In today’s climate of uncertainty, it is normal to feel unstable about our jobs, kids, the education system, credit scores, global warming, stimulus plan… the list continues. I believe that as our lives get busier, our tendency to “worry” increases.  Excessive worry can lead to an inability to function in daily life. Similar to terms like depression and bipolar, anxiety has become a part of our daily language to communicate a feeling state.

But how do we discriminate between anxiety, which can be debilitating, and fear, which is something we share with animals? DSM-IV-TR, today’s bible of psychiatry, lists the diagnostic features of General Anxiety Disorder (GAD) as the following:

“Excessive anxiety and worry (apprehensive expectation), occurring more days than not for a period of at least 6 months, about a number of events or activities. The anxiety and worry are accompanied by at least three additional symptoms from a list that includes restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension and disturbed sleep”.

The National Institute of Mental Health reports that 19 million adults in the US suffer from one form of anxiety or another. Sleep disorders or early awakening, depression, tension, muscle aches, and fatigue can all accompany chronic anxiety. I would guess that with the current state of national economy, this number is on the rise.

I have been in both states of fear and anxiety quite often in my life. For many years, I didn’t understand the difference and used these words synonymously. But I’ve recently learned that there is a major difference between the two. Anxiety has the basic experience of paralysis. I’ve experienced it as a constant feeling of being in quicksand, unable to move or breath, just a feeling of dread in the pit of my stomach. Fear has a different sensation, for it’s the impulse that moves me into action. Fear accompanies a fight-or-flight state, a basic instinct of survival, experienced physically as an increased heart rate, sweating palms, muscle tightness and a rush of adrenaline which makes me feel like running faster than a cougar.

This differentiation is quite significant, for one is created by not facing reality, and the other by facing the truth. Although there may be a biological basis to anxiety disorders, the feeling of dread and angst is often created by our inability to face our fears. Let’s say I’m terrified of snakes, and hiking with a friend. Because I don’t want to seem afraid, I pretend to be enjoying the trip. Meanwhile, the little voice in the back of my head tells me to ‘be careful’, ‘there could be a snake anywhere’. My muscles become stiff, stomach cramps, I feel nauseous, face turns white and I suddenly become unable to breath, and there is no snake in sight. Am I experiencing a fear of snakes, or my fear of being afraid?

What if I had accepted my fear, did some research about possibility of snakes in that particular trail, talked to my friend and came up with a solution? Perhaps we’d choose another trail or a different activity. Would I still experience anxiety, or just fear?

About a year ago I was experiencing medical complications. Coincidentally, or not, I was also in an unfulfilling career, working for a company that didn’t respect me as an individual. I was living in constant fear of the unknown: test results, side effects of treatment, losing my job, keeping the job and losing my soul, financial insecurity, worrying my family, etc. One would say these were all legitimate reactions to a difficult time in my life, and perhaps not a psychological disorder. During one of my weekly doctor visits, I broke down and began to cry, unable to breathe and felt completely powerless over my life. The well-intentioned doctor offered me a prescription for anti-anxiety medication to ‘take the edge off’. I looked at her in disbelief, refused the script and realized I had better get used to being with my own pain since others around me did not seem to have that capacity.

My point is that fear is a normal reaction to everyday life, one that moves us into making the right choices for our individual paths. Anxiety steps in when we fail to face the hard truths about ourselves – when we are unwilling to face our shadows. Our fears are the most powerful when not acknowledged and often manifest as phobias, panic attacks and disorders.

What I’ve learned from that experience is that each time I don’t face my own truth and wait for another to give me the answers I have within, I fall into a state of paralysis and panic. Do I need to be medicated or hospitalized? Perhaps. Or maybe just trust my own intuition.

What is your story? Do you have a fear that’s waiting to be acknowledged?

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14 Responses to “Anxiety or Fear?”

  1. This is a great post. I've experienced both anxiety and fear but have never looked at them the way you have described here.

    I would suggest that anxiety is being in a continual state of fear. It doesn't necessarily mean that you aren't facing your fears, just that there are so many of them, and you don't have the tools to deal with them, that you become overwhelmed.

    I came into this backwards, by first experiencing anxiety (insomnia, inexplicable crying, that horrible feeling in the pit of your stomach, irritability, etc…) for close to a year with no clue why. I too was handed script after script. Some helped with the extreme insomnia, some helped with the anxiety itself.

    Only working through the fears themselves and learning where they came from and ways to overcome them, was I able to get off the meds, get back to sleep and actually deal with all of my fears. I'm still a work in progress, still suffer from anxiety frequently, but I'm with you, meds are not the long term solution and are handed out like candy by general practitioners no less!

  2. Cassi says:

    In a way, I'm kind of where you are about a year ago. Hit with unexpected health issue, and compound that with the state of the economy/money "lost" in investments, and two oldest kids (twins) about to start college in the fall and being unsure if we'll be able to afford their #1 school choices any more. Fear – of disappointing my children, over my own health – It is weighing on me, but I think it is more fear (as you described) rather than a long-term or excessive anxiety issue. I've looked it in the face, and know what I'm dealing with.

    Still, I can feel lethargic, and sometimes distracted/unable to concentrate, but I tend to be able to move beyond that state, with some effort. Excercise, getting outside, is what helps me most. It is during those times that my head seems to clear. I'm not yet ready to medicate the issue. I also have confidence that the unknown will become clearer with time … I just need to manage patience, which for me can be the most challenging part.

    (Excellent article — found it thanks to tweet by your husband.)

  3. rashin says:

    Thanks Cassi for sharing your personal story with us. I think on some level we are all being asked to reshift our focus and priorities today, which can (and often is) pretty scary. I really want to acknowledge your courage to look at your challenges in an authentic way. And yes, time and patience often bring clarity.

  4. rashin says:

    True anxiety, as you have described above, can be quite overwhelming and there are times when medication is necessary to bring back a sense of stability. Sometimes the feelings are so intense that it's not realistic to process and deal with them at that moment. That's when meds are a necessary crutch to get the strength to deal with the real issues. It sounds to me that you have done things in exactly the way that was right for you. Thank you for reading and sharing your experience.

  5. Jennifer Sandoval says:

    Wow, this is an excellent article. The other night at my women's group, one of the women shared that in the midst of the anxiety she's been experiencing due to the economic downturn, she had recently discovered zanax and what a lifesaver that was for her. Then she offered her stash of pills to everyone in the group! The inability or unwillingness to be with our experience is one of the most important problems we face as human beings. Acknowledging the darkness within- the pain, the terror, the emptiness and despair – and holding the tension of the existence of those aspects, just allowing them to be there instead of repressing or projecting, is a path to transformation. I think this is the gold that depth psychology offers.

  6. […] Anxiety or Fear? | Panic Attacks Treatments […]

  7. rashin says:

    A depth psychological approach certainly asks us to "be" with our feelings, no matter how painful. You are correct in that the true path to transformation is only through acknowledgment of our inner darkness, no matter how frightening it may be.

  8. Angela says:

    Great article Rashin. I have been taking a Cognitive Behavior Therapy course and we were just discussing this yesterday. I think the easiest way for us to see connections between fear and anxiety are as part of the same continuum with terror being at the extreme end and worry being at the other. The intensity of the anxiety or fear is what can paralyze. I feel both a little fear and anxiety when flying but I do because it means getting to visit people I love, far off places, or locations I need to go. I often take a little pill that does "tale the edge off" because although I do deep breathing and practice visualization, I still don't like the lack of control feeling flying triggers for me. I think tuning into our bodies cues when we're feeling anxious or scared and asking "what can i do to take care of myself?" has helped. I have been anxious, I have been fearful, but I have also been aware…. and it helps :) Take care!

  9. rashin says:

    Using our bodies to tune in to feelings is a great way to build awareness. Thank you for reading and offering your experience and knowledge!

  10. Michael Grubb says:

    You might be interested in looking at Harry Stack Sullivan's book "The Interpersonal Theory of Psychiatry". He has an interesting discussion of anxiety and fear in infants. His distinction is that anxiety, unlike fear or other emotions that rise up from within, is a state of agitation that is projected into the child by the mother (or presumably other primary caregiver). Since the agitation comes from the mother, the mother is not able/available to soothe the child or to process the emotion for the child, so the agitation goes unresolved and quickly escalates to intolerable levels. I'm not sure I fully buy this is all that "anxiety" is, and it doesn't (to me) fully connect up with the manifestation of anxiety in adults, but it is a very interesting discussion, well worth reading up on, surprisingly consistent with what we've learned about attachment and neurobiology in the subsequent 50 years.

  11. rashin says:

    Thanks for the book suggestion. I'll definitely check it out. I also agree that anxiety may be more than that in adults. However, from the objection relation's view, I can see how a mother's agitation can create that state in the infant and inhibit the self-regulation skill building needed later in adult to deal with anxious states.

  12. I’m glad you’re finding the blog useful. That is the intention.

  13. anxiety says:

    Anxiety functions as a warning that thee ego is being threatened. Freud envisioned a continuous struggle within the personality as the ego is pressured by insistent and opposing forces. It must try to delay the urgings of the id, perceptive and manipulate reality to relieve tension, and cope with the superego’s striving for perfection. Whenever the ego is too greatly stressed, the result is the condition known as anxiety. Freud described three types of anxiety: objective, neurotic, and moral. Objectives anxiety arises from fear of actual dangers in the real world. The others two types derive from it.

  14. antoinette says:

    All i can write is i cant cope anymore someone out there please help me

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