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Chapter 6 Anxiety

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Konstantine Zakzanis

Chapter 6: Anxiety Anxiety is the unpleasant feeling of fear & apprehension Anxiety also plays an important role in the study of the psychology of normal people, for very few of us go through even a week of our lives without experiencing some measure of anxiety or fear Anxiety disorders are diagnosed when subjectively experienced feelings of anxiety are clearly present. DSM-IV-TR proposed six categories: phobias, panic disorder, generalized anxiety disorder (GAD), OCD, post-traumatic stress disorder (PTSD), & acute stress disorder Often someone with one anxiety disorder meets the diagnostic criteria for another disorder, as well. This comorbidity among anxiety disorders arises for two reasons: 1) symptoms of the various anxiety disorders are not entirely disorder specific. 2) the etiological factors that give rise to various anxiety disorders may be applicable to more than one disorder Physical or sexual abuse during childhood may increase a persons risk for developing several disorders The anxiety disorders are the most common psychological disorders According to the Ontario Mental Health Supplement study, 16% of women and 9% of men suffered from anxiety disorders in the preceding year. The highest one-year prevalence rates (almost 1 in 5) were found in women 15-24 years of age Although for both men & women the rates of anxiety disorders decrease with age A majority of Canadians who met criteria for an anxiety disorder reported that it interfered with their home, school, work, & social work Young Canadians from the CCHS revealed that those with an anxiety disorder were less likely to seek help from any mental health service, relative to those with a mood disorder Work stress was independently associated with these disorders It should be noted at the outset that a growing body of evidence suggests that PTSD & GAD have more in common with major depression than with other anxiety disorders Phobias Psychopathologies define a phobia as a disturbing, fear-mediated avoidance that is out of proportion to the dangers actually posed & is recognized by the sufferer as groundless The term phobia usually implies that the person suffers intense distress & social or occupational impairment bc of the anxiety Claustrophobia is the fear of closed spaces; agoraphobia, fear of public places; & acrophobia, fear of heights; ergasiophobia, fear of writing; pnigophobia, fear of chocking; taphephobia, fear of being buried alive; Anglophobia, fear of Englan; mysophobia, fear of contamination & dirt Psychoanalysts focus on the content of the phobia & see the phobic object as a symbol of an important unconscious fear Psychoanalysts believe that the content of phobias has important symbolic value Behaviourists tend to ignore the content of the phobia & focus instead of its function Specific Phobias Specific phobia are unwarranted fears caused by the presence or anticipation of a specific object or situation DSM-IV-TR subdivides these phobias according to the source of the fear: blood, injuries, & injections; situations; animals; & the natural environment Recent empirical research involving a nationally representative sample suggests that fears can be grouped into one of five factors: 1) agoraphobia, 2) fears of height or water, 3) threat fears, 4) fears of being observed, & 5) speaking fears Lifetime prevalence of specific phobias that involve specific objects was estimated at 7% for men & 16% for women in the NCS Lifetime prevalence in the NCS-R was 8.9% for men & 15.8% for women The specific fear focused on in a phobia can vary cross-culturally Social Phobias Social phobias are persistent, irrational fears linked generally to the presence of other people Individuals with a social phobias try to avoid particular situations in which they might be evaluated, fearing that they will reveal signs of anxiousness or behave in an embarrassing way Generalized social phobias involve many different interpersonal situations, specific social phobias involve intense fear of one particular situation People with the generalized type have an earlier age of onset, more comorbidity with other disorders, such as depression & alcohol abuse, & more severe impairment Social phobias are fairly common, with a lifetime prevalence in the NCR of 11% in men & 15% in women The NCR-R obtained rates of 11.1% & 13% for men & women A telephone survey of 499 residents from Winnipeg illustrates the different findings can occur as a result of the stringency of criteria used Social phobias have a high comorbidity rate with other disorders & often occur in conjunction with generalized anxiety disorder, specific phobias, panic disorder, avoidant personality disorder, & mood disorder Onset generally takes place during adolescence, when social awareness & interaction with others become much more important in a persons life Analyses of data from Ontarios Mental Health Supplement found that diagnosed social phobia was associated with marked dissatisfaction & low functioning in terms of quality, & it was actually linked with dropping out of school Vriends attempted to determine the rate of natural recovery from social phobia in the community in 1.5-year longitudinal study of young German women & reported that 64% were at least partially recovered & 36% showed full recovery Predictors of recovery included being employed, no lifetime depression, fewer than three lifetime psychiatric disorders, less psychopathology, less anxiety sensitivity, fewer daily hassles, & better mental health Etiology of Phobias Psychoanalytic Theories According to Freud, phobias are a defence against the anxiety produced by repressed id impulses. This anxiety is displaced from the feared id impulse & moved to an object or situation that has some symbolic connection to it
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