This is an informative chapter about anxiety disorders. None of this information in here or other chapters can be used to diagnose people. Only psychiatry professions are obligated to diagnose. Psychopathology chapters are review and summary of Textbook “David H. Barlow, V. Mark Durand (2014) Abnormal Psychology: An Integrative Approach” and lecture notes.
Anxiety
An emotional state that involves fear, worry, and physiological arousal.
A feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.
Worry, concern, apprehension, apprehensiveness, uneasiness, unease, fearfulness, fear, disquiet, disquietude, inquietude, perturbation, agitation, angst, misgiving, nervousness, nerves, tension, tensenes.
Latin: Sollicitudo, anxietas, sollicitudo, metus, anxitudo, sollicitatio, trepidation, tumultus, tumultuatio, pavor, aestus, salum, anxietudo, scrupula
French: Las angoisse, La anxiété
German: Die Angst
Spanish: La ansiedad
*In anxiety disorders anxiety is the major symptom, but it takes different forms in different disorders.
Different forms of anxiety;
- Be linked to specific objects (phobic disorders)
- Be general; “free floating” (generalized anxiety disorder)
- Occur in sudden bursts; lead to panic (panic disorder)
Phobic disorders: Persistent and irrational fears of a specific object, activity or situation.
Generalized anxiety disorder: Anxiety that occurs across many situations and persists for at least 6 months.
Panic disorder: Brief periods of exceptionally intense anxiety accompanied by physical symptoms that include shortness of breath and chest pain
Symptoms of Anxiety
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To some extent, anxiety is a necessary function to survive and perform well. Graph below shows the Yerkes-Donson Law
3 point to distinguish normal vs abnormal anxiety
- The level of the anxiety.
- The justification of the anxiety.
- The consequences of the anxiety.
If anxiety interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is a marked distress about having the anxiety symptoms
Phobias
Persistent and irrational fears of specific objects, activities or situations.
Fears which have no justification in reality (fear of harmless animals).
The individual is aware of the irrationality of his or her fear, but they cannot stop being afraid.
In phobias, there is an inappropriate separation of the cognitive and emotional aspects of psychological functioning.
Phobias can lead to disruptive behavior;
- Avoiding the phobic object or situation can have unfortunate consequences.
- If the feared object or situation cannot be easily avoided, the individual may experience uncontrollable and overwhelming fear and panic
Phobic Disorders
*Agoraphobia
*Social phobia
*Specific phobias
Agoraphobia: Afraid of being in situations in which escape would be difficult or embarrassing if panic like symptoms occurred. They avoid public places, because something might happen that they cannot control and they will embarrass themselves.
Social phobia: An irrational fear that they will behave in an embarrassing way, and as a consequence they show high levels of anxiety in social situations and/or they avoid social situations. An extreme introversion or shyness
Specific phobias: All of the phobias other than agoraphobia and social phobia fears about specific objects and situations. (animals, flying, heights, injections, seeing blood etc.)
Explanations for phobias
Psychodynamic explanations: Symbolically expressed conflicts and stress. Repression and displacement.
Learning explanations: Classically conditioned fear responses.
Cognitive explanations: Incorrect beliefs about the danger posed by the phobic objects or situations.
Physiological explanations: Some individuals inherit high levels of arousal. The high levels of arousal lead to better classical conditioning. The enhanced classical conditioning increases the likelihood that the individuals will develop phobias
Treatments for phobias
*The learning approach;
Systematic desensitization: A treatment for reducing fear responses in which an individual is first taught to relax and then, while relaxed, is presented with fear-related stimuli, beginning with those that produce the least fear.
Modeling: A treatment strategy for phobias in which the fearful individual watches another person who does not show fear of the object or situation, resulting in extinction of the fear response.
*The cognitive approach;
Individuals exposed to groups of people and given cognitive training to change their incorrect beliefs. A combination of exposure and cognitive strategies.
*The physiological approach;
To block the physiological arousal and thereby block the fear, benzodiazepines and beta blockers are used.
Generalized Anxiety Disorder
Anxiety is persistent in many situations and lasts for at least 6 months. Anxiety that is not linked to any particular stimuli but instead is constantly present. Anxiety is general in nature and often difficult for the individual to explain. Uncontrollable worries
Explanations for generalized anxiety disorder
Cognitive explanations: Incorrect beliefs.
Physiological explanation: Neurological arousal and genetics. (underactivity of inhibitory neurons-GABA)
Treatments for generalized anxiety disorder
Learning approach: Learning to relax, progressive muscle relaxation training, biofeedback training.
Cognitive approach: Changing beliefs and distraction, cognitive therapy, meditation
Physiological approach: Anxiolytics
Panic Disorder
Brief periods of exceptionally intense spontaneous anxiety. Usually, last about ten minutes. Unpredictable. Can be misinterpreted as a heart attack.
Explanations for panic disorder
Psychodynamic explanation: When threatening material that is stored in the unconscious threatens to break out. (sexual and aggressive impulses)
Learning explanation: Classically conditioned anxiety responses.
Cognitive explanation: Misinterpretations and exaggerations of normal physical arousal and symptoms. Individual misinterprets that increase in arousal as a symptom of a serious medical problem (heart attack)
Physiological explanation: Overly sensitive respiratory control center in the brain stem. (This center monitors the levels of oxygen in the blood; its overreaction to low levels of oxygen can lead to a panick attack)
Treatments for panic disorder
Cognitive approach: Correcting misinterpretations and coping. Teaching to interpret the physiological changes more realistically (chest pain is not a heart attack). Convincing that they can cope (you can handle this situation). Teaching how to relax (breath deeply and slowly).
Physiological approach: Serotonin serves to inhibit the activity of the respiratory control center. SSRI’s increases the serotonin activity and decreases the sensitivity of the respiratory control center. Aerobic exercise increases the production of serotonin. Enhances cardiovascular fitness, and to process oxygen more effectively and avoid build up carbon dioxide.
Table of Contents
- Introduction and Historical Issues
Normality and abnormality in clinical psychopathology - Diagnostic Systems and Techniques
Interviews, observations and tests - Anxiety Disorders I
Symptoms of anxiety, phobic disorders, generalized anxiety disorders, panic disorder - Anxiety Disorders II
Obsessive-compulsive disorders, post traumatic and acute stress disorders. - Mood Disorders I
Major depressive disorder and dysthymia - Mood Disorders II
Bipolar disorder - Schizophrenia I
Symptoms and issues - Schizophrenia II
Explanations and treatments - Disruptive Behavior Disorders-I
(Attention Deficit/Hyperactivity Disorder) - Disruptive Behavior Disorders-II
(Conduct Disorder and Oppositional Defiant Disorder) - Pervasive Development Disorders
(Autistic Disorder, Asberger`s and other Developmental Disorders) - Elimination Disorders and Tic Disorder
- Mental Retardation
- Cognitive disorders
(Amnesia Disorders, Dementia Disorders, Delirium Disorders) - Suicide
- Substance related disorders
- Sexual Dysfunctions