The words fear, anxiety and panic are often used interchangeably. These emotional states can often overlap, however they are different. Understanding the difference is important for the management and regulation of these feelings and for the course of therapy.
Fear is an emotional response to an outside threat such as a suspicious person following us on a dark street, a fire, or an earthquake, all of which pose the possibility of injury, death or destruction of possessions important to us. The loss of a job brings forth fear as it can threaten our ability to meet our expenses and survive economically. Medical threats such as cancer or heart attack are considered external threats. Fear ultimately distills down to the experience of anxiety as will become evident below.
Anxiety, one the other hand, is a warning signal of an internal threat. It is a signal that an unacceptable or forbidden thought, feeling, or impulse is being stimulated within us. As example, we might learn as children that anger is not an acceptable or safe feeling either from teaching, punishment, or the experience of anger as a destructive force, such as a parent with an explosive temper that leads to emotional or physical harm or divorce. At a later point when we find ourselves feeling the emergence of frustration or anger, that might be appropriate for given event or situation, anxiety (or the warning system) will turn on and the chance for appropriate expression of our anger will be stifled and suppressed. If we have learned that sadness is not an acceptable feeling or crying a safe behavior then anxiety will replace the experience and expression of this emotion. An external threat that causes fear can lead to an internal threat if it involves the re-experiencing of an old trauma including loss, the feeling of shame (i.e., losing one's job or home), or the end of our existence.
Panic or panic attacks come from two sources: the mislabeling of anxiety and social panic. Individuals who have received medical clearance and do not identify anxiety for what it is are at risk for misinterpreting or mislabeling its symptoms as a medical or psychiatric emergency. Symptoms of anxiety can include heart palpitations, chest tightness, trembling, sweating, or hyperventilation. People who mislabel these common symptoms often believe that they are having a heart attack, stroke, going to faint, or that they are going crazy. This belief often escalates the anxiety into panic. Individuals who experience social panic believe that their anxiety is visible to others. An intensification of anxiety can occur that further confirms the belief that their anxiety is more transparent to others. A spiraling effect results that will increase one's level of anxiety into a panic attack. People with panic disorder can also suffer from agoraphobia causing them to avoid places such as buses, airplanes, a possible traffic jam on the freeway, or crowds where escape from exposure or medical help is not easily accessible.
The following is an example of how these emotional states can be intertwined. A man on an airplane hears unfamiliar noises and has a fear that the plane might crash. This fear will usher in anxiety around death. Also, if being afraid is an unacceptable feeling (i.e., he believes it is shameful for a grown man to be afraid), then a surge of anxiety will also occur. If the feeling of anxiety is also mislabeled as medical emergency or if he believes that his anxiety is obvious to those around him and he has no way to escape, his anxiety can escalate into panic.
Copyright © 2007 Bruce A. Howard, Ph.D. All rights reserved.