Fear: What is the limit between normal and pathological?

Fear: What is the limit between normal and pathological?

Fear is my most faithful companion, it has never tricked me into leaving with another. Woody Allen. American actor, director and writer.

In this article we offer you a tour of the neurobiology of fear. And the limits between the natural behaviors of the fear and the pathological ones of the same are described, as well as some therapeutic alternatives in their treatment.

  • Alberto, spends days and nights thinking that he wants to do one and a thousand things in his life, but almost always he stops a thought that paralyzes him; the fear of dying (necrophobia).
  • Toño is apparently a sociable person, but in most cases he tries to avoid contact with people. He has friends who consider him as rare, but in the innermost part of his being, he has been diagnosed since adolescence with a condition called: social phobia.
  • Bety is a very attractive woman in every way, but nobody explains how she supports her partner who treats her very badly. She thinks it is better to pay that price so as not to be alone, she is afraid of being alone (autophobia).
  • Margarita, is going to present her degree exam, she considers it the most important of her life. Despite feeling fear, try to relax with music, meditation exercises and creative visualization. His body is tense, but in his internal dialogue he knows he can achieve his desired goal (just experience some anxiety).

What do all these characters have in common? They live the emotion of fear in different degrees. Sometimes we can control it, but unfortunately in others fear itself governs their lives and unfortunately it can become disabling.


  • 1 What is fear?
  • 2 The semantic and polysemic linguistic structure of emotions
  • 3 Our fears or fears
  • 4 The boundary between health and illness
  • 5 Reactions to fear
  • 6 Fear in our brain
  • 7 Treatments

What is fear

Fear is one of the few emotions we share with animals on our evolutionary scale. All emotions have an adaptive function. Some disadvantages of feeling fear are: it represses our playful part, it can paralyze us, it slows our creativity, our potential capacities and also makes us unhappy. Emotions are there to be felt, but we don't necessarily know how to control them. If we did not feel emotions we would be like automatons, zombies or robots.

Fear and fear serve as protection and alarm signal (Vass, 2019, p. 5).

Fear, is one of our most primitive emotions and possibly the strongest because our survival is involved, lives deep within our DNA. In an emergency situation it keeps us safe, but also if we are prey to fear it can significantly alter our lives. It helps us to make decisions and also in extreme situations, it makes us clumsy or aggressive.

Emotions are so important in our lives that they build personality traits.. When we think of the people we know, we surely say “he is a very person”… cheerful, affectionate, kind, anxious, sad, angry, fearful, etc. That is to say, We assign the emotion that manifests most frequently as a personality trait. A tendency to respond with anger, unrelated to the present situation, is a personality trait. This means that we are building our personality with the emotions that we externalize. And many times we are not aware of it (Bisquerra, 2017, p. 43).

Defining fear

Fear is part of our basic emotions. The others are: disgust, surprise, joy, anger and sadness. And, all of them have a special adaptive function.

Fear is a reaction of the primitive response of the body of fight or run away (Boyes, 2007, p. 21).

Fear is an emotion that you experience a real and imminent danger that is lived as overwhelming and that puts health and life at risk (Bisquerra & Laymuns, 2018, p. 108).

It is an intense emotion activated for the detection of an imminent threat, it involves an immediate alarm reaction that mobilizes the organism by generating a set of physiological changes (APA, 2010, p. 316).

As you can see the fear can be experienced in the face of an imminent real danger, or simply imagined, it is a primitive response to safeguard us from harm, it has an intensity that can be mild or acute, it is also characterized as a unique or chronic, active experience psychosocial, as well as physiological mechanisms that alter the life of the sufferer. If emotions cannot be managed and we leave them free, they become a source of conflict (mental disorders or toxic relationships with ourselves or with other people), if we keep them they become somatized and they will also bring us psychosomatic problems.

The semantic and polysemic linguistic structure of emotions

From the classic book by Daniel Goleman (1995) on emotional intelligence, it was already proposed that emotions rather formed families, quite possibly described by the degree of semantic and physiological intensity in which they were presented, fear was classified as fear and There were degrees of severity in the experimentation of emotion:

  1. Nervousness, worry, restlessness, apprehension, restlessness and caution.
  2. Anxiety, dismay, uncertainty and fear.
  3. Dread, terror, phobia and panic on a psychopathological and disabling level (the classification is mine).

Bisquerra & Palau (2017), made an interesting classification more recently to describe emotions. They detected of the six basic emotions, more than 300. Especially in relation to fear, they found more than 18 meanings in their Spanish version, which are described below (again the classification in relation to its intensity, from lowest to highest, is mine):

  1. Cushioned, Alert, Funk, Indecision, Inhibition, Medieval, Fear, Denial, Submission, Fright, Fear, Hesitant.
  2. Disorientation, Alarm, Scared, Shitty, Duress, Cowardice, Fright, Overwhelming.
  3. Phobia, attacked, helpless, horror, panic, dread, terror.

The linguistic, semantic and polysemic learning is that the different variants in how we express our fear differ in their linguistic concept, but denote the intensity with which one lives. This will ultimately result in the severity of how our brain will capture the emotion of fear and act accordingly. It brings also cultural connotations, in Mexico the fearful is the zacatón or the fag, for example.

Our fears or fears

Fear is part of some of our anxiety disorders and is an essential component in our phobias. Disorders caused by fear are the raison d'être of the most common psychic diseases.

Phobias are irrational and continuous fears of an object (tryphobia, fear of black holes), an animal (musophobia, fear of rats), an activity or a situation (agoraphobia, fear of open spaces) in particular (Halguin & Krauss, 2004. p. 597 ). For their part, the anxiety states (such as obsessive compulsive disorder) cause uncontrollable or panic reactions that take over thinking In many areas. The affected person has sometimes been able to describe what distresses him, but cannot explain the causes (Vass, 2019, p. 7).

How human beings fear various situations consciously or unconsciously and in many cases govern our lives: the fear of getting sick (hypochondria), to the death (necrophobia), to the loss of a loved one (tanatophobia), at heights (acrophobia), to one's fear, to fire (arsonphobia), to sleep (somniphobia), to loneliness or to be alone (autophobia), to social interaction with people (social phobia), to fall in love (phylophobia), to failure (atiquifobia), fear of ugly people or ugliness (cacophobia), fear of open spaces and crowds (agoraphobia), fear of black holes (tryphobia), the future (chronophobia), change, criticism, not to meet our goals, at heights to animals (for example; animals in general-zoophobia, insects-entomophobia, rats or mice-musophobia or snakes), pain (algophobia), fear of life, in short the list is almost inexhaustible.

The boundary between health and illness

However, how far is the border between "normal" fear and "pathological fear." It is important to highlight that each of these has multiple etiologies, but there are areas of the brain specialized in detecting fear and in most cases they can be treated, to live a fuller life.

It is natural that we all get to have a certain dose of fear when facing ourselves or a specific situation (coexistence with others or with some environmental situation, for example), can even have a positive component paradoxically speaking. We feel good when we face an event that scares us, which we thought we couldn't do. Another positive aspect is that facing fear prevents us from later more painful situations, this is the case when people go to the doctor, if he detects any disease, it can be treated and healed in time.

Emotions are there to be felt and adapt to various social circumstances, then it is "normal to feel fear" in the face of some circumstances, whether imagined or face-to-face. However, if we can still control our fears, we can move on with our lives. In counterpart, the emotion of fear becomes a problem when fear controls us or dominates us (we become toxic people), when fear is totally unfounded, when by association it remains installed in our brain or when it remains constant in our lives and becomes limited or incapacitated to perform our daily tasks (they become mental disorders or phobias).

Reactions to fear

  • Physiological:
    • Muscle stiffness, general body tremor, skin becomes pale, piloerection occurs, it is likely to sweat cold. Rapid heartbeat, redirection of blood flow from the periphery to the viscera and general mobilization of the organism to perform an action: fight, flee or stay petrified with fear.
    • “Fear is also demonstrated in the face through the increase of the blinking of the eyes and also with a fixed gaze of light bulb, the eyelids are stretched upwards and the eyeballs come out. The pupils dilate. The mouth is tense and stretches back. Lips tremble and teeth may chatter. Sometimes the action of clearing the throat is performed and the breathing rate can increase while adrenaline is produced in the body ”(Boyes, 2007, p. 21). Fast heartbeat, blood flow redirection.
  • Psychological: attention is focused on the near threats and our memories assess whether we have already been through a similar situation before. We can get into a situation of discomfort, anxiety until we go up to panic.
  • Behavioral: Fight, run away or stay still.
  • Social: If we can avoid fear, it is very likely that we will stay at home so as not to face any stimulus that potentially endangers our identity and we are safe. However, the more we avoid fear, the more it strengthens.

Fear in our brain

Previously it was thought that mainly the cerebral tonsil was activated almost exclusively. It is like a brain inside the brain, the size of an almond and one in each cerebral hemisphere.

However, in the neurobiology of fear, Rüdiger Vass (2019) describes the following route where many more brain structures are involved, in summary:

  • Faced with a stimulus that produces fear, whether internal or external, the amygdala receives information from the thalamus.
    • In the amygdala the normal and pathological fear is recorded. It produces fear or aggression. If it is damaged it produces submission or affective flattening. Detects good and bad stimuli. It is the most important region in the memory of fear. It is activated before the stimuli that cause fear and anxiety disorders.
    • The thalamus is an oval structure that transmits information from our sense organs (sight, touch, taste, smell, hearing) to the cerebral cortex (it is the largest part evolutionarily). The communication between the cortex and the thalamus is reciprocal and bidirectional. It has sensory motor functions, these can be mechanical, thermal and painful stimuli. It is involved at the motor level in voluntary and involuntary movements and includes the march. It involves attention in the sleep-wake cycle. In language it is its motor aspects and its syntactic alterations. It is divided into 4 zones: 1) Previous, which participates in memory and emotions, 2) Medial, is divided into three zones that involve memory, 3) Ventral, is responsible for motor control and 4) Later, is divided Turn into three parts.
      • 1) Medial geniculate, is a component of the auditory system.
      • 2) Lateral geniculate, receives information from the retina and sends it to the visual cortex.
      • 3) Pulvinar geniculate, projects to more developed areas of parieto-occipito-temporal association in humans.
    • The tonsil sends signals to the cerebral cortex and both feed back.
    • The central nucleus of the amygdala receives information from the cortex, the hippocampus and the thalamus.
    • The hypothalamus increases blood pressure and regulates the release of stress hormones; the brainstem and midbrain transmit the stiffness linked to terror and the reactions derived from fright.
      • The hypothalamus governs the hormonal system and is a bridge with neurons. Faced with a threatening situation, it releases, among other cortisol hormones, the stress hormone and prepares the body to fight.
      • The hippocampus is the conductor of our different memories.
    • The lateral and inferior nuclei receive signals from the thalamus and direct the different forms of behavior, such as the change of direction in the flight.

This indicates that there is no exclusive region where fear occurs and becomes conscious. Rather it comes from different areas at the brain level and from the feedback between them.

Theoretical approaches

  • From the point of view of psychoanalysis, fears correspond to unconscious conflicts.
  • For behaviorists, fears originate from external factors (stimuli) that are associated with such behavior (response).
  • For cognitive psychologists, they are due to a cognitive distortion that has been learned and must be unlearned.


There are different therapies, each of them obeys various strategies to work with fear, there is no one that is the most effective, they are simply methods of treatment.


  • Emotional control with relaxation and meditation techniques. The goals of meditation overlap with many of the clinical psychology, psychiatry, preventive medicine and education. As more and more data indicate, meditation can be an effective treatment for depression, fear and chronic pain and also helps to cultivate a sense of well-being (Ricard, Lutz & Davidson, 2014).
  • Thoughts create reality in good and evil. Negative expectations generate detrimental effects and poor results (nocebo effect), while positive expectations generate pleasurable effects (placebo effect). Irving Kirsch (2012) points out: "the way we feel depends largely on how we anticipate that we will feel."
  • Hypnosis, the use of the low-frequency pulsating electromagnetic field that balances the electrical charges of the body at the cellular level, the technique of successive approximations and systematic desensitization and overexposure to the stimulus that causes fear have been used as alternatives. Music therapy with binaural music.


  • A combined antidepressant and anxiolytic therapy is used.


APA (2010) Concise Dictionary of Psychology, Mexico, Editorial the Modern Manual.

Bisquerra R. (2017) Universe of emotions, Spain, Editorial PalauGea Comunicación.

Bisquerra R. & Laymuns G. (2018) Dictionary of Emotions and Affective Phenomena, Spain, Editorial PalauGea Comunicación.

Boyes C. (2007) The language of the body, Buenos Aires, Editorial Albatros.

Goleman D. (1995) Emotional intelligence (Why it is more important than the intellectual quotient), Mexico, Editorial Javier Vergara.

Halguin R. & Krauss S. (2004) Psychology of abnormality, Editorial McGrawHill, Mexico.

Kirsch I. (2012) Networks for science 135, Nocebo the evil brother of the placebo, Irving Kirsch interview with Eduardo Punset, accessed June 1, 2016, online: // -Sjs6BAA

Ricard M., Lutz A. & Davidson R. (2014) Nuroscience, In the brain of the meditator (The new neuroimaging techniques shed light on the brain changes produced by contemplative practices), Research and Science, January 2015, Barcelona

Vass R. (2019) Fear (Neuropsychology of fear and phobias), Neurobiology of Fear, Mind and Brain Notebooks, third four-month period, Number 24, Spain, Research and Science Editions.

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