In the clinical presentation of anxiety disorders, there is a particular pattern that can be especially challenging to address.
Patients often lack awareness of their own symptoms, deny being anxious, and resist any attempt to change.
They may insist that the problem lies in other people’s misunderstanding of them, rather than in their own condition.
At the same time, they frequently depend heavily on reassurance and protection from others, sometimes deriving comfort from appearing vulnerable.
For family members or friends, excessive sympathy may not help. Instead, it can lead to emotional contagion, where the caregiver gradually absorbs the same anxiety and becomes distressed themselves.
🔹 Scientific Basis
1. Lack of Insight
Many patients with anxiety disorders show poor insight, meaning they do not recognize their symptoms as a psychological disorder. Instead, they may see them as personality traits or simply as normal stress.
Research shows that individuals with generalized anxiety disorder (GAD) often underestimate the severity of their condition and attribute it to external stressors rather than an internal problem.
2. Resistance to Change
According to the Transtheoretical Model of Change (Prochaska & DiClemente), individuals in the precontemplation stage do not believe they have a problem and therefore reject treatment or lifestyle changes. This resistance is common in some anxiety patients, making intervention difficult.
3. Dependence on Comfort and Secondary Gain
Some patients unconsciously use anxiety symptoms as a way to gain care or protection.
This is known as secondary gain, where the illness provides hidden psychological or social benefits (such as extra attention or avoidance of responsibility).
In addition, people with dependent personality traits may seek comfort and protection by portraying themselves as helpless, thereby reinforcing the cycle of dependence.
4. Emotional Contagion
Anxiety is highly “contagious.”
Studies in psychology show that emotions spread quickly through tone of voice, facial expressions, and body language.
Caregivers and close family members of anxious patients are at risk of developing caregiver burden and even sharing the same anxious mood.
✅ Conclusion
The pattern of denying anxiety, resisting change, depending on others’ reassurance, and transmitting anxiety to those around them is not just anecdotal. It is supported by well-established findings in psychology and psychiatry. Recognizing these mechanisms helps both patients and caregivers approach anxiety more constructively—by setting boundaries, maintaining perspective, and seeking professional help when needed.
📚 References
- O’Leary, K., Dour, H., Smits, J., & Meuret, A. E. (2017). Insight in anxiety disorders: Relationship with symptom severity and functioning. Journal of Affective Disorders, 207, 221–227.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.
- Westra, H. A. (2011). Managing resistance in cognitive behavioural therapy: The application of motivational interviewing in mixed anxiety and depression. Cognitive Behaviour Therapy, 40(3), 161–173.
- Fishbain, D. A. (1994). Secondary gain concept: Definition problems and its abuse in medical literature. American Pain Society Journal, 3(4), 264–273.
- Bornstein, R. F. (1992). The dependent personality: Developmental, social, and clinical perspectives. Psychological Bulletin, 112(1), 3–23.
- Hatfield, E., Cacioppo, J. T., & Rapson, R. L. (1993). Emotional contagion. Current Directions in Psychological Science, 2(3), 96–100.
- Tully, E. C., & Zajac, K. (2016). Youth anxiety and parent emotion dysregulation: Emotional contagion in families. Journal of Abnormal Child Psychology, 44(6), 1073–1086.
