The definitions of fear and anxiety are often confounded, the words being used interchangeably for the same general concept, even though there are obvious advantages to using two distinct words to designate separate though related phenomena. In order better to understand the meanings of these terms, consider their dictionary definitions and derivations.
The traditional meanings are more useful in clarifying the semantic and conceptual confusion than are some contemporary distinctions made by behavioural scientists. The word fear comes from the Old English word fear (Oxford English Dictionary, 1933), which meant “sudden calamity or danger.” It is currently defined as “an agitated foreboding often of some real or specific peril” (Webster’s Third International Dictionary, 1981) and as “the possibility that something dreaded or unwanted may occur” (Standard College Dictionary, 1963). These definitions underscore several connotations of the word fear;
It points to the possible occurrence of an “unwanted” or calamitous event the event has not yet occurred (that is, it is in the future); and the individual is concerned (agitated foreboding) about the event. Fear, then refers to the appraisal that there is actual or potential danger in a given situation. It is a cognitive process as opposed to an emotional reaction. Anxiety, on the other hand, is defined as a “tense emotional state” (Funk & Wagnalls, 1963) and is “often marked by such physical symptoms as tension, tremor, sweating, palpitation and increased pulse rate” (Webster’s Third International Dictionary, 1981).
The term anxiety comes from the Latin word anxius, and its usage dates back as early as 1525. The Latin term was defined as a condition of agitation and distress. The stem of anxious-anx -comes from another Latin word, angere, which means “to choke” or “to strangle.” The word anxius probably referred to the choking sensation frequently experienced by anxious individuals (Lewis 1970). Phobia refers to a specific kind of fear and is defined as “an exaggerated and often disabling fear” (Webster’s Third International Dictionary, 1981). A phobia is also characterized by an intense desire to avoid the feared situation, and evokes anxiety when one is exposed to that situation.
The word is derived from the Greek work phobos for “flight,” which was in turn derived from the name of a Greek deity, Phobos, who was able to provoke fear (and panic) in his enemies. The Roman encyclopedist Celsus coined the term hydrophobia in the first century to describe a common symptom of rabies. Hippocrates wrote two of the earliest clinical descriptions of phobic men: a man who feared nightfall and also a cat phobic. The first nonmedical writing about phobias appeared in the thirteenth century when demonphobias and theophobias were described by philosophers.
The term phobia was not introduced into psychiatric literature until the nineteenth century. The clinical descriptions of phobias have not changed much since their earliest descriptions. Tully and Demosthenes had stage fright. Augustus Caesar could not sit in the dark. In The Merchant of Venice, Shakespeare described a cat phobic. Pascal, a mathematician, was said to suffer from what is known today as agoraphobia. C. Westphal (1871-72) wrote three clinical descriptions of agoraphobia.
The clinical syndrome of agoraphobia has not changed radically since Westphal’s writing. Panic is defined as a “sudden overpowering fright accompanied by increasing or frantic attempts to secure safety” (Webster’s Third International Dictionary, 1981). The word, which was in use as early as 1603, derives from the name of the Greek deity Panikos, the god of woods and shepherds, who was regarded as the cause of panic among the Persians at Marathon and, by the Greeks, as the cause of any sudden, groundless fear.
ANXIETY AND FEAR
Anxiety may be distinguished from fear in that the former is an emotional process while fear is a cognitive one. Fear involves the intellectual. appraisal of a threatening stimulus; anxiety involves the emotional response to that appraisal. When a person says he fears something, he is generally referring to a set of circumstances that are not present but occur at some point in the future. At this point the fear is said to be “latent.” When a person has anxiety he experiences a subjectively unpleasant emotional state characterised by unpleasant subjective feelings such as tension or nervousness, and by physiological symptoms like heart palpitations, tremor, nausea, and dizziness. A fear is activated when a person is exposed, either physically or psychologically, to the stimulus situation he considers threatening. When the fear becomes activated, he experiences anxiety. Fear then, is the appraisal of danger; anxiety is the unpleasant feeling state evoked when fear is stimulated. In addition to anxiety, a variety of symptoms referable to the autonomic and the somatic nervous systems may be provoked concurrently.
PHOBIAS AND PANIC ATTACKS
A phobia refers to a specific object of fear. Initially, a person is afraid of a specific type of situation or event (for example, heights, closed spaces, or deep water). When in the situation, he is acutely afraid of the consequences (falling, suffocating, or drowning). When a phobia or fear is activated, the individual’s reaction may range from mild anxiety to panic. The objects of phobias can range from small animals to natural occurrences such as thunderstorms or to events in the social arena, such as speaking in front of large groups or going to parties.
The main quality of a phobia is that it involves the appraisal of a high degree of risk in a situation that is relatively safe. An example will clarify the complex interrelations among these terms. A person with a fear of small animals perceives these animals to be dangerous. However, he does not experience anxiety until he finds himself exposed to a small animal or imagines himself in such a situation. The presence of, say, a mouse on the scene activates the fear, and the person may think, “The mouse may bite me and I might get rabies and die, or, “The mouse may bite me and I might faint and become embarrassed in front of all these people.” The person who perceives this threat as overwhelming may have a panic attack.
The concept of danger arises from the possible consequences of contact with the animal. Before a person has contact with the mouse, the fear is latent. Once in the presence of the mouse, the fear is activated; and all the unpleasant affective and physiological symptoms associated with panic attack are aroused. Similarly, a person who is phobic of certain social situations such as attending parties or giving lectures is less afraid of the situations themselves than of possible consequences of being in them. The social phobic is afraid, for example, that, in a social situation, he will make a fool of himself or “go out of control” and embarrass himself. This person might feel jittery or shaky, sweat profusely, and experience any or all the uncomfortable affective and physiological symptoms of anxiety or panic.
Panic is an intense, acute state of anxiety associated with other dramatic physiological, motor, and cognitive symptoms. The physiological correlates of panic are an intensified version of those of anxiety-that is, rapid pulse, dizziness, cold and profuse sweating, and tremor. In addition, one has a sense of impending catastrophe, pervasive inhibitions, and an overwhelming desire to flee or get help.