Anxiety, like pain, is one of those amorphous symptom categories that are about as precise, taxonomically, as the two-letter state code on an envelope.
Psychiatric diagnoses help get us a little closer—perhaps to the zip code level—by separating out behavioral clusters like panic, anorexia, or obsessive-compulsive disorder. But there’s still a dearth of precision in the language used to describe the emotional states—fear vs. worry vs. dread—that these conditions entail.
In the spring of 2007, I was privileged to work with Martin Goldstein, a neurologist at Mount Sinai, on a functional MRI study of anticipatory anxiety, also known as dread. To understand how dread differs from fear, consider the difference between waiting in the lounge for a painful dental procedure and actually watching the drill coming at your mouth. Goldstein and his team were among the first to identify the activation of a collar-shaped brain region called the anterior cingulate cortex (ACC) in dread. They have studied this region in both healthy and pathological states.
More recent work on the topic made news when, this past fall, a group of British researchers demonstrated that people will electively endure extra pain just to avoid dread. Giles Story and his London team offered study participants the choice between less pain in the form of an electrical shock later, and more pain now. People consistently chose to experience electric shocks rated a 6 out of 10 immediately rather than to wait for a 4 of 10 in 15 minutes.