Anxiety Disorders

Chapter 5: Anxiety Disorders

Outline of Anxiety Disorders

  • 1. Describe the Symptom Components of Anxiety and Distinguish between Normal and Clinical Levels of Anxiety

  • 2. Define Various Specific Phobias

  • 3. Describe Social Anxiety Disorder (SAD)

  • 4. Explain the Theories of Etiology of Specific Phobias and SAD

  • 5. Describe Panic Disorder and Agoraphobia, and their Etiology

  • 6. Describe Generalized Anxiety Disorder (GAD) and its Etiology

  • 7. Compare and Contrast the Components and Effectiveness of Therapies For Anxiety Disorders

Symptoms and Components of Anxiety

  • Anxiety is described as the unpleasant feeling of fear and apprehension.

    • Components of Anxiety:

    1. Physiological Component: Heightened level of arousal and physiological activation.

      • Examples include increased heart rate, shortness of breath, and dry mouth.

    2. Cognitive Component: Subjective perception of anxious arousal and associated cognitive processes.

      • Examples include worry and ruminations.

    3. Behavioral Component: Involves clinicians' addition of safety behaviors, avoidance, and is often future-oriented.

  • When does anxiety become a problem?

    • Chronic, relatively intense, associated with role impairment, and causing significant distress for self or others.

    • Situational factors play a role: Propensity to perceive threat or concern when there is no objective threat.

    • Longitudinal studies (Craske et al., 2012) indicate that adolescents responding strongly to neutral stimuli are more likely to develop anxiety disorders.

    • Association with suicide attempts and thoughts (Thibodeau et al., 2013).

Prevalence of Anxiety Disorders

  • Anxiety disorders are the most common psychological disorders.

    • Majority of Canadians with anxiety disorders report interference in home, school, work, and social life (Government of Canada, 2006).

    • Ontario Mental Health Supplement study (1994): Clear gender difference; 16% of women and 9% of men suffered from anxiety in the past year.

    • Highest prevalence among women aged 15 to 24 years.

    • Similar findings across 15 countries (Seedat et al., 2009).

International Prevalence of Anxiety Disorders

  • Somers et al. (2006): pooled international studies showed:

    • One-year prevalence: 10.6%

    • Lifetime prevalence: 16.6%

    • Early age of onset typically during childhood.

Comparison of Anxiety Disorders with Other Mental Health Conditions

  • Lifetime morbid risk (Kessler et al., 2012):

    • Major depressive episode: 29.9%

    • Specific phobia: 18.4%

    • Social phobia: 13.0%

    • Post-traumatic stress disorder (PTSD): 10.1%

    • Generalized anxiety disorder (GAD): 9.0%

    • Separation anxiety disorder: 8.7%

    • Panic disorder: 6.8%

  • Early onset for phobias and separation anxiety (15-17 years).

  • Late onset for panic disorder and GAD (23-30 years).

Summary of Major Anxiety Disorders

  • Specific Phobia: Fear and avoidance of objects or situations that do not present real danger.

  • Social Anxiety Disorder (SAD): Fear and avoidance of social situations due to potential negative evaluations from others.

  • Panic Disorder: Characterized by recurrent panic attacks leading to physiological symptoms coupled with terror and feelings of impending doom.

  • Agoraphobia: Fear of being in public places or feeling unable to escape.

  • Generalized Anxiety Disorder (GAD): Persistent, uncontrollable worry often about minor issues.

  • Separation Anxiety: Worrying about losing contact with significant others, common in children but observed in adults as well.

  • Selective Mutism: Failure to speak in certain situations, typically school, while able to speak in others, usually home.

Specific Phobias

  • Defined as unwarranted fears caused by the presence or anticipation of a specific object or situation, often out of proportion to the threat posed.

  • The term “phobia” suggests intense distress and social or occupational impairment.

  • Examples of Specific Phobias by Naming:

    • Claustrophobia (fear of closed spaces)

    • Acrophobia (fear of heights)

    • Ergasiophobia (fear of working)

    • Pnigophobia (fear of choking)

    • Taphephobia (fear of being buried alive)

    • Erythrophobia (fear of blushing)

    • Triskaidekaphobia (fear of the number 13)

    • Ornithophobia (fear of birds)

Cultural Expressions of Phobias

  • The focal fear in phobias can differ across cultures, for example, Pa-leng (fear of the cold) in China relates to the philosophy of yin and yang.

Social Anxiety Disorder (SAD)

  • Formerly termed Social Phobia:

    • Definition: An irrational fear of being judged by others often leading to avoidance of such situations.

    • Characterized by:

    • Public speaking anxiety.

    • Social interaction fears.

    • Anxiety about being observed in public.

  • Onset and Prevalence:

    • Onset often occurs during adolescence.

    • Lifetime prevalence: 7.5% in men, 8.7% in women (CCHS 1.2 survey).

    • Average age of onset: 13 years, average duration: 20 years.

  • Cultural Factors:

    • In Japan, taijin kyofusho reflects extreme concern for not embarrassing others in social interactions.

Etiology of Specific Phobias and SAD

Behavioral Theories

  • Emphasizes learning as a means of acquiring phobias.

    • Avoidance Conditioning: Responses learned through classical and operant conditioning.

    • Modelling: Learned through imitation, as per Bandura's experiments.

  • Prepared Learning: Classical conditioning to fear specific stimuli that posed historical threats (Ohman & Mineka, 1989).

Cognitive Theories

  • Suggests misinterpretation of physiological symptoms leads to heightened anxiety responses.

  • Socially anxious individuals may overemphasize potential evaluative threat from others.

Biological Theories

  • Higher activity observed in the amygdala and insula in those with specific phobias and SAD (Ipser et al., 2013).

    • Autonomic Nervous System (ANS) predisposition to fear responses is genetically significant.

Psychoanalytic Theories

  • Propose that phobias serve as defense mechanisms against underlying unconscious anxieties.

Panic Disorder

  • Characterized by recurrent panic attacks, symptoms include:

    • Rapid or labored breathing, heart palpitations, nausea, chest pain, choking sensations, dizziness, and intense terror.

  • Differences from Phobias:

    • Panic disorder presents with uncued panic attacks, while phobias often involve cued attacks.

Prevalence and Cultural Aspects of Panic Disorder

  • 1-year prevalence in Canada: 6.4%.

  • Cultural issues include unique expressions of panic, such as kayak-angst among Inuit seal hunters, characterized by fear of drowning.

Agoraphobia with Panic Disorder

  • Defined by anxiety in at least 2 of the following:

    • Public transportation, open spaces, enclosed spaces, crowds, or being alone outside the home.

  • Avoidance behaviors can lead to severe restrictions in daily functioning.

Etiology of Panic Disorder

  • Biological theories suggest genetic predisposition and noradrenergic activity. Panic is posited to arise from dysfunction in the noradrenergic system.

  • Psychological theories focus on fear-of-fear model, highlighting the fear of experiencing panic attacks in public settings.

Generalized Anxiety Disorder (GAD)

  • Defined by chronic and excessive worry about everyday issues coupled with difficulty concentrating, irritability, and muscle tension.

  • Etiology: Psychological theories focus on learning theories associated with anxiety linked to past experiences and intolerance of uncertainty.

Treatment Approaches for Anxiety Disorders

Behavioral Approaches

  • Systematic Desensitization: Gradual exposure to anxiety-evoking stimuli while in a relaxed state.

  • In Vivo Exposure Treatment: Involves real-life exposure to feared situations, though may have high dropout rates.

Cognitive Behavioral Therapy (CBT)

  • Noted for its effectiveness; emphasizes the importance of homework and between-session learning to reinforce gains from therapy.

Mindfulness and Acceptance-Based Approaches

  • Focus on becoming more open and accepting of anxious thoughts instead of trying to avoid them. Evidence shows efficacy in treating various anxiety disorders.

Biological Approaches

  • Drug Treatments: Include benzodiazepines, MAO inhibitors, and SSRIs. Each category has unique side effects and efficacy profiles.

Medication Summary

  • Table 5.6 summarizes drug categories, specifications, and uses for anxiety disorders, highlighting effectiveness and side effects.

Ethical and Practical Implications

  • Consider ways to tailor treatments based on individual response patterns, cultural factors, and specific phobia characteristics.

  • Address societal perceptions and stigma surrounding mental health treatment, focusing on improving the quality of life for those with anxiety disorders.