The distinction between fear and anxiety in English language is mainly one of terminology, in which fear is the normal biological response to a threatening stimulus, whereas anxiety are the prolonged or disproportionate feelings of fear one can have. When the anxiety becomes so important or overwhelming that normal daily functioning is impeded, it can be diagnosed as a psychiatric disorder.

Phobia is merely a specific variety of anxiety disorders, where the disproportionate fear is linked directly to a certain kind of stimulus (eg insects, heights, etc).

Normally, people with anxiety problems do realize themselves that their fear is overexaggerated and disproportionate to the supposed threat, so they can still rationally consider their fears as unadjusted.

Paranoaia is something different altogether, because here the potential for rational interpretation is lost and ideas of paranoia acquire a delusional component.

Stress has been linked to many disorders as a triggering factor, and abnormalities in HPA-axis functioning have been studied in anxiety disorders as well, but results seem inconsistent so far. When talking about stress it is always important to remember that the effects of circumstances and stressful events are determined more by the reaction and the meaning an individual gives to these circumstances, than by the stressor itself.

It seems reasonable to assume most anxiety disorders have a genetic component which causes the individual vulnerability, to which the addition of a triggering factor (like stress) can then cause an anxiety disorder.

Thank you Livia De Picker for the explanations. Could you give please give me a few examples for them and also something about the treatment.

Of course :)

Fear can be understood as the normal biological response to a genuine threat, say, a bear crossing your path. It is triggered by the noradrenergic response pathway (fight, flight or freeze) and occurs in almost all animals, as it represents a strong evolutionary survival strategy. If an animal would not feel fear when faced with danger, it would probably not survive for long. As it is a normal biological response, fear in itself does not warrant treatment.

However, when fear becomes anxiety, the same biological reactions are continuing without the necessary danger trigger. This can happen related to a specific situation or trigger (phobia), for example by a (rationally not really dangerous) animal, by heights, etc. Contrasting, some anxiety problems are not related to a specific trigger and the anxiety feelings can come up seemingly out of the blue as panic attacks or remain continuously active like the worries in generalized anxiety.

It is important to mention that none of these problems should be considered as psychiatric diagnosis unless they also significantly affect daily functioning. This means that someone might have a big phobia of snakes, but if this person lives in an area where snakes are not present, treatment will not be necessary.

Similarly, panic attacks have a high lifetime prevalence in the general population, but only a limited percentage of these people will actually go on to develop a panic disorder, with recurrent attacks and intermittent anticipatory anxiety (and sometimes agoraphobia).

When talking about treatment of anxiety disorders, the most important message is that, while these disorders can have a huge effect on quality of life and cause major suffering to those inflicted, they are actually among the best treatable psychiatric disorders. If adequate treatment can be installed, prognosis is actually very good.

Treatment options consist mostly of:

- CBT psychotherapy: is a very effective treatment strategy for all anxiety disorders, based on principles of cognitive remediation and exposure.

--> in monotherapy for phobias.

--> in monotherapy or combined with pharmacological treatment for other anxiety disorders.

- pharmacological treatment:

--> SSRIs: are active to reduce fear, but their effect starts only after 2-4 weeks. In the beginning of treatment, there might even be a temporary increase of anxiety feelings. Especially some of the common and temporary SSRI side-effects (nausea etc) can be very threatening to these patients and a common reason for medication discontinuation.

--> benzodiazepines: reduces fear quickly, but not recommended for treatment in the long term. Problems of abusus and dependence can easily occur, especially in this group of patients, who might conceive the instant fear-reduction of these products as their saving and thus do not learn to overcome difficult situations themselves. I have known patients that walk around with a benzodiazepine in their purse wherever they go "just in case". Also, when the benzodiazepines are discontinued, the anxiety problem almost always returns.

These are the basic treatment principles for anxiety disorders, but of course every case needs to be evaluated individually to determine the optimal treatment strategy.

Thank you so much Livia De Picker .

Unfortunately (or, fortunately) this informal discussion highlights one of the main problems with the field of psychology--mainly, one of terminology, followed closely by a lack of general semantics. This situation has hurt the field in numerous ways: most psychologists can never be truly inter-disciplinary due to their profound lack of what is required to be productive and accurate when working with a trained group or person from a different field. Few notables have made impacts, and we are truly better off for their efforts. Gottlieb comes to mind immediately, as he was one of the few, if not only, psychologists with the background in development and biology/physiology to recognize, then use the findings from the handful of hard sciences which first introduced the world to 'epigenetics', gene switches, etc. His unique adaptation was titled probabalistic epigenesis; however, it took his extensive background, his philosophical understanding of language and scientific discovery, and his own observations over the years of anomalies present in many facets of development to pull everything together. He did it. And produced one of the rare theories/concepts with real implications for developmental psychology in particular.

In short, there is no reason to ever use the phrase 'nature vs. nurture' or the description found in every textbook of the past several decades--'some believe the environment plays a more important role...others see an individual's biology and neurological differences as all important...it's clear both matter,' --again. Ever. If you survey his work (esp. w/Lickliter) and compare it to how the topic of epigenesis has been handled by our field as a whole, the differences in approaches (derived in part from world views, education, experience) become crystal clear. There simply is no replacement for, in this case, a thorough background and understanding of both biological and developmental factors, garnered over a lifetime of service and through educating oneself beyond the minimum. Today, Gottlieb is no longer with us, and probabalistic epigenesis has not been moved forward relative to its capacity to truly inform developmental psychology research, interventions, theories, re-evaluations, and the education/parenting of children. But many others have apparently familiarized themselves with the terms, concepts, methods, and body of work in epigenetics, primarily found in the hard sciences that matched, but did not exceed their existing ability to actually read and understand what geneticists, for one, are saying. This is extremely common in psychology. You don't see neurologists, geneticists, physicists, biologists reading our journal articles, and if they do, their critical analysis of how very little we know is the take away message. Yet, we continue to take piece-meal from these fields and formulate both research agendas and applied tactics which have the very real possibility of doing more harm than good. At this point, I see my developmental colleagues across the U.S. for the most part steering clear of Gottlieb's findings and recommendations (not to mention the ripe research arena he left), and either striking out on their own without the requisite education and understanding necessary for a productive outcome, or they avoid the breakthrough altogether and continue along typical developmental projects, possibly incorporating a term or two from epigenetics into their theories.

In my opinion, this simply cannot continue. It appears that developmental psychologists are very tied to prediction, and clearly Gottlieb's thoughts and findings indicate that a radical shift from that perspective to one that does not rule out prediction (and therefore does not r/o developing interventions and all the other things we love to do), but rather emphasizes the probabalistic nature of any efforts. One could take that to mean we needn't give up, rather hunker down and spend the time it will definitely take to understand individual development. He historically has not been the only scientist who worked within the field of development to pull together various inter-disciplinary pieces and make similar recommendations. In every case where this has occured, it has required the ability to let go of conditioned thinking and put in decades of work.

I see the question posed above as a variant of the terminology/inter-disciplinary issue. Fear has long been defined primarily as an adaptive, biological response common to nearly all humans; it doesn't become anxiety, but is distinct with a distinct purpose. Anxiety is often conceptualized as somewhere between a heavily biological response, conditioned by any number of events to produce symptoms different from fear: fear is quick, anxiety often occupies a person for hours, days, possibly weeks, or longer, off and on, especially when the person is reminded mentally or tangibly about what originally 'caused' their emotional response. The simplistic idea that humans avoid pain if possible has been almost universally applied to how anxiety (which has been in the literature for thousands of years, and is considered part of the human condition by all but the U.S.) morphs into such a problem that a diagnosis is warranted. I'm sure that approach is A factor, but we are still a long way away from understanding, therefore being prepared to act, in the case of anxiety, but we do descriptions and lists of symptoms very well. Anxiety is a nice mix of sweaty palms and scary thoughts. Worry is differentiated further...less biological (apparent biological) basis and more mental occupation, what if's, rumination and so on. Phobias take no work to define: at this point, we diagnose someone with social phobia, or specific phobia if there is not another diagnosis which better explains the symptoms (i.e., PTSD wins, even though your patient may evidence phobias after a trauma); if a person reacts strongly, irrationally to an event/situation which in reality does not pose a threat to them that would make their reaction justified; if their irrational response includes freezing, crying, withdrawing, giving up a job, a relationship, etc. in a knee-jerk reaction (kids afraid of dogs often give up all outdoor activities due to the idea there may be an unchained dog loose); and of course we look at duration and interference. Again, the model we favor is the same as that of anxiety: if being near something in the case of a phobia feels bad, we avoid it, and when that feels good, we continue avoiding. Panic is recognized as both a symptom possible with most of the anxiety disorders, but the dx would not be panic dx, but rather 'X with panic' and it occupies a diagnostic category of its own, panic disorder. The findings--from the role of anxiety sensitivity to the observable physiological differences between people with panic dx and people without (lower BP; lower blood volume, vagus nerve involvement, lower thresholds in areas like fainting) to the typical behavioral 'explanation' to some variant of predisposition which seems to blend all of the above--leave us with less knowledge about panic dx than other anxiety disorders. A proper treatment plan truly takes investigative and inter-disciplinary digging. Paranoia? Interesting that this is included, as, again. how we, just within our own field, have various working definitions and often produce piles of literature which cannot be effectively mined for answers. Is it paranoid to worry after going through a fearful (but not traumatic) event, or is that a reasonable reaction? Is paranoia different from rumination (NOT in words...in reality), and if so, how would you know? Does the term paranoia, whenever it is used clinically, always involve an element of psychosis, delusion or other perceptual disturbance? Is it better viewed as hypervigilance, a symptom found associated with many different disorders? I'd like to end here as this illustrates my point perfectly. We don't know what we are talking about most of the time, and we have no gold standard to compare what we think with what 'is'. Rarely do we ask, as could have been done in the case of this question, what do you mean by all the terms you listed before actually discussing them. Very quickly, very automatically we simply fill the gap which is rarely even identified with our own understanding of what the definitions are, and nobody is the wiser. This was one of Pavlov's most emphatic criticisms of psychology at its inception, and we haven't made real headway, sadly. One need only read Meehl, or Pavlov :), Gould, a few other notables to see that this has been recognized but not elevated to the level required for progress.

Thank you Kelly Hammond Laurence for the vivid explanations.