Pathological Anxiety Research Paper
TABLE OF CONTENTS
INTRODUCTION......................................................................................……………………….2
Normal Anxiety ………..............................................................................................................3-4
Pathological Anxiety...................................................................................................................4-5
ANXIETY DISORDERS ………………………….......................................................................5
Generalized Anxiety Disorder.....................................................................................................5-6 Panic Disorder .............................................................................................................................6-7 …show more content…
Post Traumatic Stress Disorder....................................................................................................7-8
Distinguishing between psychological and medical models of anxiety…………………………..8
The importance of Distinguishing between normal anxiety and pathological anxiety…………8-9
CONCLUSION..........................................................................................................................9-10
REFERENCES………………………………………………………………………………10-11
Introduction
All persons experience feelings of anxiety. It is a normal and positive dimension of human life and does not refer only to exaggerated worries. There is a distinction between the healthy and unhealthy anxiety, describing the first one as a concern and vigilance which helps people who are coping with different or difficult situations. ( Ruscio, 2002). However, the unhealthy anxiety or anxiety that is pathological is an emotional response to the threats perceived as real but are largely imaginary due to a very low probability of occurrence. Additionally, the behavioral theories postulate that anxiety is a conditioned response to specific environmental stimuli. Typically, it is characterized by diffuse or intense fear often accompanied by autonomous symptoms such as headaches, sweating, palpitations, tightness in chest, stomach discomfort and agitation, indicated by the inability to sit still for a long period of time.(Smith, 2006). This particular constellation of symptoms during anxiety tends to vary from person to person depending on the type of anxiety disorder. Additionally, anxiety does not refer only to exaggerated worries as troubles are normal. The average levels of anxiety are often beneficial to increase anyone’s capability and those relatively high may be considered normal in certain circumstances. It is also important to note that excessive emotional reactions have no simple one-dimesional cause but come from multiple sources. (Durand &Barlow, 2006,p. 37 )
This paper highlights how one can distinguish between normal anxiety and anxiety that is pathological. The answer is illustrated using Generalised Anxiety Disorder, Panic Disorder and Post Traumatic Stress Disorder.
Normal anxiety
Anxiety is a negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future. (American Psychiatric Association, 1994; Barlow,1988)
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defined anxiety as “apprehensive anticipation of future danger or misfortune accompanied by a feeling of dysphoria or somatic symptoms of tension”. (American Psychiatric Association, Washington, DC, 1994). It is thus a future-oriented state, motivating the person to avoid the perceived danger. Anxiety need not be negative as it may increase vigilance and arousal and thereby enhance performance and learning. (Ruscio, 2002) .Additionally, it is considered normal and adaptive when it serves to improve peoples ' functioning or to preserve their well-being. On the most basic level, anxiety is an emotion. Simply stated, an emotion is a subjective state of being that is often associated with changes in feelings, behaviors, thoughts and physiology. Anxiety, like all emotional states, can be experienced in varying degrees of intensity. Additionally, anxiety is a single word that represents a broad range of emotional intensity. At the low end of the intensity range, anxiety is normal and adaptive. However, at the high end of the intensity range, anxiety can become pathological and maladaptive. (Ruscio &Burkovec, 2002)
According to Creswell et. al ( 2006), anxiety is best considered a complex, subjective experience, produced by multiple causes and expressed by a diverse set of symptoms that includes physical, emotional, behavioral and cognitive components. There is a considerable degree of variation among normal individuals in their proneness to anxiety, with some people seemingly always calm, unruffled and laid back no matter what happens to them and others hyperactive, jumpy, apprehensive and fearful even when things are going well for them. Inborn and sometimes genetic factors probably play a significant role in such differences. (p.214).
Also, normal anxiety is applied to states of arousal/anxiety which occur in everyday life, in response to stimuli. It has an adaptive role and is a signal to take action. In normal anxiety, the assessment of the danger is appropriate and the action taken is effective. For example, the healthy person who has lost her/his pay-packet will be anxious about paying outstanding bills. Translating this into more clinical terms and to expand on what has been previously stated, Hamilton (1969) distinguished between anxiety as a normal reaction to danger, anxiety as a pathological mood and anxiety as a neurotic state or syndrome. Anxiety is a normal response to threats or challenges, especially those perceived to be uncontrollable. The anxiety reaction to danger is milder but more prolonged than fear and includes biological changes that prepare the organism to handle stress. It involves a loose blend of apprehension with a state of physical readiness to cope with upcoming events.
Pathological Anxiety
By contrast to normal anxiety, pathological anxiety arises not in reaction to an external threat but to an internal stimulus.
Abnormal anxiety is a chronic condition which impairs peoples ' functioning and interferes with their well-being, thereby causing them significant distress. According to the American Psychiatric Association (DSM-IV-TR), in addition to specific symptoms that may accompany a particular anxiety disorder, the main criteria used to distinguish normal anxiety from an anxiety disorder is the impairment that results in a person 's social, occupational, and/or academic functioning (2000). Additionally, according to Creswell et al, (2006), “the unhealthy anxiety makes you very often restrict your activities” when you do not need to do this, or it can make you lose control because of the psychosomatic symptoms of panic, phobia, tremors that interfere with the ability to appropriately face the situation. (p.265)
Unfortunately for others, their anxiety may be experienced to such a heightened degree that it actually causes them significant distress. Sadly, this level of anxiety often interferes with people 's functioning in many important areas of their lives such as work, school, and relationships. When the normal human experience of anxiety reaches this level of distress, and results in impaired functioning, we begin to speak of an anxiety disorder. …show more content…
(Wilde,1996).
Anxiety Disorders
Generalized Anxiety Disorder
Specific anxiety disorders are complicated by panic attacks or other features that are the focus of the anxiety. In generalized anxiety disorder, the focus is generalized to the events of everyday life. Most people worry to some extent. The DSM-IV criteria specify that at least 6 months of excessive anxiety and worry(apprehensive expectation)must be ongoing more days than not. Furthermore, it must be very difficult to turn off or control the worry process. This is what distinguishes pathological worrying and anxiety from the normal kind that humans experience from time to time as they get ready for an upcoming event or challenge. Most people worry and are anxious for a time but can set the problem aside and go on to another task. However, with Generalized Anxiety Disorder, this is not possible. (Wilde, 1996)
Additionally, Generalized Anxiety Disorder is characterized by muscle tension, mental agitation and susceptibility to fatigue (probably the result of chronic excessive muscle tension, some irritability and difficulty.
(Durand & Barlow, 2006, p. 130). The American Psychiatric Association (2000) recognized Generalized Anxiety Disorder (GAD) as a debilitating condition, with uncontrolled and excessive worry as its unique feature. The anxiety associated with this disorder focuses on minor everyday events and not one major worry or concern. People with GAD cannot seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They cannot relax, get startled easily and have difficulty concentrating. Generalized Anxiety Disorder develops slowly. It often starts during the teen years or young adulthood. Symptoms may get better or worse at different times, and often are worse during times of stress. (Behar
et.al,2009)
Additionally, when their anxiety level is mild, people with Generalized Anxiety Disorder can function socially and effectively handle a job. Although they do not avoid certain situations as a result of their disorder, people with Generalized Anxiety Disorder can have difficulty carrying out the simplest daily activities if their anxiety is severe. Biological models postulate people are predisposed to develop anxiety disorders by genetic inheritance. (Wilde, 1996)
Panic Disorder
Panic disorder exists worldwide, although its expression may vary from place to place. People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. A person may also have a strong physical reaction during a panic attack. They may feel as though they are having a heart attack. Panic attacks can occur at any time and many people with panic disorder worry about and dread the possibility of having another attack. Additionally, a person with panic disorder may become discouraged and feel ashamed because he or she cannot carry out normal routines like going to the grocery store or driving. Having panic disorder can also interfere with school or work. Panic disorder (PD) is a chronic and fluctuating disease that generates intense malaise, entailing worse quality of life and social deterioration. People with panic disorder may have a fear or avoidance of places where panic attacks have occurred in the past. During an attack, there are physical symptoms such as a pounding or racing heart, sweating, breathing problems, weakness or dizziness, feeling hot or a cold chill, tingly or numb hands, chest pain, or stomach pain.(Durand &Barlow,2006, p.137 ).
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is classified as an anxiety disorder (APA,1994) and describes the cluster of symptoms associated to a traumatic event outside the range of usual human experience .Epidemiologic studies have linked the exposure to traumatic events to the onset of PTSD as well as other specific psychiatric disorders, such as major depression, other anxiety and psychoactive substance use disorders (Smith et al.1990; David et al.1996; Dew et al. 1996).
PTSD is an enduring, distressing, emotional disorder that follows exposure to a severe helpless or fear-inducing threat. The victim reexperiences the trauma, avoids stimuli associated with it and develops a numbing of responsiveness and an increased vigilance and arousal. PTSD is subdivided into acute and chronic. Acute PTSD can be diagnosed one month after the event occurs. (Durand &Barlow, 2006).When PTSD continues longer than 3 months, it is considered chronic. Chronic PTSD is usually associated with more prominent avoidance behaviors (Behar et. al, 2009) as well as with the more frequent co-occurrence of additional diagnoses such as social phobia. In PTSD with delayed onset, individuals show few if any symptoms immediately after a trauma, but later, perhaps years afterward they develop full blown PTSD. Additionally, PTSD is the one disorder for which we are sure of the etiology: someone personally experiences a trauma and develops a disorder. Almost all psychiatric or psychological problems, conditions and illnesses are accompanied by some degree of anxiety as a nonspecific accompanying feature. People suffering from depression, for example, are very commonly anxious as well.
Distinguishing between psychological and medical models of anxiety
It is important to recognize a distinction between psychological and medical models of anxiety. The medical approach is categorical; to receive a diagnosis of anxiety, a patient must meet specified criteria, as laid out, for example, in the DSM-IV. The categorical approach is practical and provides a basis for deciding whether or not to treat a patient. The underlying assumption is that there is a qualitative distinction between those who are well and those who are sick; although sickness can vary in severity, cases either do not lie on the same continuum as non-cases, or at least form a distinctive cluster at one end of a continuum. This conception is widely challenged, however. (Durand &Barlow, 2006, p. 155). Studies conducted by Ellis (1998) show that psychologists take a dimensional approach that treats anxiety as a continuum of severity (or, in some models, a set of continua) with no intrinsic threshold. The arguments for a dimensional conception point out that there does not seem to be a bimodal distribution of scores representing well and sick groups; there also seems to be a continuum of impairments due to anxiety, with no threshold beyond which rising anxiety scores would indicate an anxiety disorder. Similarly, a dimensional model has been proposed in mental status testing, where there is a diagnostic dilemma of how to classify people who do not meet the criteria for dementia, but who are also not normal. Most of the anxiety scales provide intensity or severity scores that reflect an underlying dimensional model of anxiety.
The importance of distinguishing between normal anxiety and pathological anxiety
According to Ruscio (2002), there are several reasons it is important to make the distinction between anxiety as an adaptive emotion and anxiety as a disorder. First, it would be incorrect to conclude that someone is suffering from an anxiety disorder simply because they are experiencing some degree of anxiety. As explained above, anxiety as an emotion is a normal reaction to certain situations and even serves a useful purpose. Thus, it is neither necessary, nor beneficial, to attempt to rid ourselves of all anxiety.
Second, it is important for each of us to recognize that our own normal experiences of ordinary anxiety are qualitatively different from a person experiencing an anxiety disorder. Often, well-intentioned family and friends will offer advice to people attempting to recover from anxiety disorders. Unfortunately, these well-meaning friends and family cannot understand why the person-in-recovery reacts so negatively to their genuine efforts to help them "get over it" or to "just forget about it." These sorts of techniques may be useful for coping with ordinary anxiety, but are not effective once anxiety has reached a pathological level. Indeed, without proper information about anxiety disorders, people-in-recovery and their loved ones may find themselves becoming increasingly frustrated with each other, even though their goals are the same to deal with anxiety in a constructive manner on a daily basis. (Ruscio,2002)
Conclusion
Anxiety is a normal and positive dimension of human life. It becomes pathological only when it exceeds a certain threshold, defined mainly on the basis of a substantial change in the quality of life. Anxiety covers a wide range of experiences, much of which are normal and experienced by everyone at some point in life, some of which being even pleasant. At the pathological extreme, anxiety is unpleasant, disturbing and in its most extreme form, it is one of the most intolerable experiences that the mind and body are exposed to. People with anxiety disorders suffer more from the negative consequences as they affect their work and the personal relations, limit their activities and their chances because of their tendency to avoid the difficult situations, preferring to stay in the shade of others than to take action. (Dombeck & Zupanick, 2010).
References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th Edition). American Psychiatric Association, Washington, DC
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, (3rd edition). American Psychiatric Association, Washington, DC
Barlow, D.H (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic: New York: Guilford Press
Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23, 1011–1023. doi:10.1016/j.janxdis.2009.07.006
Creswell, C., O’Connor, T. G., & Brewin, C. R. (2006). A longitudinal investigation of maternal and child ‘anxious cognitions.’ Cognitive Therapy and Research, 30, 135–147. doi:10.1007/s10608-006-9021-1
Durand M.V, & Barlow, D.H (2006). Essentials of Abnormal Psychology (4th Edition): USA: Thomson Wadsworth.
Dombeck M., & Zupanick C. (2010). Pathological, Abnormal Anxiety. Bio Behavioral Institute.
Ellis A. (1998). How to control your anxiety before it controls you. Secaucus, NJ
Hamilton M. (1969). Br J Psychiatry; Special Publication #3:76-79)
Ruscio, A. M. (2002). Delimiting the boundaries of generalized anxiety disorder: Differentiating high worriers with and without GAD. Journal of Anxiety Disorders,16, 377–400. doi:10.1016/S0887-6185(02)00130-5
Ruscio, A. M., & Borkovec, T. D. (2004). Experience and appraisal of worry among high worriers with and without generalized anxiety disorder. Behaviour Research and Therapy, 42, 1469–1482. doi:10.1016/j.brat.2003.10.007
Smith EM, North CS, McCool RE, Shea JM (1990) Acute post disaster psychiatric disorders: identification of persons at risk. Am J Psychiatry 147:202–206
Wilde J. (1996). Treating anger, anxiety, and depression in children and adolescents: A cognitive-behavior perspective: NewYork
INTRODUCTION......................................................................................……………………….2
Normal Anxiety ………..............................................................................................................3-4
Pathological Anxiety...................................................................................................................4-5
ANXIETY DISORDERS ………………………….......................................................................5
Generalized Anxiety Disorder.....................................................................................................5-6 Panic Disorder .............................................................................................................................6-7 …show more content…
Post Traumatic Stress Disorder....................................................................................................7-8
Distinguishing between psychological and medical models of anxiety…………………………..8
The importance of Distinguishing between normal anxiety and pathological anxiety…………8-9
CONCLUSION..........................................................................................................................9-10
REFERENCES………………………………………………………………………………10-11
Introduction
All persons experience feelings of anxiety. It is a normal and positive dimension of human life and does not refer only to exaggerated worries. There is a distinction between the healthy and unhealthy anxiety, describing the first one as a concern and vigilance which helps people who are coping with different or difficult situations. ( Ruscio, 2002). However, the unhealthy anxiety or anxiety that is pathological is an emotional response to the threats perceived as real but are largely imaginary due to a very low probability of occurrence. Additionally, the behavioral theories postulate that anxiety is a conditioned response to specific environmental stimuli. Typically, it is characterized by diffuse or intense fear often accompanied by autonomous symptoms such as headaches, sweating, palpitations, tightness in chest, stomach discomfort and agitation, indicated by the inability to sit still for a long period of time.(Smith, 2006). This particular constellation of symptoms during anxiety tends to vary from person to person depending on the type of anxiety disorder. Additionally, anxiety does not refer only to exaggerated worries as troubles are normal. The average levels of anxiety are often beneficial to increase anyone’s capability and those relatively high may be considered normal in certain circumstances. It is also important to note that excessive emotional reactions have no simple one-dimesional cause but come from multiple sources. (Durand &Barlow, 2006,p. 37 )
This paper highlights how one can distinguish between normal anxiety and anxiety that is pathological. The answer is illustrated using Generalised Anxiety Disorder, Panic Disorder and Post Traumatic Stress Disorder.
Normal anxiety
Anxiety is a negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future. (American Psychiatric Association, 1994; Barlow,1988)
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defined anxiety as “apprehensive anticipation of future danger or misfortune accompanied by a feeling of dysphoria or somatic symptoms of tension”. (American Psychiatric Association, Washington, DC, 1994). It is thus a future-oriented state, motivating the person to avoid the perceived danger. Anxiety need not be negative as it may increase vigilance and arousal and thereby enhance performance and learning. (Ruscio, 2002) .Additionally, it is considered normal and adaptive when it serves to improve peoples ' functioning or to preserve their well-being. On the most basic level, anxiety is an emotion. Simply stated, an emotion is a subjective state of being that is often associated with changes in feelings, behaviors, thoughts and physiology. Anxiety, like all emotional states, can be experienced in varying degrees of intensity. Additionally, anxiety is a single word that represents a broad range of emotional intensity. At the low end of the intensity range, anxiety is normal and adaptive. However, at the high end of the intensity range, anxiety can become pathological and maladaptive. (Ruscio &Burkovec, 2002)
According to Creswell et. al ( 2006), anxiety is best considered a complex, subjective experience, produced by multiple causes and expressed by a diverse set of symptoms that includes physical, emotional, behavioral and cognitive components. There is a considerable degree of variation among normal individuals in their proneness to anxiety, with some people seemingly always calm, unruffled and laid back no matter what happens to them and others hyperactive, jumpy, apprehensive and fearful even when things are going well for them. Inborn and sometimes genetic factors probably play a significant role in such differences. (p.214).
Also, normal anxiety is applied to states of arousal/anxiety which occur in everyday life, in response to stimuli. It has an adaptive role and is a signal to take action. In normal anxiety, the assessment of the danger is appropriate and the action taken is effective. For example, the healthy person who has lost her/his pay-packet will be anxious about paying outstanding bills. Translating this into more clinical terms and to expand on what has been previously stated, Hamilton (1969) distinguished between anxiety as a normal reaction to danger, anxiety as a pathological mood and anxiety as a neurotic state or syndrome. Anxiety is a normal response to threats or challenges, especially those perceived to be uncontrollable. The anxiety reaction to danger is milder but more prolonged than fear and includes biological changes that prepare the organism to handle stress. It involves a loose blend of apprehension with a state of physical readiness to cope with upcoming events.
Pathological Anxiety
By contrast to normal anxiety, pathological anxiety arises not in reaction to an external threat but to an internal stimulus.
Abnormal anxiety is a chronic condition which impairs peoples ' functioning and interferes with their well-being, thereby causing them significant distress. According to the American Psychiatric Association (DSM-IV-TR), in addition to specific symptoms that may accompany a particular anxiety disorder, the main criteria used to distinguish normal anxiety from an anxiety disorder is the impairment that results in a person 's social, occupational, and/or academic functioning (2000). Additionally, according to Creswell et al, (2006), “the unhealthy anxiety makes you very often restrict your activities” when you do not need to do this, or it can make you lose control because of the psychosomatic symptoms of panic, phobia, tremors that interfere with the ability to appropriately face the situation. (p.265)
Unfortunately for others, their anxiety may be experienced to such a heightened degree that it actually causes them significant distress. Sadly, this level of anxiety often interferes with people 's functioning in many important areas of their lives such as work, school, and relationships. When the normal human experience of anxiety reaches this level of distress, and results in impaired functioning, we begin to speak of an anxiety disorder. …show more content…
(Wilde,1996).
Anxiety Disorders
Generalized Anxiety Disorder
Specific anxiety disorders are complicated by panic attacks or other features that are the focus of the anxiety. In generalized anxiety disorder, the focus is generalized to the events of everyday life. Most people worry to some extent. The DSM-IV criteria specify that at least 6 months of excessive anxiety and worry(apprehensive expectation)must be ongoing more days than not. Furthermore, it must be very difficult to turn off or control the worry process. This is what distinguishes pathological worrying and anxiety from the normal kind that humans experience from time to time as they get ready for an upcoming event or challenge. Most people worry and are anxious for a time but can set the problem aside and go on to another task. However, with Generalized Anxiety Disorder, this is not possible. (Wilde, 1996)
Additionally, Generalized Anxiety Disorder is characterized by muscle tension, mental agitation and susceptibility to fatigue (probably the result of chronic excessive muscle tension, some irritability and difficulty.
(Durand & Barlow, 2006, p. 130). The American Psychiatric Association (2000) recognized Generalized Anxiety Disorder (GAD) as a debilitating condition, with uncontrolled and excessive worry as its unique feature. The anxiety associated with this disorder focuses on minor everyday events and not one major worry or concern. People with GAD cannot seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They cannot relax, get startled easily and have difficulty concentrating. Generalized Anxiety Disorder develops slowly. It often starts during the teen years or young adulthood. Symptoms may get better or worse at different times, and often are worse during times of stress. (Behar
et.al,2009)
Additionally, when their anxiety level is mild, people with Generalized Anxiety Disorder can function socially and effectively handle a job. Although they do not avoid certain situations as a result of their disorder, people with Generalized Anxiety Disorder can have difficulty carrying out the simplest daily activities if their anxiety is severe. Biological models postulate people are predisposed to develop anxiety disorders by genetic inheritance. (Wilde, 1996)
Panic Disorder
Panic disorder exists worldwide, although its expression may vary from place to place. People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. A person may also have a strong physical reaction during a panic attack. They may feel as though they are having a heart attack. Panic attacks can occur at any time and many people with panic disorder worry about and dread the possibility of having another attack. Additionally, a person with panic disorder may become discouraged and feel ashamed because he or she cannot carry out normal routines like going to the grocery store or driving. Having panic disorder can also interfere with school or work. Panic disorder (PD) is a chronic and fluctuating disease that generates intense malaise, entailing worse quality of life and social deterioration. People with panic disorder may have a fear or avoidance of places where panic attacks have occurred in the past. During an attack, there are physical symptoms such as a pounding or racing heart, sweating, breathing problems, weakness or dizziness, feeling hot or a cold chill, tingly or numb hands, chest pain, or stomach pain.(Durand &Barlow,2006, p.137 ).
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is classified as an anxiety disorder (APA,1994) and describes the cluster of symptoms associated to a traumatic event outside the range of usual human experience .Epidemiologic studies have linked the exposure to traumatic events to the onset of PTSD as well as other specific psychiatric disorders, such as major depression, other anxiety and psychoactive substance use disorders (Smith et al.1990; David et al.1996; Dew et al. 1996).
PTSD is an enduring, distressing, emotional disorder that follows exposure to a severe helpless or fear-inducing threat. The victim reexperiences the trauma, avoids stimuli associated with it and develops a numbing of responsiveness and an increased vigilance and arousal. PTSD is subdivided into acute and chronic. Acute PTSD can be diagnosed one month after the event occurs. (Durand &Barlow, 2006).When PTSD continues longer than 3 months, it is considered chronic. Chronic PTSD is usually associated with more prominent avoidance behaviors (Behar et. al, 2009) as well as with the more frequent co-occurrence of additional diagnoses such as social phobia. In PTSD with delayed onset, individuals show few if any symptoms immediately after a trauma, but later, perhaps years afterward they develop full blown PTSD. Additionally, PTSD is the one disorder for which we are sure of the etiology: someone personally experiences a trauma and develops a disorder. Almost all psychiatric or psychological problems, conditions and illnesses are accompanied by some degree of anxiety as a nonspecific accompanying feature. People suffering from depression, for example, are very commonly anxious as well.
Distinguishing between psychological and medical models of anxiety
It is important to recognize a distinction between psychological and medical models of anxiety. The medical approach is categorical; to receive a diagnosis of anxiety, a patient must meet specified criteria, as laid out, for example, in the DSM-IV. The categorical approach is practical and provides a basis for deciding whether or not to treat a patient. The underlying assumption is that there is a qualitative distinction between those who are well and those who are sick; although sickness can vary in severity, cases either do not lie on the same continuum as non-cases, or at least form a distinctive cluster at one end of a continuum. This conception is widely challenged, however. (Durand &Barlow, 2006, p. 155). Studies conducted by Ellis (1998) show that psychologists take a dimensional approach that treats anxiety as a continuum of severity (or, in some models, a set of continua) with no intrinsic threshold. The arguments for a dimensional conception point out that there does not seem to be a bimodal distribution of scores representing well and sick groups; there also seems to be a continuum of impairments due to anxiety, with no threshold beyond which rising anxiety scores would indicate an anxiety disorder. Similarly, a dimensional model has been proposed in mental status testing, where there is a diagnostic dilemma of how to classify people who do not meet the criteria for dementia, but who are also not normal. Most of the anxiety scales provide intensity or severity scores that reflect an underlying dimensional model of anxiety.
The importance of distinguishing between normal anxiety and pathological anxiety
According to Ruscio (2002), there are several reasons it is important to make the distinction between anxiety as an adaptive emotion and anxiety as a disorder. First, it would be incorrect to conclude that someone is suffering from an anxiety disorder simply because they are experiencing some degree of anxiety. As explained above, anxiety as an emotion is a normal reaction to certain situations and even serves a useful purpose. Thus, it is neither necessary, nor beneficial, to attempt to rid ourselves of all anxiety.
Second, it is important for each of us to recognize that our own normal experiences of ordinary anxiety are qualitatively different from a person experiencing an anxiety disorder. Often, well-intentioned family and friends will offer advice to people attempting to recover from anxiety disorders. Unfortunately, these well-meaning friends and family cannot understand why the person-in-recovery reacts so negatively to their genuine efforts to help them "get over it" or to "just forget about it." These sorts of techniques may be useful for coping with ordinary anxiety, but are not effective once anxiety has reached a pathological level. Indeed, without proper information about anxiety disorders, people-in-recovery and their loved ones may find themselves becoming increasingly frustrated with each other, even though their goals are the same to deal with anxiety in a constructive manner on a daily basis. (Ruscio,2002)
Conclusion
Anxiety is a normal and positive dimension of human life. It becomes pathological only when it exceeds a certain threshold, defined mainly on the basis of a substantial change in the quality of life. Anxiety covers a wide range of experiences, much of which are normal and experienced by everyone at some point in life, some of which being even pleasant. At the pathological extreme, anxiety is unpleasant, disturbing and in its most extreme form, it is one of the most intolerable experiences that the mind and body are exposed to. People with anxiety disorders suffer more from the negative consequences as they affect their work and the personal relations, limit their activities and their chances because of their tendency to avoid the difficult situations, preferring to stay in the shade of others than to take action. (Dombeck & Zupanick, 2010).
References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th Edition). American Psychiatric Association, Washington, DC
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, (3rd edition). American Psychiatric Association, Washington, DC
Barlow, D.H (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic: New York: Guilford Press
Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23, 1011–1023. doi:10.1016/j.janxdis.2009.07.006
Creswell, C., O’Connor, T. G., & Brewin, C. R. (2006). A longitudinal investigation of maternal and child ‘anxious cognitions.’ Cognitive Therapy and Research, 30, 135–147. doi:10.1007/s10608-006-9021-1
Durand M.V, & Barlow, D.H (2006). Essentials of Abnormal Psychology (4th Edition): USA: Thomson Wadsworth.
Dombeck M., & Zupanick C. (2010). Pathological, Abnormal Anxiety. Bio Behavioral Institute.
Ellis A. (1998). How to control your anxiety before it controls you. Secaucus, NJ
Hamilton M. (1969). Br J Psychiatry; Special Publication #3:76-79)
Ruscio, A. M. (2002). Delimiting the boundaries of generalized anxiety disorder: Differentiating high worriers with and without GAD. Journal of Anxiety Disorders,16, 377–400. doi:10.1016/S0887-6185(02)00130-5
Ruscio, A. M., & Borkovec, T. D. (2004). Experience and appraisal of worry among high worriers with and without generalized anxiety disorder. Behaviour Research and Therapy, 42, 1469–1482. doi:10.1016/j.brat.2003.10.007
Smith EM, North CS, McCool RE, Shea JM (1990) Acute post disaster psychiatric disorders: identification of persons at risk. Am J Psychiatry 147:202–206
Wilde J. (1996). Treating anger, anxiety, and depression in children and adolescents: A cognitive-behavior perspective: NewYork