Anxiety is an apprehension of experiencing fear in the future. The danger feared isn’t imminent and may not even be known or realistic. In contrast, fear is an emotional and physical reaction to a present, known threat. Anxiety is typically characterized by obsessive worry and an inability to concentrate that may affect our sleep.
It can trigger a full-blown fight-flight-or-freeze response of our sympathetic nervous system that prepares us to meet real danger; however, a big difference between fear and anxiety is that because anxiety is an emotional response to something that hasn’t occurred, there is nothing to fight or flee. Therefore, tension builds up inside our body, but there is no action we can take to release it. Instead, our mind goes round and round, replaying possibilities and scenarios.
Physical symptoms can still include any of the following:
- Increased heart rate
- Numbness or tingling in hands or feet
- Shortness of breath
- Tunnel vision
- Nausea or diarrhea
- Dry mouth
- Muscle tension
When excessive, unrealistic worry persists about two or more things for at least six months and is accompanied by at least three of these symptoms: irritability, fatigue, difficulty concentrating, sleep problems, or the last two listed above. In some cases, anxiety can manifest in specific phobias that are inappropriate to the specific situation, or in a panic disorder, where we feel sudden, unprovoked terror that can cause chest pain and a choking sensation and be mistaken for a heart attack.
When I was hit while driving by an oncoming car, in the moments before impact, I felt terror and didn’t expect to survive the crash. For about a month afterward, I felt anxiety about driving and drove slower and more cautiously. This was a traumatic event, but eventually, my anxiety passed.
Abuse and trauma, including major losses, are considered foremost causes of anxiety.
We can feel anxiety about our finances or serious medical diagnosis, but most anxiety is shame anxiety, which is apprehension about experiencing shame. It’s caused by traumatic shame that has been internalized from the past, usually from childhood. Shame anxiety affects our self-esteem. We worry about what we say, how well we perform, and how we’re perceived by others. It can make us very sensitive to real or imagined criticism from ourselves or others. Shame anxiety may manifest as social phobia or in symptoms of codependency, such as controlling behavior, people-pleasing, perfectionism, fear of abandonment, or obsessions about another person or addiction. Worry about our performance on the job, an exam, or speaking before a group is an apprehension about how we’ll be evaluated or judged. Whereas men are more vulnerable to shame anxiety about loss of work, women worry more about their appearance and relationships. Men in particular, have shame anxiety about failing or not being a good provider. Perfectionism, too, is an attempt to achieve an imaginary ideal in an attempt to be accepted by others.