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What's the Difference Between Anxiety and Fear?

How to avoid confusing the two.

"All that we see or seem, is but a dream within a dream" —Edgar Allen Poe

In recent times we have seen a sharp rise in fear based conditions, what has been described as an anxiety epidemic. Fear, anxiety, phobias, obsessions and compulsions are the order of the day for television programs, radio phone-ins and magazine articles. But the tide is changing and patients who are now empowered see themselves as health consumers and these consumers are demanding more.

The Prevalence of Anxiety Disorders

It is estimated globally that about 273 million people or 4.5% of the world’s population has had an anxiety disorder. They're more common in females than males, with up to 16% of people suffering from these disorders right across our lifetime. This increases to nearly 29% of the population suffering from an anxiety disorder in Western societies.

While many children suffer from normal childhood fears such as night terrors and school phobia, many diagnoses at this life stage are wrong and children are often misdiagnosed with problems such as physical issues or ADHD. However, levels of anxiety vary in children and some conditions such as autism can result in the display of increased anxiety. Adults and children alike can also experience traumatic events in their lives and these can trigger fear and the ‘anxiety response’. People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from an anxiety disorder.

Fight or Flight?

Let me begin with the unraveling of some unhelpful beliefs about fear and anxiety. Like so many other psychophysiological reactions, (that is the psychological and physical response in humans), fear, when it exceeds a certain threshold, leads to people becoming blocked and incapable of reacting appropriately to the events they face. Fear makes humans want to run and escape from the perceived threat, known popularly as the fight-or-flight response. We can become self-focused and hypervigilant in these aroused phases. When we feel threatened by circumstances, fear activates the body’s normal arousal system, setting us up to respond appropriately to the situation. The fight/flight/freeze response sees our pupils dilate, blood drain in our core, and we can feel cold and clammy in our extremities. In this state, our hearing becomes highly sensitive and we can appear more pale than normal. These are the normal and highly developed responses human beings have developed to successfully deal with threats.

Fear and Anxiety

Fear and anxiety are very closely related and both contain the idea of danger or the possibility of injury. In general, fear is seen as a reaction to a perception of threat posed by a specific, observable danger. Anxiety, however, is seen as diffuse, a kind of unfocused, objectless, future-oriented feeling. Thus, fear is a perception that is attached to a specific thing, thought or circumstance. For instance, worries about dying are more likely to take the form of nagging anxiety than actual fear. Anxiety also refers to emotional states such as doubt, boredom, mental conflict, disappointment, and bashfulness or arousal associated with the perception of fear.

We must also understand that fear, as a psychobiological emotion or reaction, is not, in and of itself, a form of pathology or disorder; on the contrary, it is a fundamental sensation we use to adapt to our environment successfully. The use of fear by animals and human beings alike has assisted us in surviving in hostile social and physical environments. Without a healthy dose of fear, we would not have survived; we would not care about our grades in school or the quality of our lives. Not only does fear bring our attention to real dangers, it allows us to face such situations, having recognised them as threatening to our psychological, physical or social well-being. It is important that we realise that we should never look to remove fear, even though it would be impossible even if we wanted to, because fear is a functional, healthy and meaningful experience that allows us to manage life effectively. Fear only becomes problematic and pathological when it fails to achieve its purpose, which is to manage and respond effectively to the situation at hand. Instead, when it turns to anxiety it blocks us and turns us into a shivering wreck, incapable of progress.

Pathological Anxiety

Anxiety, even when intense, is seldom pathological until it becomes chronic and consistently interferes with our performance and enjoyment of life. When anxiety is excessive and disconnected from reality, it no longer provides an accurate and reliable signal of danger. As a result, you might feel anxious thinking about an important exam, going to a dinner party where you don’t know people or traveling to an unfamiliar place. These anxious thoughts are driven by “what if” thinking (e.g., “what if the car breaks down” or “what if I don’t know anyone”).

Therefore, what makes the difference between fear as a useful natural emotion, and fear as a pathological reaction, is that the former increases our capacity to manage reality and events in front of us. The latter, on the contrary, limits us or renders us incapable to respond, often leading to generalised anxiety disorders or panic attacks. Only when our threatening perception of reality becomes incapacitating and limiting do we find ourselves with a difficulty that needs to be addressed urgently. We should not be complacent about the effects of the migration of fear from a specific area of one’s life to an all-encompassing terror of many aspects of normal daily activities of living.

Anxiety Versus Fear

Anxiety does not necessarily require a triggering stimulus. It is the actual anticipation of a threat that stimulates the physical-psychological response to a perceived fear or threat, and so anxiety can, as a result, become chronic, leading us to become hypervigilant to any possible or potential threats, real or imagined. For example, a panic attack involves the interaction of the fear system with an inappropriate and maladaptive learning mode (i.e. false alarm). Panic is usually marked by a sudden feeling of dread and imminent doom, as well as a number of uncomfortable and distressing physical sensations such as a racing heart, difficulty breathing, shaking, stomach and muscle tension, and so forth. The ambiguous nature of anxiety makes it difficult to overcome.

If we don’t know the source of our anxiety, it is difficult to deal with the problem, and this is the case for many of the current fears people present with in our clinic. It is possible to be anxious about things that will almost certainly never affect us. Anxiety can be a source of strength and can, for example, lead to better job performance. Worriers are more likely to be more goal oriented, more organized, and self-disciplined. They plan effectively for unforeseen events and consequences that others may ignore. They are better at taking care of their health.

In short, anxiety is productive when it is not excessive. In fact, the goal of of any good therapy is to reduce anxiety, not eliminate it.


Gibson, P. and Boardman, D. (2017) Heresies From Practice; in Simon, G., and Mc Carthy, I. (eds) Systemic Therapy as Transformative Practice. Everything is Connected Press.

Gibson, P ., Pietrabissa, G., Manzoni GM, et al. (2018) Brief strategic therapy for obsessive–compulsive disorder: a clinical and
research protocol of a one- group observational study. BMJ Open 2016;6:e009118. doi:10.1136/bmjopen-2015- 009118

Gibson, P., (2019) Systemic Family Therapy Paradigm in Nardone, G., Salvini, A. (eds) The International Dictionary of Psychotherapy. Karnac Books.

Nardone, N. and Watzlawick, P. (1990), L’Arte del Cambiamento, manuale di terapia strategica. Ipnoterapia senza trance, Ponte alle Grazie, Firenze.

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