Anxiety disorders

Anxiety disorders are characterized by abnormal levels of anxiety being the primary disturbance. Anxiety is a universal human experience, but anxiety disorders are exaggerated, persistent, and interfere with functioning.

Body dysmorphism and eating disorders are categorized differently but often come hand in hand with anxiety disorders.

Anxiety disorders are learned through observational modeling, operant conditioning, and classical conditioning.

Anxiety prompts avoidance, and avoidance reinforces anxiety (positive feedback loop).

Distinguishing between normal and abnormal anxiety

In order for anxiety to be considered abnormal, fear has to interfere with one's normal way of living life.

Questions to consider include:

• Is it dangerous or threatening?
• Is there an irrational fear?

Sometimes, anxiety is good and necessary. For instance, anxiety of plane passengers needs to be very low so they don't freak out on the flight. However, anxiety of the pilot needs to be higher than a passenger, as their job requires concentration and active engagement, so a healthy dose of anxiety helps ensure they don't crash the plane.

Anxiety symptoms

• Cognitive (thoughts)
• Behavioral (actions) - e.g.: avoidance
• Somatic (physical body) - e.g.: stumble over words, mouth dries out, sweat, etc.

Background

Anxiety disorders are the most prevalent of all mental health problems. They account for ⅓ of mental health costs. Anxiety affects 19 million adults in the United States.

The most common types of anxiety disorders are specific phobias and social phobias. They are among the most treatable of disorders; 85% to 90% fix rate for specific phobias when using most prevalent empirically proven methods.

For most people, if interference in one's life is not very big for legitimate specific phobias, they don’t seek treatment.

Most common anxieties are across childhood and adolescence. Panic attacks come in early, become more and more common. Social phobias don’t come in until late elementary age and adolescence.

There exists a gender difference in anxiety disorders; the gap becomes larger with age.

• At younger ages - no gender difference
• Starts to diverge in late elementary years
• By age 30, many more women have anxiety disorders

In general, females are more likely to have anxiety disorders than men.

Phobias

Phobias are persistent, unrealistic fears of specific objects and situations. Exposure to feared stimulus produces intense fear or panic attacks. Avoidance responses are almost always present. Anxiety dissipates when phobic situation is not being confronted. Phobias can be named (i.e. people know exactly what they're scared of) and people are aware they fear it.

Recognition of whether this phobia is rational depends on age. Children can’t tell, but adults can tell and have awareness they are irrational.

Contrary to popular belief, phobic objects did not harm/hurt the person with that phobia; nothing explains phobia. Phobias are predicted by close-call experiences—avoidance experiences can prompt the irrational, overblown fear.

The worse the phobia gets, the more avoidance becomes central to the phobia. This is an example of negative reinforcement.

Negative reinforcement is removal of something aversive contingent upon a particular behavior that will increase that behavior.

• Example: giving crying child piece of candy
  • Giving candy reinforces behavior
  • More importantly: Stopping the scream reinforces giving of candy
• Example: avoiding a bee
  • Running away from a bee removes fear, reinforces the behavior of running away from bee
• Example: experience a phobia in class
  • Causes us to not want to go to class anymore
  • Not going to class because that’s where phobia happened

The best way to treat phobias is exposure to the phobia.

It's rare for people to have phobias about harmful things, like guns, knives, etc.; instead, we have phobias about small and regular animals.

There’s a difference between being afraid of something naturally vs. overblown fear in phobias. For instance, spider phobic people (arachnophobes) don’t distinguish between dangerous spiders and non-dangerous spiders.

Biological factors in phobias

Some phobias are probably inherited/prepared learning. Natural selection led our ancestors to learn to fear snakes, spiders, and other animals Fear is adaptive in that it preserves the species itself

Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias.

Autonomic nervous system reactivity (ANS reactivity) may predispose some people to develop phobias.

Treatments for biological phobias

Beta blockers are the most common medication used to treat social phobia. They interfere with autonomic nervous system functioning. However, they are much less effective than cognitive behavioral therapy/exposure therapy.

Exposure therapy is actually good! Clinicians expose gradually, slowly, and gently to make people less and less afraid of something, not more and more.

Anxiety disorder list

• Separation anxiety disorder - limited to children
• Selective mutism
• Specific phobia
• Social anxiety disorder (social phobia)
• Panic disorder
• Generalized anxiety disorder
• Agoraphobia - fear of crowds; not considered a specific or social phobia
• Obsessive-Compulsive Disorder (OCD)
• Obsessive-Compulsive Personality Disorder (OCPD)