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Anxiety

Anxiety is an emotion which is characterised by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events.[2][3][4] Anxiety is different from fear in that fear is defined as the emotional response to a present threat, whereas anxiety is the anticipation of a future one.[5] It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.[6]

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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.[7] It is often accompanied by muscular tension,[8] restlessness, fatigue, inability to catch one's breath, tightness in the abdominal region, nausea, and problems in concentration. Anxiety is closely related to fear,[4] which is a response to a real or perceived immediate threat (fight-or-flight response); anxiety involves the expectation of a future threat including dread.[8] People facing anxiety may withdraw from situations which have provoked anxiety in the past.[9]


The emotion of anxiety can persist beyond the developmentally appropriate time-periods in response to specific events, and thus turning into one of the multiple anxiety disorders (e.g. generalized anxiety disorder, panic disorder).[10][11] The difference between anxiety disorder (as mental disorder) and anxiety (as normal emotion), is that people with an anxiety disorder experience anxiety most of the days during approximately 6 months, or even during shorter time-periods in children.[8] Anxiety disorders are among the most persistent mental problems and often last decades.[12] Besides, strong perceptions of anxiety exist within other mental disorders, e.g., obsessive-compulsive disorder, post-traumatic stress disorder.[13][14]

Anxiety vs. fear[edit]

Anxiety is distinguished from fear, which is an appropriate cognitive and emotional response to a perceived threat.[15] Anxiety is related to the specific behaviors of fight-or-flight responses, defensive behavior or escape.[16] There is a false presumption that often circulates that anxiety only occurs in situations perceived as uncontrollable or unavoidable, but this is not always so.[17] 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,"[18] 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.[19] In positive psychology, anxiety is described as the mental state that results from a difficult challenge for which the subject has insufficient coping skills.[4][20]


Fear and anxiety can be differentiated into four domains: (1) duration of emotional experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction. Fear is short-lived, present-focused, geared towards a specific threat, and facilitating escape from threat. On the other hand, anxiety is long-acting, future-focused, broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat and interferes with constructive coping.[21]


Joseph E. LeDoux and Lisa Feldman Barrett have both sought to separate automatic threat responses from additional associated cognitive activity within anxiety.[22][23]

Neurological, as , paresthesias, fasciculations, vertigo, or presyncope.

headache

Digestive, as abdominal pain, , diarrhea, indigestion, dry mouth, or bolus. Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate IBS.

nausea

Respiratory, as or sighing breathing.

shortness of breath

Cardiac, as , tachycardia, or chest pain.

palpitations

Muscular, as , tremors, or tetany.

fatigue

Cutaneous, as , or itchy skin.

perspiration

Uro-genital, as , urinary urgency, dyspareunia, or impotence, chronic pelvic pain syndrome.

frequent urination

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 anxiety.[24] Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. However, most people do not suffer from chronic anxiety.[25]


Anxiety can induce several psychological pains (e.g. depression) or mental disorders, and may lead to self-harm or suicide for which dedicated hotlines exist.[26][27][28]


The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative feelings in the past.[9] 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).[9]


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"[29] as well as "nightmares/bad dreams, obsessions about sensations, déjà vu, a trapped-in-your-mind feeling, and feeling like everything is scary."[30] It may include a vague experience and feeling of helplessness.[31]


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 an 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."[32]


The physiological symptoms of anxiety may include:[26][27]

Co-morbidity[edit]

Anxiety disorders often occur with other mental health disorders, particularly major depressive disorder, bipolar disorder, eating disorders, or certain personality disorders. It also commonly occurs with personality traits such as neuroticism. This observed co-occurrence is partly due to genetic and environmental influences shared between these traits and anxiety.[78][79]


It is common for those with obsessive–compulsive disorder to experience anxiety. Anxiety is also commonly found in those who experience panic disorders, phobic anxiety disorders, severe stress, dissociative disorders, somatoform disorders, and some neurotic disorders.[80] Anxiety has also been linked to the experience of intrusive thoughts. Studies have revealed that individuals who experience high levels of anxiety (also known as clinical anxiety) are highly vulnerable to the experience of intense intrusive thoughts or psychological disorders that are characterised by intrusive thoughts.[81]

Prevention[edit]

The above risk factors give natural avenues for prevention. A 2017 review found that psychological or educational interventions have a small yet statistically significant benefit for the prevention of anxiety in varied population types.[154][155][156]

Pathophysiology[edit]

Anxiety disorder appears to be a genetically inherited neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol.[157]


In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms. Increased flow in the right parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients are the diagnostic factors for prevalence of anxiety disorder.


The amygdala is central to the processing of fear and anxiety,[158] and its function may be disrupted in anxiety disorders. Anxiety processing in the basolateral amygdala has been implicated with expansion of dendritic arborization of the amygdaloid neurons.[159] SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization.[160]

List of people with an anxiety disorder

 – Intense feeling of apprehension, anxiety, or inner turmoil

Angst

 – Basic emotion induced by a perceived threat

Fear

 – Model of anxiety and depression

Tripartite Model of Anxiety and Depression

 – Psychological experience of something being strangely familiar

Uncanny

Mental stress-induced myocardial ischemia