Concepts such as anxiety, distress and stress have become widespread nowadays. It seems to be common that we ourselves or some person in our environment has suffered at some time from these problems. It would not be difficult to agree that they all refer to unpleasant states, which can range from a momentary discomfort to a generalized fear or terror, which can extend to overwhelming us in our daily lives.

Beyond understanding them as problems, do we know the differences between each concept? Is it possible that the confusion between terms makes it difficult for us to approach them?

Next, we intend to provide information about the origin and nuances of each concept and of the differences between anxiety, distress and their relationship with stress , in order to clarify the ideas we have and, perhaps, to provide a little light when facing each one of them.

Fear as an adaptive resource

Humans have natural resources for protection in the face of danger, sometimes referred to as adaptive anxiety or fear. It would be like a tool that would act as a warning signal in the face of danger. For example, imagine the following situation:

“We are walking quietly down an avenue, and we hear screams of terror and see people running in one direction. Without thinking, we run faster than ever, looking for somewhere to take shelter.”

In this situation, the interpretation of danger has been automatic , since it has generated the response of the sympathetic nervous system (SNS), a key activation in what are known as the “E-situations” (escape, stress, emergency). When the SNS is activated, hormones to increase blood pressure (such as cortisol) and neurotransmitters to prepare an explosive muscular action (catecholamines such as adrenaline, norepinephrine and dopamine) are released, among other elements, which allow this escape reaction and therefore protection from a dangerous situation. At this point, fear protects us from imminent danger and therefore has an important functional value.

In this situation, do we act on the basis of fear or anxiety? The key difference between the two is that anxiety is related to anticipation, that is, to future, diffuse or unpredictable dangers, while fear is related to one or several stimuli or present situations.

But what if this adaptive mechanism is related to stimuli or situations that do not represent a real danger or threat? Despite the individual differences and the particular way of living of each person, if the generalized fear or the anxious state is maintained and intensified, both in duration and in frequency, it generates negative consequences for the integral health of the person that must be attended to.

Differences between distress and anxiety

At the beginning of the 20th century, Sigmund Freud was the first to introduce the concept of anguish in a technical way. He used the German term Angst to refer to a state of mind, with negative affect, with the consequent physiological activation and, most importantly, based on something indeterminate, that is, without a known or definable object.

This concept was translated into English as anxiety and in Spanish was translated with a double meaning: anxiety and anguish . From here we could understand that the two concepts appear as synonyms, in non-clinical settings, until today, used to describe an unpleasant psycho-physical state, which occurs with great restlessness, uneasiness, uneasiness in the face of imprecise dangers and/or which generate an exaggerated and unadaptive fear for daily life.

Although they are used as synonyms in a colloquial way, in the current clinical environment the differentiation between distress and anxiety does appear . The most widespread tool at the international level for the classification of mental disorders is the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), which includes a section dedicated to anxiety disorders.

In this manual, distress is treated as a subtype of anxiety disorders. In this sense, distress is defined as what is commonly known as a “panic attack” , explained as an episode of intense fear that has a short duration. In contrast, anxiety would refer to a state that lasts longer.

Anxiety can be found in a generalized way in multiple events or it can manifest itself in different areas and for different reasons or causes. At this point, the different known phobias (social phobia, agoraphobia, obsessive-compulsive disorder, phobias of a specific stimulus…) would be driven by anxiety but would be differentiated according to the manifestations or triggering events.

Anxiety as such, beyond the nuances or explanations provided by the different currents within Psychology (psychoanalysis, gestalt, cognitive-behavioral…) must be understood from its complexity, since it encompasses a multidimensional response. This means that includes cognitive, emotional and physiological aspects , characterized by an activation of the autonomic nervous system (formed by the sympathetic and parasympathetic nervous system) that usually generates unadaptive behaviours and that sometimes can imply a high risk for the person who suffers it.

Stress: a set of physical, psychological and social ailments

Once the concepts of anxiety and distress have been explained, the concept of stress can be understood, which may include the above. In summary, stress could be understood as a negative relationship between the person and the environment . This unadaptive relationship between the environment and the person is dynamic, bidirectional and changing, but has as its core the fact that the person perceives that he/she cannot cope with the environmental demands.

The situation is understood as a set of factors that exceed the available resources. At this point, the person could develop anxiety, anguish and other diverse physical and psychological problems, which would have as a common point the generation of a profound malaise .

The complexity of the relationship between the person and the environment makes it a priority that both anxiety, distress and stress are addressed from a broad perspective and taking into account the multiplicity of factors involved (physiological, cognitive, emotional, social …).

Given the influence of social factors in the involvement of these problems that are already beginning to be known as “diseases of the 21st century”, it is the responsibility of all people who are aware of them to detect them and work on their management, especially on their prevention. If a person perceives some type of related problem, either in him or herself or in someone in his or her environment, it is advisable to attend to the symptoms, to ask for help and the sooner the better , to avoid these generating more serious consequences.

Bibliographic references:

  • American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders DSM-V.” Washington: APA (2013).
  • Martínez Sánchez, F. & García, C. (1995). Emotion, stress and coping. In A. Puente (Ed.), Psicología básica: Introducción al estudio de la conducta humana (pp. 497-531). Madrid: Pirámide.
  • Sierra, Juan Carlos, Virgilio Ortega, and Ihab Zubeidat. “Anxiety, distress and stress: three concepts to differentiate.” Revista malaise e subjectivitye 3.1 (2003).