Ch. 18 Section 2: Anxiety Disorders Obj: Describe the anxiety disorders.

Anxiety refers to a general state of dread or uneasiness that occurs in response to a vague or imagined danger. It differs from fear, which is a response to a real danger or threat. Anxiety is typically characterized by nervousness, inability to relax, and concern about losing control. Physical signs and symptoms of anxiety may include trembling, sweating, rapid heart rate, shortness of breath, increased blood pressure, flushed face, and feelings of faintness or light-headedness. All are the result of overactivity of the sympathetic branch of the autonomic nervous system.

Everyone feels anxious at times-for example, before a big game or an important test. In such situations, feeling anxious or worried is an appropriate response that does not indicate a psychological disorder. However, some people feel anxious all or most of the time, or their anxiety is out of proportion to the situation provoking it. Such anxiety may interfere with effective living, the achievement of desired goals, life satisfaction, and emotional comfort. When these problems occur, anxiety is considered a sign of a psychological disorder. Anxiety based disorders are among the most common of all psychological disorders in the US.

Types of Anxiety Disorders Anxiety disorders classified in the DSM-IV include phobic disorder, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and stress disorders. A description of each follows.

Phobic Disorder – The word phobia derives from the Greek root phobos, which means “fear.” Simple phobia, which is the most common of all the anxiety disorders, refers to a persistent excessive or irrational fear of a particular object or situation. To be diagnosed as a phobic disorder, the fear must lead to avoidance behavior that interferes with the affected person’s normal life.

When people with simple phobias are confronted with the object or situation they fear, they are likely to feel extremely anxious. As a result, they tend to avoid what they fear. For example, someone with hematophobia (a fear of blood) might avoid needed medical treatment. Thus, although most people with simple phobias never seek treatment for their disorders, a simple phobia can seriously disrupt a person’s life.

Social phobia is characterized by persistent fear of social situations in which one might be exposed to the close scrutiny of others and thus be observed doing something embarrassing or humiliating. Some people with social phobias fear all social situations; others fear specific situations, such as public speaking, eating in public, or dating. People with social phobias generally try to avoid the situations they fear. They may invent excuses to avoid going to parties or other social gatherings, for example. If avoidance is impossible, the situations are likely to cause great anxiety. In addition, the avoidance behavior itself may greatly interfere with work and social life.

Panic Disorder and Agoraphobia – people with panic disorder have recurring and unexpected panic attacks. A panic attack is a relatively short period of intense fear or discomfort, characterized by shortness of breath, dizziness, rapid heart rate, trembling or shaking, sweating, choking, nausea, or other distressing physical symptoms. It may last from a few minutes to a few hours. People having a panic attack may believe they are dying or “going crazy.” Not surprisingly, they usually have persistent fears of another attack.

For most people who suffer panic disorder, attacks have no apparent cause. However, many people with panic disorder also have agoraphobia. Agoraphobia is a fear of being in places or situations in which escape may be difficult or impossible. People with agoraphobia may be especially afraid of crowded public places such as movie theaters, shopping malls, buses, or trains. Agoraphobia is a common phobia among adults. In fact, according to the DSM-IV, people with one or both disorders make up about 50 to 80 percent of the phobic individuals seen in clinical practice.

Most people with agoraphobia have panic attacks when they cannot avoid the situations they fear. They are afraid they will have a panic attack in a public place, where they will be humiliated or unable to obtain help. Panic disorder and agoraphobia both lead to avoidance behaviors. These behaviors can range from avoiding crowded places to never leaving home at all. Thus, these phobias can be very serious.

Generalized Anxiety Disorder – according to the DSM-IV, generalized anxiety disorder (GAD) is an excessive or unrealistic worry about life circumstances that lasts for at least six months. The worries must be present during most of that time in order to warrant a diagnosis of GAD. Typically, the worries focus on finances, work, interpersonal problems, accidents, or illness. GAD is one of the most common anxiety disorders, yet few people seek psychological treatment for it because it does not differ, except in intensity and duration, from the normal worries of everyday life. It is difficult to distinguish GAD from other anxiety disorders as well, most often phobic disorders.

Obsessive-Compulsive Disorder – Among the most acute of the anxiety disorders is obsessive-compulsive disorder (OCD). Obsessions are unwanted thoughts, ideas, or mental images that occur over and over again. They are often senseless or repulsive, and most people with obsessions try to ignore or suppress them. The majority of people with obsessions also practice compulsions, which may reduce the anxiety their obsessions produce. Compulsions are repetitive ritual behaviors, often involving checking or cleaning something.

The following examples are typical of people with OCD The following examples are typical of people with OCD. One person is obsessed every night with doubts that he has locked the doors and windows before going to bed. He feels driven to compulsively check and recheck every door and window in the house, perhaps dozens of times. Only then can he relax and go to sleep. In another example, a team of researchers reported the case of a woman who was obsessed with the idea that she would pick up germs from nearly everything she touched. She compulsively washed her hands over and over again, sometimes as many as 500 times a day.

People who experience obsessions are usually aware that the obsessions are unjustified. This distinguishes obsessions form delusions. Although obsessions are a sign of a less serious psychological disorder than delusions, they still can make people feel extremely anxious, and they can seriously interfere with daily life. Compulsions may alleviate some of the anxiety associated with obsessions, but the compulsions themselves are time-consuming and usually create additional interference with daily life.

Stress Disorders – Stress disorders include post-traumatic stress disorder (PTSD) and acute stress disorder. The two disorders have similar symptoms, but they differ in how quickly they occur after the traumatic event that triggers the disorder. They also differ in how long they last. Post-traumatic stress disorder refers to intense, persistent feelings of anxiety that are caused by an experience so traumatic that it would produce stress in almost anyone. Experiences that may produce PTSD include rape, severe child abuse, assault, severe accident, airplane crash, natural disasters, and war atrocities.

It appears to be a common syndrome in people who have experienced extensive trauma. For example, more than one third of the victims of Hurricane Andrew in 1992 developed PTSD. People who suffer from PTSD may exhibit any or all of the following symptoms. Flashbacks, which are mental reexperiences of the actual trauma Nightmares or other unwelcome thoughts about the trauma Numbness of feelings Avoidance of stimuli associated with the trauma Increased tension, which may lead to sleep disturbances, irritability, poor concentration, and similar problems.

The symptoms may occur six months or more after the traumatic event, and they may last for years or even decades. The more severe the trauma, the worse the symptoms tend to be. Acute stress disorder is a short-term disorder with symptoms similar to those of PTSD. Also like PTSD, acute stress disorder follows a traumatic event. However, unlike with PTSD, the symptoms occur immediately or at most within a month of the event. The anxiety also lasts a shorter time-from a few days to a few weeks. Not everyone who experiences a trauma, however, will develop PTSD or acute stress disorder.

Explaining Anxiety Disorders Several different explanations for anxiety disorders have been suggested. As is true for most of the psychological disorders discussed in this chapter, the explanations fall into two general categories: psychological views and biological views.

Psychological Views – for anxiety disorders, as well as the other disorders discussed later in this chapter, psychoanalytic views are presented even though they are no longer widely accepted. These views are included because they influenced later theories and had a major impact on the classification of psychological disorders until recently, as discussed earlier.

According to psychoanalytic theory, anxiety is the result of “forbidden” childhood urges that have been repressed, or hidden from consciousness. If repressed urges do surface, psychoanalysts argue, they may do so as obsessions and eventually lead to compulsive behaviors. For example, if one is trying to repress “dirty” sexual thoughts, then repetitive hand washing may help relieve some of the anxiety.

Learning theorists believe that phobias are conditioned, or learned, in childhood. This may occur when a child experiences a traumatic event – such as being lost in a crowd or frightened by a bad storm – or when a child observes phobic behavior in other people. If a parent screams or faints when a child picks up a spider, for example, the child may learn that spiders are things to be feared and develop a fear of them. Learning theorists argue that such conditioned phobias may remain long after the experiences that produced them have been forgotten.

Learning theorists also believe that people will learn to reduce their anxiety by avoiding the situations that make them anxious. For example, a student who feels anxious speaking in front of others in class may learn to keep quiet because it reduces his or her feelings of anxiety. However, by intentionally avoiding the anxiety-producing behavior, the student has no chance to learn other ways of coping with or unlearning the anxiety. As a result, the anxiety may worsen or be generalized to other situations that involve speaking in front of others. Cognitive theorists, on the other hand, believe that people make themselves feel anxious by responding negatively to most situations and coming to believe they are helpless to control what happens to the. This creates great anxiety.

Biological Views – Research indicates that heredity may play a role in most psychological disorders, including anxiety disorders. For example, one study showed that if one pair of identical twins exhibited an anxiety disorder, there was a 45 percent chance that the other twin would also exhibit the disorder. This was true even of twins raised in different families. By contrast, the chances of fraternal twins both developing anxiety disorders was only about 15 percent. Similarly, adopted children are more likely to have an anxiety disorder if a biological parent has one than if an adoptive parent does. Both types of studies suggest that genes play at least some role in the development of anxiety disorders.

How did genes get involved How did genes get involved? Some psychologists believe that people get involved? Some psychologists believe that people are genetically inclined to fear things that were threats to their ancestors. These psychologists argue that people who rapidly acquired strong fears of real dangers – such as large animals, snakes, heights, and sharp objects – would be more likely to survive and reproduce. To the extent that the tendency to develop such fears is controlled by genes, they conclude, the tendency would be passed on to future generations, causing the disorders to be relatively common today.

Interaction of Factors – Some cases of anxiety disorder may reflect the interaction of biological and psychological factors. People with panic disorder, for example, may have a biologically based tendency to overreact psychologically to physical sensations. The initial physical symptoms of panic – such as rapid heart rate and shortness of breath – cause these people to react with fear, leading to even worse panic symptoms. They may think they are having a heart attack and experience severe psychological stress. Anxiety about having another panic attack becomes a psychological disorder itself – one that originated in a biological reaction.

Regardless of their cause, anxiety disorders are both common and disabling. In serious cases, they lead to tremendous restrictions and limitations in lifestyle, relationships, and work. They can also lead to great personal distress. Fortunately, most people who suffer from anxiety disorder respond well to treatment.