ANXIETY DISORDER
My today’s article is on Anxiety Disorder. Before you start reading it further please answer these questions:
§ Are you finding yourself trying to avoid certain situations everyday?
§ Are you plagued by certain fears that appear to be totally irrational?
§ Is your anxiety so extreme and intense that it is starting to interfere not only with your relationship with others but also your performance?
§ Are you constantly feeling jittery, tense and worrying excessively about the smallest of things?
§ Are you experiencing bouts of panic in very normal situations with or without the physical symptoms associated with anxiety such as palpitations and sweating excessively?
If you have answered any of these questions in affirmation then there is every possibility that you might be suffering from some form of anxiety disorder. Then this topic is for you please go ahead.
WHAT IS ANXIETY AND ANXIETY DISORDER?
What is Anxiety as such? Well no one needs any explanation for that for we all have experienced anxiety at one time or the other, either while speaking in front of a class, or waiting to play in a big game, or while appearing for the interview or date or exam any one of us might feel anxious, the state of tension and apprehension that is a natural response to perceived threat. At times we may feel enough anxiety to avoid making eye contact or talking with someone what we all refer to as “shyness”.
Anxiety is a universal and normal emotion. It is a necessary and adaptive response of the organism to stress. It is associated with the activation of the sympathetic nervous system which in turn activates the physiological and behavioural responses in the body that, helps protect us from danger. Fortunately for most of us, our uneasiness is not intense and persistent. If it becomes so, we may have one of the anxiety disorders, marked by distressing, persistent anxiety or dysfunctional anxiety-reducing behaviours. In anxiety disorders, the frequency and intensity of anxiety responses are out of proportion to the situations that trigger them, and the anxiety interferes with daily life. But too much anxiety can be debilitating, and every year millions of people suffer from anxiety disorders, which are psychological disturbances marked by irrational fears, often of everyday objects and situations (Kessler, Chiu, Demler, & Walters, 2005).
FEAR VERSUS ANXIETY
Anxiety is an alerting signal; it warns of impending danger and enables a person to take measures to deal with a threat. Fear is a similar alerting signal, but it should be differentiated from anxiety. Generally anxiety can be described as a sense of uneasiness, worry, fear, dread or nervousness in a person relating to something that is about to happen or to something that may happen. Fear is a response to a known, external, definite, or non conflictual threat; anxiety is a response to a threat that is unknown, internal, vague, or conflictual.
EPIDEMIOLOGY
The anxiety disorders make up one of the most common groups of psychiatric disorders. According to The National Comorbidity Study reported that one of four persons met the diagnostic criteria for at least one anxiety disorder and that there is a 12-month prevalence rate of 17.7 percent. Women (30.5 percent lifetime prevalence) are more likely to have an anxiety disorder than are men (19.2 percent lifetime prevalence). The prevalence of anxiety disorders decreases with higher socioeconomic status. Prevalence refers to the number of people who have a disorder during a specified period of time. Large-scale population studies indicate that anxiety disorders are the most prevalent psychological disorders in the United States, affecting 17.6 percent of Americans during their lifetimes (Kessler et al., 1994; Robins & Regier, 1991).
In more than 70 percent of cases, anxiety disorders are considered clinically significant, meaning that they interfere significantly with life functions or cause the person to seek medical or psychological treatment (Narrow et al., 2002).
SYMPTOMS OF ANXIETY DISORDER
The symptoms associated with anxiety disorders are actually symptoms of stress. Many people refer anxiety symptoms because of increase in their stress levels. The symptoms of anxiety can be broadly classifed in two groups: physical and psychological (psychic)
1. Physical Symptoms
A. Motoric Symptoms:
(1) Tremors;
(2) Restlessness;
(3) Muscle twitches;
(4) Fearful facial expression
B. Autonomic and Visceral Symptoms:
(1) Palpitations;
(2) Tachycardia;
(3) Sweating;
(4) Flushes;
(5) Dyspnoea;
(6) Hyperventilation;
(7) Constriction in the chest;
(8) Dry mouth;
(9) Frequency and hesitancy of micturition;
(10) Dizziness;
(11) Diarrhoea;
(12) Mydriasis
2. Psychological Symptoms
A. Cognitive Symptoms:
1) Poor concentration;
2) Distractibility;
3) Hyperarousal;
4) Vigilance or scanning;
5) Negative automatic thoughts
B. Perceptual Symptoms:
1) Derealisation;
2) Depersonalisation
C. Affective Symptoms:
(1) Diffuse, unpleasant, and vague sense of apprehension;
(2) Fearfulness;
(3) Inability to relax;
(4) Irritability;
(5) Feeling of impending doom (when severe)
D. Other Symptoms:
(1) Insomnia (initial);
(2) Increased sensitivity to noise;
(3) Exaggerated startle response
In some people the symptoms described above can appear suddenly, whilst in others they can build up gradually and only when they become more persistent do these people begin to realize that something is wrong.
So Anxiety responses have four components:
(1) a subjective-emotional component, including feelings of tension and apprehension;
(2) a cognitive component, including worrisome thoughts and a sense of inability to cope;
(3) physiological responses, including increased heart rate and blood pressure, muscle tension, rapid breathing, nausea, dry mouth, diarrhea, and frequent urination; and
(4) behavioural responses, such as avoidance of certain situations and impaired task performance.
TYPES OF ANXIETY DISORDER
Anxiety disorders can be viewed as a family of related but distinct mental disorders, which according to DSM5 (Diagnostic and Statistical Manual) include (1) generalized anxiety disorder, (2) panic disorder, (3) agoraphobia, (4) specific phobia, and (5) social anxiety disorder or phobia.
1) Generalized anxiety disorder: in which a person is unexplainably and continually tense, uneasy, apprehensive, and in a state of autonomic nervous system arousal.
2) Panic disorder: in which a person experiences sudden episodes of intense dread, terror and accompanying chest pain, choking, or other frightening sensations.
3) Agoraphobia: refers to a fear of or anxiety regarding places from which escape might be difficult.
4) Specific phobias: in which a person feels irrationally and intensely afraid of a specific object or situation and avoidance of a specific object or situation.
5) Social anxiety disorder or phobia: Social anxiety disorder (also referred to as social phobia) involves the fear of social situations, including situations that involve scrutiny or contact with strangers.
CAUSAL FACTORS IN ANXIETY DISORDERS
Anxiety is a complex phenomenon having biological, psychological, and environmental causes. Within the vulnerability-stress model presented earlier in topic Psychopathology, any of these factors can create predispositions to respond to stressors with an anxiety disorder (Beidel et al., 2007; Velotis, 2006).
1. BIOLOGICAL FACTORS
Genetic factors may create a vulnerability to anxiety disorders (Jang, 2005). Where clinical levels of anxiety are concerned, identical twins have a concordance rate (i.e., if one twin has it, so does the other) of about 40 percent for anxiety disorders, compared with a 4 percent concordance rate in fraternal twins (Carey & Gottesman, 1981).
According to David Barlow (2002), genetically caused vulnerability may take the form of an autonomic nervous system that overreacts to perceived threat, creating high levels of physiological arousal. Hereditary factors may also cause over-reactivity of neurotransmitter systems involved in emotional responses (Mineka et al., 1998). One such transmitter is GABA (gamma-aminobutyric acid), an inhibitory transmitter that reduces neural activity in the amygdala and other brain structures that trigger emotional arousal. Some researchers believe that abnormally low levels of inhibitory GABA activity in these arousal areas may cause some people to have highly reactive nervous systems that quickly produce anxiety responses to stressors (Bremner, 2000). In support of this hypothesis, brain scans show that patients with a history of panic attacks have a 22 percent lower concentration of GABA in the occipital cortex than age-matched controls without panic disorder (Goddard et al., 2001). Such people also could be more susceptible to classically conditioned phobias because they already have a strong unconditioned arousal response in place, ready to be conditioned to new stimuli. Other transmitter systems also may be involved in the anxiety disorders.
As noted earlier, women exhibit anxiety disorders more often than men do. In a large scale study of adolescents, Peter Lewinsohn and coworkers (1998) found that this sex difference emerges as early as 7 years of age. Such findings suggest a sex linked biological predisposition for anxiety disorders, but social conditions that give women less power and personal control may also contribute (Craske, 2003).
2. PSYCHOLOGICAL FACTORS
Four major schools of psychological theories viz; psychoanalytic, behavioural, existential and cognitive theories have contributed to the causes of anxiety.
1) Psychoanalytic Theories: Anxiety is a central concept in psychoanalytic conceptions of abnormal behaviour. Freud referred to anxiety-based disorders as neuroses. According to Freud, neurotic anxiety occurs when unacceptable impulses threaten to overwhelm the ego’s defenses and explode into consciousness or action. How the ego’s defense mechanisms deal with neurotic anxiety determines the form of the anxiety disorder. Freud believed that in phobic disorders, neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to the underlying conflict. For example, in one of Freud’s most celebrated cases, a 5-year-old boy named Hans suddenly developed a fear of horses and the possibility of being bitten. Seeing a horse fall down near his home worsened his fear, and little Hans began to dread leaving his home. To Freud, the phobia resulted from the boy’s unresolved Oedipus complex. The powerful horse represented Hans’s father, and the fear of being bitten symbolized Hans’s unconscious fear of being castrated by his father if he acted on his sexual desire for his mother; the falling horse symbolized Hans’s forbidden triumph over his father.
2) Behavioural Theories: The behavioural or learning theories i.e. classical conditioning, observational learning, or operant conditioning theories can contribute to the development of an anxiety disorder. In a model of classic conditioning, a girl raised by an abusive father, for example, may become anxious as soon as she sees the abusive father. Through generalization, she may come to distrust all men. In the social learning model, a child may develop an anxiety response by imitating the anxiety in the environment, such as in anxious parents. Once anxiety is learned, either through classical or vicarious conditioning, it may be triggered either by cues from the environment or by internal cues, such as thoughts and images (Pitman et al., 2000). In phobic reactions, the cues tend to be external ones relating to the feared object or situation. In panic disorders, the anxiety-arousing cues tend to be internal ones, such as bodily sensations (e.g., heart palpitations) or mental images (such as the image of collapsing and having a seizure in a public place; (Craske, 1999). In addition to classical conditioning and observational learning, operant conditioning also plays a role. People are highly motivated to avoid or escape anxiety because it is such an unpleasant emotional state. Behaviours that are successful in reducing anxiety, such as compulsions or phobic avoidance responses, become stronger through negative reinforcement. Thus, in the case of agoraphobia, remaining at home serves as a safety signal, a place where the person is unlikely to experience a panic attack (Seligman & Binik, 1977).
3) Existential Theories: Existential theories of anxiety provide models for generalized anxiety, in which no specifically identifiable stimulus exists for a chronically anxious feeling. The central concept of existential theory is that persons experience feelings of living in a purposeless universe. Anxiety is their response to the perceived void in existence and meaning.
4) Cognitive Theories: Cognitive theorists stress the role of maladaptive thought patterns and beliefs in anxiety disorders. People with anxiety disorders catastrophize about demands and magnify them into threats. They anticipate that the worst will happen and feel powerless to cope effectively (Clark, 1988). Attentional processes are especially sensitive to threatening stimuli (Bar-Haim et al., 2007). Cognitive processes also play an important role in panic disorders. According to David Barlow (2002), panic attacks can be triggered by exaggerated misinterpretations of normal anxiety symptoms, such as heart palpitations, dizziness, and breathlessness. The person appraises these as signs that a heart attack or a psychological loss of control is about to occur, and these catastrophic appraisals create even more anxiety until the process spirals out of control, producing a full blown state of panic.
3. ENVIRONMENTAL FACTORS
Environmental Factors or sociocultural Factors also play a role in the development of anxiety disorders (Lopez & Guarnaccia, 2000). The role of culture is most dramatically shown in culture-bound disorders that occur only in certain locales. One such disorder found in Japan is a social phobia called Taijin Kyofushu (Tanaka-Matsumi, 1979). Another culture-bound disorder is Koro, a Southeast Asian anxiety disorder.
Different types of Anxiety Disorder would be dealt in detail in subsequent posts. So if you like this article, do subscribe the blog.
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· Beidel, D. C., & Turner, S. M. (2007). Shy children, phobic adults: Nature and treatment of social anxiety disorders. Washington, DC: American Psychological Association.
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