Signs and Symptoms of Anxiety

The philosopher Kierkegaard offered a general characterization of anxiety, likening it to the experience of dizziness that we feel when we look down into a “yawning abyss” (Kierkegaard, 2013). This certainly goes a significant way towards capturing the essence of this common experience. Still, it is possible to isolate more specific features of anxiety. The following represents what is currently a widely accepted description of the experience (see Clark & Beck, 2011):

Bodily/physiological features

  • increased heart rate
  • heart palpitations
  • shortness of breath
  • chest pain or pressure
  • dizziness
  • sweatiness
  • tingling and numbness of limbs
  • weakness
  • muscle tension
  • dry mouth
  • nausea
Thought processes/cognitive features

  • perceptions of unreality or detachment
  • poor concentration
  • confusion
  • narrowed attention
  • poor memory
Behavioural features

  • pursuit of safety and reassurance
  • pacing
  • freezing
  • difficulty speaking
Feelings/affective features

  • nervousness
  • impatience
  • fright
  • edginess

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What is Anxiety in the DSM-5? DSM-5 Anxiety Disorders

Generally speaking, current medical approaches to anxiety take the Diagnostic and Statistical Manual (DSM) as their starting point. The DSM lays out a set of criteria for distinguishing normal from abnormal anxiety. When a person has abnormal anxiety, they are considered to have an “anxiety disorder.”

According to the DSM, a defining feature of abnormal anxiety is that it is “excessive,” which can mean that it lasts longer than would be expected (American Psychiatric Association, 2013). For example, the diagnosis of certain anxiety disorders requires that anxious symptoms are present for at least 6 months.

The DSM distinguishes different anxiety disorders based the specific things that a person fears and the kinds of thoughts and beliefs that go along with these fears. The following are some of the anxiety disorders that the DSM-5 describes (American Psychiatric Association, 2013).

  • Specific phobia: the person’s anxiety relates to specific objects or situations (such as particular animals), and the level of anxiety is “out of proportion” to the actual risk. The 12-month prevalence of specific phobias in the United States is estimated at 7%-9% of the population.
  • Social anxiety disorder: the person’s anxiety relates to social situations and interactions in which they may face possible scrutiny. Thoughts may centre around being embarrassed, humiliated, or rejected by others. The US 12-month prevalence of social anxiety disorder is estimated at 7% (in European countries, this turns out to be lower, at roughly 2.3%).
  • Panic disorder: the person experiences recurrent and unexpected panic attacks, and may be continually worried about having further panic attacks. The 12-month prevalence of panic disorder in the US and a number of European countries is estimated at 2%-3% of the population.
  • Generalized anxiety disorder: the person experiences persistent and excessive worry and anxiety about various aspects of life, such as work and school performance, and also experiences bodily and other symptoms. The 12-month prevalence for generalized anxiety disorder among US adults is estimated at 2.9%.

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Theories of Anxiety

What is Anxiety in Cognitive Psychology?

Although the DSM-5 focuses on the classification diagnosis of anxiety disorders, it has never been part of its aim to explain the nature of anxiety. That is the role for theories of anxiety. One such theory, derived from cognitive psychology, has been widely influential.

Modern cognitive psychology was developed alongside advances in our understanding of computers. It is, therefore, mainly interested in the human mind to the degree that it functions to process information as would a computer (Gardner, 2008). The cognitive model of anxiety focuses on the ways in which the mind processes information about threats that a person faces.

Cognitive psychology views anxiety as a defensive response co-ordinated by the mind that promotes a person’s self-protection. For example, a person approached by a hostile dog tends to experience an anxiety response, which can help the person to mobilize a fight or flight response (Clark & Beck, 2011).

On the cognitive model, anxiety is considered abnormal when the person has not processed information about the threat they face in a suitable way. This can include overestimating how threatening the situation is, and then becoming needlessly anxious.

A good deal of research has accompanied the cognitive model of anxiety. This typically investigates the ways in which people who experience high anxiety levels process information compared to those with lower anxiety levels. For example, it has been found that people with social anxiety diagnoses are more likely than others to process information in ways that overestimate both the probability and cost of negative social events (Uren, Szabo, & Lovibond, 2004).

CBT (cognitive-behavioral therapy), the widely discussed method of anxiety treatment, is based on cognitive psychology’s information processing model of anxiety. It is educational in nature, aiming to teach people how to become better at processing information about the threats they believe they face.

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What is Anxiety in Psychoanalysis?

There are some similarities between the ways in which cognitive psychology and psychoanalysis attempt to understand the nature of anxiety.

First, both emphasize that anxiety is related to the experience of threat. Freud held that anxiety serves an adaptive function of “self-preservation,” allowing a person to prepare to face a given threat. In this sense, anxiety can serve as a “signal” of danger (Freud, 1926).

Second, as do cognitive psychologists, Freud takes account of the anxious person’s estimation of threat. He understands this to consist in the “estimation of his own strength compared to the magnitude of the danger and in his admission of helplessness in the face of it—physical helplessness if the danger is real and psychical helplessness if it is instinctual” (Freud, 1926, p. 166).

Freud added that a person’s estimation of threat is influenced partly by his or her prior experiences, including “traumatic situations” in which the person has actually experienced such helplessness.

However, a defining difference between the two approaches turns on the issue of the unconscious. The psychoanalytic approach holds that factors that are central to a person’s anxiety can be unconscious, in the sense of being funedamentally outside his or her awareness.

According to Freud, the difference between “neurotic” and non-neurotic anxiety comes down to the role played by unconscious. In both cases there is a danger, but only in the case of realistic anxiety is the danger known. Freud writes:

Real danger is a danger that is known, and realistic anxiety is anxiety about a known danger of this sort. Neurotic anxiety is anxiety about an unknown danger. Neurotic danger is thus a danger that has still to be discovered. Analysis has shown that it is an instinctual danger. By bringing this danger which is not known to the ego into consciousness, the analyst makes neurotic anxiety no different from realistic anxiety, so that it can be dealt with in the same way. (Freud, 1926, p. 165)

There can be different ways of describing just what sorts of dangers might be unknown to the anxious person. An interesting and quite general way of approaching this question has been proposed by Jacques Lacan. On Lacan’s view, a threat that exists at a deep level of human subjectivity is that long-held images of oneself might be revealed to be at least partly false. To put it another way, that certain fundamental ego identifications may be found to be illusory (Lacan, 2007). In that case, the person would be forced to confront experiences of “lack.” Using his terminology, this amount to confronting the “object a” (Lacan, 2014).

It is worth noting that, on this front, there are important similarities between psychoanalytic and Buddhist philosophical views of the connection between anxiety and the ego (De Silva, 2001).

The cognitive model of anxiety is often presented as being at odds with the psychoanalytic model. However, the case can be made that they are actually designed to address different aspects of the human experience of anxiety – with the latter aiming to understand more subtle manifestations that are not necessarily accounted for by the former.

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Internet Resources

National Institute of Mental Health – Anxiety Disorders
Anxiety Disorders Association of Canada
Anxiety and Depression Association of America
Psych Central – Anxiety
The Anxiety Network
The Child Anxiety Network

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References and Further Reading

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.

Barlow, D. H. (2002). Anxiety and its disorders. New York: Guilford Publications.

Beck, A. T., Gary, E., & Greenberg, R. L. (1985). Anxiety Disorders and Phobias. New York: Basic Books.

Beck, A. T., Laude, R., & Bohnert, M. (1974). Ideational components of anxiety neurosis. Archives of General Psychiatry, 31, 319–325.

Boothby, R. (1991). Death and desire: Psychoanalytic theory in Lacan’s return to Freud. New York: Routledge.

Clark, D. A., & Beck, A. T. (2011). Cognitive therapy of anxiety disorders. New York: Guilford Press.

Compton, A. (1972). A study of the psychoanalytic theory of anxiety: I. The development of Freud’s theory of anxiety. Journal of the American Psychoanalytic Association.

De Silva, P. (2001). An Introduction to Buddhist Psychology. London: Rowman & Littlefield Publishers.

Freud, S. (1926). Inhibitions, Symptoms and Anxiety. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XX (1925-1926): An Autobiographical Study, Inhibitions, Symptoms and Anxiety, The Question of Lay Analysis and Other Works, 75-176.

Gardner, H. (2008). The Mind’s New Science. Basic Books.

Harari, R. (2013). Lacan’s Seminar On Anxiety. New York: Other Press.

Kierkegaard, S. (2013). Concept of Anxiety: A Simple Psychologically Orienting Deliberation on the Dogmatic Issue of Hereditary Sin. Princeton: Princeton University Press.

Lacan, J. (2014). Anxiety. (J.-A. Miller, Ed., A. R. Price, Trans.). Cambridge: Polity.

Lacan, J. (2007). The Mirror Stage. In B. Fink (Trans.), Ecrits: The first complete edition in English.(1st ed.). New York: W. W. Norton & Company.

Uren, T. H., Szabó, M., & Lovibond, P. F. (2004). Probability and cost estimates for social and physical outcomes in Social Phobia and Panic Disorder. Journal of Anxiety Disorders, 18, 481–498.

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