Study Notes on Stigma, Causes, and Biological Factors of Anxiety and Related Disorders

Stigma Associated with Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders

• Definition of Stigma: Stigma refers to characterizing others with disgrace or reproach based on an individual characteristic.

Stigma in Anxiety-Related Disorders

• Individuals with anxiety-related disorders often experience stigma, which can manifest in various life situations:
  • Example: Feeling judged when nervously speaking in public or when struggling to board an airplane.
• Research Findings:
  • A significant percentage of people hold negative attitudes towards individuals with generalized anxiety disorder:
  • 16.7% considered individuals with generalized anxiety disorder to be unstable.
  • 13.0% believed generalized anxiety disorder was not a real mental disorder.
  • 7.8% thought those with anxiety-related disorders were not suitable employees.
  • 6.4% viewed them as self-centered.
  • 6.0% saw anxiety-related disorders as signs of personal weakness.
  • Other stigma-related beliefs included views that individuals with anxiety disorders are lazy, shameful, dangerous, or to blame for their problems (Griffiths, Batterham, Barney, & Parsons, 2011).
• Impact on Families:
  • Children of parents with obsessive-compulsive disorder may also worry about others' opinions regarding their parent's condition, leading to feelings of stigmatization (Griffiths, Norris, Stallard, & Matthews, 2011).
• Consequences of Stigma:
  • Individuals with anxiety-related disorders who perceive stigma may be less likely to seek help or admit to having a problem.
  • This is notably impactful in military personnel returning from Iraq and Afghanistan, many of whom have PTSD and related disorders.
  • Self-stigma can lead to avoidance of treatment for PTSD (Mittal et al., 2013).
• Addressing the Issue:
  • Greden and colleagues (2010) introduced programs to train "soldier peers" to encourage military personnel to seek treatment and maintain adherence to treatment.
  • Emphasized that seeking treatment is a sign of strength and aimed at reducing military cultural barriers that perpetuate stigma.

Interim Summary of Anxiety Symptoms and Disorders

• Components of Anxiety: Anxiety consists of three core parts:
  • Physical feelings
  • Thoughts
  • Behaviors
• Types of Anxiety Disorders:
  • Panic Attacks:
  • Characterized by intense physical symptoms (e.g., heart racing, sweating, dizziness) and cognitive symptoms (e.g., thoughts of losing control, going crazy, or dying). Panic attacks can be either expected or unexpected.
  • Panic Disorder: Regular, unexpected panic attacks accompanied by worry about the implications of these attacks.
  • Agoraphobia: Avoidance of situations where panic attacks may occur, often linked with panic disorder.
  • Social Phobia: Intense fear of embarrassing situations leading to expected panic attacks.
  • Specific Phobia: Excessive, unreasonable fear concerning a particular object or situation.
  • Generalized Anxiety Disorder (GAD): Persistent, uncontrollable worry that is extreme in nature.
  • Obsessive-Compulsive Disorder (OCD): Involves obsessions (troubling, recurring thoughts) and compulsions (actions performed to mitigate distress).
  • Posttraumatic Stress Disorder (PTSD): Involves the persistent re-experiencing of a traumatic event through various means (images, memories, nightmares, flashbacks).
  • Acute Stress Disorder: Short-term psychological distress that occurs following a trauma, which may include dissociative symptoms.
  • Separation Anxiety Disorder: Excessive worry about being apart from home or family, which can manifest as refusal to attend school.
• Prevalence: Anxiety-related disorders are notably common in the general population, with a higher prevalence among females. These disorders frequently emerge during late adolescence or early adulthood.
• Comorbidity: Anxiety-related disorders often coincide with other anxiety disorders, depression, and substance use disorders.

Causes and Prevention of Anxiety, OCD, and Trauma-Related Disorders

• The following section addresses the causes of these disorders and discusses prevention measures.

Biological Risk Factors

• Many individuals experience intense physical feelings and thoughts that compel them to avoid certain situations due to a combination of biological predispositions and environmental factors. This perspective is grounded in the diathesis-stress model.

Genetic Risk Factors

• Family Studies:
  • Disorders might have a genetic basis if they are observed more frequently among first-degree relatives compared to the general population.
  • First-degree relatives: parents, siblings, children.
• Twin Studies:
  • Used to gauge heritability, comparing genetic similarities between identical (monozygotic) and nonidentical (dizygotic) twins.
• Genetic Findings:
  • Anxiety-related disorders measurably exhibit a genetic basis:
  • Panic Disorder:
    • First-degree relatives are 3 to 17 times more likely to have panic disorder than controls. Heritability estimated at $h^2 = 0.55$ (Kendler et al., 2011).
  • Social Phobia:
    • Higher prevalence in close family relatives. Heritability $h^2 = 0.57$ (Kendler et al., 2011).
  • Generalized Anxiety Disorder:
    • Runs in families, especially with co-occurring depression. Heritability $h^2 = 0.51$ (Kendler et al., 2011).
  • Specific Phobia:
    • 31% of first-degree relatives report phobias, with a heritability of $h^2 = 0.55$ (Kendler et al., 2011).
    • Family members often share similar types of phobias (e.g., animal or blood-injection-injury phobias).
  • Obsessive-Compulsive Disorder:
    • More prevalent among first-degree relatives (8.2%) vs. controls (2.0%). Heritability $h^2 = 0.52$ (Mataix-Cols et al., 2013).
  • Posttraumatic Stress Disorder:
    • Modest genetic influence linked to factors such as combat exposure. Heritability $h^2 = 0.46$ (Sartor et al., 2012; Wolf et al., 2014).
• Conclusions from Genetic Studies:
  • Anxiety-related disorders commonly occur in families, indicating genetic predispositions, albeit not as strongly as other serious disorders like schizophrenia. Genetics play a role in forming brain/neurochemical responses or temperament that can interact with environmental factors to influence the emergence of anxiety-related disorders.

Brain Features

• Certain brain areas associated with normal and abnormal behaviors are pivotal in the context of anxiety and include:
  • Amygdala:
  • Traditionally linked with fearful responses; facilitates reactions to perceived threats (e.g., fast heart rate, sweating, emotional apprehension).
  • Septal-Hippocampal System:
  • Involved in the regulation of anxiety-related responses.