Anxiety versus Fear
The difference between anxiety and worry is that anxiety is the emotional experience of anticipating a potentially threatening future event, whereas worry is the mental rehearsal in one’s mind of dealing with a problem that has already occurred or may occur in the future. Anxiety versus fear is a One commonality between all forms of anxiety disorders and clinical-level anxiety is excessive autonomic arousal or activation. At its essence, this means problems with either too much activity, as seen in generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), panic disorder (PD), and other phobias; or problems with too little activity, as seen in depression and some personality disorders.
While there are many people who experience anxiety and worry at different levels of severity, some people’s lives are so impaired by them that they seek professional mental-health assistance. Anticipatory anxiety is voluntary and beyond the individual’s control, while worry is involuntary and beyond the individual’s control.
Worry can be seen as a series of connected thoughts revolving around what the thinker believes to be an important issue or problem, such as one affecting his or her own health or that of children or loved ones. The process of worrying typically involves reviewing in one’s mind things that could possibly go wrong in the future; identifying problems and what causes them; generating solutions; evaluating the solutions with regard to possible consequences (positive and negative); deciding which solution(s) to implement, and putting the solutions into action.
What is Anxiety?
In contrast to worry, anxiety is a complex emotional and physiological state that even when mild can adversely affect how one thinks, feels, or acts. In contrast, to worry, anxiety is considered an emotion resulting from the anticipation of a perceived negative event; it is also considered as a mood-based disorder characterized by disproportionate feelings of apprehension and fear often accompanied by somatic symptoms such as stomach ache, headache, sweating/panting (cold and clammy hands), heart racing (palpitations), difficulty breathing (feeling smothered), muscle tension/aches/pains/cramps. Anxiety can be differentiated from general worrying in that there are some “distinct” differences:
1) worry is future-oriented and anxiety is present-oriented,
2) worry does not have a negative outcome orientation whereas anxiety has a negative outcome orientation,
3) worry targets a specific source of threat but anxiety can affect the individual as a whole,
4) worry has a positive outcome expectancy while fear/anxiety has no positive outcome expectancy.
When individuals worries excessively about the possible consequences of some event or situation in their lives, they may be having difficulty coping with their worry. This is called “problematic worrying”. When an individual attempt to alleviate this excessive worry unsuccessfully for extended periods then that person’s persistent attempt to gain control over the worries may indicate the presence of generalized anxiety disorder (GAD). It may be difficult for an individual to discern where the line between normal and problematic worry lies. Sometimes they may not even realize that their worrying is excessive or a problem.
Anxiety Disorders
Anxiety disorders can often be traced back to earlier times of stress and trauma, such as in the case of posttraumatic stress disorder (PTSD), which has been found to have stemmed from events such as physical abuse, sexual molestation, car accidents, natural disasters, terrorist attacks, sudden loss of a loved one, war experiences and other traumatic events. Anxiety can be either anticipatory i.e., fear of future threat and/or fear about oneself in relation to some expected demand; or it can be situationally bound i.e., phobic avoidance of an actual feared object or situation.
Generalised Anxiety Disorder
People with a generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school and work performance.
Separation Anxiety Disorder
The intensity of the symptoms experienced by people who suffer from a separation anxiety disorder is often dictated by the level of fear provoked by the hallucination or delusion that accompanies it. For example: if the hallucination involves the thought that one’s home is being robbed then intense fear will result; in comparison, if a man who suffers from auditory hallucinations hears voices behind him saying “empty your pockets” then he will be prompted by his anxiety to turn around and face what is behind him (as opposed to continuing walking forward) thus the accompanying level of fear would not be as intense as it would be if he were confronted by someone actually standing there.
Social Anxiety Disorder
Social anxiety disorder, also known as social phobia, “is an extreme and unreasonable fear of social situations.” Social anxiety disorder can have a wide range of symptoms that usually come about in certain types of situations such as public speaking or meeting new people. People who experience this condition often avoid many social encounters for fear that they will be humiliated, embarrassed, rejected or looked down upon in public settings. If left untreated, those afflicted can sometimes suffer from depression due to growing self-consciousness over the years, which can negatively impact their daily life.
Panic Attacks
People commonly experience panic attacks as a direct result of exposure to an object/situation that they have a phobia for. Panic attacks may also become situationally bound when certain situations are associated with panic due to previously experiencing an attack in that particular situation. People may also have a problem with anticipatory anxiety where they fear future panic attacks and worry excessively about having another attack in any possible situation (i.e., driving, being out in public, shopping). “Someone with separation anxiety disorder has excessive anxiety concerning separation from those to whom the individual is attached.” This can include parents or guardians, siblings, friends or even school teachers; regardless of the relationship the person has toward these people. These individuals often report a vague and constant feeling of worry or dread, as well as an unwillingness to go into any type of new situation without the companionship of those who they are attached with. “Studies have shown that people with OCD experience elevated anxiety levels when faced with stressful situations.” This is because stress has become associated with relaxing and letting their guard down due to prior experience and is now known as a “relaxation” cue for their body.
In addition to the symptoms already mentioned early childhood anxiety may also present itself through full-blown temper tantrums at extremely inconvenient times, incessant crying by a baby who appears to be otherwise perfectly healthy, excessive distress when separated from caregivers (e.g., going to school or other activities), looking pale and/or acting ill when faced with a certain situation, being afraid of going to sleep without a parent nearby or in a dark room, nightmares involving threats to the child’s safety, exaggerated startle response (e.g., reacting as though something terrible is about to happen when it isn’t actually very threatening).
Phobias
Phobias are fears of certain objects or situations that pose little real danger but provoke anxiety and may interfere with daily functioning. This disorder is not related to obsessive-compulsive disorder (OCD) although some forms of OCD can produce phobic symptoms. The most common specific phobias are fear of animals (such as snakes, rats, dogs), fear of heights (acrophobia), and fear of closed-in places (claustrophobia). Some individuals with social phobias have a fear of speaking in public or other situations in which they feel watched and judged by others.
Phobias usually begin in late childhood or early adolescence, although some people do not develop symptoms until their twenties, thirties, or forties. Simple phobias typically start suddenly and may continue to escalate if untreated. Social phobias usually begin through observing another person’s extremely negative reaction to the object/situation and then feeling significant fear while experiencing subsequent events similar to the first time the situation occurred. A child will often learn this by observing adults behave scared around something that is actually not dangerous at all. As an example, a child witnesses a friend having a panic attack behind their fear of spiders, and then begins to fear going near or touching a spider themselves. This is an example of observational learning which can be applied to all phobias in general.
“It is estimated that social anxiety disorder accounts for one-fifth to one-third of youth clinic visits.” The prevalence rate has been found to be approximately 5% among youth and it has the highest prevalence among white non-Hispanic children (8%). “The condition typically begins around age 13, although symptoms often precede this manifestation by several years”, and often goes unrecognized by parents since young children cannot recognize what it means to feel anxious due to lack of experience. Symptoms may even develop prior to age 10.
School Refusal as a Result of Anxiety
School refusal is the persistent refusal to attend school by a child who previously attended full-time. New onset of fear of attending school may signify an anxiety disorder, panic disorder, social phobia, or separation anxiety. If there are other risk factors present such as bullying or disruptive home life it may be categorized under adjustment disorders. The DSM IV states that if symptoms are caused exclusively by the effects of a substance (drug of abuse, medication) or medical condition (illness), they do not qualify for this diagnosis. Similarly, problems that are largely bereavement-related should also not receive this diagnosis. Appropriate differential diagnoses involve mood disorders and schizoaffective disorder including psychotic features in children and. Children with ADHD will often have comorbid school refusal as they tend to avoid anything that causes them frustration, including school.
There are a number of reasons why children may refuse to go to school. Some children may be afraid of school because of bullying or other forms of victimization that occur there. Others may find the academic material to be too challenging. Some children may have difficulty separating from their parents or caregiver and feel anxious about being away from them for an extended period of time. Children with ADHD may find the school environment to be too stimulating or chaotic, while children with sensory processing disorder may find certain textures, sounds, or smells overwhelming in a school setting.
Treatment for school refusal typically involves a multidisciplinary team approach that includes the child’s parents, teachers, and mental health professionals. Therapeutic interventions may include cognitive-behavioral therapy (CBT), exposure therapy, parent training, and medication management. CBT is a form of talk therapy that helps children to identify and challenge negative thoughts and beliefs that contribute to their anxiety. Exposure therapy involves gradually exposing the child to the feared situation in a safe and controlled environment. Parent training helps parents to better understand and support their child’s anxiety. Medication management may be necessary in some cases to help the child manage their symptoms of anxiety.
School refusal is a serious problem that can have a significant impact on a child’s academic performance and social development. It is important to seek professional help if you suspect that your child may be struggling with an anxiety disorder.
Anxiety and fear are two different emotions that can both be experienced by an individual. Fear is typically a response to a specific situation or object, while anxiety is a feeling of unease or worry that may be present in many situations. Fear is usually short-lived, while anxiety can persist for long periods of time. Fear is often associated with the fight or flight response, while anxiety does not always have an obvious trigger. Fear is usually caused by external stimuli, while anxiety can be caused by internal factors such as thoughts or feelings. Anxiety disorders are more common than fear disorders, and they often cause significant impairment in daily functioning. Treatment for anxiety disorders typically involves cognitive-behavioral therapy, exposure therapy, parent training, and medication management.
