Anxiety - Wikipedia https://en.wikipedia.

org/wiki/Anxiety

Anxiety
From Wikipedia, the free encyclopedia

Anxiety is an emotion characterized by an

unpleasant state of inner turmoil, often Anxiety
accompanied by nervous behavior, such as
pacing back and forth, somatic complaints, and
rumination.[1] It is the subjectively unpleasant
feelings of dread over anticipated events, such as
the feeling of imminent death.[2] Anxiety is not
the same as fear, which is a response to a real or
perceived immediate threat,[3] whereas anxiety is
the expectation of future threat.[3] 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.[4] It is often accompanied by
muscular tension,[3] restlessness, fatigue and
problems in concentration. Anxiety can be
appropriate, but when experienced regularly the
Facial expression of someone with chronic anxiety
individual may suffer from an anxiety
disorder.[3] Classification and external resources
Specialty Psychiatry, Psychology
People facing anxiety may withdraw from
OMIM 607834 (https://omim.org/entry
situations which have provoked anxiety in the
/607834)
past.[5] There are various types of anxiety.
Existential anxiety can occur when a person MedlinePlus 003211 (https://medlineplus.gov
faces angst, an existential crisis, or nihilistic /ency/article/003211.htm) 000917
feelings. People can also face mathematical (https://medlineplus.gov/ency/article
anxiety, somatic anxiety, stage fright, or test /000917.htm)
anxiety. Social anxiety and stranger anxiety are
MeSH D001007 (https://www.nlm.nih.gov
caused when people are apprehensive around
/cgi/mesh/2017/MB_cgi?field=uid&
strangers or other people in general.
Furthermore, anxiety has been linked with term=D001007)
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 treatment.[6][7] Anxiety symptoms may
be masking an organic disease, or appear associated or as a result of a medical disorder.[6][7][8][9]

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

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feelings of anxiety and fear.[10] 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.

Contents
1 Descriptions
2 Types
2.1 Existential
2.2 Test and performance
2.3 Stranger, social, and intergroup
2.4 Trait
2.5 Choice or decision
2.6 Anxiety disorders
3 Risk factors
3.1 Neuroanatomy
3.2 Genetics
3.3 Medical conditions
3.4 Substance-induced
3.5 Psychological
3.6 Social
4 See also
5 References
6 External links

Descriptions
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.[11] 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,"[12] 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.[13] In positive psychology, anxiety is
described as the mental state that results from a difficult challenge for which the subject has
insufficient coping skills.[14]

Fear and anxiety can be differentiated in four domains: (1) duration of emotional experience, (2)

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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.[15]

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 A job applicant with a worried
anxiety.[16] Symptoms of anxiety can range in number, facial expression
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.[6][9]

The behavioral effects of anxiety may include withdrawal from situations which have provoked
anxiety or negative feelings in the past.[5] 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).[5]

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"[17] as well
as "nightmares/bad dreams, obsessions about sensations, dj vu, a trapped in your mind feeling,
and feeling like everything is scary."[18]

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 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."[19]

The physiological symptoms of anxiety may include:[6][9]

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 impotence.

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Types
Existential

The philosopher Sren Kierkegaard, in 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 differentiation.

The theologian Paul Tillich characterized existential anxiety[20] 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".[20]

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.[21]

Test and performance

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.[22]

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,[23] debate exists as to
whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social
phobia.[24] The DSM-IV classifies test anxiety as a type of social phobia.[25]

While the term "test anxiety" refers specifically to students, [26] many workers share the same
experience with regard to their career or profession. The fear of failing at a task and being

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negatively evaluated for failure can have a similarly negative effect on the adult.[27] Management
of test anxiety focuses on achieving relaxation and developing mechanisms to manage anxiety.[26]

Stranger, social, and intergroup

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.[28]

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,[29] 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 disorder.[30]

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 intergroup anxiety.[31]

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.[32][33][34] Additionally recent research has found that
implicit racial evaluations (i.e. automatic prejudiced attitudes) can be amplified during intergroup
interaction.[35] Negative experiences have been illustrated in producing not only negative
expectations, but also avoidant, or antagonistic, behavior such as hostility.[36] 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 intergroup situation.

Trait

Anxiety can be either a short term 'state' or a long term "trait". Trait anxiety reflects a stable
tendency to respond with state anxiety in the anticipation of threatening situations.[37] A

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meta-analysis showed that a high level of neuroticism is a risk factor for development of anxiety
symptoms and disorders.[38] Such anxiety may be conscious or unconscious.[39]

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.[40] 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."[41]

In a decision context, unpredictability or uncertainty may trigger emotional responses in anxious

individuals that systematically alter decision-making.[42] 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 probabilities. [42]

Anxiety disorders

Anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fear.[10]
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.[10]

The cause of anxiety disorders is a combination of genetic and environmental factors.[43] 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.[44] 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.[10][44] Other problems that may result in similar symptoms including hyperthyroidism,
heart disease, caffeine, alcohol, or cannabis use, and withdrawal from certain drugs, among others.
[44][7]

Without treatment, anxiety disorders tend to remain.[10][43] Treatment may include lifestyle
changes, counselling, and medications. Counselling is typically with a type of cognitive
behavioural therapy.[44] Medications, such as antidepressants or beta blockers, may improve
symptoms.[43]

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.[44][45] They occur about twice as often in females as males, and
generally begin before the age of 25.[10][44] The most common are specific phobia which affects

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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 Europe.[44]

Risk factors
Neuroanatomy

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.[47] People who have anxiety tend to
show high activity in response to emotional stimuli in the
amygdala.[48] 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.[49][50]

Research upon adolescents who as infants had been highly

apprehensive, vigilant, and fearful finds that their nucleus A marble bust of the Roman
accumbens is more sensitive than that in other people when Emperor Decius from the
deciding to make an action that determined whether they Capitoline Museum. This portrait
received a reward.[51] This suggests a link between circuits "conveys an impression of
responsible for fear and also reward in anxious people. As anxiety and weariness, as of a
researchers note, "a sense of 'responsibility', or self agency, in a man shouldering heavy [state]
context of uncertainty (probabilistic outcomes) drives the neural responsibilities".[46]
system underlying appetitive motivation (i.e., nucleus
accumbens) more strongly in temperamentally inhibited than
noninhibited adolescents".[51]

Genetics

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.[52]
Genetic differences account for about 43% of variance in panic disorder and 28% in generalized
anxiety disorder.[53] 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.[54][55][56] 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.[57]

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Medical conditions

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.
[58][59][60] Conditions that cause abdominal pain or chest pain can cause anxiety and may in some

cases be a somatization of anxiety;[61][62] the same is true for some sexual dysfunctions.[63][64]
Conditions that affect the face or the skin can cause social anxiety especially among
adolescents,[65] and developmental disabilities often lead to social anxiety for children as well.[66]
Life-threatening conditions like cancer also cause anxiety.[67]

Furthermore, certain organic diseases may present with anxiety or symptoms that mimic anxiety.
[6][7] These disorders include certain endocrine diseases (hypo- and hyperthyroidism,

hyperprolactinemia),[7][68] metabolic disorders (diabetes),[7][69][70] deficiency states (low levels of

vitamin D, B2, B12, folic acid),[7] gastrointestinal diseases (celiac disease, non-celiac gluten
sensitivity, inflammatory bowel disease),[71][72][73] heart diseases, blood diseases (anemia),[7]
cerebral vascular accidents (transient ischemic attack, stroke),[7] and brain degenerative diseases
(Parkinson's disease, dementia, multiple sclerosis, Huntington's disease), among others.[7][74][75][76]

Substance-induced

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.[52] 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.[77]

Psychological

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. Anxiety is also linked and perpetuated by the person's own pessimistic outcome
expectancy and how they cope with feedback negativity.[78] Temperament (e.g., neuroticism)[38]
and attitudes (e.g. pessimism) have been found to be risk factors for anxiety.[52][79]

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.
Such unhealthy thoughts can be targets for successful treatment with cognitive therapy.

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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.

Evolutionary psychology

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.[80]

When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or
tastes, PET-scans show increased bloodflow in the amygdala.[81][82] 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

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 maternal 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)).[52][83]

Gender socialization

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.[84]
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

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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.[85]

See also
Tripartite Model of Anxiety and Depression

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Anxiety - Wikipedia https://en.wikipedia.org/wiki/Anxiety

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