Abnormal Psychology

Anxiety Disorders 327

Summary of

Common Features of

Anxiety Disorders

The key symptoms of anxiety disorders are ex-

treme anxiety, intense arousal, and attempts

to avoid stimuli that lead to fear and anxiety.

The fi ght-or-fl ight response arises when peo-

ple perceive a threat; when the arousal feels

out of control—either because the individual

has an overactive stress response or because

he or she misinterprets the arousal—the per-

son may experience panic. In response to

the panic, some people develop a phobia of

the stimuli related to their panic and anxiety

symptoms.

Anxiety disorders frequently co-occur with

other psychological disorders, such as de-

pression or substance-related disorders. Men-

tal health clinicians must determine whether

the anxiety symptoms are the primary cause

of the problem or are the by-product of an-

other type of disorder. The high comorbidity

of depression and anxiety disorders suggests

that the two disorders share some of the

same features, specifically high levels of

negative emotions and distress—which can

lead to concentration and sleep problems and

irritability.

Thinking like a clinician

What is the difference between fear and anxi-

ety? Why (or when) might the fight-or-flight

response become a problem? If people can

have symptoms of anxiety when they have

other types of disorders, what determines

whether an anxiety disorder is the diagnosis?

Summary of Generalized

Somatization Disorder

Generalized anxiety disorder (GAD) is marked

by persistent uncontrollable worry about a

number of events or activities. A majority of

people with GAD also have comorbid depres-

sion. Neurological factors associated with

GAD include abnormal activity of dopamine

and other neurotransmitters, which influ-

ences motivation, response to reward, and

attention, and a genetic predisposition to

become anxious and/or depressed.

Psychological factors that contribute to

GAD include being hypervigilant for possible

threats, a sense that the worrying is out of

control, and the reinforcing experience that

worrying prevents panic. Social factors

that contribute to GAD include stressful life

events, which can trigger the disorder.

Treatments for GAD include (1) medication

such as buspirone or an SNRI or SSRI when

depression is present as a comorbid disor-

der; and (2) CBT, which may be employed in a

group format.

Thinking like a clinician

Based on what you have read, what differenti-

ates a “worrywart”—someone who worries a

lot—from someone with GAD? If having GAD

is distressing, why don’t patients simply stop

worrying—what factors maintain the disor-

der? If someone you know with GAD asked

you for advice about what kind of treatment

to get, what would you recommend (based on

what you have read) and why?

Summary of Panic

Disorder (With and

Without Agoraphobia)

The hallmark of panic disorder is recurrent

panic attacks. 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

symptoms, such as ataque de nervios and

wind-and-blood pressure. Some people with

panic disorder also develop agoraphobia.

Less commonly, people develop agoraphobia

without panic disorder, but they fear trigger-

ing symptoms of panic.

Neurological factors contribute to panic

disorder and agoraphobia, including: (1) A

heightened sensitivity to detect breathing

changes, which in turn leads to hyperventila-

tion, panic, and a sense of needing to escape.

(2) Too much norepinephrine, which increases

heart and respiration rates and other aspects

of the fight-or-flight response. (3) A genetic

predisposition to anxiety disorders.

Psychological factors that contribute

to panic disorder and agoraphobia include:

(1) Conditioning of learned alarms that elicit

panic symptoms. (2) Heightened anxiety sen-

sitivity and misinterpretation of bodily symp-

toms of arousal in turn lead to a hypervigilance

for—and fear of—further sensations, increas-

ing arousal and creating a vicious cycle.

Social factors related to panic disorder

and agoraphobia include: (1) a greater than

average number of social stressors during

childhood and adolescence; (2) the pres-

ence of a safe person, which can decrease

catastrophic thinking and panic; and (3) cul-

tural factors.

The treatment that targets neurological fac-

tors is medication, specifi cally benzodiazepines

for short-term relief and antidepressants for

long-term use. CBT is the first-line treatment

for panic disorder and targets psychological

factors. Treatments that target social factors

include group therapy focused on panic disor-

der and couples or family therapy, particularly

when a family member is a safe person.

Thinking like a clinician

All you know about Fiona is that she has

had about ten panic attacks. Is this enough

information to determine whether she has

panic disorder? If it is, does she have the dis-

order? If this isn’t enough information, what

else would you want to know and why? Now

suppose that Fiona starts missing Monday

classes because of panic attacks on those

days. She also stops going to parties on

the weekend because she had a couple of

panic attacks at parties. Would you change

or maintain your answer about whether she

has panic disorder—why or why not? Sup-

pose Fiona does have panic disorder. Explain

how she might have developed the disorder.

By the end of the semester, Fiona no longer

goes out of her apartment for fear of getting

a panic attack. What might be appropriate

treatments for Fiona?

Treating Social Phobia

(Social Anxiety Disorder)

Social phobia is an intense fear of public

humiliation or embarrassment, together

with an avoidance of social situations likely

to cause this fear. When such social situa-

tions cannot be avoided, they trigger panic

or anxiety. Social phobia may be limited to

specifi c types of performance-related situa-

tions or may be generalized to most social

situations. The anxiety about performing

poorly and being evaluated by others can,

in turn, impair an individual’s performance,

creating a vicious cycle.

Neurological factors that give rise to so-

cial phobia include an amygdala that is more

easily activated in response to social stimuli,

too little dopamine in the basal ganglia, too

little serotonin, and a genetic predisposition

toward a shy temperament, or behavioral in-

hibition. Psychological factors that give rise to

social phobia include cognitive distortions and

hypervigilance for social threats— particularly

about being (negatively) evaluated. Classical

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