What Exactly Is Anxiety?

Anxiety and Modern Research

What is worry? In the first blog we discussed the experience of worry and in the second we addressed the multi-layered potential shaping influences that impact the degree to which we may struggle with anxiety. But what exactly is anxiety/worry? How do you begin to define it?

Let’s begin with the advent of modern psychology and psychiatry. A great deal of empirical research has been done over the past century. While these disciplines are quite young in many ways, they have proven to generate a wealth of observable data. When Christians stop and listen to the research, they are able to wisely engage rather than dismiss it out of hand. The following definition is an excerpt taken from the DSM Psychiatry Online Website:

Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these two states overlap, but they also differ, with fear more often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors, and anxiety more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors. Sometimes the level of fear or anxiety is reduced by pervasive avoidance behaviors. Panic attacks feature prominently within the anxiety disorders as a particular type of fear response. Panic attacks are not limited to anxiety disorders but rather can be seen in other mental disorders as well.

Here is a list of classifications of worry that can be found in the most current version of the Diagnostic and Statistical Manual of Mental Disorders V (DSM V). Where possible, screening questions from Allen Frances’ book, Essentials of Psychiatric Diagnosis, are included in italics:

  • Separation Anxiety Disorder: Is your child inordinately scared of separations?
  • Selective Mutism: the voluntary refusal to speak (typically occurring outside the home or immediate family).
  • Specific Phobia: Do you have a particular fear that causes you special trouble, like flying, heights, closed places, animals, seeing blood, or getting an injection?
  • Social Anxiety Disorder (Social Phobia): Do you frequently avoid social situations because you are afraid of doing something stupid or looking silly?
  • Panic Disorder: Have you ever had a panic attack?
  • Panic Attack Specifier: A panic attack associated with a certain trigger (social anxiety, etc.).
  • Agoraphobia: Are there many things you’re afraid to do and many places you’re afraid to go?
  • Generalized Anxiety Disorder: Are you a ‘worry-wart,’ unnecessarily anxious all the time about a lot of different things?
  • Substance/Medication-Induced Anxiety Disorder: Have you had a lot of anxiety symptoms associated with using drugs, drinking alcohol or coffee, taking medication, or withdrawing from drugs or medication?
  • Anxiety Disorder Due to Another Medical Condition: Have you had symptoms of anxiety in association with a medical condition, like and overactive thyroid?
  • Obsessive-Compulsive Disorder: Do you ever have weird thoughts that you can’t get out of your mind? Are there rituals you can’t resist doing over and over and over and over again?
  • Post-traumatic Stress Disorder: Have you experienced a traumatic event that keeps haunting you in terrible memories, flashbacks, or nightmares?

Below is a helpful chart that compares “normal” anxiety and “abnormal” anxiety.

Everyday anxiety or an anxiety disorder?

What are we to make of this information?

While this is a very brief representation of the data, it still begs the question, "How can we engage this information and learn from it?" Here are some initial thoughts:

  1. We can certainly learn a great deal from this descriptive material. When someone tells you that they are struggling with anxiety, it is not uncommon to assume you know what they mean. You often extrapolate from your own experience of anxiety or others whom you have helped in the past. But that would be a mistake. These various descriptions help you to see how complex each and every person’s struggle with anxiety can be. The data teaches us to be more curious and to ask more questions as we get to know the particular contours of a person's struggle.
     
  2. If you are not careful, it may seem like the person who is high-functioning with “everyday” anxiety is normal and okay. Yet, biblically, every person is in need of God’s help no matter how seemingly small or big the problem. In the chart above, the person in the left column needs to be as vigilant about their low-grade anxiety as the person with a more intense struggle. No matter where you fall on the worry continuum, each and every person should be asking these questions on a daily basis. We will see why this is so important when we begin to see how Scripture defines worry.
  • “How can I love God and neighbor more fully regardless of my level of struggle with anxiety?"
  • “How can I be more and more conformed into the likeness of Jesus?”
Living without worry
By Timothy Lane

3. It might be tempting to think that the person who is high-functioning has a deeper faith than the person who struggles more intensely. But that is not necessarily so. Someone who struggles more intensely with anxiety may actually have a more robust faith than the person whose struggle is less. The Scriptures remind us again and again that the weak know their need of God’s grace while the “strong” may be falsely self-confident and self-reliant.

4. Finally, you may conclude that these diagnoses are similar to a medical diagnosis. You might conclude that the person “has” a psychopathology in the same way a person has a medical pathology or disease. While there may be an organic aspect to the person’s struggle, the DSM V categories are largely, if not only, descriptive. They are describing thoughts and behaviors that are observable. The cause may be largely unknown.

Please share your thoughts in the comment section below. In the next post, we will begin to see how Scripture defines anxiety.

Copyright © 2016 Timothy S. Lane

2 Comments

Tim Lane

Dr. Timothy S. Lane is the President of the Institute for Pastoral Care and has a counseling practice in Fayetteville, GA. He is a minister in the Presbyterian Church in America (PCA), having been ordained in 1991 and a member of Metro-Atlanta Presbytery. Tim has authored Living Without Worry: How to Replace Anxiety with Peace, and co-authored How People Change and Relationships: A Mess Worth Making. He has written several mini-books including PTSD, Forgiving Others, Sex Before Marriage, Family Feuds, Conflict, and Freedom From Guilt.

He has experience in both campus ministry (University of Georgia, 1984-1987) and pastoral ministry where he served as a pastor in Clemson, SC from 1991 until 2001. Beginning in 2001 until 2013, he served as a counselor and faculty at CCEF in Philadelphia, PA (Christian Counseling & Educational Foundation). Beginning in 2007, he served as its Executive Director until 2013.

In 2014, Tim and his family re-located to his home state, Georgia, where he formed the non profit ministry the Institute for Pastoral Care. His primary desire and commitment is to help pastors and leaders create or improve their ability to care for the people who attend their churches.  For more information about this aspect of Tim's work, please visit the section of this site for the Institute for Pastoral Care. He continues to write, speak and travel both nationally and internationally. Tim is adjunct professor of practical theology at several seminaries where he teaches about pastoral care in the local church.