Download Ch. 18 S. 2

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 lightheadedness. 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, obsessivecompulsive 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. 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 timeconsuming and usually create additional
interference with daily life.
• Stress Disorders – Stress disorders include posttraumatic 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 timefrom 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 anxietyproducing 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? 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.