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Panic, Anxiety, andTheir Disorders THE FEAR AND ANXIETY RESPONSE PATTERNSOVERVIEW OF THE ANXIETY DISORDERS ANDTHEIR COMMONALITIESSPECIFIC PHOBIAS Blood-Injection-Injury Phobia Age of Onset and Gender Differences inSpecific Pho biasPsychosocial Causal FactorsGenetic andTemperamentalCausalFactors Treating Sp ecif icPhobias SOCIAL PHOBIAS Interactionof Psychosocialand Biological CausalFactors Treating SocialPhobias PANIC DISORDER WITH AND WITHOUTAGORAPHOBIA Panic DisorderAgoraphobiaPrevalence,Gender, andAge of Onset of Panic Disorder wi th and without Agoraphobia Comorbiditywith Other Disorders The Timing of a First Panic Attack BiologicalCausal Factors Behavioral and Cognitive Causal FactorsT reating Panic Disorder and Agoraphobia GENERALIZED ANXIETY DISORDER GeneralCharacteristics Prevalence andAge of Onset Comorbidity with Other Disorde rs PsychosocialCausal Factors BiologicalCausalFactors Treating GeneralizedAnxiet y Disorder OBSESSIVE-COMPULSIVE DISORDER Prevalence, Age of Onset, and Comorbidity Characteristics of OCD PsychosocialCau salFactors BiologicalCausalFactors Treating Obsessive-Compulsive Disorder SOCIOCULTURAL CAUSAL FACTORS FOR ALLANXIETY DISORDERS CulturalDif f erences in Sources of Worry Taijin Kyof usho s we noted in Chapter 5, even stable, well-adjusted people may break down ifforc ed to face extensive combat stress,torture, or devastating natural disaster. But for some people, simply performing everyday activities can be stressful.Faced wi ththe normal demands of life-socializing with friends, waiting in line for a bus , beingon an airplane, touching a doorknob-they become seriously fearful or anxi ous. Inthe most severe cases, people with anxiety problems may be unable even to leavetheir homes for fear of having a panic attack, or may spend much of their time inmaladaptive behavior such as constanthand washing. Anxiety-a general feeling of apprehension about possible danger-was, inFreud's formulation , a sign of an inner battle or conflict between some primitivedesire (from the i d) and prohibitions against its expression (from the ego and super-ego). Today t he DSM has identified a group of disorders that share obvious symp-toms and feat ures of fear and anxiety. These anxiety disorders, as they are known,affect approximately 25 to 29 percent of the U.s. population a t some point in theirlives (over 23 million Americans) and are the most common c ategory of disorders forwomen and the second most common for men (Kessler et aI. , 1994; Kessler, Berglund, et aI., 2005b). In any 12-month period, about 23 perc ent of women and 12 percent ofmen suffer from at least one anxiety disorder (Kes

sler et aI., 1994). Anxiety disorderscreate enormous personal, economic,and heal th care problems for those affected. For example, in 1990 anxiety disorders cost the United States $42.3 billion in directand indirect costs, with 90 percent of these being direct costs (about 30 percent ofthe nation's total mental health b ill of $148 billion in 1990; Greenberg et aI., 1999). Consider the following cas e of an anxious electrician: A 27-year-old married electrician complains of dizziness, sweating palms, heart palpitations, and ringingofthe earsofmore than 18 months' duration.Hehas also experienced dry mouth and throat, periods of extreme muscle tension,and a constant "edgy" and watchful feeling that has ofteninterfe red with his ability to concentrate. These feelingshave been presentmost ofthe t ime during the previous 2years ...Because ofthese symptoms the patient has seena familypractitioner, a neurologist, a neurosurgeon, a chi-ropractor,and an ear-n ose-throat specialist....Healso has many worries.He constantly worries about the health of his parents ... Healso worries about whether he isa "goodfather," whe ther his wife will ever leave him (there is noindication that she is dissatisfie d with the marriage), andwhether he is liked by co-workers on the job. Although herecognizes that his worries are often unfounded, he can'tstop worrying.Forthe past 2years the patient has had fewsocial contacts because of his nervous sympto ms...he sometimes has to leaveworkwhen the symptoms becomeintolerable. (Adapted fromSpitzer et aI.,2002.) Sourc e: Adaptedwith permission from the DSM-/V - TR Casebook (Copyright 2000.) American Psychiatric Publishing,Inc.) Thephysicians thismanconsulted couldnot determine the cause of hisphysicalsympto ms, andone of them finally ref erred him for treatmentatamental healthclinic, wh erehewas diagnosed ashaving generalized anxietyd is- or d er -one of seven primary anxiety disorders. Historically, cases likethis andother cases of anxiety disorders were considered to beclassic examples of neurotic behavior .Although neuroticbehavior is mal- adaptive andself-def eating, aneurotic person is notoutof touchwithreality,incoherent,or dangerous. To Freud, neuroseswerepsy chological disordersthat resulted when intrapsychic conflict producedsignif ican tanxiety.Some- times this anxiety was overtly expressed(as inthosedis- orders kn owntoday asthe anxietydisorders). In certain other neurotic disorders, however, hebelieved that the anxietymight not beobvious, either to theperson involved or to others,if psychological def ense m echanisms were able todeflect or mask it.In1980 the DSM -III dropped the term neurosis andreclassif ied mostof these disorders that didnot involve obvious anxiety symp toms as eitherdisso- ciative or somatoform disorders(see Chapter 8).DSM-III made this change in order to group together smaller sets of disordersthatsharemore obvious symptoms and features. Webegin bydiscussing thenature of fear and anxiet y as emotionalstates, both of whichhaveanextremely importantadaptive value butto which humans attimes seem alltoo vulnerable. We wi llthen moveto a discussion of the anxietydisorders. THE FEAR AND ANXIETY__RESPONSE PATTERNS It isdifficult todefine fear and anxiet y, and therehas never beencomplete agreementabout howdistinct the two emotions are f rom eachother.Historically,themost commonway of distinguishing between f earan

danxiety has beenwhether thereis aclearand obvioussourceof dangerthat would be regardedas real bymost people. When thesource of dangerisobvious, the experience d emotionhas been called fear (e.g.,''I'mafraid of snak es"). With anxiety, however,wefrequentlycannotspecify clearlywhat the dangeris (e.g., ''I'm anxiousa bout my parents'health"). Intuitively,anxiety seemsto be experi- enced as an unp leasantinner stateinwhich weare antic- ipating something dreadf ul happeningthat isnotentirely predictable fromour actualcircumstances (e.g.,Barlow, 2002a). FEAR Inrecentyears,manyprominent researchershave proposeda more f undamental distinct ion betweenfearand anxiety(e.g., Barlow,1988, 2002a;Gray & McNaughton,1996).Accordingto thesetheorists,fearor panic is abasic emotion(share d by many animals)that involvesactivation of the"f ight-or-f light" responseof t he sympatheticner- vous system. This is analmost instantaneousreaction to any im minent threatsuchasa dangerouspredatoror someone pointing aloadedgun.Its adaptiv e valueisthat it allowsus to escape f rom imminent danger.When the fear/panic re sponse occurs inthe absence of any obvious external danger, we saythe person has had a spontaneous or uncued panicattack . The symptomsof apanic attack are nearly identical tothose experienced duringa s tate of fearexceptthat panic attacks are of tenaccompanied by a subjective sens e of impendingdoom,including fears of dying,going crazy, orlosing control.These lattercognitive symptomsdo notgenerally occurduringf earstates. Thus f ear and p anichavethreecomponents: 1.cognitive / sub jectivecomponents ("Ifeel afraid /ter rif ied";''I'm going to die"); 2.physiologicalcomponents (suchasincreased heart rate and heavybreathing); 3.behavioral components (a strongurge to escape or fle e; Lang,1968, 1971). These components are only "loosely coupled" (Lang, 1985), w hich meansthatsomeone might show, f orexam- ple, physiological and behavioralind ications of f ear with- out muchof the sub jective component, or viceversa. As a primitive alarm response todanger, thef earresponsemust be activatedwithgreatsp eed toserveits adaptivepurpose: enabling us toescapeoravoid danger.Indeed, we of ten seem to go froma normalstate to a state of intensef ear almost instantaneou sly. F ear or panic is a basicemotiont hat is shared bymany animals,includ ing humans, and may activate t he " f ight-or- flig ht" res ponse o f t hesympatheticner vous syst em.Thisallowsust o respond r api dly when faced with a danger aus situation , such as beingt hreat ened b y a pred ator .I nhumans who ar e having a panicattack ,t here is no external t hreat; panic occurs because of somemisfiringof this response syste m. ANXIETY Incontrastto f ear and panic,anxiety is a complexblend of unpleasantemotions and cognitions that isbothmore orientedtothe f uture andmuch more dif f use than fe ar(Barlow,1988, 2002a).But likef ear, it hasnotonlycognitive /subjectivecomponen tsbutalso physiologicaland behavioralcomponents. At the cognitive / sub jective level,anxiety involves negative mood, worry about possible f uturethreat ordange

r, self- preoccupation,anda sense of beingunable to predict the future threat or to controlit if itoccurs.At a physiological level,anxiety of tencreates a state of tensionand chronic overarousal, which may reflect readiness for dealing with dangershouldit occur("Something awf ulmay happen and I had betterbe ready forit if itdoes"). Although there is noactivationof the fight-or-flight response as in f ear, anxietydoesprepareorprime a personfor the fight-or- flight response shoul d the anticipated danger occur. At a behavioral level, anxiety may create a stro ng tendencyto avoid situations where danger might be encountered, but thereis no ttheimmediateurgeto fleewithanxiety as there is with f ear (Barlow,1988, 2002a). Support f orthe idea thatanxietyisdescriptivelyandf unctionallydistinct Leave a Comment Submit Characters: 400 006 - Chapter 6 - Panic, Anxiety, And Their Disorders 2,646 Reads Joseph Eulo Uploaded by Joseph Eulo TIP Press Ctrl-F to quickly search anywhere in the document. 9 p. 3R NFLM3535 Pitching Handouts Week 2 2 p. 3R NFLM3535 Syllabus 2 p. 1 - 2011 Official Rules Upload a Document Search Documents Follow Us! scribd.com/scribd twitter.com/scribd facebook.com/scribd About Press Blog Partners Scribd 101 Web Stuff Support FAQ Developers / API Jobs Terms Copyright Privacy Copyright 2012 Scribd Inc. Language: English