Download Chapter Five - Anxiety and the Anxiety Disorders

Chapter Five:
Anxiety and the Anxiety
Disorders
The Core Concepts
© 2005 John Wiley & Sons, Inc.
The Importance of Context
• Disordered anxiety occurs in contexts
in which anxiety doesn’t make sense
 Extreme anxiety in the presence of a minor
threat (as in phobias)
 Extreme anxiety when no danger is present
(as in flashbacks)
© 2005 John Wiley & Sons, Inc.
The Continuum Between
Normal and Abnormal Anxiety
• Anxiety is an expectable part of everyday life
• Pathological anxiety is on the extreme end of the
continuum for
 Trait anxiety: how anxious a person
feels in general (as in generalized
anxiety disorder) and/or
 State anxiety: how anxious a person
feels in response to specific events
(as in phobias)
© 2005 John Wiley & Sons, Inc.
The Advantages the DSM-IV-TR Anxiety
Disorder Diagnoses
• Strong reliability
 Anxiety disorder diagnoses are
likely to be applied consistently
• Strong validity
 Anxiety disorder diagnoses are
likely to be applied accurately
© 2005 John Wiley & Sons, Inc.
The Limitations of the DSM-IV-TR
Anxiety Disorder Diagnoses
• High Comorbidity
 20%-82% of people with an anxiety disorder warrant
at least one other DSM-IV-TR diagnosis
• Applying an anxiety disorder diagnosis may
 Artificially divide complex
clinical conditions
 Arbitrarily emphasize anxiety
symptoms over other relevant
symptoms
© 2005 John Wiley & Sons, Inc.
Classification in
Demographic Context - Age
• Adults tend to describe anxiety in terms of their
emotional experience
• Children often exhibit anxiety behaviorally (or
through physical symptoms
• Children are not always bothered
by their anxiety symptoms
• Anxiety disorders are
underdiagnosed among
older adults
© 2005 John Wiley & Sons, Inc.
Classification in
Demographic Context - Gender
• Five out of six of the anxiety disorders are 2-3
times more common in women
• OCD occurs equally in women and men
• Gender disparity explanations:
 Differences in socialization
 Genetic vulnerabilities
 Hormonal differences
 Women experience higher
rates of victimization
© 2005 John Wiley & Sons, Inc.
Classification in
Demographic Context - Class
• People living in poor, urban environments
are at heightened risk for PTSD because
they are:
 More likely to experience trauma
 More likely to have additional risk
factors for PTSD (low social support,
high psychological stress)
• The impoverished are also at heightened
risk for GAD
© 2005 John Wiley & Sons, Inc.
Cultural Relativism in
Defining and Classifying Anxiety
• The expression of anxiety is culturally relative
 Nervios: Generalized anxiety symptoms in Latino
populations (often with somatic features)
 Ataque de nervios: Panic symptoms in Latino populations
(often with behavioral features)
 Shenjing shuairuo: Mixed anxiety,
mood, and physical symptoms in
Chinese populations
 Taijin kyofusho: Social phobia
symptoms in Japanese populations
(focus on bodily appearance
or functioning)
© 2005 John Wiley & Sons, Inc.
Historical Relativism in
Defining and Classifying Anxiety
• PTSD not recognized by the DSM until
1980 (in the DSM-III)
 PTSD symptoms generally seen as signs of
malingering or cowardice during the American
Civil War and both World Wars
 PTSD ultimately added to the DSM in
response to research and clinical knowledge
gained from
Vietnam War veterans
© 2005 John Wiley & Sons, Inc.
The Multiple Causality
of Anxiety Disorders
• Cognitive and behavioral components are often
combined to explain and treat anxiety disorders
 Maladaptive cognitions are often reinforced by
maladaptive behaviors
 Cognitive-behavioral interventions are
especially effective for treating OCD
and panic disorder
• Many theoretical perspectives
emphasize facing fears in order to overcome
them
© 2005 John Wiley & Sons, Inc.
The Connection
Between Mind and Body
• The HPA axis:
 Regulates the release of stress hormones
 May be damaged by sustained stress during critical
developmental periods
 HPA damage may lead to chronic anxiety
• PTSD appears to be related to changes in the
hippocampus and Broca’s area
• Psychotherapy for OCD appears to
have same neural effects as
medications for OCD
© 2005 John Wiley & Sons, Inc.