Abnormal Psychology

Anxiety Disorders 251

explanations point to biological differences, such as the hormonal shifts that occur

during a woman’s childbearing years (Ginsberg 2004); the gender difference in

anxiety disorders coincides with the onset of puberty (as is the case with depression;

see Chapter 6). Other explanations for the gender difference point to cultural factors

(Pigott, 1999): Men tend to be reluctant to acknowledge symptoms of anxiety be-

cause they fear that admitting such feelings might undercut the masculine image they

project to others.

Comorbidity of Anxiety Disorders

As you’ll see throughout this text, symptoms of anxiety or avoidance may occur in

many psychological disorders, including mood disorders (Chapter 6), somatization

disorder (Chapter 8), body dysmorphic disorder (Chapter 8), and anorexia nervosa

(Chapter 11). Clinicians must determine whether the anxiety and avoidance symp-

toms are the primary cause of the disturbance or a by-product of another

type of problem. In the case of anorexia nervosa, for example, when some-

one gets anxious about eating high-calorie foods, the anxiety is secondary

to larger concerns about food, weight, and appearance.

Anxiety and depression often occur together; about 50% of people

with an anxiety disorder are also depressed (Brown et al., 2001). For Earl

Campbell, depression followed anxiety. A couple of weeks after his fi rst

anxiety episode, on the fi rst morning in his new house in Austin, Campbell

experienced debilitating depression settling on him:

The moment I woke up in the morning, a heaviness enveloped me. I couldn’t

avoid it. I would open my eyes and start crying. I would sit in the bedroom

all day long, wearing pajamas and sunglasses, the curtains closed against the

daylight. Life had slipped into slow motion. Sometimes I’d sit in a daze on the

couch, watching Reuna unpacking boxes and organizing the house. I would just

sit there in pain. I began to have terrible headaches. The depression would not

let up. I told Reuna I was sure I was going to die. She knew I was quite serious.

(Campbell & Ruane, 1999, p. 92)

Researchers and clinicians are trying to discover why there is such high

comorbidity between anxiety disorders and depression. Some researchers

have proposed a three-part model of anxiety and depression that specifi es the

ways in which the two kinds of disorders overlap and the ways in which they

are distinct (Clark & Watson, 1991; Mineka, Watson, & Clark, 1998). This

model has been supported by subsequent research (Joiner, 1996; Olino et al.,

2008). The three parts of the model are as follows (see Figure 7.2):

1. High level of negative emotions, which include general distress. Both anxiety
   and depressive disorders can involve poor concentration, sleep disturbances,
   and irritability, as well as anxious apprehension. This part of the model
   represents the common factor shared by anxiety disorders and depression (and
   other disorders as well).


2. Low level of positive emotions. Symptoms of depression include
   a lack of enjoyment and slowed motor functioning. Low positive
   affect is a symptom of depression, but generally not a symptom of
   anxiety disorders.


3. Physiological hyperarousal (overarousal), which is found in anxi-
   ety disorders, but not in depression.

Approximately 10–25% of those with anxiety disorders also abuse

or are dependent on alcohol (Bibb & Chambless, 1986; Otto et al.,

1992). Among people with phobias, the alcohol use usually occurs af-

ter the anxiety symptoms develop. Among those with other kinds of

anxiety disorders, alcohol use may either precede or follow the onset of

the anxiety disorder (Swendsen et al., 1998).

7.2 • Tripartite Model of Anxiety and

Depression Anxiety and depression have in

common a high level of negative emotions, but each

has unique elements: Anxiety generally involves a

very high level of physiological arousal, whereas

depression involves a low level of positive emotions.

Figure 7.2

f

g7

Anxiety Depression

Physiological

hyperarousal

General

distress

(high level

of negative

emotions)

Lack of

enjoyment

(low level

of positive

emotions)

People with phobias, such as musicians with

performance anxiety (stage fright), may use alco-

hol to relieve their anxiety symptoms. However,

using alcohol in this way can lead to abuse or

dependence.

Dynamic Graphics/Jupiterimages