Anxiety Disorders

Question 1

Fear vs Anxiety

Fear is…
Anxiety is…

Answer 1

Fear: response to real & present danger. Helps organize
responses to threats, like “fight or flight.”
- present focus

Anxiety: apprehension about anticipated events.
- future-oriented
- uncertain
– Physiological changes.
– Difficulty controlling thoughts in a state of anxiety.
– Halo effect.

Question 2

Classification of Anxiety Disorders

• Emerged as a distinct group of disorders in DSM-III.
• Previously part of “neuroses” (emotional disturbance, w/
  awareness).
  – Awareness dropped in DSM-5. Now, it is merely necessary for
  fear & worry to be “disproportionate to the
  situation”…who judges that?
• Splitting movement has divided anxiety disorders. Share core
  symptom – intense worry disproportionate to actual
  environmental danger.
  – How neat are these categories?
  – What about division from other diagnostic categories?

Question 3

“Neroses”

Answer 3

Emotional disturbance, w/ awareness (which makes it different from psychosis), that mainly effects emotion

Question 4

Rise of Interest in Anxiety

Answer 4

• Asylums primarily housed those deemed psychotic and/or dangerous.
• Freud’s emphasis on neuroses opened an entirely new domain of human emotion: Anxiety.
• What counts as a “psychiatric concern” is not fixed.

Question 5

Panic Disorder

Answer 5

• Characterized by recurrent, unexpected panic attacks.
  Usually occurs without warning and finishes within ten
  minutes.

– has physical symptoms: palpitations;
pounding heart; sweating; trembling/shaking;
shortness of breath; feeling of choking; chest pain or
discomfort; nausea; feeling dizzy/faint.

– Derealisation (unreality) or depersonalization
(detachment from oneself)

• Person may obsessively worry about another attack.
• May lead to avoidance strategies…avoidance works.

Question 6

Specific (Simple) Phobia

Answer 6

• Persistent, excessive, narrowly defined fears
  associated with a specific object or situation.
• Phobias are “irrational or unreasonable.”
• Must always occur when exposed to the source.
• Daily life is consumed on some level with avoidance, fear, and dread.
• Common phobias?
• spiders, needles, heights, flying,

Question 7

Agoraphobia

Answer 7

• Extreme fear about situations where escape is difficult or embarrassing - crowded shops, theatres, tunnels.
• Unlike other phobias, not closeness to a specific object but distance from “safety” that’s the problem.
• “Most complex and incapacitating phobic disorder.”
• Hard to bring a place or thing you view as safety everywhere, but you can avoid planes

Question 8

Social Anxiety Disorder (SAD)
How does social phobia differ from specific phobia?

Answer 8

How does social phobia differ from specific phobia?
– Focused on performance or interpersonal interactions.

• Involves concerns of being humiliated or embarrassed. If
  anxiety related to specific situation (e.g. a speech), anxiety
  disappears if task performed privately.
• Introduced in DSM-III:
  – 1980s: 0.5%, 2019: 9-15%
  – Criteria expanded to be more inclusive with subsequent
  editions.
  – Culture bound?
  – Archetype of medicalization?

Question 9

Generalized Anxiety Disorder (GAD)

Key issues

Answer 9

• There is a constant level of anxiety (chronic, low-key, long lasting)
• distress/impairment in occupational or social functioning.
• Worry not fixed, may not even have clear source.
• Accompanied by minor disturbances in sleep, irritability, concentration, restlessness.
• Key issues:
  – Lower diagnostic reliability.
  – Far more common in women (roles? stereotypes?)
  – Overlap: a distinct disorder or just a symptom?
  – If low key, is this really a distinct syndrome?

Question 10

Comorbidity

• 50% of people that meet criteria for one anxiety disorder meet
  criteria for another.
• Anxiety and mood disorders, high degree of comorbidity (61% of people w/ MDD qualify for anxiety disorder).
  – How distinct?
• Those w/ anxiety disorders roughly 3x more likely to be diagnosed w/ substance abuse disorder. Chicken/egg?
• Some argue “splitting movement” behind high level of
  comorbidity b/t disorders.
  – Artificial divisions create overlapping disorders, “pure” cases
  of most types very rare.

Question 11

Diagnostic Growth

• Anxiety disorders at forefront of increase in the prevalence of
  mental disorders. Why?

– Medicalization of ‘uncomfortable’ feelings into ‘ill’ ones?
– Blurred lines between wellness and disturbance, when does
discomfort become disorder?
– Environmental shifts to produce stress?
– Does greater awareness (of ourselves and the world) mean
greater anxiety? Can this be stopped?
– Medications produce clear effect – we can see them “work”
and this seems to validate diagnoses.

Question 12

Conclusions

• Share much common ground with mood disorders.
• Boundaries between anxiety disorders are among the finest, target of much criticism.
• Case for mental illness as a spectrum of normal human experience?
• Widespread belief that we are becoming more anxious as a population. Is this a medical issue?