Abnormal Psychology

Anxiety Disorders 277

Earl Campbell’s Anxiety

The most appropriate diagnosis for Campbell appears to be panic disorder with

agoraphobia. Despite using medication, Campbell continues to have some panic

symptoms, but he makes good use of various cognitive and behavioral methods and

of social support. He acknowledged his continuing efforts: “Even though crowds

and noise bother me, I’ll push myself to tolerate them for as long as I can. I know I

must keep trying to get past the fear. It takes far more discipline for me to get through

an average day with panic than it took for me to perform as a top running back in

the NFL. The challenges of panic are greater” (Campbell & Ruane, 1999, p. 199).

In the rest of the chapter we examine other anxiety disorders, disorders not applic-

able to Campbell. As we discuss these other anxiety disorders, we consider Howard

Hughes and his symptoms of anxiety, and the role these symptoms played in his life.

Key Concepts and Facts About Panic Disorder (With and Without Agoraphobia)

• The hallmark of panic disorder is recurrent panic attacks—
  periods of intense dread, fear, and feelings of imminent doom
  along with increased heart rate, shortness of breath, and other
  signs of hyperarousal. Panic attacks may be cued by particular
  stimuli (usually internal sensations), or they may arise without
  any clear cue. Panic disorder also involves fear of further attacks
  and, in some cases, restricted behavior in an effort to prevent
  further attacks.


• People in different cultures may have similar—but not identical—
  constellations of panic symptoms, such as ataque de nervios
  and wind-and-blood pressure.


• Some people with panic disorder also develop agoraphobia—
  avoiding situations that might trigger a panic attack or from
  which escape would be diffi cult, such as crowded locations or
  tunnels. Less commonly, people develop agoraphobia without
  panic disorder.


• Neurological factors that contribute to panic disorder and agora-
  phobia include:
  
  
  • A heightened sensitivity to detect breathing changes,
    which in turn leads to hyperventilation, panic, and a sense
    of needing to escape. This mechanism involves withdrawal
    emotions and the right frontal lobe, the amygdala, and the
    hypothalamus.
  
  
  • Too much norepinephrine (produced by an over-reactive
    locus coeruleus), which increases heart and respiration
    rates and other aspects of the fi ght-or-fl ight response.
  
  
  • A genetic predisposition to anxiety disorders, which makes
    some people vulnerable to panic disorder and agoraphobia.
  
  
  
  


• Psychological factors that contribute to panic disorder and
  agora phobia include:
  
  
  • Conditioning of the initial bodily sensations of panic (intero-
    ceptive cues) or of external cues related to panic attacks,
    which leads them to become learned alarms and elicit panic
    symptoms. Some individuals then develop a fear of fear and
    avoid panic-related cues.
  
  
  • Heightened anxiety sensitivity and misinterpretation of
    bodily symptoms of arousal as symptoms of a more serious
  
  
  
  

problem, such as a heart attack, which can, in turn, lead to

hypervigilance for—and fear of—further sensations and

cause increased arousal, creating a vicious cycle.

• Social factors related to panic disorder and agoraphobia include:
  
  
  • greater than average number of social stressors during
    childhood and adolescence;
  
  
  • the presence of a safe person, which can decrease cata-
    strophic thinking and panic.
  
  
  • cultural factors, which can infl uence whether people de-
    velop panic disorder.
  
  
  
  


• The treatment that targets neurological factors is medication,
  specifically benzodiazepines for short-term relief and anti-
  depressants for long-term use.


• CBT is the first-line treatment for panic disorder and targets
  psychological factors. Behavioral methods focus on the bodily
  signals of arousal, panic, and agoraphobic avoidance. Cognitive
  methods (psychoeducation and cognitive restructuring) focus
  on the misappraisal of bodily sensations and on mistaken infer-
  ences about them.


• Treatments that target social factors include group therapy fo-
  cused on panic disorder, and couples or family therapy, particu-
  larly when a family member is a safe person.

Making a Diagnosis

• Reread Case 7.2 about S, and determine whether or not her
  symptoms meet the criteria for panic disorder. Specifi cally, list
  which criteria apply and which do not. If you would like more
  information to determine her diagnosis, what information—
  specifi cally—would you want, and in what ways would the infor-
  mation infl uence your decision?


• Reread Case 7.3 about Shirley B., and determine whether or
  not her symptoms meet the criteria for agoraphobia with or
  without panic disorder. Specifi cally, list which criteria apply and
  which do not. If you would like more information to determine
  her diagnosis, what information—specifically—would
  you want, and in what ways would the information infl uence
  your decision?