326 CHAPTER 7
Howard Hughes and Anxiety Disorders
We’ve seen that Howard Hughes may have had enough symptoms of social phobia
to meet the DSM-IV-TR criteria at some points in his life, and he may have had
specifi c phobia, other type (fear of contracting an illness). He did not seem to suf-
fer from a stress disorder. Without a doubt, though, he clearly suffered from OCD.
Although there is evidence that some of his symptoms began in childhood, his OCD
symptoms worsened signifi cantly when he was in his 40s. There are several rea-
sons for his progressively impaired functioning at this time. First, he used increas-
ingly larger and more frequent doses of codeine and Valium, which likely led to his
diminished cognitive functioning and control over his behavior—his compulsions.
Second, he had by then suffered brain damage, which came about from two sources:
(1) the 14 occurrences of head trauma Hughes withstood from various plane and
car accidents (Fowler, 1986), and (2) the effects of advanced syphilis (Brown &
Broeske, 1996).
Hughes contracted syphilis when in his 30s, before antibiotics were available
(Brown & Broeske, 1996). To treat the disease, he underwent painful and risky mer-
cury treatment; unfortunately, the treatment was not a complete success, and by the
time he was in his 40s, the disease appears to have progressed. After Hughes’s death,
his autopsy indicated that signifi cant brain cell death had occurred, which is a sign
of advanced syphilis (a condition previously called general paresis; see Chapter 1).
Symptoms can include gradual personality changes and poor judgment, which may
take up to 15 years to emerge. For the first few decades of his adult life, then,
Hughes was able to keep his OCD symptoms suffi ciently in check that his func-
tioning was far less impaired than it became in his 50s and afterward. It is possible
that the effects of syphilis and the brain trauma from his accidents exacerbated his
OCD. Thus, two physical factors contributed to the worsening of Hughes’s OCD
symptoms: brain damage, discussed in Chapter 15, and substance abuse, which is
the focus of Chapter 9.normal responses to trauma, and because the symptoms speci-
fi ed in the criteria overlap with those for other disorders.- Brain areas involved in PTSD include parts of the frontal lobe,
the hippocampus, the locus coeruleus, and the amygdala—
most of these areas are involved in emotion and fear. Patients
with PTSD respond to high levels of norepinephrine by having
panic attacks or fl ashbacks; they also have abnormal serotonin
function and produce less cortisol in response to the traumatic
event than do people who do not go on to develop a stress
disorder. Although genes—through their infl uence on temper-
ament—may affect an individual’s tendency to enter risky sit-
uations, characteristics of the traumatic event itself are more
important in determining whether PTSD will arise. - Psychological factors that exist before a traumatic event con-
tribute to PTSD; these factors include a history of depression
or other psychological disorders, a belief in being unable to
control stressors, the conviction that the world is a dangerous
place, and lower IQ. After a traumatic event, classical and oper-
ant conditioning contribute to the avoidance symptoms.- Social factors that contribute to PTSD include the stress of low
socioeconomic status and a relative lack of social support for
the trauma victim. Culture can infl uence the ways that individu-
als cope with traumatic stress. - Medication is the treatment that directly targets neurological
factors, specifi cally an SSRI. Treatments that target psychologi-
cal factors include CBT, specifi cally psychoeducation, exposure,
relaxation, breathing retraining, and cognitive restructuring.
Treatments that target social factors are designed to ensure that
the individual is as safe as possible from future trauma and to in-
crease social support through group therapy or family therapy.
- Social factors that contribute to PTSD include the stress of low
Making a Diagnosis
- Reread Case 7.7 about A. C., and determine whether or not his
symptoms met the criteria for posttraumatic stress disorder.
Specifi cally, list which apply and which do not. If you would like
more information to determine his diagnosis, what information—
specifi cally—would you want, and in what ways would the infor-
mation infl uence your decision?