The Differences Between Anxiety and Anguish

Anxiety and anguish are very similar emotions, but they present certain differences in terms of intensity and time scale. Both can be controlled with proper learning.

Written and verified by el biólogo Samuel Antonio Sánchez Amador.

Last update: 08 August, 2023

Negative emotions are common in nature and in human culture. Feeling fear, restlessness, and discomfort is something that defines us as beings of the Homo sapiens species, as well as the experience of beautiful situations, events, and memories. In any case, it’s interesting to know the differences between states such as anxiety and anguish, as they can become chronic and give rise to pathological clinical entities.

Fear, anxiety, and anguish are highly interrelated emotions, but they present certain differences at both physiological and psychological levels. Keep reading because, in the following article, we’ll address the emotions of rejection and danger in human beings, and you’ll see that the differences between anxiety and anguish are wider than they may seem at first.

Fear, anxiety, and anguish

Before comparing anxiety and anguish, it’s good to know where they are on the “emotional scale”. Although summarizing the complexity of the human mind in a series of ordered processes can be a bit reductionist, it provides a very useful background. Therefore, we’ll briefly explore fear, anxiety, and anguish as separate concepts.

What is fear?

Fear is the first “step” on the ladder of human emotionality on this front. It’s one of the 6 basic emotions suggested by psychologist Paul Ekman, along with anger, disgust, joy, sadness, and surprise. Many of these sensations aren’t limited to the human species and are necessary for survival in the natural environment.

This emotion is a physiological and psychological process that responds to an intensely unpleasant sensation caused by the perception of danger (real or supposed) in the past, present or future. The changes produced in the body of living beings when they feel fear are quantifiable and are included in the fight or flight reaction.

Sensing immediate danger, the pituitary gland is activated and releases the hormone ACTH (adrenocorticotropic). In turn, the adrenal glands synthesize and release epinephrine into the bloodstream, which stimulates the release of cortisol. Cortisol is the stress hormone par excellence and causes a series of physiological changes.

When we’re afraid and the body responds according to it, the body produces an increase in respiratory rate, an increase in heartbeat, an inhibition of stomach action, a dilation of the pupils, and a mobilization of energy to the muscular environment (among other changes). In other words, the brain tells us the following: “Focus on danger and either fight or run.”

Fear has a clear physiological component, but also behavioral and cognitive. Therefore, it has a high subjective charge, and we all perceive it (and respond to it) differently. In addition, this can be innate (inherited at the genetic level in the species) or acquired (taught or based on personal experience).

What is anxiety?

Explaining the characteristics of fear is essential, as it’s closely interrelated with the differences between anxiety and anguish. The second step on this sensory scale is anxiety, which isn’t as adaptive or universal as the term we just described.

The American Psychological Association defines this emotion as “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” In any case, it differs from fear in a key concept: The response to the event in this case is disproportionate and remains once the direct threat has been removed from the environment.

Anxiety presents somatic symptoms derived from the fight or flight reaction, but in all cases, the emotional process is excessive, generalized, unfocused, and highly subjective. It appears in situations that are perceived as unavoidable and uncontrollable, although human perception isn’t objective with the threat.

This emotion is different from fear on 4 fronts:

1. Duration of emotion: Fear disappears along with the threat, while anxiety remains. It’s very common for this emotion to be accompanied by rumination or the repetition of conflicting thoughts over variable time intervals.
2. Temporal focus: Fear focuses on responding to a threat that has appeared in the immediate present. On the other hand, anxiety is always future-oriented.
3. Specificity of the threat: Anxiety is diffuse and the threat is self-perceived, while in fear, the danger is clear and objective (“I’m afraid of fire because it burns me”, for example).
4. Motivated Direction: Fear and the fight or flight reaction make it easy to escape from a really dangerous situation. On the other hand, anxiety bases its mode of action on the approach to a potential threat and interferes with various mental processes.

What is anguish?

We arrive at the last rung of human emotionality in this area, as anguish can be defined as a “mixture” of fear, anxiety, exhaustion (distress), and panic. The Royal Spanish Academy of the Language defines this emotion as “affliction, distress, anxiety, or an oppressive fear without a precise cause.”

The term anguish is much more diffuse than that of anxiety or fear, although it’s clear that both are components of this complex (and uniquely human, as far as we know) emotion. The stressors that lead to it are the cause of a huge degree of dissonance (a large difference between reality and thought), which can lead to diagnosable psychological disorders.

Anxiety has a higher psychological component than the two terms already described, but it also manifests itself physically. For example, it’s often accompanied by an elevated heart rate, excessive sweating, a feeling of tightness in the chest, shortness of breath, and an upset stomach. Part of the hormones and neurotransmitters involved in the fight or flight response explain these signs.

The famous psychologist Sigmund Freud is the father of the first theories of anguish. In them, he differentiates the following types within human psychology:

1. Realistic anguish: This appears in the face of an external and known danger, such as suffering a serious illness or having lost a loved one. It’s a state of increased sensory attention and motor tension, something similar to that described in the case of anxiety.
2. Neurotic anguish: This appears in the face of an internal and unknown danger, so it seems devoid of meaning. In other words, the patient doesn’t really know what they’re afraid of in neurotic anxiety, although they can channel it by attributing its emergence to any possible object (expectant anguish).

The differences between anxiety and anguish

Going through this long terminological path was necessary. As you may have seen, anguish can’t be understood without fear and anxiety, but these last 2 emotional processes can present themselves without the need to become anguish. In other words, we’re talking about both causes and consequences.

Now, we’ll present the differences between anxiety and anguish separately. Keep reading until the end, as we’ll also show how each of them can become chronic to the point of reaching the level of a psychological disorder.

1. Anguish is the elevation of anxiety and fear

This first difference between anxiety and anguish has been established in previous lines. As the Polifarma portal indicates , anguish is a step that goes beyond anxiety and fear. It clearly has an anxious component, but it’s even more bothersome, disabling, and has a higher emotional flow.

The distinction between terms is fuzzy, as some may use the 3 interchangeably. In any case, most sources consulted agree that anxiety is an exacerbated form of anxiety. It’s also worth noting that the word anguish has acquired different meanings throughout human history, so we can’t affirm that one conception is “wrong” and another is “right.”

2. Anxiety is more chronic than anguish

It’s often said that anguish is more concrete than anxiety and that it occurs in the form of a crisis, while the other aforementioned emotion tends to appear chronically and constantly, but not so evident at certain times. Take as an example a patient with cancer, as this is one of the most distressing medical events that a human being can suffer today.

As indicated by the American Cancer Society, the anguish of a cancer patient is expressed in “peaks” at the following moments:

1. If you receive a new diagnosis of cancer after having had a previous neoplasm
2. While you’re awaiting treatment or if you learn that a new clinical approach is required
3. At the time of hospital admission
4. When the end of life is near

Although we’re being a bit reductionist, it can be said that anxiety is there as a constant noise, while the peaks of anguish are reached at specific times. Although the term anxiety is very diffuse, the trigger is something that’s more concrete than that of anxiety.

3. The psychological disorders derived from each condition are different

Ultimately, you need to remember that no matter how many differences exist between anguish and anxiety, both can become psychological problems if left unchecked. Below, we’ll see how each of these emotions become chronified separately.

3.1 Generalized anxiety disorder (GAD)

Having anxiety for a while after a stressful period is normal, even if the feeling doesn’t correspond to what you actually experienced. On the other hand, feeling constantly anxious is considered pathological and is included in the clinical picture of generalized anxiety disorder (GAD). According to the medical portal Statpearls, these are the symptoms of the box:

• Excessive worrying and feeling anxious for a period of 6 months or more.
• Difficulty controlling worries.
• Anxiety is associated with 3 or more of the following symptoms in a period of at least 6 months: Lack of rest (or feeling that you’re at the limit at all times), easily feeling fatigued, difficulty in concentrating (the mind goes blank), muscle tension, irritability, and sleep problems.
• Anxiety translates into difficulty within the social, family, or occupational spheres.
• This constant emotion can’t be attributed to another psychological or physical picture.

Generalized anxiety disorder is more common than it sounds. For example, the prevalence in the age group between 13 and 18 years is 6%. At the same time, it’s estimated that 3 to 6% of adults suffer from this condition at any given time and place. It’s closely associated with major depressive disorder, which is also very common.

3.2 Panic disorder (panic attacks)

As indicated by the National Library of Medicine of the United States, anxiety disorder or panic disorder is part of the block of anguish disorders (such as GAD). It causes panic attacks, which are sudden feelings of imminent danger accompanied by the need to escape on the part of the patient.

For panic attacks to be considered as such, at least 4 of the 12 cognitive or somatic symptoms listed below must be met:

1. Sweating
2. Shaking and tremors
3. Elevated heart rate or palpitations
4. A feeling of suffocation
5. A feeling of choking or shortness of breath
6. Nausea and discomfort in the abdominal region
7. Chest discomfort or tightness in the chest
8. Depersonalization or derealization
9. Fear of losing control or going crazy
10. Paresthesias (abnormal sensations without prior stimulation, such as tingling)
11. Fear or death
12. Chills or hot flashes

The panic attacks that characterize this disorder can appear anytime, anywhere, and without warning. They’re characterized by the presence of a specific anguish and reach their maximum expression within 10 minutes of its manifestation. In this picture, a curious anticipatory anguish is generated, as the patient is afraid of the attacks that they may suffer due to the fear they feel.

The differences between anxiety and anguish: Two sides of the same coin

The differences between anxiety and anguish are few, but one is stronger than the other and occurs in more specific peaks. At the same time, it should be noted that there are different anxiety disorders, but the one that’s associated with “classic anxiety” is GAD and the one that’s associated with anguish is panic disorder.

Beyond terminological divergences, it’s important to emphasize that neither anxiety nor anguish are natural from an adaptive point of view. Both are emotions that can become chronic and, therefore, it’s best to seek psychological help to learn how to manage them. If you see yourself reflected in these lines, rest assured that a mental health professional can help you.