Anxiety Disorders and Emotional Disturbances

Individual Differences in Reacting to Unknown Situations

• Variation in Response: Individuals vary significantly in their reactions to novel and ambiguous situations. This difference is often illustrated through the metaphor of discovering a cave entrance while on a walk.

• The Cave Metaphor: If you encounter a dark cave entrance and have only a small flashlight, your reaction defines your placement on the spectrum of avoidance versus approach. Questions to consider include:

  • Would you enter the cave at all?

  • How far would you venture inside?

  • At what speed would you move?

• Amygdala Damage and Approach Tendency: According to Harrison et al. (2015), people with damage to the amygdala (a concept tied to Lecture 6) exhibit a very strong approach tendency. These individuals demonstrate almost no avoidance tendency, even in potentially dangerous or unknown scenarios.

• Anxiety Disorders and Avoidance: At the opposite extreme are individuals with anxiety disorders. They exhibit fearful avoidance, which often extends even to familiar and harmless situations.

• Normality vs. Abnormality: While being cautious in uncertain or ambiguous situations is considered a normal survival mechanism, a critical question in psychology is determining the exact point at which this caution becomes abnormal.

Understanding Anxiety Disorders in the DSM

• Scope of Anxiety Disorders: The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists more than a dozen psychological disorders where excessive anxiety serves as the primary symptom.

• Generalized Anxiety Disorder (GAD):

  • Characterization: GAD is defined by almost constant nervousness and intense worry.

  • Focus of Worry: Individuals worry about health, finances, their job, and even minor matters such as car repairs or household chores.

  • Ambiguity of Source: Frequently, people suffering from GAD are not even sure what specifically they are worried about.

  • Physical and Emotional Toll: These constant worries lead to symptoms such as irritability, restlessness, and fatigue.

  • Comorbidity: Because anxiety is a symptom across many conditions, most individuals diagnosed with GAD qualify for additional psychological diagnoses (Bruce et al., 2001).

• Panic Disorder:

  • Symptomatology: Characterized by repeated panic attacks involving a sharply increased heart rate, rapid breathing, sweating, trembling, and chest pains.

  • Distinction from Panic Attacks: Having a panic attack does not automatically result in a diagnosis of panic disorder; the disorder is defined by the frequency of attacks and the persistent fear of future episodes.

  • Anticipatory Anxiety: People with panic disorder live in frequent anticipation of having another attack, which often triggers secondary conditions.

• Agoraphobia:

  • Definition: This involves the excessive avoidance of public situations where having a panic attack might be embarrassing or where escape might be difficult.

  • Cognitive Loop: The thought "I might be starting to have a panic attack" can trigger an excessive emotional response. This reinforces the individual's appraisal of the situation as dangerous (linking back to Lecture 1 regarding the connections between emotions and appraisals).

Specific Phobias

• Definition: A specific (or simple) phobia is an excessive fear of a particular object or situation.

• Demographics: Phobias are most commonly diagnosed in young people and are more prevalent among women than among men, a pattern similar to panic disorder.

• Common Targets: Most phobias involve items that possess an inherent degree of danger, such as snakes or spiders.

• Criteria for Phobia: The defining feature of a phobia is not necessarily that the fear is unrealistic, but that it is exaggerated and significantly interferes with the person's daily life.

  • Example 1: Being unable to ride an elevator due to a fear of enclosed spaces.

  • Example 2: Being unable to enjoy nature due to a fear of snakes.

• Theoretical Explanations:

  • Evolutionary Predisposition: Humans may be born with a biological predisposition to fear certain stimuli like snakes, spiders, or lightning (Ohman, 2009).

  • Uncontrollability: Another explanation posits that humans fear dangers that they perceive as uncontrollable.

Posttraumatic Stress Disorder (PTSD)

• Definition: PTSD occurs when an individual fails to readjust their anxiety levels after moving from a high-stress, dangerous environment to a safe one.

• Traumatic Triggers: Common events leading to PTSD include:

  • War zones.

  • Physical or sexual assaults.

  • Serious accidents.

  • Natural disasters.

• Behavioral Manifestations (e.g., Soldiers): Soldiers returning from war may remain in a state of high tension, reacting to every sight and sound as a potential threat. Symptoms include strong startle responses, light sleeping, frequent nightmares, and waking up ready to fight at the slightest noise.

• Fear Conditioning: PTSD is linked to fear conditioning, where neutral stimuli (specific sounds or smells) become associated with the earlier trauma, triggering a full fear response later.

• Necessity vs. Sufficiency: By definition, a traumatic experience is a necessary condition for PTSD, but experiencing trauma is not always sufficient on its own to cause the disorder in everyone.

Etiology: What Causes Anxiety Disorders?

• Classical Conditioning: Many phobias are developed through classical conditioning, famously demonstrated by Watson & Rayner (1920) in the "Little Albert" fear conditioning study.

• Heredity: There is a genetic component; individuals with anxiety disorders are likely to have biological relatives who suffer from similar conditions.

• Serotonin and the Amygdala: Researchers like Li et al. (2015) focus on genes regulating serotonin, which influences the amygdala.

  • Short Form Gene: People with the short form of this serotonin-regulating gene show increased attention to threatening stimuli and heightened amygdala responses to photographs of angry or fearful faces (Hariri et al., 2002).

  • Learning Speed: These individuals learn fears more quickly if a cue predicts a shock or other danger (Lonsdorf et al., 2009).

• Epigenetics: This involves differences in gene expression caused by environmental conditions rather than changes to the inherited DNA sequence itself.

• Family Environment:

  • Abuse: Sexually abused children are statistically more likely to develop fear-related disorders (Friedman et al., 2002) and depression (Nelson et al., 2002).

  • Neglect: Children who suffer from neglect are also at significant risk for developing these disorders (Berntsen et al., 2012).

Treatment Methods for Anxiety Disorders

• Cognitive Behavioral Therapy (CBT):

  • Focus: Reinterpreting or reappraising situations, practical problem-solving, and relaxation techniques.

  • Effectiveness: CBT has been shown to reduce anxiety and improve quality of life across most cases (Cuijpers et al., 2014; Hofmann et al., 2014).

• Exposure Therapy (Systematic Desensitization):

  • Procedure: Gradual exposure to the feared object or situation. While a patient may feel terror initially, the body begins to relax when no harm occurs.

  • Outcome: As the patient becomes calmer in the presence of the fear stimulus, they gain confidence.

  • Virtual Reality (VR): Modern exposure therapy often utilizes VR devices that allow patients to view immersive scenes of their phobia in a controlled environment.

• Pharmacological Interventions:

  • Anxiolytics: These are drugs specifically designed to relieve anxiety, often referred to colloquially as tranquilizers.

  • Benzodiazepines: This is the most common biochemical class of anxiolytics.

Obsessive-Compulsive Disorder (OCD)

• DSM-5 Classification: Previously classified as an anxiety disorder, OCD is now in its own separate category because anxiety and depression are often not the primary symptoms.

• Obsessions: These are recurrent, persistent, and intrusive thoughts, images, or impulses that cause significant distress.

• Compulsions: These are repetitive behaviors (e.g., hand washing, ordering items) or mental acts (e.g., counting, repeating words) performed in response to obsessions.

• The Paradox of Compulsion: A person feels distress if they are prevented from performing the act, yet completing the compulsion does not fully relieve the original distress.

• Disgust and Contamination: Many OCD sufferers are highly prone to feelings of disgust, particularly regarding contamination (Pauls et al., 2014).

• Thought-Action Fusion: Many with OCD believe that thinking about a shameful act is morally equivalent to performing it (Cough et al., 2013).

• The Cycle of Avoidance: Efforts to avoid a thought often make it more intrusive, leading to repetitive rituals intended to maintain rigid self-control (e.g., "If I keep doing this, then I won't do that other terrible thing").

Antisocial Personality Disorder (APD)

• Emotional Insufficiency: While other disorders involve too much emotion, APD is characterized by a lack of emotion.

• Lack of Empathy and Guilt: Most people feel anxious or guilty when imagining hurting someone; those with APD do not. They also fail to imitate the facial expressions of sad or frightened people (Lishner et al., 2015).

• Behavioral Traits: APD behavior is described as deceitful, impulsive, aggressive, and irresponsible. It includes a reckless disregard for safety (self and others) and a total lack of remorse (Black, 2015).

• Terminology: APD symptoms overlap with psychopathy and sociopathy, though the latter two are not officially recognized DSM disorders.

• Neurological Markers: The amygdala and prefrontal cortex in individuals with APD show significantly reduced responses when witnessing others suffering (Thompson et al., 2014).

Other Disorders with Emotional Disturbances

• Borderline Personality Disorder: Marked by extreme emotional volatility, impulsivity, and extremely poor skills in emotion regulation (Lieb et al., 2004).

• Autism: Characterized by deficits in the ability to recognize the emotional expressions of others (Clark et al., 2008).

• Schizophrenia: Often involves "flat affect" (low outward emotional expression). However, these individuals often report experiencing normal levels of subjective internal emotion (Kring et al., 1993).

• Substance Abuse: Alcohol is frequently used as a tool to regulate emotions (Sher & Grekin, 2007). Alcoholism and drug abuse often follow the same familial patterns as depression (Dawson & Grant, 1998).

The Dimensional View of Psychopathology

• Diagnostic Difficulty: Many symptoms (e.g., sleep disruption, distractibility) overlap across multiple disorders, making "clean" diagnoses difficult for practitioners.

• Categories vs. Dimensions: Insel et al. (2010) proposed that researchers should move away from rigid categories and instead view psychopathology as continuous dimensions.

• The Dimensional Approach: In this model, a psychiatric disorder is not something you either "have" or "don't have" (like a physical infection). Instead, it is a series of problems that occur to varying degrees.

• Continuous Dimensions to Measure:

  • Degree of sad mood.

  • Reward insensitivity.

  • Anxiety levels.

  • Sleep disturbance.

  • Inability to concentrate.

  • Disordered thinking.

• Research Benefits: By studying symptoms within the general population rather than through complex DSM criteria, researchers may better identify the root causes of specific dysfunctions (Cuthbert & Insel, 2013). Kring (2010) suggests this approach is particularly useful for symptoms involving emotion.

Bibliography

• Source Material: Shiota, M., & Kalat, J.W. (2018). Emotion (3rd ed.). Oxford University Press.

• Focused Reading: Chapter 14.