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Chapter 7

Chapter 7-Anxiety Disorders.doc

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Ayesha Khan

Abnormal PsychologyChapter 7 Anxiety DisordersThe fears of people with anxiety disorders are severe and ultimately lower the quality of their lives Their fears are chronic and frequent enough to interfere with their functioning Finally their fears are out of proportion to the dangers that they truly faceFour types of symptoms that make up anxiety oPhysiological or somatic symptomsMuscle tension heart palpitations stomach pain and the need to urinateSimilar to those of fightorflight response oEmotional symptomsPrimarily a sense of fearfulness and watchfulnessoCognitive symptomsUnrealistic worries that something bad is happening that his father is ill or is about to happen that he will lose his joboBehavioral symptomsAvoids situations because of his fearsAn adaptive response to a threat which we will refer to as adaptive fear and a maladaptive anxiety response although these distinctions are often not sharpoIn adaptive fear peoples concerns are realistic given the circumstances in maladaptive anxiety their concerns are unrealistic What they are anxious about cannot hurt them or is very unlikely to come aboutoIn adaptive fear the amount of fear people experience is in proportion to the reality of the threat in maladaptive anxiety the amount of fear experienced is out of proportion to the harm the threat could causeoIn adaptive fear peoples fear response subsides when the threat ends in maladaptive anxiety peoples concern is persistent when a threat passes and they may have a great deal of anticipatory anxiety about the futureAnxiety is a prominent feature in many psychological disorders For example the majority of people with serious depression also report bouts of anxiety Freud and many other early theorists believed that anxiety was the underlying cause of most forms of psychopathology He used the term neurosis to refer to disorders in which the anxiety aroused by unconscious conflicts could not be quelled or channeled by defence mechanisms This anxiety could be experienced more or less directly as conscious symptoms of anxietyThe DSM no longer uses the term neurosis Instead it classifies disorders in which the predominant symptoms are anxiety as anxiety disordersResearch suggests that some people do have a general tendency toward anxiety from a very early age This tendency is sometimes referred to as neuroticism negative affectivity or behavioral inhibitionChildren and adults who have high levels of neuroticism negative affectivity or behavioral inhibition become anxious or depressed easily in response to stressors and they may chronically carry a low level of anxietyHigh levels of these characteristics in childhood have been shown to predict several of the anxiety disorders in adulthoodChildren who are neurotic or behaviorally inhibited may not develop a fullblown anxiety disorder unless they also experience parenting that exacerbates their anxious tendencies rather than quells themThe parents of anxious children tend to be overprotective controlling and intrusiveParents may be overinvolved and controlling with their anxious children in an attempt to prevent the childrens distress but this behavior promotes their childrens perceptions that the world is a dangerous place over which they have no control In support a study at Sick Childrens Hospital in Toronto found that among 18 mothers with anxiety disorders all were insecurely attached and 81 of their preschool offspring were found to be insecurely attached In 65 of cases the mother and child shared the same insecure attachmentThe parents of anxious children tend to be anxious themselvesParenting behaviors foster anxiety in their childrenPanic DisorderPanic attacks short but intense periods in which she experiences many symptoms of anxiety heart palpitations trembling a feeling of choking dizziness intense dread and so onMost panic attacks are characterized by one of three core themes dizzinessrelated symptoms cardiorespiratory distress and cognitive factors Some people have panic attacks that are triggered by specific situations or events For example people with a social phobia may have panic attacks when forced into a social situationPanic attacks are related to certain situations The person is more likely to have them in certain situations but does not always have them when in those situationsA panic attack is a terrifying experience causing a person intense fear or discomfort the physiological symptoms of anxiety and the feeling of losing control going crazy or dying40 of all young adults have occasional panic attacks especially during times of intense stress such as exam weekMany people facing a severely traumatic event will have a panic attack Some people with panic disorder have many attacks in a short time such as every day for a week and then go for weeks or months without having another attack followed by another period in which the attacks come oftenPeople who have panic disorder often fear that they have lifethreatening illnesses and they are more likely to have a history of serious chronic illness in themselves or family members If the disorder is left untreated they may become demoralized and depressedThe disorder tends to be chronic once it beginsMany people with panic disorder also suffer from chronic generalized anxiety depression and alcohol abuse Onethird to onehalf of people diagnosed with panic disorder develop agoraphobiaTheories of Panic Disorder The Role of Genetics Panic disorder appears to run in families A review of family history studies of panic disorder found that about 10 of the firstdegree relatives of people with panic disorder also have panic disorderOnly about 2 of the firstdegree relatives of people without panic disorder have the disorderThe children of parents with panic disorder are at increased risk of developing panic disorderTwin studies of panic disorder report a broad range of concordance rates for monozygotic and dizygotic twins but generally find that 30 to 40 of the variation in rates of panic disorder is due to geneticsA biological vulnerability to panic disorder or to a chronic diffuse anxiety that predisposes a person to panic disorder may be transmitted at least in part through genesNeurotransmitters and the Brain Most of the modern neurological theories of panic disorder are the result of the fortuitous discovery by psychiatrist Donald Klein in the 1960s that antidepressant medications reduce panic attacksBecause these medications affect the levels of the neurotransmitter norepinephrine in the brain Klein and others reasoned that norepinephrine may be involved in panic disorderNorepinephrine may be poorly regulated in people with panic disorder especially in an area of the brain stem called the locus ceruleusThen people are given drugs that alter the activity of norepinephrine particularly in the locus ceruleus this alteration can induce panic attacks
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