Definitions of anxiety
What is anxiety?
Bearing in mind that there is still no single definition of anxiety, let’s now look at a couple of helpful attempts. The first comes from the DSM (the Diagnostic and Statistical Manual of Mental Disorders), a standard resource for mental health professionals compiled by the American Psychiatric Association. According to the DSM, anxiety is:
The apprehensive anticipation of future danger or misfortune accompanied by a feeling of dysphoria or somatic feelings of tension. The focus of anticipated danger may be internal or external.
And here’s a slightly less technical definition of anxiety from the US psychologist David Barlow:
Anxiety is a future-oriented mood state in which one is ready or prepared to attempt to cope with upcoming negative events…. If one were to put anxiety into words, one might say, ’That terrible event could happen again and I might not be able to deal with it, but I’ve got to be ready to try.’
Both definitions make the point that anxiety is an emotion (though the DSM uses the term ’feeling’ and Barlow refers to it as a ’mood state’). As we all know, anxiety is no fun; this is what the DSM means by ’dysphoria’ (the psychological term for an unpleasant feeling). Our body may behave in unusual ways (stomach churning, eyes widening, heart racing) — hence the DSM’s reference to ’somatic’ feelings. And at the root of it all is the perception that we may be facing serious trouble.
A closely related but slightly different concept is stress. Stress is defined as what we feel when we believe we can’t cope with the demands facing us. It comprises two elements: a problem and a self-perception (specifically, that we’re not able to deal with the problem in question). Like anxiety, stress is rooted in the fight or flight system. It can trigger a range of emotional responses including, very often, anxiety.
You may also be wondering how anxiety differs from fear. In fact, the two terms are often used interchangeably, and we do so in this book. That said, some researchers do make a differentiation, and typically it revolves around the object of our emotion. Fear usually has a clear object — seeing a shark’s fin while we’re swimming, perhaps, or a dangerous piece of driving from the car alongside us on the motorway — and it often functions as a sort of emergency reaction (being mildly frightened is almost a contradiction in terms). But things are generally much less clear-cut when it comes to anxiety. Instead of situations in which we know exactly what it is that’s scaring us — and when our fear will soon disappear once the threat has passed — we may not have a clue why we feel anxious. As Holly Golightly put it in Breakfast at Tiffany’s: ’something bad is going to happen, only you don’t know what it is.’
Anxiety can often be a less intense feeling than fear. It can seem vague and amorphous — and for that very reason difficult to rid ourselves of. After all, if we don’t know what is making us anxious, it’s difficult to know how to deal with the problem. Some experts have suggested that anxiety is the emotion we feel when we can’t, or don’t know how to, take action to deal with a threat. So a large dog charging towards us with its teeth bared is likely to prompt us to a fearful sprint; worries about dying are more likely to take the form of nagging anxiety than straightforward fear.
If anxiety is normal, how can we tell whether it’s getting out of hand? At what point does ordinary, run-of-the-mill anxiety become a clinical problem that needs attention? Every case must be judged in its own context, but a mental health professional will consider:
• whether the individual is becoming anxious inappropriately (their anxiety is like an overly sensitive car alarm);
• whether the anxiety is based on an unrealistic or excessive perception of danger;
• how long anxiety has been affecting the person;
• how distressing it is for the individual;
• and the degree to which anxiety is interfering with the person’s day-to-day life.
They’ll then try to match the person’s experiences to the six types of anxiety disorder — the ones categorized as such by the main psychiatric diagnostic systems — that we describe in Chapters 5 to 10.
If you’re concerned about your own levels of anxiety, you’ll find self-assessment questionnaires for many specific disorders in the Appendix on pp. 124—132.