Module 48: Anxiety-Related Disorders

How do genes affect anxiety?

-fearfulness runs in families. -if one identical twin has an anxiety disorder, the other is also at risk. -one research team identified 17 gene variations associated with typical anxiety disorder symptoms; another found genes associated specifically with OCD.

reinforcement

-helps maintain learned fears and anxieties -anything that enables us to avoid or escape a feared situation can reinforce maladaptive behaviors.

characteristics of hypervigilant people

-more often interpret stimuli as threatening. -more other remember threatening events. -anxiety is especially common when people cannot switch off such intrusive thoughts and feel helpless.

Duration of generalized anxiety disorder

-those affected usually cannot identify, relieve, or avoid their anxiety -anxiety is FREE-FLOATING: not linked to a specific stressor/threat. -often accompanied by a depressed mood; can lead to physical health problems like high blood pressure. -as time passes, emotions tend to mellow; by age 50, generalized anxiety disorder becomes fairly rare.

characteristics of generalized anxiety disorder

-worry continually, feel jittery, agitated, and sleep-deprived. -concentration suffers -autonomic nervous system arousal may manifest itself through furrowed brows, twitching eyelids, trembling, perspiration, or fidgeting.

Why do some 5 to 10 percent of people develop PTSD after a traumatic event, but others don't?

1. Amount of emotional distress: The higher the distress (such as the level of physical torture suffered by prisoners of war), the greater the risk for posttraumatic symptoms 2. Some people may have a more sensitive emotion-processing limbic system that floods their bodies with stress hormones. 3. Genes: twins, compared with non-twin siblings, more commonly share PTSD risk factors. 4. Gender: After a traumatic event, women experience PTSD more often than do men.

Three kinds of anxiety disorders

1. generalized anxiety disorder 2. panic disorder 3. specific phobias

Other OCD related disorders

1. hoarding disorder: cluttering one's space with acquired possessions one can't part with 2. body dysmorphic disorder: preoccupation with perceived body defects 3. trichotillomania: hair-pulling disorder 4. excoriation disorder: skin-picking disorder

How does experience affect gene expression?

A history of wartime trauma or child abuse can leave long-term epigenetic marks: molecular tags that attach to chromosomes and turn certain genes on or off. -experiences such as abuse can increase the likelihood that a genetic vulnerability to a disorder such as PTSD will be expressed.

LOQ 48-1: How do generalized anxiety disorder, panic disorder, and specific phobias differ?

Anxiety disorders are psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. People with generalized anxiety disorder feel persistently and uncontrollably tense and apprehensive, for no apparent reason. In the more extreme panic disorder, anxiety escalates into periodic episodes of intense dread. Those with a specific phobia may be irrationally afraid of some object, activity, or situation.

How does culture have an effect on somatic symptom disorder?

Cultural context has a big effect on people's physical complaints and how they explain them. -In China, anxiety disorders are the most common psychological disorder. Yet psychological explanations of anxiety and depression are socially less acceptable there than in many Western countries, so people less often express the emotional aspects of distress. -The Chinese appear more sensitive to—and more willing to report—the physical symptoms of their distress.

How did Sigmund Freud interpret anxiety?

His psychoanalytic theory proposed that, beginning in childhood, people REPRESS intolerable impulses, ideas, and feelings. -Freud believed that this submerged mental energy sometimes leaks out in odd symptoms, such as anxious hand washing.

LOQ 48-4: What are somatic symptom and related disorders?

In somatic symptom and related disorders, including illness anxiety disorder,symptoms take a somatic (bodily) form without apparent physical cause.

Specific phobias and compulsive acts

Just as our specific phobias focus on dangers faced by our ancestors, our compulsive acts typically exaggerate behaviors that contributed to our species' survival. -Grooming had survival value. Gone wild, it becomes compulsive hair pulling. -Washing up becomes ritual hand washing. -Checking territorial boundaries becomes checking and rechecking already locked doors.

In what age group is OCD common?

OCD is more common among teens and young adults than among older people. A 40-year follow-up study of 144 Swedes diagnosed with the disorder found that, for most, the obsessions and compulsions had gradually lessened, though only 1 in 5 had completely recovered.

example of illness anxiety disorder

People with this relatively common disorder interpret normal sensations (a stomach cramp today, a headache tomorrow) as symptoms of a dreaded disease. -No amount of reassurance by any physician convinces the patient that the trivial symptoms do not reflect a serious illness. -So, the patient moves on to another physician—seeking and receiving more medical attention, but failing to confront the disorder's psychological roots. -Sympathy, and temporary relief from everyday demands may reinforce their behaviors.

LOQ 48-2: What is OCD?

Persistent and repetitive thoughts (obsessions), actions (compulsions), or both characterize obsessive-compulsive disorder (OCD).

RP-1 Unfocused tension, apprehension, and arousal are symptoms of _____ _____ disorder.

RP-1 generalized anxiety.

RP-2 Those who experience unpredictable periods of terror and intense dread, accompanied by frightening physical sensations, may be diagnosed with ______ disorder.

RP-2 panic.

RP-3 If a person is focusing anxiety on specific feared objects, activities, or situations, that person may have a _____ ______ .

RP-3 specific phobia.

RP-4 Those who express anxiety through unwanted repetitive thoughts or actions may have a(n) _____-_____ disorder.

RP-4 obsessive-compulsive.

RP-5 Those with symptoms of recurring memories and nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia for weeks after a traumatic event may be diagnosed with __________ __________ disorder.

RP-5 posttraumatic stress.

RP-6 What does somatic mean, and how does it apply to somatic symptom disorders?

RP-6 Somatic means "relating to the body"; somatic symptom disorders produce distressing bodily symptoms that have no apparent physical cause.

RP-7 Researchers believe that conditioning and cognitive processes are aspects of learning that contribute to anxiety-related disorders. What biological factors also contribute to these disorders?

RP-7 Biological factors include inherited temperament differences and other gene variations; experience-altered brain pathways; and outdated, inherited responses that had survival value for our distant ancestors.

How do some antidepressant drugs work for OCD?

Some antidepressant drugs dampen this fear circuit activity and its associated obsessive-compulsive behavior. -Fears can also be blunted by giving people drugs as they recall and then rerecord ("reconsolidate") a traumatic experience. -although they don't largely forget the experience, the associated emotion is largely erased.

specific fear

Some common specific fears Researchers surveyed Dutch people to identify the most common events or objects they feared. A strong fear becomes a specific phobia if it provokes a compelling but irrational desire to avoid the dreaded object or situation. (Data from Depla et al., 2008.)

What can make PTSD worse?

Some well-intentioned procedures—such as "debriefing" people by asking them to revisit the experience and vent their emotions—may worsen stress reactions

LOQ 48-3: What is PTSD?

Symptoms of posttraumatic stress disorder (PTSD) include four or more weeks of haunting memories, nightmares, hypervigilance, avoidance of trauma-related stimuli, social withdrawal, jumpy anxiety, numbness of feeling, and/or sleep problems following some traumatic experience.

LOQ 48-5: How do conditioning, cognition, and biology contribute to the feelings and thoughts that mark anxiety-related disorders?

The learning perspective views anxiety-related disorders as products of fear conditioning, stimulus generalization, fearful-behavior reinforcement, and observational learning of others' fears and cognitions. The biological perspective considers genetic predispositions for high levels of emotional reactivity and neurotransmitter production; abnormal responses in the brain's fear circuits; and the role that fears of life-threatening dangers played in natural selection and evolution.

How are "evolutionary relevant" stimuli influential?

They are easy to condition and hard to extinguish.

How are we biologically prepared to fear threats faced by our ancestors?

Those fearless about occasional threats of spiders, snakes, and other animals; enclosed spaces and heights; and storms and darkness were less likely to survive and leave descendants.

Classical conditioning and anxiety

Through classical conditioning, our fear responses can become linked with formerly neutral objects and events. -Anxious or traumatized people learn to associate their anxiety with certain cues.

Traumatic fear-learning experiences have what affect on the brain?

Traumatic fear-learning experiences can leave tracks in the brain, creating fear circuits within the amygdala. -These fear pathways create easy inroads for more fear experiences.

posttraumatic stress disorder (PTSD)

a disorder characterized by haunting memories, nightmares, hypervigilance, avoidance of trauma-related stimuli, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience. (p. 565) -recurring, vivid, distressing memories and nightmares -laser-focused attention on possible threats, social withdrawal, jumpy anxiety, and trouble sleeping.

obsessive-compulsive disorder (OCD)

a disorder characterized by unwanted repetitive thoughts (obsessions), actions (compulsions), or both. (p. 565)

illness anxiety disorder

a disorder in which a person interprets normal physical sensations as symptoms of a disease. (Formerly called hypochondriasis.) (p. 566)

somatic symptom disorder

a psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause. (p. 566) -formerly known as somatoform disorder

survivor resiliency

ability to recover after severe stress

generalized anxiety disorder

an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous systemarousal. (p. 563) -marked by excessive and uncontrollable worry that persists for 6 months or more. -2/3 of the people with this condition are women

specific phobia

an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation. (p. 565) ex. insects, animals, heights, blood, enclosed spaces

panic disorder

an anxiety disorder marked by unpredictable, minutes-long episodes of intense dread in which a person may experience terror and accompanying chest pain, choking, or other frightening sensations; often followed by worry over a possible next attack. (p. 563)

hypervigilant

an overactive awareness of things around you

Nine-month-old infants attend to more sounds signaling ____ than they do to sounds representing ____ .

ancient threats (hisses, thunder); modern threats (a bomb exploding, breaking glass)

When the brain's danger-detection system becomes hyperactive, we are at greater risk for

anxiety disorder, and for 3 other disorders that involve anxiety: obsessive-compulsive disorder (OCD), post traumatic stress disorder (PTSD), and the somatic symptom disorders

When a person with an anxiety disorder eases anxiety by avoiding or escaping a situation that inspires fear, this is called: a. free-floating anxiety. b. reinforcement. c. an epigenetic mark. d. hypervigilance.

b.

Anxiety or an anxiety-related disorder is more likely to develop when

bad events happen unpredictably and uncontrollably.

anterior cingulate cortex

brain region that monitors our actions and checks for errors -is often especially active in those with OCD.

An episode of intense dread that can be accompanied by chest pains, choking, or other frightening sensations is called: a. an obsession. b. a compulsion. c. a panic attack. d. a specific phobia.

c.

The learning perspective proposes that specific phobias are: a. the result of individual genetic makeup. b. a way of repressing unacceptable impulses. c. conditioned fears. d. a symptom of having been abused as a child.

c.

Most psychologists today instead embrace three modern perspectives for interpreting anxiety:

conditioning, cognition, and biology.

agoraphobia

fear or avoidance of situations from which escape might be difficult or help unavailable when panic strikes

By observing others, we can learn to

fear what they fear

anxiety is a ____ and also a _____ .

feeling; cognition

Some of our modern fears, such as _____ can also have an evolutionary explanation _____.

flying; a biological predisposition to fear confinement and heights

Marina became consumed with the need to clean the entire house and refused to participate in any other activities. Her family consulted a therapist, who diagnosed her as having __________ - __________ disorder.

obsessive-compulsive.

Generalized anxiety disorder, panic attacks, specific phobias, OCD, and PTSD express themselves biologically as...

overarousal of brain areas involved in impulse control and habitual behaviors. -these disorders reflect the brain's danger-detection system gone hyperactive- producing anxiety when little danger exists.

Some psychologists believe that PTSD has been...

overdiagnosed -too often, PTSD gets stretched to include normal stress-related bad memories and dreams.

Our everyday lives are full of little rehearsals and fussy behaviors. They cross the fine line between normality and disorder only when they....

persistently interfere with everyday life and cause distress.

anxiety disorders

psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. (p. 563) 1. distressing, persistent anxiety 2. dysfunctional anxiety-reducing behaviors

post-traumatic growth

refers to the positive psychological change experienced as a result of the struggle with highly challenging life circumstances

Some genes influence disorders by

regulating brain levels of neurotransmitters. -These include: *serotonin- influences sleep, mood, and attending to threats *glutamate- heightens activity in the brain's alarm centers

compulsive behaviors are...

responses to those obsessive thoughts

anxiety is often just a response to...

self-produced fake news.

In OCD, when the brain detects that something is amiss, it seems to generate a mental hiccup of repeating thoughts (obsessions) or actions (compulsions). Brain scans of people with OCD reveal elevated activity in ...

specific brain areas during behaviors such as compulsive hand-washing, checking, organizing, or hoarding.

Anxiety that takes the form of an irrational and maladaptive fear of a specific object, activity, or situation is called a __________ __________.

specific phobia.

stimulus generalization

the tendency to respond to a stimulus that is only similar to the original conditioned stimulus with the conditioned response -when a person experiences a fear-provoking event and later develops a fear of similar events.

Conditioning influences our feelings of anxiety, but so do our...

thoughts, memories, interpretations, and expectations.

obsessive thoughts are...

unwanted and seemingly unending.