Is It Anxiety? Depression? Or Anxious Depression?
- 6 days ago
- 4 min read
Anxiety and depression are two of the most prevalent conditions and two of the biggest causes of disability worldwide. Perhaps unsurprisingly, it is estimated that roughly 50% of people diagnosed with depression also experience an anxiety disorder. The combination of both anxiety and depression take multiple different forms and, although it is not a formal diagnosis, many people express what seems not to be two distinct conditions – anxiety and depression – but a more layered kind of anxious depression.
What is Anxious Depression?
Anxious depression is characterized by anxiety arising from a fear that one’s perceived inadequicies or sources of unhappiness will persist or worsen. For example, someone who is depressed might think “I feel terrible and nothing seems to matter anymore.” Someone with anxiety might think, “Did I say something weird back there?” Someone with anxious depression might think “I’m alone, everyone else is moving forward with their lives, and if I don’t find someone soon, I’m going to end up alone forever. I’m such a loser”. The key feature in anxious depression that distinguishes it from just anxiety is that it is not solely a worry or fear, but a fear rooted in self-hatred or a negative view of oneself and one’s life.
Obviously, a common way anxious depression manifests is through what is known as “imposter syndrome.” Imposter syndrome occurs when one fears that they will be found out as a fraud, that they aren’t actually as smart or as capable as they have made themselves out to be and that when their boss, or love interest, or friends find out, they will be fired, hated, ignored, or ostracized. Imposter syndrome involves not only a persistent fear, but a negative self-assessment. The person isn’t worried that something bad might happen, they worry that it will happen because they are fundamentally inadequate. The anxiety one feels then becomes evidence for the painful conclusion that they that they are not good enough and do not deserve what they have.
When Anxiety and Depression Feed One Another
One of the most common patterns we see in therapy is a person whose anxiety is organized around protecting themselves from their own depressive beliefs. The constant culture of achievement and work in New York City is a breeding ground for this kind of intense anxious depression and we see it often in teenagers in overly demanding high-schools and high-achieving people with demanding careers. It is so common that likely know someone (or are that someone) that meets the description: Imagine someone who is constantly working, who believes that unless they are being productive they are worthless, who works relentlessly and is constantly monitoring their performance.
On the surface, that can look like anxiety, but it is motivated by a belief that nobody cares about them, but only what they produce. This kind of view can (at times) motivate people to do great things, but at a terrible expense that doesn’t need to be paid.
The same pattern appears in relationships: Imagine the friend who obsesses over every text message, repeatedly needs reassurance, and always needs you to spend hours figuring out whether they said the wrong thing on a date. Because the energy behind these behaviors is so clearly driven by uncertainty and fear, they can appear to be just a strong form of anxiety, but it is just as often a belief that they are worthless or unlovable, that they will be abandoned unless they can please the other person.
The Need to Matter
Psychologists have long observed that people differ in what they believe they must achieve in order to feel worthwhile: For some, self-esteem is organized around their relationships, for others, it is organized around achievement.
Aaron Beck and Sidney Blatt argued that these are two common pathways into depression. Blatt described one pattern as anaclitic (or sociotropic), in which self-worth depends heavily on belonging and a feeling like one is accepted. Such people may become intensly anxious about rejection because relationships are experienced as the foundation of their identity, and so rejection says something, not just about compatibility, but about who they are as a person.
Others develop a more introjective (or autonomous) style. Here, self-worth depends less on being loved than on success or being accomplished. Criticism, even when it is inevitable, or falling short of impossibly high standards, are experienced as threats to one’s identity.
Although these patterns look very different, they often produce a similar cycle: anxiety develops because there is something to protect (the relationship/the quality of one’s work) that is freighted with the weight of staving off depressive feelings (that one is unlovable/that one is worthless).
Jennifer Crocker's research on contingent self-worth reaches a remarkably similar conclusion. The more our self-esteem depends upon external achievements, approval, attractiveness, or success, the more psychologically fragile it is. Confidence no longer comes from a stable sense of self but from continually obtaining evidence that we matter. Every setback therefore carries emotional consequences far beyond the event itself.
This also helps explain why anxiety and depression often appear together. Anxiety motivates relentless efforts to secure self-worth. Depression emerges when those efforts no longer seem capable of succeeding.
Therapy for Depression, Therapy for Anxiety, Therapy for Anxious Depression at Lexington Park Psychotherapy
When anxiety and depression occur together, treatment involves more than deciding which diagnosis fits best. Our therapists look beyond diagnosis, asking “What is the anxiety for? What is it trying to prevent? What does it communicate about the way you see the world?”
Rather than focusing only on reducing worry or improving mood, effective therapy begins exploring the assumptions that make those worries so emotionally compelling. Why does making a mistake feel unbearable? Why does a disappointing date become evidence that you will always be alone? Why does slowing down immediately provoke guilt? Why has your sense of worth become so dependent on achievement, approval, or being needed by others?
As these questions become clearer, treatment becomes more precise and change becomes easier. Rather than simply teaching strategies to manage symptoms, psychotherapy helps people develop a more stable sense of self—one that is less dependent upon constant success, reassurance, or external validation. As that foundation becomes stronger, both the anxiety that drives relentless striving and the depression that follows perceived failure often begin to loosen their grip.
