Chapter 6: Anxiety Disorders
Anxiety is an unpleasant feeling of fear and apprehension
It can occur in many psychopathologies
An anxiety disorder is diagnosed when feelings of anxiety are clearly present
DSM proposes 6 categories
o Phobias
Fear & avoidance of objects or situations that do not present any real danger
o Panic disorder
Recurrent panic attacks involving a sudden onset of physiological symptoms
(dizziness, rapid heart rate etc) accompanied by terror and feeling of impending
doom; sometimes accompanied with agoraphobia, a fear of being in public places
o Generalized anxiety disorder
Persistent, uncontrollable worry, often about minor things
o Obsessive-compulsive disorder
Experience of uncontrollable thoughts, impulses, or images (obsessions) and
repetitive behaviours or mental acts (compulsions)
o Posttraumatic stress disorder
Aftermath of traumatic experience in which the person experiences increased
arousal, avoidance of stimuli associated with the event, and anxiety in recalling the
event
o Acute stress disorder
Symptoms are the same as those of posttraumatic stress disorder, but last for 4
weeks or less
Often someone with one anxiety disorder meets the diagnostic criteria for another disorder as well
(co-morbidity) because...
o Symptoms of the various anxiety disorders are not entirely disorder specific
o The etiological factors that give rise to various anxiety disorders may be applicable to more
than one disorder
16% of women and 9% of men suffer from anxiety disorders (mostly women 15-24 years)
Phobias
Phobia: a disrupting, fear mediated avoidance that is out of proportion to the danger actually posed
and is recognized by the sufferer as groundless
Examples: fear of heights, closed spaces, snakes or spiders
The person suffers intense distress and social or occupational impairment because of the anxiety
For other phobia disorders, the suffix phobia is preceded by a Greek word for the feared object or
situation
o Claustrophobia: fear of closed spaces
o Agoraphobia: fear of public places
o Acrophobia: fear of heights
o Ergasiophobia: fear of writing
o Pnigophobia: fear of choking
o Taphenphobia: fear of being buried alive
o Anglophobia: fear of England
o Mysophobia: fear of contamination and dirt that plagues many ppl (eg. Howie mandel)
Psychoanalysts believe that the content of the phobias has important symbolic value
Behaviourist ignore the content of the phobia and focus on its function instead
There are 2 types of phobias: Specific & Social Phobias
Specific Phobias
C h a p t e r 6 : A n x i e t y D i s o r d e r s
Page 1 Specific Phobia: unwarranted fears caused by the presence or anticipation of a specific object or
situation
DSM-IV subdivides these phobias according to the source of the fear
o Blood
o Injuries & Injections
o Situations
o Animals
o Natural Environment
Recent empirical research involving a national representative sample suggests that fear can be
grouped into 1 of 5 factors
o Agoraphobia
o Fears of heights of water
o Threat fear (blood/needle, storms/thunder)
o Fear or being observed
o Speaking fears
-These fears were then classified under the 2 higher-order categories specific & social
fears
Specific fear focused on in a phobia can vary cross culturally
o Pa-leng: fear of the cold
They worry that loss of body heat may be life threatening
In Chinese culture
o Taijinkyofu-sho: fear of other people
Fear of embarrassing others
Social Phobias
Social Phobia: persistent, irrational fears linked generally to the presence of other people
They try to avoid particular situations where they might be evaluated, fearing 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
Generalized social phobia: involve many different interpersonal situations
Specific social phobias: involve intense fear of one particular situation (public speaking)
People with generalized type have an earlier age of onset, more co-morbidity with other disorders
(depression, alcohol abuse, and more severe impairments)
Social phobias are fairly common
Lifetime prevalence of 11% in men and 15% in women
Often occur in conjunction with generalized anxiety disorder, specific phobias, panic disorder,
avoidant personality disorder, and mood disorders
Onset is usually during adolescent when social awareness and interaction with others is important
There was a link between social phobia and dropping out of school
Etiology of Phobias
Psychoanalytic Theories
Freud (first to attempt to account systematically for the development of phobic behaviour)
o Phobias are a defence against the anxiety produced by repressed id impulses
o Anxiety is displaced from the feared id impulse and moved to an object or situation that has
some symbolic connection to it
Arieti
o He proposed that Repression stems from a particular interpersonal problem of childhood
rather than from an id impulse
Behavioural Theories
Learning is the way in which phobias are acquired
Types of learning (3)
Avoidance Conditioning
C h a p t e r 6 : A n x i e t y D i s o r d e r s
Page 1 o Phobias reactions are learned avoidance responses
o (Watson & Rayner) Phobias develop from 2 related sets of learning:
Via classical conditioning (a person learns to fear a neutral stimulus when its
paired with a painful or frightening event). The person learns to reduce the
conditioned fear by avoiding/escaping it
Via operant conditioning (response is maintained by its reinforcing consequence of
reducing the fear)
o The evidence is very little in the laboratory (because you cant apply aversive stimuli to
peopleethical considerations) and mixed outside the laboratory (some people do produce
a phobia through bad experiences)
Modelling
o A person can learn a fear through imitating the reaction of others
o Vicarious learning: learning of fear by observing others
o Vicarious learning can also be accomplished through verbal instructions
o Anxious-rearing model: anxiety disorders in children are due to constant parental
warnings that increase anxiety in the child
Prepared Learning
o Prepared stimuli: certain neutral stimuli
o prepared stimuli are more likely than others to become classically conditioned stimuli
o People tend to fear only certain objects and events; spiders, snakes and heights
o It is also relevant to learning fear by modelling
A diathesis is needed
So why do some people have this fear and others dont?
o Cognitive diathesispredisposition (a tendency to believe that a similar situation will
happen in the future) is important in developing a phobia
In sum, some phobias are developed through avoidance conditioning other are not
Social Skills Deficits in Social Phobias
This view says that a person develops social phobias because the individual has not learned how
to behave so that he/she feels comfortable with others OR the person repeatedly commits faux pas,
is awkward and socially unskilled and is often criticized by social companions
(Behaviourists say its caused by inappropriate behaviour or lack of social skills)
Cognitive Theories
How peoples thought processes can serve as a diathesis and how thoughts can maintain a phobia
People are more likely to attend to negative stimuli, and believe that negative events are more likely
than positive ones to occur in the future
Socially anxious people are more concerned of what others think of them and are preoccupied with
hiding imperfections
cognitive behavioural models of social phobia link social phobia with certain cognitive
characteristics
o Attention on negative social information
o Perfectionistic standards for accepted social performances
o High degree of public self-consciousness
Research has shown social phobia is linked with high self criticism
Predisposing Biological Factors
Maybe there is a biological malfunction (diathesis) that predisposes someone to develop a phobia
to a stressful event
Autonomic nervous system
o People
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