What Is Anxiety?

We all have to make sense of what any given anxious moment may or may not mean. I go about this process in my office by taking the “anxiety temperature,” as if on a thermometer. I visualize this instrument as being a basic warning scale that human beings use as part of our “fight-or-flight” survival response to any potentially life-threatening situation. For example, if someone has a very high anxiety temperature, he perceives himself to be in real danger regardless of the actual circumstances.

He might have some classic physiologic and/or psychological symptoms, which can feel above and beyond one’s  conscious control. He might experience characteristic chest pain, nausea, sweating, dizziness, and palpitations of the heart consistent with a  panic attack at this high temperature. He also might have the psychological symptoms of intense worry, or of a sense of doom—that he could die or that some disaster will soon happen. This  fear could become an obsessive worry about the magnitude of any given action in that moment. These types of symptoms would be diagnosable, in a formal kind of way, in the Diagnostic and Statistical Manual of Mental Disorders (DSM),1 a descriptive field guide to the most commonly recognized psychiatric syndromes encountered today.

When our own or the patient’s temperature is medium-high, we meet the types of daily, potentially less symptomatic, more potentially adaptive roles of anxiety. These states might belong more to a person’s character, or to the way he or she has evolved over time. If our friends and family would characterize us as chronically anxious, we are likely in this range. Loneliness, dependency, anger, sadness, fear, or just needing to be in control of a situation might be related to anxiety.

These feeling states may, in turn, be intimately connected to a behavior designed to respond to the given anxiety, which then defines itself, over time, as a character trait. Loneliness might lead to substance abuse; anger might lead to aggression; or dependency might lead to clinging. These less acute states may still impact a life substantially, however. Later, I will explain the potential benefits of treatment for this kind of seemingly less overt anxiety. Finally, at the lower, cooler temperature ranges, one might be described as or simply feel free, carefree, euphoric, joyous, happy, relaxed, at peace, or calm— the feeling that life is safe and potentially going well at that moment, and that no immediate danger is at hand.