What 

is the difference between Existential Anxiety and so called Neurotic Anxiety? 
December 18, 2010 
 
‘The sine qua non of true vitality’1

An examination of the difference between existential anxiety and neurotic

anxiety

ABSTRACT

Macquarrie2 (1973) states that ‘anxiety has a subtle and elusive character that thought

can scarcely grasp,’ (p173). This paper describes the development of the concept of

anxiety in psychotherapeutic and philosophical thinking. It also attempts to define

existential anxiety and compare and contrast it with neurotic anxiety, with reference to

normal anxiety, without which, the picture would be incomplete. Finally, the paper

looks at the implications of responding to a client’s anxiety as neurotic or existential and

proposes that an integral relationship between the two exists, which is captured in the

Integrated Anxiety Model defined by the author.

INTRODUCTION

Violent winds
Tear us apart. Terror scatters us
To the four coigns. Faintly our sounds
Echo each other, unrelated
Groans of grief at a great distance

W.H. Auden’s (1947) poem ‘The Age of Anxiety’ was part of a discourse of anxiety that

exploded into everyday life in post war Europe and America. The legacy of the 2nd

World War, the birth of the atomic age and the beginning of the cold war all brought

anxiety to the forefront of philosophical, scientific and psychological study. Since Rollo

May’s (1950) groundbreaking work ‘The Meaning of Anxiety’ was published, many
                                                             
1
 van Deurzen, 1998 p10 
2
 Macquarrie, 1973 p173 
 What is the difference between Existential Anxiety and so called Neurotic Anxiety? 
December 18, 2010 
 
thousands of books, scientific studies and magazine articles have focused on this most

‘universal’ (Spinelli, 2007, p27) and ‘basic’ (van Deurzen, 2002, p61) feature of human

existence.

Reviewing just some of this literature reveals a quagmire of confusing definitions,

contradictory explanations and bewildering etiologies (Lewis , 1967; Hallam, 1985). And

the waters have continued to muddy through the end of the 20th and beginning of the

21st century.

Some writers, like Zeig (1987) have used the terms fear and anxiety synonymously.

Others, such as Tillich (1951) ’distinguish anxiety from fear by emphasizing it to be the

fear of fear, without having the concrete object that fear does,’ (in May, 1977, p76).

Of those that differentiate, some see anxiety as resulting from fear (Freud, 1974) others,

including May (1977), reverse this and see fear resulting from anxiety.

Anxiety for many is seen in pathological terms ( e.g. Freud ,1936; Beck, 1985; Barlow,

2002) or as a symptom to get rid of (e.g. American Psychiatric Association, 2000). For

others it is described as an inevitable and therefore normal consequence of human

existence (Yalom, 1980; van Deurzen, 2002; Spinelli, 2007) and something we can learn

from - ‘whoever has learnt to be anxious in the right way, has learnt the ultimate,’

(Kierkegaard, 1844, p155).

Evolutionary psychologists see anxiety as an evolutionary response to day to day

dangers (Lewis & Haviland-Jones, 2000) and others, like van Deurzen and Kenward

(2005) as something beyond these daily trials – ‘ ...anxiety or angst is an apprehension of

something beyond everyday concerns,’ (p6).

   
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Theories on the psychic origins of anxiety have proliferated at a similar pace. Rank

(1952 ) proposed a basis in separation, Sullivan (1948) and Mower (1939) in frustration of

a central value, Kardiner (1945) in the introduction of taboos early in life, Freud (1936) in

helplessness in the face of a threat, Stekel (1923) in psychic conflict, Ellis (2001) in

irrational thoughts and Spielberger (2005), in possession of a particular personality trait.

Existential philosophers, writers and practitioners have described its origins in existential

givens such as death (Yalom, 1980), freedom (Kierkegaard,1944), isolation (Heidegger,

1962), non-being (Tillich, 1980), nothingness (Sartre, 1958) and consciousness (Niebuhr,

1941).

Perhaps Macquarrie (1973) hits the nail on the head when he says ‘anxiety has a subtle

and elusive character that thought can scarcely grasp,’ (p173).

EXISTENTIAL AND NEUROTIC ANXIETY

Introduction

Many have tried to divide anxiety into different types (e.g. Tillich, 1951; Jaspers, in

Schilpp, 1957; May, 1977; Baumeister, 1991). This paper centers on two of these –

Existential Anxiety and Neurotic Anxiety – but also considers Normal Anxiety, without

which the picture would be incomplete.

The meaning of the two core terms in many ways mirrors the two different focuses

brought upon the subject by doctors/psychotherapists who follow the medical model

(and focus almost exclusively on Neurotic Anxiety) and existential philosophers and

practitioners who use a phenomenological approach (focusing on Existential Anxiety,

while acknowledging its vital relationship with Neurotic Anxiety). This paper looks at

   
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December 18, 2010 
 
definitions of Neurotic and Existential Anxiety from this second, existential point of view,

and leaves the discussion of Neurotic Anxiety from the point of view of other schools of

psychology/ psychotherapy to the relevant proponents of those schools.

Key Features

Figure 1 summarises the key features of Existential and Neurotic Anxiety, together with

illustrative quotes from a wide range of authors, philosophers and practitioners. It’s

important to note that not all ‘anxiety experts’ would agree with every identified

feature of Existential or Neurotic Anxiety. Therefore, the two categories cannot be

taken, as a whole, as representative of any one view, nor can they be seen as de facto

definitions of the two terms (though they do inform the definitions outlined below).

Existential Anxiety – A Working Definition

Since Kierkegaard (1944) almost all existential philosophers and practitioners have

examined Existential Anxiety and have contributed significantly to its understanding.

However their observations and conclusions have differed widely. To Kierkegaard

(1944) it was an ‘adventure that every human being must go through’ (p138) and ‘the

recognition of our freedom’ (p64). Heidegger (1962) linked it to our awareness of the

inevitability of death and the ‘impossibility of our possibilities’. Sartre (1958) described it

as a necessary experience that allows us to ‘become free in relation to our nothingness’

(in van Deurzen and Kenward, 2005, p7). Lidell (1956) saw it as the ‘shadow of our

intellect’ (p82) - the necessary counterpart of us being truly alive, and Jaspers (1971)

described it as ‘the metaphysical fear of choice,’ (in van Deurzen & Kenward, 2005,

p7). van Deurzen and Kenward (2005) describe it as the ‘instigator of reflection on the

   
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situation one is in’ (p7)and van Deurzen (2008) as the ‘key to our authenticity’. Finally,

Tillich (1965) saw it as a pointer in the direction of the ‘ultimate concern’ (p92).

Existential Anxiety is clearly a complex phenomenon, difficult to define concisely. For

the purposes of this paper I have defined it as:

…the ‘inevitable unease or malaise’ (van Deurzen, 2002, p34) that comes from
awareness of yourself, your freedom and the finitude of human existence.

Neurotic Anxiety – A Working Definition

Neurotic Anxiety has received somewhat less attention from existential philosophers

and practitioners. However, it has been variously described as ‘mere worrying, and is a

smokescreen, a distraction, a psychological evasion, so that the worrier can shift his or

her attention away from their angst,’ (Tillich, 1980), as the ‘feeling one gets when one

decides to conform, accept the conditions of worth of others, and give up possible

personal growth, all in the name of safety and security,’ (May, 1977). It’s what occurs

when we displace Existential Anxiety - ‘the nothing which is the object of dread

becomes, as it were, more and more of a something,’ (Kierkegaard, 1944) - or the

price we pay when we avoid it - ’(it) is avoided at the price of apathy or numbing of

one’s sensibilities and imagination,’ (May, 1977, p76). To Yalom (1980) it is Existential

Anxiety ‘transformed into something less toxic for the individual’ (p93) and to May

(1977) it is a cover up for the more essential deep anxiety (p127). It is what people

experience when they try to ‘eliminate the awareness of (this) fundamental choice,’

(van Deurzen, 2002, p41) or when they cannot manage their Existential Anxiety (van

Deurzen, 1998) or when they attempt to run against ‘unmovable boundaries such as

   
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death and chance.’ (Cooper, 2003, p23). Bugental (1981) describes it as the result of

‘defensive behaviours’ (in Cooper, 2003, p66) that cause more problems than they

alleviate and Kirkand-Handley(2002) as ‘the dread which accompanies our attempts to

distort reality by seeking to evade the challenges of our human situation,’ (p167).

Once again, such diversity of views makes a definition difficult. In this paper I define it
as:

The anxiety that manifests when we try to evade existential givens, or when we
are overwhelmed by them. It is our attempt to detoxify and replace Existential
Anxiety.

Normal Anxiety – A Working Definition

Despite Heidegger’s (1962) view that the distinction between Neurotic and Normal

Anxiety was unnecessary, I have sided with May (1977) and Tillich (1980) who see them

as separate entities.

Normal Anxiety - what Freud (1936) called ‘objective’ anxiety- is a response to

everyday life events, such as starting a new job, being threatened by a stranger, or

getting lost on the way to an important meeting. It is proportionate to its cause, and

can be used constructively to identify and confront the dilemma from which it arose.

As we will see below, however, It can also become Neurotic Anxiety, if the individual is

unable to confront the experience constructively.

Normal Anxiety occurs when the person reacts appropriately and proportionately
to the events of everyday life.

   
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THE IMPLICATIONS OF RESPONDING TO A PERSON’S ANXIETY AS NEUROTIC VERSUS
EXISTENTIAL

Introduction

The Cognitive Behavioural Therapist might be content to use learning theories to

change the focus of a client’s Neurotic Anxiety (May, 1977). However, there are a

number of negative implications in responding to anxiety as purely neurotic, including

the focus on symptoms, and the implication that these are part of a pathological

problem that needs to be cured, without recognition of the purpose these strategies

play in avoiding wider, ever-present anxieties. This is likely to result in a focus on the

individual’s internal world, without a look at the universal issues that face us all. While

the client might learn to ‘manage’ his or her anxiety, they are unlikely to appreciate the

power it has to invigorate, inspire and teach. For the Existential Therapist, the focus is on

helping the client to listen to what the Neurotic Anxiety is trying to tell them (Kirkland-

Handley, 2002).

Practically speaking, it is very difficult in most cases to distinguish the normal from the

neurotic elements in anxiety – most people present with the two types interwoven (May

1977) so that, as Tillich points out, we are mostly ‘unable to draw the boundary sharply’

(p181).

If we insist on treating the two ‘types’ of anxiety as distinct entities, we do nothing to

demonstrate the integral relationship between the two, nor do we illustrate to our

clients, or to our fellow practitioners, a way in which the concepts can be integrated

and responded to within the psychotherapeutic setting. Anxiety as a totality

   
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(existential, neurotic, and normal) is a vital source of information ‘pointing its subject

towards a more authentic way of living,’ (Kirkland-Handley, 2002). We can’t deprive the

client of something that may benefit them greatly for the sake of a neat typology. For

these reasons, the rest of this paper considers anxiety as an integrated concept, and

looks of the implications of this stance for the client, whether they present initially with

Neurotic or Existential Anxiety.

Key Assumptions Underlying The Integrated Anxiety Model (IAM)

The Integrated Anxiety Model (IAM) in Figure 2 opposite demonstrates the relationship

between the three types of anxiety defined above. Key assumptions underlying this

model are:

• The anxiety to which a person is subject consists of Existential Anxiety and Normal

Anxiety;

• Existential Anxiety is universal and unavoidable;

• The individual’s response to anxiety is influenced by a range of factors including

their sensitivity to anxiety, life events to which the individual is subject, values they

hold as fundamental, awareness of and ability to cope with life’s paradoxes and

the adaptive capabilities they possess;

• These factors can all operate in a positive and a negative direction and combine

to influence whether or not anxiety is successfully negotiated or needs to be

‘managed’ through resistances and defenses;

• Successful negotiation results in the individual learning from the anxiety, growing

as an individual, becoming aware of the choices they face and freedom they

have to make them;

   
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• Unsuccessful negotiation leads to the creation of resistances and defenses

designed to help the individual avoid the original anxiety. These disguise, rather

imperfectly, the Existential Anxiety and Normal Anxiety which transforms into

symptoms of Neurotic Anxiety.

• Left unaddressed, or addressed merely through the implementation of techniques

to manage it, Neurotic Anxiety leads to stagnation, rigidity and restriction in the

individual’s life. Examined and understood, it can enrich and enlarge their life.

Responding to Anxiety as Existential and Neurotic

The psychotherapist informed by the Integrated Anxiety Model is able to respond to

anxiety as both Existential and Neurotic. The implications of this are outlined below:

• While beginning therapy, as Yalom (1980) suggests, ‘at the level of the patient’s

concerns,’ (p112), the therapist will be able to support the client in an exploration

of the deeper Existential Anxiety these presenting issues may be obscuring;

• The ‘various ways in which the client evades her anxiety and attempts to opt out

of life’ (van Deurzen, 2002, p40) will be identified as such and the costs and

benefits of facing such anxiety explored;

• The therapist will convey the message that anxiety is ‘neither avoidable, nor is it an

aspect of pathology, but rather a basic ‘given’ of human existence’ (Spinelli, 2007,

p27) encouraging the client to view it as an opportunity for learning rather than as

a troublesome symptom;

• The therapeutic relationship will encourage the identification of what Spinelli

(2007) terms ‘a more adequate and courageous way to acknowledge and live

   
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with the inescapable given of Existential Anxiety,’ (p79), rather than working

towards the impossible aim of eradication of anxiety;

• Helping the client to clarify the internal conflicts which can exacerbate anxiety will

enable them to ‘come to terms with inner freedom, through facing inner

existential anxiety,’ (van Deurzen, 2002, p35);

• The client will gain awareness of the paradoxical nature of human existence (van

Deurzen, 1998) and the ways in which such paradoxes can be tolerated and will

be able to explore their personal stance to them – learning, as Winnicott (1971)

says, the importance of ‘a paradox to be accepted and tolerated and

respected, and for it not to be resolved,’ (pxvi).

• Focusing on increasing what May (1977) calls ‘insight handling capabilities’ will

offer the client new ways of learning from Existential and Normal Anxiety and

make it easier for them to avoid Neurotic Anxiety;

• Examining their individual response to Existential and Normal Anxiety will help the

individual to discover ways in which they can use their special talents (van

Deurzen, 2002), or their sensitivity to anxiety (Taylor, 1995) to negotiate anxiety

successfully;

• Regarding Neurotic Anxiety as having a basis in Existential Anxiety and existential

givens will encourage the individual to work to identify the source of meaning in

their life and to clarify their personal values. van Deurzen (2002) confirms that

‘what ultimately matters in existential work is to determine what it is that really

matters to the clients, and not what ought to matter to them.’ (p106);

• Finally, the Integrated Anxiety Model will allow the client to choose the depth at

which they wish to explore their experience of anxiety. The existential perspective

   
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might, as van Deurzen (2005) suggests ‘for some clients offer a welcome

opportunity to embrace their life situation’ (p187) but for others might be alien and

inappropriate. Ultimately the therapist will be led by the client.

   
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CONCLUSIONS

Regarding anxiety as either Neurotic or Existential serves only the theorists/ practitioners

who seek to support their particular modalities through a focus on one or the other. An

integrated model, such as presented in this paper, offers the client insight into the

relationship between Neurotic and Existential Anxiety. In particular, the use of the IAM

to inform therapeutic practice achieves the therapeutic aims highlighted by van

Deurzen (2002). It:

• ‘Pinpoints the various ways in which the client evades her anxiety and attempts to

opt out of life’;

• Encourages her to ‘face the anxiety once it is uncovered’;

• Assists her in ‘understanding the significance of her anxiety’;

• And finally ‘explores constructive and creative ways of rising to the challenge

pointed at by the anxiety,’ (p40).

Our purpose is not to collude with the client in evading life by avoiding its unpalatable

realities, but rather to help them to embrace anxiety, learn from it and thrive with it

despite them. As Kirkland-Handley (2002) states

‘…when anxiety is properly and deeply understood….it is the chief ally of the
therapeutic couple in their endeavour to wake the patient out of his or her illusions
and to spur him or her on to living life more authentically,’ (p186).

   
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Susan Iacovou is a final year Doctoral student at the New School of Psychotherapy and

Counselling. (Thanks to other students and to Tutor Emmy van Deurzen for their

valuable contributions to this paper.) She lives and works in Cheshire, where she has her

own private practice and from where she teaches on various Masters in Psychotherapy

programmes. Susan is particularly interested in developing an existential approach to

couples and relationship therapy (and is currently co-editing a book on this topic with

Emmy van Deurzen). Her doctoral research focuses on the impact of active service on

the intimate relationships of ex-armed services personnel. In a previous life, Susan was a

management consultant, working on training and development programmes with

managers across Europe, the former Soviet Union and Africa. During this time she also

wrote a number of books, training packs, magazine, newspaper and journal articles on

human related topics. Susan can be contacted on susan@iacovou.biz.

   
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Figure 1

Existential  Neurotic 
Anxiety Anxiety
‘Anxiety is part of existence,  .’.avoiding all situations, 
and no individual who  thoughts or feelings 
continues to grow and  Inevitable Avoidable which might arouse 
create will ever be free of it.’   anxiety.’ Horney (1999) p92
Yalom (1980) p167

‘In neurotic 
‘We still cling to the illogical  patterns...anxiety is the 
belief that mental health is  primary etiological 
living without anxiety.’  Normal Pathological phenomenon.’ 
May (1977) pxiv May (1977) p231

‘Whoever has learnt to be  ‘Anxiety then makes the 
anxious in the right way has  individual impotent.’ 
learnt the ultimate.’ Kierkegaard (1944 ) pxii
Kierkegaard (1844) p155 Instructive Destructive

‘Neurotic anxiety is 
‘Anxiety is the 
characterised by persistent 
metaphysical fear of 
nervous system tension 
choice.’ Jaspers (1944) Metaphysical Embodied and arousal.’ 
Barlow (2002) p66

‘Anxiety consists intrinsically  ‘Anxiety is not diffuse but 
of that inability to know from  is related to specific 
whence danger threatens.’  fears.’ Beck & Emery (1985) 
Goldstein (1939)  p292 Diffuse Focused p 14

‘..existential anxiety is the 
‘Neurosis may be called a 
sine qua non of true 
negating of possibilities; it 
vitality.’
is the shrinking of one’s 
van Deurzen (1998) p 10 Promotes 
Promotes growth world.’  May (1977) p381
shrinkage

‘Original anxiety can awaken  ‘....life brings acute anxiety 
in existence at any moment.  whenever their basic 
It needs no unusual event to  security is threatened.’ 
rouse it.’  Heidegger (1962) p35 Periodic van Deurzen(2002) p35
Daily struggle
extremes
‘The existential approach does  ‘..eliminate fear and 
not seek to eliminate but  anxiety by opposing them 
rather to free anxiety.’ with positive emotions.’  
van Deurzen (2002 ) p 61 Wolpe (1958) p17
To be embraced To be eliminated

‘Anxiety is always to be  ‘Pathological 
understood as oriented  anxiety..impels towards a 
towards freedom’,  security which is 
Kierkegaard (1884) p 143 Oriented towards  Oriented towards  comparable to...a prison.’  
freedom safety Tillich (1980)

   
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 What is the difference between Existential Anxiety and so called Neurotic Anxiety? 
December 18, 2010 
 
Figure 2

Existential 
Anxiety

Normal 
Anxiety

Individual’s 
Individual 
Response
Response
• Sensitivity to
anxiety        
(Spielberger, 2005)
• Life events, 
Successful  values and  Unsuccessful 
meanings
Negotiation (Baumeister,     Negotiation
1991)
• Internal   
conflicts 
(Tillich, 1980)
• Paradoxes
(van Deurzen, 
1998)
• Actualising 
capabilities Resistances Defence 
(May, 1977) Bugental (1981) Mechanisms
Yalom (1980)

Neurotic
Anxiety

Growth
May (1977)
Vitality
van Deurzen (1998)
Choice Stagnation
Kierkegaard(1944) May (1977)
Creativity Vulnerability
Spinelli (2007) (van Deurzen, 2002)
Constriction
(Keirkegaard, 1944)

   
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