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Konstantine Zakzanis

Chapter 6 Anxiety Disorders anxiety an unpleasant feeling of fear and apprehension accompanied by increased physiological arousal; in learning theory, it is considered a drive that mediates between a threatening situation and avoidance behavior; anxiety can be assessed by self-report, by measuring physiological arousal, and by observing overt behavior anxiety disorders disorders in which fear or tension is overriding and the primary disturbance: phobic disorders, panic disorder, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), acute stress disorder, and post-traumatic stress disorder(PTSD); these disorders form a major category in DSM- IV and cover most of what used to be referred to as the neuroses - anxiety disorders are diagnosed when subjectively experienced feelings of anxiety are clearly present - often someone with one anxiety disorders meets the diagnostic criteria for another disorder, as well; this comorbidity among anxiety disorders arises for 2 reasons: 1. symptoms of the various anxiety disorders are not entirely disorder specific; for example, somatic signs of anxiety (eg: perspiration, fast heart rate) are among the diagnostic criteria for panic disorder, phobias, and PTSD 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 - as a group, the anxiety disorders are the most common psychological disorders - the highest 1-year prevalence rates were found in women 15-24 years old - anxiety disorders were more common in women than in men across all age groups, although for both men and women the rates of anxiety disorders decreased with age - a majority of Canadians who met criteria for an anxiety disorder reported that it interfered with their home, school, work, and social life - those with an anxiety disorder were less likely to seek help from any mental health service, relative to those with a mood disorder - a growing body of evidence suggests that PTSD and GAD have more in common with major depression than with the other anxiety disorders Phobias phobia an anxiety disorder in which there is intense fear and avoidance of specific objects and situations, recognized as irrational by the individual - psychopathologists define a phobia as a disrupting, fear-mediated avoidance that is out of proportion to the danger actually posed and is recognized by the sufferer as groundless (not justified) - extreme fear of heights, closed spaces, snakes, or spiders provided that there is no objective danger accompanied by sufficient distress to disrupt ones life is likely to be diagnosed as a phobia - the term phobia usually implies that the person suffers intense distress and social or occupational impairment because of the anxiety - the suffix phobia is preceded by a Greek word for the feared object or situation - the suffix is derived from the name of the Greek god Phobos, who frightened his enemies - claustrophobia fear of closed spaced - agoraphobia fear of public spaces - acrophobia fear of heights - ergasiophobia fear of writing - pnigophobia fear of choking - taphephobia fear or being buried alive - Anglophobia fear of England - mysophobia fear of contamination and dirt; Howie Mandel (Deal or No Deal guy) has this - psychoanalysts believe that the content of phobias has important symbolic value - behaviorists tend to ignore the content of the phobia and focus instead on its function Specific Phobias specific phobias an unwarranted fear and avoidance of a specific object or circumstance; for example, fear of nonpoisonous snakes or fear of heights - specific phobias are unwarranted fears caused by the presence or anticipation of a specific object or situation - DSM-TR subdivides these phobias according to the source of the fear: blood injuries, and injections; situations (eg: planes, elevators, enclosed spaces); animals; and the natural environment (eg: heights, water) - research suggests that fears can be grouped into 1 of 5 factors: (1) agoraphobia (2) fear of heights or water (3) threat fears (eg: blood/needles, storms, thunder) (4) fears of being observed (5) speaking fears - these fears were then classified under the 2 higher-order categories: specific fears and social fears - the specific fear focused in a phobia can vary cross-culturally - in China, a person with Pa-leng (a fear of the cold) worries that loss of body heat may be life-threatening - theres a Japanese syndrome called taijikkyofusho, fear of other people; this is an extreme fear of embarrassing others for example, by blushing in their presence, glancing at their genital areas, or making odd faces Social Phobias social phobia a collection of fears linked to the presence of other people - social phobias are persistent irrational fears linked generally to the presence of other people - individuals with a social phobia 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 - social phobias can be either generalized or specific, depending on the range of situations that are feared and avoided - while generalized social phobias involve many different interpersonal situations, specific social phobias involve intense fear of one particular situation (eg: public speaking) - people with the generalized type have an earlier age of onset, more comorbidity with other disorders, such as depression and alcohol abuse, and more severe impairment - social phobias have a high comorbidity rate with other disorders and often occur in conjunction with GAD, specific phobias, panic disorder, avoidant personality disorder, and mood disorders - onset generally takes place during adolescence, when social awareness and interaction with others become much more important in a persons life - a study found that students with social phobia have lower self-esteem and a distorted body image relative to students who are not phobic - predictors of recovery from social phobia include: being employed, no lifetime depression, fewer than 3 lifetime psychiatric disorders, less psychopathology, less anxiety sensitivity, fewer daily hassles, and better mental healthy Etiology of Phobias - proposals about the causes of phobias have been made by adherents of the psychoanalytic, behavioral, cognitive, and biological paradigms Psychoanalytic Theories - according to Freud, phobias are a defense against the anxiety produced by repressed id impulses - this anxiety is displaced from the feared id impulse and moved to an object or situation that has some symbolic connection to it - these objects or situations for example, elevators or closed spaces then become the phobic stimuli - by avoiding them the person is able to avoid dealing with repressed conflicts Behavioral Theories - behavioral theories focus on learning as the way in which phobias are acquired; several types of learning may be involved Avoidance Conditioning - the main behavioral account of phobias is that such reactions are learned avoidance responses - the avoidance-conditioning formulation holds that phobias develop from 2 related sets of learning: 1. via classical conditioning, a person can learn to fear a neutral stimulus (the CS) if it is paired with an intrinsically painful or frightening event (the UCS) 2. the persnd can learn to reduce this conditioned fear by escaping from or avoiding the CS; this 2 kind of learning is assumed to be operant conditioning; the response is maintained by its reinforcing consequence of reducing fear - the Little Albert and white rat experiment demonstrates only the possibility that some fears may be acquired in this particular way; Little Albert was classically conditioned to fear a white rat - recent data confirms the possibility that people can learn to fear certain stimuli Modeling - in addition to learning to fear something as a result of an unpleasant experience with it, a person can also learn fears through imitating the reactions of others - thus some phobias may be acquired by modeling; the learning of fear by observing others is generally referred to as vicarious learning vicarious learning learning by observing the reactions of others to stimuli or by listening to what they say - vicarious learning may also be accomplished through verbal instructions; thus, phobic reactions can be learned through anothers description of what could happen - the anxious-rearing model is based on the premise that anxiety disorders in children are due to constant parental warnings that increase anxiety in the child Prepared Learning - another issue that the original avoidance-learning model fails to address is that people tend to fear only certain objects and events, such as spiders or snakes but not others like lambs - the fact that certain neutral stimuli, called prepared stimuli, are more likely than others to become classically conditioned stimuli may account for this tendency - some fears may well reflect classical conditioning, but only to stimuli to which an organism is physiologically prepared to be sensitive - conditioning experiments that show quick extinction of fear may have used CSs that the organism was not prepared to associate with UCSs - not every stimulus is capable of becoming a source of acquired fear A Diathesis is Needed - some people
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