Module 42: Anxiety-Related Disorders - Detailed Notes

Anxiety Related Disorders

Introduction to Anxiety

• Anxiety is a normal part of life, experienced in situations like public speaking or awaiting exam results.
• It can manifest as shyness or avoidance of social interactions.
• For most people, anxiety is not intense or persistent.
• Some individuals are more prone to fearing the unknown and perceiving threats (Gorkhan et al, 2017; Midi, 2008).
• A hyperactive danger detection system in the brain increases the risk of anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and somatic symptom disorders.

Anxiety Disorders

Overview

• Anxiety disorders involve distressing, persistent anxiety or dysfunctional anxiety-reducing behaviors.
• Social anxiety disorder causes extreme anxiety in social settings where judgment by others is possible.
• Symptoms include palpitations, tremors, blushing, and sweating in social situations.
• Avoidance of social situations can be maladaptive, preventing coping skills and leading to loneliness (And Louiek, 2017).

Types of Anxiety Disorders

• Generalized Anxiety Disorder:
  • Characterized by continual tension and uneasiness for no obvious reason.
• Panic Disorder:
  • Involves panic attacks, which are sudden episodes of intense dread, along with the fear of future attacks.
• Specific Phobias:
  • Intense, irrational fear of specific objects or situations.

Generalized Anxiety Disorder

Symptoms and Characteristics

• Excessive and uncontrollable worry that persists for six months or more.
• Physical symptoms like dizziness, sweating palms, and irregular heartbeat.
• Feelings of being on edge and shaking.
• Two-thirds of those affected are women.
• People often experience being jittery, on edge, and sleep-deprived (McLean & Anderson, 2009).
• Concentration is impaired due to constant worrying.
• Autonomic nervous system arousal may manifest as furrowed brows, twitching eyelids, trembling, perspiration, or fidgeting.
• Individuals cannot identify, relieve, or avoid their anxiety.
• Sigmund Freud described it as "free-floating" anxiety, not linked to a specific stressor.
• Often co-occurs with depression.
• Can lead to physical problems like high blood pressure.

Panic Disorder

Symptoms and Characteristics

• Intense anxiety escalates into panic attacks.
• Panic attacks are minutes-long episodes of intense fear that something horrible is about to happen.
• Symptoms include irregular heartbeat, chest pains, shortness of breath, choking, trembling, or dizziness.
• Individuals may feel hot, unable to breathe, with a racing heart, sweating, trembling, numbness, and feelings of unreality (Grez et al, 1986).
• About 3% of people have panic disorder.
• Panic attacks are recurrent and create significant worry about future attacks.
• Worrying about anxiety symptoms can amplify the symptoms themselves (Alatunji & Walletsky Taylor, 2009).
• Can lead to agoraphobia, which is the fear or avoidance of public situations where escape might be difficult.
• Smokers have at least double the risk of panic disorder (Nuts et al, 2010; Svolinski & Bernstein, 2005).
• Nicotine, being a stimulant, exacerbates anxiety.

Personal Accounts

• Kristen Stewart experienced frequent anxiety and panic attacks, which she found relief through transparency (Lapetus, 2016).
• Charles Darwin suffered from panic disorder at age 28, which led him to seclusion that helped his work.

Specific Phobias

Symptoms and Characteristics

• Persistent, irrational fear and avoidance of specific objects, activities, or situations.
• Common examples include fear of animals, insects, heights, blood, or closed spaces.
• Avoidance of triggers that provoke fear.

Examples

• A 28-year-old woman feared thunderstorms so much that she felt anxious at the mere mention of possible storms.
• She would hide from windows during a storm to avoid seeing lightning.

Defining Phobias

• An intense fear becomes a specific phobia when it provokes a compelling, irrational desire to avoid the dreaded object or situation (Depla et al, 2008).

Obsessive-Compulsive Disorder (OCD) and Related Disorders

Overview of OCD

• Obsessive thoughts are unwanted and seemingly unending.
• Compulsive behaviors are responses to those thoughts.
• OCD crosses the line between normality and disorder when it persistently interferes with everyday living and causes distress.
• Checking the door once is normal, checking it ten times is not.
• About 2% of people experience OCD at some point in their lives, often during their late teens or early adulthood (Kessler et al, 2012).
• Obsessive thoughts are irrational, haunting, and compulsive rituals are time-consuming, impairing effective functioning (Peres Vigil et al, 2018).

Common Obsessions and Compulsions

• Obsessions:
  • Repetitive thoughts.
  • Concern with dirt, germs, or toxins (40%).
  • Something terrible happening (fire, death, illness) (24%).
  • Symmetry, order, or exactness (17%).
• Compulsions:
  • Repetitive behaviors.
  • Excessive handwashing, bathing, toothbrushing, or grooming (85%).
  • Repeating rituals (46%).

Characteristics

• OCD is more common among teens and young adults.
• Obsessions and compulsions gradually lessen over time, though full recovery is rare (Scoop & Scoop, 1999).
• Support from family and a sense of humor can help cope with OCD.

Related disorders

• Hoarding disorder: cluttering with possessions they can't part with.
• Body dysmorphic disorder: preoccupation with perceived body defects.
• Trichotillomania: hair-pulling disorder.
  • Excoriation: skin-picking disorder.
• These behaviors and feelings must occur frequently and disrupt people's lives.

Post-Traumatic Stress Disorder (PTSD)

Overview of PTSD

• Occurs after experiencing or witnessing traumatic events such as war, terror, torture, rape, earthquakes, and refugee displacement (Charlson et al, 2016; Westermeyer, 2018).
• Hallmark symptoms include recurring vivid, distressing memories and nightmares.
• Other symptoms includes focused attention on possible threats, social withdrawal, jumpy anxiety, and trouble sleeping (Fried et al, 2018; Lazarov et al, 2019; Melactaris & Lin, 2019).
• Many people exhibit survivor resiliency after severe stress (Galatzer-Levi et al, 2018).
• About half of trauma victims report post-traumatic growth (X. Wu et al, 2019).

Factors Influencing PTSD Development

• Amount of emotional distress: Higher distress increases the risk (King et al, 2015; Ozer et al, 2003).
• High combat intensity and self-blaming catastrophic thinking make individuals especially vulnerable (Seligman et al, 2019).
• Location during a traumatic event influences the risk of PTSD (Bonanno et al, 2006).
• Experiences like the Parkland, Florida, school shooting, have highlighted PTSD symptoms and survivor suicide (Matt say, 2019).

Individual Differences and Risk Factors

• Difficulties inhibiting unwanted memories are linked to PTSD (Mary et al, 2020).
• Systemic racism, sexism, and inequality increase the risk (Paul et al, 2020).
• Sexual assault in college women leads to a higher risk of PTSD (AAU, 2020; Dworkin et al, 2017).

Controversies and Considerations

• Some psychologists believe PTSD is overdiagnosed (Dobbs, 2009; McNally, 2003).
• Critics argue that normal stress reactions are sometimes included.
• Debriefing procedures may worsen normal stress reactions (Bonanno et al, 2010; Wakefield & Spitzer, 2002).

Somatic Symptom and Related Disorders

Overview

• Characterized by medically unexplained illnesses (Johnson, 2008).
• Symptoms have unconscious psychological origins, but are genuinely felt.
• Symptoms include vomiting, dizziness, blurred vision, difficulty swallowing, and prolonged pain.
• Symptoms become a disorder when associated with significant distress and impaired functioning.
• Cultural context influences physical complaints and explanations (Kermayer & Sartorius, 2007).
• In China, psychological explanations are less accepted, so people report more physical symptoms (Huang et al, 2019; Ryder et al, 2008).

Illness Anxiety Disorder

• Formerly known as hypochondriasis.
• People interpret normal sensations as symptoms of a dreaded disease.
• Reassurance from physicians is ineffective, leading patients to seek more medical attention.
• Patients fail to confront the disorder's psychological roots.

Understanding Anxiety Related Disorders

The Nature of Anxiety

• Anxiety involves feelings and cognitions (doubt-laden self-appraisal).
• Psychologists attribute anxiety to conditioning, cognition, and biology.

Conditioning

• Fear responses can become linked with formerly neutral objects and events through classical conditioning.
• Lab rats given unpredictable electric shocks become uneasy in their lab environment (Schwartz, 1984).
• Anxious people associate anxiety with certain cues (Barham et al, 2007; Dice et al, 2015).
• Social anxiety disorder often begins after a traumatic event (Austin Hugtel, 1981).
• Anxiety is more likely to develop when bad events are unpredictable and uncontrollable (Field, 2006; Maneka & Olberg, 2008).
• A single painful event can trigger a full-blown phobia through:
  • Classical conditioning
  • Stimulus generalization
  • Operant conditioning's reinforcement
• Stimulus generalization occurs when fear of one event extends to similar events.

Reinforcement

• Helps maintain learned fears and anxieties.
• Avoiding feared situations reinforces maladaptive behaviors.
• Compulsive behaviors, like handwashing, relieve anxiety and are thus repeated.

Cognition

• Thoughts, memories, interpretations, and expectations influence anxiety.
• Fears are learned by observing others (Helson et al, 2011; Olson et al, 2007).
• Anxiety is often a response to self-produced "fake news."
• People with anxiety tend to be hypervigilant, interpreting stimuli as threatening (Everett et al, 2018).
• They readily remember threatening events (Van Voxel et al, 2014).
• Anxiety is common when people cannot switch off intrusive thoughts and feel helpless (Franklin Anfoa, 2011).

Biology

• Biology plays a role in anxiety disorders, OCD, and PTSD.

Genes

• Fearfulness runs in families in monkeys (Swami, 1986).
• Identical twins are at risk if one has an anxiety disorder (Polderman et al, 2015).
• Separated identical twins may develop similar specific phobias (Carrie, 1990; Eckert et al, 1981).
• Gene variations are associated with anxiety disorder symptoms and specific disorders (Purvis et al, 2020; Smaller, 2020).
• Genes regulate neurotransmitter levels (serotonin, glutamate) (Pergum & Hyde et al, 2012; Welch et al, 2007).
• Some individuals have genes that make them more fragile, while others are hardy (Ellis & Boys, 2008; Lewis & Belsky).
• Experiences affect gene expression through epigenetic marks (Mehta et al, 2013; Zanis et al, 2015).

The Brain

• Experiences change the brain, creating fear circuits within the amygdala (Etkin & Wager, 2007; Hiringa et al, 2013; Klasa & Albert, 2007).
• Some antidepressant drugs dampen fear circuit activity.
• Anxiety disorders express themselves biologically as over-arousal of brain areas involved in impulse control and habitual behaviors.
• The brain's danger detection system becomes hyperactive.
• In OCD, the brain generates a mental hiccup of repeating thoughts and actions (sharing et al, 2000).
• Brain scans reveal elevated activity during compulsive behaviors (Insul, 2010; Matteiks calls et al, 2004, 2005).
• The anterior cingulate cortex is hyperactive (Maltby et al, 2005).

Natural Selection

• We are biologically prepared to fear threats faced by ancestors.
• Specific phobias focus on spiders, snakes, enclosed spaces, heights, storms, and darkness.
• Infants attend more to sounds signaling ancient threats (hisses, thunder) (Arlich et al, 2013).
• Fears of evolutionarily relevant stimuli are easy to condition and hard to extinguish (Kuala Luan Percus, 2009; Davy, 1995; Amon, 2009).
• Modern fears, like flying, have evolutionary explanations.

Fearless

• Biological perspectives help understand why most people fear heights more than individuals like Alex Honnold.
• Honnold's amygdala was minimally responsive to fear-inducing images.

Compulsive Acts

• Typically exaggerate behaviors that helped ancestors survive.
• Grooming becomes compulsive hair pulling.
• Washing up becomes ritual handwashing.
• Checking territorial boundaries becomes checking and rechecking doors (Rappaport, 1989).