Before you start to watch this video, I want to clarify three things.

Number one, during a panic attack, during an attack of anxiety, the patient feels that she has no control over herself, her emotions, the world out there, reality, life in general. Something horrible is going to happen and she is very anxious about it. This horrible event or occurrence can be internal. I’m going to go crazy, I’m going to disintegrate, or it can be external. Something bad is going to happen to me or to my loved ones.

But at the end of the panic attack, when the panic attack ends and the anxiety attack is over, the patient feels relieved, in control, comfortable because she is in unfamiliar territory. She knows anxiety, she’s intimate with anxiety, she has been friends with panic for like forever and she ironically anticipates the unfolding of the panic or the anxiety attack. And she’s never wrong.

So we should make a distinction between the subjective experience of the panic attack or the anxiety attack, which is an experience of disintegration, total loss of control, external locus of control, the anxiety is in control, not me and so on. And the aftermath, the immediate aftermath of the panic attack or the anxiety attack, which is actually anxiolytic, ameliorates and reduces anxiety, by definition of course, the attack is over.

I expound on this in the video, but you may get the wrong impression.

So I wanted to make this clear.

Number two, an identical process is in operation, is in action in obsessive compulsive disorders.

In obsessive compulsive disorders, there is catastrophizing, there is an anticipation of something horrible that’s going to happen. And the obsessive compulsive person engages in ritualized behaviors as a way to fend off the looming catastrophe, the menace, the ambient fuzzy threat out there.

It’s a bit like religion ceremonies, which intend to ward off the evil spirits kind of exorcism.

So there’s an element of anxiety in obsessive compulsive disorders as well.

In anxiety disorders, there’s an anticipation of a threat.

And the reaction is self negation, self annihilation.

The anxious person falls apart, disappears.

That way, the threat is no longer feasible, because the anxious patient is gone, is not there. She suspends herself for the duration of the panic attack or the anxiety attack.

And that is a defense against the threatening ominous forces out to get her.

The obsessive compulsive solution is rituals, ceremonies, rigid timetables and schedules, activities that are repetitive and stereotyped. This is the obsessive compulsive solution to anxiety, to tackle anxiety.

In both cases, there’s an attempt to tackle panic and anxiety.

And a third instance of anxiety attacks masquerading as another mental health issue is paranoia or paranoid ideation.

Again, the paranoid anticipates something malicious and malevolent and threatening and malevolent that’s going to happen. And the paranoid solution, paranoid defense is grandiosity. I am godlike, so I’m not only going to survive this, I’m going to punish the perpetrators.

So let’s summarize.

At the basis of anxiety disorders, obsessive compulsive disorders and paranoid disorders, at the basis of all three, there is anxiety.

The solutions, how to cope, the coping mechanisms and coping strategies, I would even say survival strategies in each of these families of mental illness is different.

So in anxiety disorders, disappearing, vanishing, falling apart.

In OCD, obsessive compulsive disorders, rituals, rigid discipline and so on.

And in paranoia, I’m bigger than all this. I’m invincible. I’m untouchable. I’m the center of attention and grandiose and godlike.

Okay, I wanted to clarify all this before you watch the video so that it becomes much clearer.

My name is Sam Vaknin and I’m the anxious former visiting professor of psychology in Southern Federal University. I’m also the anxious author of Malignant Self-Love: Narcissism Revisited anxiously. And of course, I’m an anxious member of the long term member of the faculty of SIAS-CIAPS.

Commonwealth Institute for Advanced Professional Studies in Cambridge, United Kingdom, Toronto, Canada and how else Lagos, Nigeria.

Being dispensed with all these anxious introductions, intros, let’s get right to business.

The business of anxiety.

Anxiety is a family of disorders, not a single one.

So we have anxiety disorders, panic attacks, for example, a form of anxiety, hypochondriasis is another form of anxiety.

But many things that you wouldn’t believe constitute anxiety are actually manifestations, or permutations, and transmutations, and mutations of anxiety.

Even psychopaths have been discovered to be anxious on a constant basis.

Okay, anxiety is not fear.

Anxiety is not fear. Fear is when there is a threat out there, a real threat, a factual menace, something that can cause harm and damage, something that could affect your life, your well-being, or your loved ones in an adverse way.

So this is fear. Fear is grounded. Fear is centered. Fear is action-oriented. Fear is directional.

And above all, fear is evidence-based. It’s factual.

Anxiety is not.

Anxiety is counterfactual. It does not reflect any real threat.

There’s a huge difference between being scared and being anxious.

When you’re anxious, you’re not reacting to any information or data. You’re reacting to catastrophizing, an internal process where you generate catastrophic scenarios, and then you treat these utterly invented scenarios, conjured up pieces of fiction, narratives as if they were reality.

So anxiety is counterfactual. Not evidence-based, but narrative-based.

And in vast majority of cases, it is generalized. It’s fuzzy. It doesn’t attach to anything specific. It wanders around in search of a reason and an explanation.

The anxious person first feels anxious and then asks herself, “Why am I anxious?” And then she begins to scan people around her, the environment, situations, the future, the neighbors, her dog.

And she comes up with a reason, a story, and an explanation as to why she’s feeling anxious.

And of course, this reason and story and narrative and explanation are nonsensical. They’re counterfactual.

In short, fear is an adaptive, evolutionary, evolutionarily beneficial emotion. It’s a survival strategy, or at least it’s an emotion attached to survival strategies. It’s helpful, it’s useful, and exactly like anger, it’s directional.

Anxiety is not.

It is counterproductive. It is self-defeating, sometimes self-destructive. It paralyzes and it doesn’t lead to any outcomes except disfavorable outcomes.

So it diminishes self-efficacy, it reduces your ability to operate in the environment and on the environment in a way which guarantees the outcomes which you want to accomplish, so it renders you less agentic, less independent, and less autonomous.

People with anxiety disorders, especially panic disorders, are invalid in the sense that they are dysfunctional to the extreme.

The problem with anxiety, as I said, it’s a reaction to catastrophizing, so it is anticipatory.

Fear can also be anticipatory, but fear is always based on intelligence, two types of intelligence, intelligence, intelligence, and information. Fear is reaction to information. Fear is reaction to possible scenarios, however improbable.

Anxiety is a reaction to fiction. Fear is a reaction to fact. And anxiety is anticipatory.

Now people with anxiety know that they can experience anxiety and even panic attacks, and it’s a very debilitating experience, sometimes imitating a heart attack.

Panic attacks could be so severe that they can be mistaken for a stroke or a heart attack and so on.

So people are aware, people with anxiety disorders, they are aware that their delusionality can drive them into bad and dark places. They’re aware, they fully anticipate the oncoming onslaught of a panic attack, the debilitating, deforming effects of an anxiety.

So they anticipate anxiety in panic attacks and this renders them anxious.

I call it secondary anxiety.

There’s the primary anxiety and then there’s the anxiety about being anxious shortly.

Like there is anxiety and then there is another layer of anticipatory anxiety.

Oh my God, I’m going to be anxious. Oh my God, I’m going to have a panic attack.

So that creates a secondary layer of anxiety.

At the same time, despite the extremely unpleasant, uncomfortable and egodystonic character of anxiety, people with anxiety disorders prefer to be anxious because anxiety is familiar by now.

It is the comfort zone. It is home.

They know how to cope with anxiety. They know the ropes, they know the rules, they know the sequence.

This familiarity breeds acceptance and so people with anxiety disorders feel most at ease when the attack actually takes place.

So prior to the attack, there is very heightened anxiety, the primary anxietywhich is forming and the secondary anxiety anticipating the anxiety attack.

But when the panic attack actually materializes, there is a sense of relief, a sense of liberation, a sense of reassertion of self-control and this is the addictive nature of anxiety.

It is only by experiencing anxiety, it is only by enduring panic that you can ameliorate and mitigate your anxiety.

That’s the paradox built into anxiety disorders.

Only by going through the horrible debilitating experience can you get rid of it.

It’s like waiting for the other shoe to drop or precipitating and initiating a conflict.

Like let’s get it over with and then when a panic attack happens or the anxiety takes over and permeates and invades and becomes ubiquitous and pervasive, it is then that gradual relief sets in and when the panic attack is over or the anxiety is finished, you feel good, you feel refreshed and released.

A little like being a hostage and then exchanged for prisoners.

Okay, now I said that people with anxiety disorders prefer to be anxious because anxiety is the comfort zone.

So ironically, anxiety is most triggered and it speaks when there is no reason to be anxious.

It is when the patients are in a calm and tranquil state of mind.

So when the patient with anxiety disorder does not experience anxiety, is calm, is happy, is content, is tranquil, is peaceful, he begins to worry. He begins to ask himself what’s happening here? What’s going to happen next? What’s the horrible thing, event that’s going to engulf me and destroy me and consume me?

So it is in periods of relative calm, stable, non-labile, non-volatile state of mind that the anticipatory anxiety starts.

The commencement of anticipatory anxiety, the construction of the catastrophic scenarios, the catastrophic narratives that later engender and foster the anxiety, this begins when the patient is actually in a good state of mind, usually immediately after a panic attack or an anxiety attack.

And so when there’s no reason to be anxious, when the patient cannot come up with any explication, any anticipation, any scenario to be anxious, it is then that the patient begins to be, begins the next cycle of anxiety because the patient then needs in order to revert to the comfort zone.

In order to return to familiar territory, the patient needs to invent the next story and experience the next panic attack or the next anxiety attack.

So let me summarize it to you because it’s very, very mind boggling and to wrap your mind around this, it’s very difficult.

I must admit it’s counterintuitive.

The patient with anxiety disorders feels relieved, it is in control when she experiences panic attacks and anxiety attacks because this is familiar ground, this is home, this is a comfort zone.

Nevermind how horrible the subjective experience is, she knows where she’s going, she knows how it’s going to end and she feels that she has the skills and the capacities developed over decades or years of anxiety. She has the skills to cope with this.

Now, she wants, she has an incentive to trigger anxiety time and again because when she is not anxious, when she’s calm, when she’s tranquil, when she’s happy, she says this is going to end badly, this something horrible is going to happen and then she triggers anxiety because that calms her down.

So the anxious patient is busy constructing catastrophic scenarios and narratives in order to trigger anxiety and he constructs these narratives and scenarios when he does not experience anxiety. Whenever the anxious patient does not experience anxiety, she generates scenarios and scripts that foster and engender anxiety because that’s her natural state. That’s her natural state.

Now, what’s the difference between paranoia and anxiety?

Paranoia is a form of anxiety coupled with grandiosity.

So I would say that paranoia is a combination of anxiety and narcissism or at least grandiosity.

And paranoid considers himself the center of the world. The focus of malign attention, everyone is conspiring around him. He is so important, so pivotal, so critical that people want to take him down or kill him or destroy him or pursue him or whatever.

So the paranoid is very grandiose and self-centered and this generates in him anxiety. The paranoid’s anxiety is derivative, unlike the anxiety of the patient with anxiety disorders.

This paradoxical state of needing to experience anxiety in order to revert to a non-anxious state compels the anxious person, the person with anxiety disorder, to trigger constantly, internally, in an anticipatory manner, anxiety. It’s an addiction. It’s an addiction to a delusion which ironically is anxiolytic. It reduces anxiety.

The anxious patient is only weapon, is only instrument, is only medication, is only way to counter his anxiety is by going through it and experiencing it.

So he has a huge incentive to provoke it and to trigger it in himself.