Margo D. Nathan, M.D., Elizabeth Winter, M.D., Paul Nestadt, M.D.
Anxiety is a topic covered in the Johns Hopkins Psychiatry Guide.

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Anxiety is an inner, nervous uneasiness that can color thoughts, behaviors, and physical sensations.

  • A state of high arousal
  • Characterized by inhibition of parasympathetic system
  • Natural state, common to all animals
  • Often a productive driving force
  • Preparatory state for danger in the future
  • Facilitates the activation of appropriate fear

Worry, a cognitive component of anxiety, includes a variety of mental attempts to avoid anticipated potential threats.

  • On its own, worry has no bodily consequences or increased physical arousal.
  • Worry is the "thought" component of anxiety.
  • In moderation, worry is just another word for preparation.
  • One may suffer from over preparation.

Anxiety, when appropriate, serves important roles as a preparatory state, motivator, and performance enhancer. However, when it is inappropriately severe, chronic, or unwarranted, it can be disabling. Both normal and pathological anxiety can exist as either a trait (an aspect of a person’s general temperament) or a state (a temporary condition).

Clinical anxiety is an emotional and physical response to a real or perceived danger that is not only highly distressing, but can also lead to avoidance behaviors that impair functioning.

  • Emotional anxiety:
    • Expectation or anticipatory fear
    • Hypervigilance
    • Trouble concentrating
    • Insomnia
  • Physical anxiety:
    • Autonomic hyperactivity, including increased heart rate, palpitations, increased work of breathing, nausea, vomiting
    • Muscle tension, tremor

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Last updated: July 1, 2017