Chapter 5 - Anxiety Disorders

PSYC 300
Chapter 5 – Anxiety Disorders
5.1 Anxiety and Anxiety Disorders
Anxiety
- An unpleasant feeling of fear and apprehension accompanied by increased physiological arousal.
 Learning theory  considered a drive that mediates between a threatening situation and
avoidance behaviour.
 Anxiety can be assessed by self-report, by measuring physiological arousal, and by
observing overt behaviour.
- There are various anxious disorders  specific phobias, social anxiety disorder (SAD), panic
disorder, agoraphobia, and generalized anxiety disorder (GAD).
 PTSD and OCD were formerly classified as anxiety disorders, but are now considered
separate chapters of DSM-5
 Separation anxiety disorder primarily applies to children
 Emerging research on adult separation anxiety has resulted in separation anxiety disorder
now being included in the DSM-5 anxiety disorders chapter.
 Selective mutism is another disorder that mostly applies to children but is now included
in the anxiety disorders chapter in DSM-5
- Anxiety has two distinguishable components:
1. Physiological component
 Heightened level of arousal and physiological activation
 Symptoms: higher heart rate, shortness of breath, dry mouth, etc.
2. Cognitive component
 Subjective perception of the anxious arousal
 Associated cognitive processes: worry and rumination.
- Clinicians also refer to a third component:
3. Behavioural component
 Avoidance and other safety behaviours
 EXAMPLE: using alcohol to manage anxiety at a party or bringing a safe person
(close friend/family member to cling to at party).
- Anxiety tends to be future-focused  emphasis on things that could happen.
 Many of the things that people worry about never actually happen
 Anxiety and worry can be reinforced by the avoidance of feared outcomes and possible
experiences that never happen.
 Persistent uncontrollable worry about many themes is the main component of GAD.
- Different elements of anxiety are reflected in conceptualizations of a form of anxiety that most
students relate to  TEST ANXIETY
 Test anxiety: feeling of tension, apprehension, and worry in actual or anticipated testing
situations.
o Usually involves physiological & cognitive symptoms (e.g., worry & sweating)
o Can be highly debilitating if it gets out of control
 Reactions to Tests Scale has two subscales tapping the physiological component (i.e.,
tension and bodily symptoms) and two subscales tapping the cognitive component (i.e.,
worry and test-irrelevant thinking)
o Test-irrelevant thinking: the tendency for the mind to wander when it is difficult
to concentrate (inability to concentrate due to mind-wandering)

,  Root of much test anxiety (and other types of anxiety) is a sense of the self as deficient
and powerless.
o Students with test anxiety tend to be self-critical and have negative thoughts
about themselves, often during the test
o A sense of the self as deficient is also viewed by some as the core of social
anxiety disorder
o In extreme cases of test anxiety, when the primary fear is being negatively
evaluated by others, a diagnosis of social anxiety disorder may be applied.
- To reach a stage of intervention  anxiety must be chronic, relatively intense, associated with
role impairment, and cause significant distress for self or others
 Subjectivity  debate took place about proposed DSM-5 changes to GAD
 Core element remains uncontrollable worry
 Key change considered for diagnostic criteria was substantial reduction in number of
associated symptoms needed to qualify for a diagnosis  everyday worries could qualify
for a diagnosis of GAD
 Prevalence rates for social anxiety disorder can vary widely  variability is in part due
to subjectivity regarding degree of impairment.
- Normal and adaptive to experience some degree of anxiety
 Protects us in potentially life-threatening situations  survival.
 Motivates us to start studying or work on an upcoming presentation.
 Tendency to perceive threats in neutral and ambiguous life situations predict elevated
anxiety
- Anxiety Disorders: disorders in which fear or tension is overriding, including specific phobias,
social anxiety disorder, panic disorder, agoraphobia, and GAD.
 Disorders form a major category in DSM-5 & cover most of what was the “neuroses.”
 Diagnosed when subjectively experienced feelings of anxiety are present

Disorder Description
Specific phobia Fear and avoidance of objects/situations that do not present real danger
Social anxiety Fear and avoidance of social situations  possible negative evaluation
disorder from others
Panic disorder Recurrent unexpected panic attacks involving a sudden onset of
physiological symptoms e.g., dizziness, rapid heart rate, trembling.
Accompanied by terror and feelings of impending doom
Agoraphobia Fear of being in public places
Generalized anxiety Persistent, uncontrollable worry often about minor things
disorder
Separation anxiety The anxious arousal and worry about losing contact with and proximity
disorder to others  typically significant others
Selective mutism Failure to speak in one situation (e.g., school) when able to speak in
other situations (e.g., home)

- Anxiety disorders are the most common psychological disorders
 Most Canadians who met criteria for an anxiety disorder said it interfered with their
home, school, work, and social life.

, - Separation anxiety: a disorder in which the individual (often a child) feels intense fear and
distress when away from someone on whom he or she is very dependent; said to be a significant
cause of school phobia.

KEY POINTS
- Anxiety disorders are among the most prevalent mental health problems.
- People with anxiety disorders feel an overwhelming apprehension that seems unwarranted.
- Anxiety consists of both physiological arousal and cognitive worry.
- Everyone can relate to the experience of anxiety, but to be diagnosed with an anxiety disorder,
the anxious symptoms must cause clinically significant distress or impairment.
- Some common themes can be found across anxiety disorders, including a sense of the self as
deficient or ineffective.

5.2 Specific Phobias
- An unwarranted fear and avoidance of a specific object or circumstance
 Fear and avoidance are out of proportion to the danger posed and are recognized by the
sufferer as groundless.
 EXAMPLES: extreme fear of heights, closed spaces, snakes, or spiders accompanied by
sufficient distress to disrupt one's life is likely to be diagnosed as a specific phobia.
o Fear of closed spaces: claustrophobia
o Fear of spiders: arachnophobia
o Fear of heights: acrophobia
o Fear of working: ergasiophobia
o Fear of choking: pnigophobia
o Fear of being buried alive: taphephobia
o Fear of blushing: erythrophobia
o Fear of 13: triskaidekaphobia
- Many specific fears do not cause enough hardship to compel an individual to seek treatment
- The term “specific phobia” implies that the person suffers intense distress and social or
occupational impairment because of the anxiety
- Nomophobia: a common and newly identified phobia focused on fear of losing access to
cellphone contact and not being connected with other people
 E.g., no mobile phone phobia
 Nomophobia arises as a way of compensating for other types of anxiety.
 Also frequent in teenagers FOMO (fear of missing out)
 EXAMPLE: a man with panic disorder and agoraphobia needs cellphone access due to
his chronic need to feel safe  phone represents a connection to other people including
emergency services
- Psychologists focus on different aspects of phobias according to the paradigm they adopt.
 Little Hans  was afraid of horses.
o Psychoanalysts focus on content of phobia and see phobic object as an important
unconscious fear.
o Hans referred to the “black things around horses' mouths and things in front of
their eyes.”  horse was regarded as representing the father (had a moustache
and wore eyeglasses)