MODULE 31 Anxiety & Mood Disorders

“The act of birth is the first experience of anxiety, and thus the source and prototype of the affect of anxiety.” - Sigmund Freud

“A crust eaten in peace is better than a banquet partaken in anxiety.” - Aesop

“Anxiety is love's greatest killer. It makes others feel as you might when a drowning man holds on to you. You want to save him, but you know he will strangle you with his panic.” - Anais Nin

“Every man has his secret sorrows which the world knows not; and often times we call a man cold when he is only sad.” - Henry Wadsworth Longfellow

“Concern should drive us into action, not a depression.” - Karen Horney

“My depression is the most faithful mistress I have known — no wonder, then, that I return the love.” - Soren Kierkegaard

Anxiety Disorders Anxiety: vague feeling of apprehension or nervousness – Most people experience general feelings of anxiety – Anxiety disorders are different; anxiety, or effort to control it, begins to take control and dominate life – Quality of life suffers, unhappiness increases

Generalized anxiety disorder: characterized by disruptive levels of persistent, unexplained feelings of apprehension and tenseness Panic disorder: characterized by sudden bouts of intense, unexplained anxiety, often associated with physical symptoms like choking sensations or shortness of breath Phobia: characterized by disruptive, irrational fears of objects, activities, or situations

Obsessive-compulsive disorder (OCD): characterized by unwanted, repetitive thoughts and actions Post-traumatic stress disorder (PTSD): characterized by reliving a severely upsetting event in unwanted, recurring memories and dreams

Generalized Anxiety Disorder & Panic Disorder Generalized anxiety disorder: – No dramatic symptoms – Symptoms last longer and are not attached to any specific event – Symptoms (must have at least 3): restlessness, feeling “on edge”, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance

Panic disorder: – Panic attacks: episodes of unexplained terror and fear that something bad is going to happen – Can last several minutes and occur several times a day – Often accompanied by physical symptoms: choking sensations, shortness of breath

Phobia Phobia: fear that is both irrational and disruptive – Phobias focus general feelings of anxiety onto a feared object, activity, or situation – Social phobias: produce fear of social situations – Agoraphobia: fear of situations the person views as difficult to escape from if panic strikes

Obsessive-Compulsive Disorder Obsessions: repetitive thoughts Compulsions: repetitive actions – Both can be helpful sometimes – Helpful tendencies become OCD when they take control of one’s life – If people are prevented from engaging in rituals, anxiety and panic build

Post-Traumatic Stress Disorder Triggered by intense stress Symptoms: nightmares, persistent fear, difficulty relating normally to others, troubling memories or flashbacks to traumatic event Common for military combat veterans, rape victims, abused children, rescue workers Children particularly vulnerable – Feelings of hopelessness, inability to trust

Causes of Anxiety Disorders Biological factors: – Heredity, brain function, evolution Learning factors – Conditioning, observational learning, reinforcement

Biological Factors Heredity: inherited predisposition, or likelihood, for developing anxiety disorder – Identical twins studies; separated twins sometimes have similar phobias – Inherit predispositions from parents – 17 genes with connections to anxiety disorder symptoms have been identified thus far

Brain function: people with anxiety disorders have brains that function differently – People with OCD: higher activity in frontal lobes (decision making) – People with phobias have higher activity in amygdala (emotional control center)

Evolution: fear situations that posed danger to earliest humans – Those who feared these dangers survived, and passed on fears to us Dark, falling, loud noises, snakes, etc. – We do not have inherited tendency to fear threats that have developed more recently

Learning Factors Conditioning: – Fear, anxiety can be learned unintentionally through conditioning – Caused by unpredictable and uncontrollable bad events

Observational learning: children can learn fears from watching parents and/or siblings Reinforcement: we learn to associate emotions with actions and their results – Avoid things that trigger fear, anxiety

Mood Disorders Mood disorders are disturbances of emotions – Magnifications of our normal reactions Magnified states: mania and depression – Mania: period of abnormally high emotion and activity – Depression: period of intense sadness

Major Depressive Disorder Major depressive disorder: mood disorder in which a person, for no apparent reason, experiences at least two weeks of depressed moods, diminished interest in activities, and other symptoms, such as feelings of worthlessness – Most common disability in the world – Affects 6% of men, 10% of women

For major depressive disorder, at least 5 of 9 of the following symptoms must exist: (1)Depressed mood most of the day, nearly every day (2)Little interest or pleasure in almost all activities (3)Significant changes in weight or appetite (4)Sleeping more or less than usual (5)Agitated or decreased level of activity

(6) Fatigue or loss of energy (7) Feelings of worthlessness or inappropriate guilt (8) Diminished ability to think or concentrate (9) Recurrent thoughts of death or suicide * Symptoms must also produce distress or impaired functioning

Bipolar Disorder Bipolar disorder: mood disorder (formerly called manic-depressive disorder) in which the person alternates between the hopelessness of depression and the overexcited and unreasonably optimistic state of mania – Less common than major depressive disorder, but more devastating effect on people’s ability to function

– Manic phases: Long periods without sleeping Racing thoughts, easily distracted Setting impossible goals – Moods follow cyclical patterns – Mania sometimes associated with bursts of creative energy

Causes of Mood Disorders Interaction of biology and environment Stress may also play a role as a trigger that can spark mood disorder if other factors are present

Biological Factors Heredity: – Fraternal twins: if one twin has major depressive disorder, other twin has 20% chance of developing depression – For identical twins, chances are 50% – If one identical twin has bipolar disorder, other twin has 70% chance of getting it

Brain function: – Positive emission tomography (PET) scans show brain is less active during major depression, particularly in frontal lobes – Neurotransmitters such as serotonin and norepinephrine are shown to be lacking Levels may be controlled by genes Antidepressants can help restore proper levels

Social-Cognitive Factors Learned helplessness: – People develop sense of helplessness when subjected to events over which they have no control – They give up and no longer try to improve situation – This alone can cause depression – Explanation for higher depression rates for women?

Attributions: – When things go wrong, we try to explain them – Explanatory style determined by type of attributions you make

– Depressed people are likely to make attributions with the following characteristics: Stable: bad situation will last a long time Internal: situation happened because of my actions Global: explanation applies to many other areas

Biological and social-cognitive factors can interact to form a vicious cycle of depression – Heredity: predisposition Unbalanced neurotransmitters – Environment: stressful situations; little or no control Cause learned helplessness and discouragement Combine with attributions