration, tightness of the chest, difficulty breathing or breathlessness, dry mouth, and headache. Unlike fear, in which the individual is usually aware of its cause, the cause of anxiety is often not clear.

Everyone experiences anxiety; it is a natural and healthy human response many theorists believe has evolved to warn us of impending dangers so that we might better cope with them. If the anxiety, however, seems to be excessive in strength or duration, or happens without sufficient objective reasons, it might be considered an unhealthy, possibly abnormal, response. There are numerous theories as to the causes and functions of anxiety. This entry will cover the four most extensive and influential theories: the existential, psychoanalytic, behavioral and learning, and cognitive.

Existential theorists generally distinguish between normal and neurotic anxiety. They believe normal anxiety is an unavoidable and natural part of being alive. It is the emotional accompaniment of the fear of death and of the immediate awareness of the meaninglessness of the world we live in. Anxiety is also felt on experiencing freedom and realizing we can create and define our lives through the choices we make. In this sense, anxiety is positive, showing us we are basically free to do whatever we choose. Neurotic anxiety is a blocking of normal anxiety which interferes with self-awareness. Rather than facing and dealing with the threat causing the normal anxiety, the individual cuts him or herself off from it.

Sigmund Freud, the Austrian physician who founded the highly influential theory and treatment method called psychoanalysis, distinguished three types of anxiety: reality, neurotic, and superego or moral. Reality anxiety is fear of real and possible dangers in the outside world. Neurotic anxiety is fear of being punished by society for losing control of one's instincts, for instance by eating large amounts of food very rapidly, or openly expressing sexual desire. Moral or superego anxiety is fear of negative self-evaluation from the conscience or superego. The anxiety may be felt as guilt, and those with strong superegos may feel guilt or anxiety when they do (or even think of doing) something they were raised to believe was wrong. In Freudian theory, anxiety functions to warn individuals of impending danger, and it signals the ego to take actions to avoid or cope with the potential danger.

Learning and behavioral theories focus on how fears and anxieties can be learned through direct experience with a noxious stimulus, for example, touching a hot pan, or by indirect observation such as seeing someone else touching a hot pan and expressing pain. Most people learn to avoid the stimuli or situations that lead to anxiety, but taken too far, avoidance can be very limiting. For example, if someone avoided all tests or job interviews, he or she would never succeed in school or have many job options. Extreme avoidance can also lead to extreme behaviors such as those seen in some phobias, which are persistent, intense, irrational fears of a thing or situation with a strong urge to flee from the source of fear. For example, someone with a phobia of pigeons might have difficulty walking calmly down a city street when pigeons are nearby. In both instances, avoidance prevents the individual from learning that the original feared stimulus may not be dangerous.

Cognitive theories focus on the role of cognition, or thinking, in anxiety. They look at how interpretations or evaluations of situations affect reactions to the situations. This is based on evidence that internal mental statements or thoughts can dictate whether anxiety or other emotions are felt.

Some theorists believe anxiety plays a central role in most, if not all, mental disorders. Today, there are many classifications of anxiety disorders. Panic attacks, obsessive-compulsive disorder (OCD), post-traumatic stress disorder, social anxiety disorder, generalized anxiety disorder, phobias, and even certain eating disorders are all believed to be forms of anxiety dysfunction. Even clinical depression is believed to have an anxiety component. Clinical research has focused on finding ways to diagnose certain anxiety disorders so that therapists can accurately help their patients. Examples of the tools therapists use to diagnose anxiety disorders are the Social Phobia and Anxiety Inventory and the Social Interactions Anxiety Scale. Both are series of questions answered by the patient that help the therapist diagnose their condition.

There is evidence that some individuals may be biologically predisposed toward experiencing strong anxiety. Knowledge of the chemical basis of anxiety and other psychological phenomena is rapidly increasing. Because the chemical basis of brain function is better understood, new medications to control inherited and acquired anxiety disorders are being developed. Paroxetine (Paxil), sertraline (Zoloft), and fluoxetine (Prozac) are examples of newer anti-anxiety medications now in wide usage.


Resources

Books

Kaplan, H.I., and B.J. Sadock. Comprehensive Textbook of Psychiatry. 6th ed. Baltimore: Williams and Wilkins, 1995.

Wolman, B.B., and G. Stricker, eds. Anxiety and Related Disorders: A Handbook. New York: John Wiley and Sons, 1994.

Periodicals

Golden, Frederic. "Mental Illness: Probing the Chemistry of the Brain." Time 157 (January 2001).

Hyman, S.E. "The Genetics of Mental Illness: Implications for Practice." Bulletin of the World Health Organization 78 (April 2000): 455-463.

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