GROUP C

Mehma Kaur Anand

PSY/22/58

UNDERSTANDING MENTAL DISORDERS

ASSIGNMENT
Q1. What do you understand by anxiety disorder? Discuss the causal factors of
anxiety disorder.

A1.
 ANXIETY DISORDER: The anxiety response pattern is a complex blend
of unpleasant emotions and cognitions that is both more oriented toward
the future. It contains cognitive/ subjective components but also
physiological and behavioral components. At the cognitive/ subjective
level, anxiety involves-
 negative mood
 worry about possible future threats or danger
 self-preoccupation
 and a sense of being unable to predict the future threat or to control it if
it occurs.
At the physiological level, anxiety often creates-
 a state of tension
 Heart racing
 Sweating
 Dry mouth
 Shaking
 dizziness
 chronic overarousal
 which may reflect risk assessment and readiness for dealing with danger
should it occur (“Something awful may happen, and I had better be ready
for it if it does”).
Although there is no activation of the fight-or-flight response as there is with
fear, anxiety does prepare or prime a person for the fight-or-flight response
should the anticipated danger occur. At behavioral level-
 anxiety may create a strong tendency to avoid situations where danger
might be encountered.
If you have a test tomorrow and have not studied, then you may feel muscle
tension (physical feeling), believe you will not do well (thought), and skip the
test (behavior). The adaptive value of anxiety may be that it helps us plan and
prepare for a possible threat. In mild to moderate degrees, anxiety enhances
learning and performance. For example, a mild amount of anxiety about how
you are going to do on your next exam, or in your next tennis match, can be
helpful. But, although anxiety is often adaptive in mild or moderate degrees, it
is maladaptive when it becomes chronic and severe, as we see in people
diagnosed with anxiety disorders. Although many threatening situations can
occur that provoke fear or anxiety unconditionally, many of our sources of fear
and anxiety are learned.

Anxiety disorders are characterized by unrealistic, irrational fears or anxieties

that cause significant distress and/or impairments in functioning. Among the
disorders recognized in DSM-5 are:
1. specific phobia
2. social anxiety disorder (social phobia)
people with specific or social phobias experience a fear or panic response not
only when they encounter the object or situation that they fear, but also in
response to even the possibility of encountering their phobic situation.
3. panic disorder
People with panic disorder experience both frequent panic attacks and intense
anxiety focused on the possibility of having another one.
4. agoraphobia
People with agoraphobia go to great lengths to avoid a variety of feared to
situations, ranging from open streets and bridges to crowded public places.
5. generalized anxiety disorder.
People with generalised personality disorder mostly experience a general sense
of diffuse anxiety and worry about many potentially bad things that may
happen. some may also experience an occasional panic attack, but it is not a
focus of their anxiety. It is also important to note that many people with one
anxiety disorder will experience at least one more anxiety disorder and/or
depression either concurrently or at a different point in their lives (Brown &
Barlow, 2009; Kessler, Berglund, Demler, et al., 2005).
 CAUSAL FACTORS:
Among common psychological causal factors, the classical conditioning of fear,
panic, or anxiety to a range of stimuli plays an important role in many of these
disorders (Mineka & Oehlberg, 2008; Mineka & Zinbarg, 2006). In addition,
people who have perceptions of a lack of control over either their
environments or their own emotions (or both) seem more vulnerable to
developing anxiety disorders. The development of such perceptions of
uncontrollability depends heavily on the social environment people are raised
in, including parenting styles (Hudson & Rapee, 2009; Mineka & Zinbarg, 2006).
For certain disorders, faulty or distorted patterns of cognition also may play an
important role. Finally, the sociocultural environment in which people are
raised also has prominent effects on the kinds of objects and experiences
people become anxious about or come to fear. As with the other disorders
described in this book, a biopsychosocial approach is best suited for
understanding how all different types of causal factors interact with one
another in the development of these disorders.
1) SPECIFIC PHOBIA- Specific phobia is said to be present if a person
shows strong and persistent fear that is triggered by the presence of a
specific object or situation and leads to significant distress and/or
impairment in a person’s ability to function.
 PSYCHOLOGICAL CAUSAL FACTORS-
PSYCHOANALYTIC VIEWPOINT According to the psychoanalytic view,
phobias represent a defense against anxiety that stems from repressed impulses
from the id. Because it is too dangerous to “know” the repressed id impulse, the
anxiety is displaced onto some external object or situation that has some
symbolic relationship to the real object of the anxiety (Freud, 1909)
PHOBIAS AS LEARNED BEHAVIOR Wolpe and Rachman (1960) developed
an account based on learning theory which sought to explain the development of
phobic behavior through classical conditioning. The fear response can readily be
conditioned to previously neutral stimuli when these stimuli are paired with
traumatic or painful events.
VICARIOUS CONDITIONING AND DIRECT TRAUMATIC
CONDITIONING in which a person has a terrifying experience in the presence
of a neutral object or situation is not the only way that people can learn
irrational, phobic fears. Simply watching a phobic person behaving fearfully
with his or her phobic object can be distressing to the observer and can result in
fear being transmitted from one person to another through vicarious or
observational classical conditioning.
INDIVIDUAL DIFFERENCES IN LEARNING Given all the traumas that
people undergo and watch others experience, why don’t more people develop
phobias (Mineka & Oehlberg, 2008)? One reason is that individual differences
in life experiences strongly affect whether conditioned fears or phobias develop.
Importantly, some life experiences may serve as risk factors and make certain
people more vulnerable to phobias than others. In contrast, other experiences
may serve as protective factors for the development of phobias (Mineka &
Sutton, 2006). For example, children who have had more previous nontraumatic
experiences with a dentist are less likely to develop dental anxiety after a bad
and painful experience than children with fewer previous nontraumatic
experiences (Ten Berge et al., 2002).
EVOLUTIONARY PREPAREDNESS FOR LEARNING Certain Fears and
Phobias, t people are much more likely to have phobias of snakes, water,
heights, and enclosed spaces than of motorcycles, guns, and chainsaws even
though the latter objects may be at least as likely to be associated with trauma?
This is because our evolutionary history has affected which stimuli we are most
likely to come to fear. Primates and humans seem to be evolutionarily prepared
to rapidly associate certain objects—such as snakes, spiders, water, and
enclosed spaces—with frightening or unpleasant events (Mineka & Öhman,
2002; Öhman, 1996; Seligman, 1971). This prepared learning occurs because,
throughout evolution, those primates and humans who rapidly acquired fears of
certain objects or situations that posed real threats to our early ancestors may
have enjoyed a selective advantage (meaning, they survived more often than
those who had no fear of such things).
 BIOLOGICAL CAUSAL FACTORS-
GENETIC AND TEMPERAMENTAL VALUES also affect the speed and
strength of conditioning of fear. For example, Lonsdorf and colleagues (2009)
found that individuals who are carriers of one of the two variants of the
serotonin transporter gene (the s allele, which has been linked to heightened
neuroticism) show superior fear conditioning than those without the s allele.
However, those with one of two variants of a different gene (the COMT
met/met genotype) did not show superior conditioning but did show enhanced
resistance to extinction. Relatedly, Kagan and his colleagues (2001) found that
behaviorally inhibited toddlers (who are excessively timid, shy, easily
distressed, etc.) at 21 months of age were at higher risk of developing multiple
specific phobias by 7 to 8 years of age than were uninhibited children.
Several behavior genetic studies also suggest a modest genetic contribution to
the development of specific phobias. For example, large twin studies show that
monozygotic (identical) twins are more likely to share animal phobias and
situational phobias (such as heights or water) than were dizygotic (nonidentical)
twins.

2) SOCIAL PHOBIA- Is characterized by disabling fears of one or more

specific social situations (such as public speaking, urinating in a
public bathroom, or eating or writing in public). In these situations, a
person fears that she or he may be exposed to the scrutiny and
potential negative evaluation of others or that she or he may act in an
embarrassing or humiliating manner. Because of their fears, people
with social phobia either avoid these situations or endure them with
great distress. Intense fear of public speaking is the single most
common type of social phobia. DSM-5 also identifies two subtypes of
social phobia, one of which centers on performance situations such as
public speaking and one of which is more general and includes
nonperformance situations (such as eating in public).
 PSYCHOLOGICAL CAUSAL FACTORS
SOCIAL PHOBIA AS LEARNED BEHAVIOUR, social phobia often seems
to originate from simple instances of direct or vicarious classical
conditioning such as experiencing or witnessing a perceived social defeat or
humiliation, or being or witnessing the target of anger or criticism. Study
reported that 92 percent of an adult sample of people with social phobia
reported a history of severe teasing in childhood, compared to only 35
percent in a group of people with obsessive-compulsive disorder.
SOCIAL FEARS AND PHOBIA IN AN EVOLUTIONARY CONTEXT,
Social fears and phobia by definition involve fears of members of one’s
species. By contrast, animal fears and phobias usually involve fear of
potential predators. Although animal fears probably evolved to trigger
activation of the fight-or-flight response to potential predators, it has been
proposed that social fears and phobia evolved as a by-product of dominance
hierarchies that are a common social arrangement among animals such as
primates. Dominance hierarchies are established through aggressive
encounters between members of a social group, and a defeated individual
typically displays fear and submissive behavior but only rarely attempts to
escape the situation completely.
PERCEPTIONS OF UNCONTROLLABLE AND UNPREDICTABILITY,
Being exposed to uncontrollable and unpredictable stressful events (such as
parental separation and divorce, family conflict, or sexual abuse) may play
an important role in the development of social phobia (Mathew et al., 2001;
Mineka & Zinbarg, 2006). Perceptions of uncontrollability and
unpredictability often lead to submissive and unassertive behavior, which is
characteristic of people who are socially anxious or phobic. This kind of
behavior is especially likely if the perceptions of uncontrollability stem from
an actual social defeat, which is known in animals to lead to both increased
submissive behavior and increased fear (Mineka & Zinbarg, 1995, 2006).
COGNITIVE BIASES, Cognitive factors also play a role in the onset and
maintenance of social phobia. Beck and colleagues (1985) suggested that
people with social phobia tend to expect that other people will reject or
negatively evaluate them. They argued that this leads to a sense of
vulnerability when they are around people who might pose a threat.

 BIOLOGICAL CAUSAL FACTORS

BEHAVIOURAL INHIBITION, shares characteristics with both neuroticism
and introversion (Bienvenu et al., 2007). Behaviorally inhibited infants who are
easily distressed by unfamiliar stimuli and who are shy and avoidant are more
likely to become fearful during childhood and, by adolescence, to show an
increased risk of developing social phobia (Hayward et al., 1998; Kagan, 1997).
Results from twin studies have shown that there is a modest genetic contribution
to social phobia; estimates are that about 30 percent of the variance in liability
to social phobia is due to genetic factors.

3) PANIC DISORDER- Panic disorder is defined and characterized by

the occurrence of panic attacks that often seem to come “out of the
blue.” ). Panic attacks are fairly brief but intense, with symptoms
developing abruptly and usually reaching peak intensity within 10
minutes; the attacks often subside in 20 to 30 minutes and rarely last
more than an hour. Periods of anxiety, by contrast, do not typically
have such an abrupt onset and are more long-lasting. Panic attacks
often are “unexpected” or “uncued” in the sense that they do not
appear to be provoked by identifiable aspects of the immediate
situation. Indeed, they sometimes occur in situations in which they
might be least expected, such as during relaxation or during sleep
(known as nocturnal panic).
Because most symptoms of a panic attack are physical, it is not surprising that
as many as 85 percent of people having a panic attack may show up repeatedly
at emergency departments or physicians’ offices for what they are convinced is
a medical problem—usually cardiac, respiratory, or neurological.

4) AGORAPHOBIA- In agoraphobia the most commonly feared and

avoided situations include streets and crowded places such as
shopping malls, movie theaters, and stores. Standing in line can be
particularly difficult. Sometimes, agoraphobia develops as a
complication of having panic attacks in one or more such situations.
Concerned that they may have a panic attack or get sick, people with
agoraphobia are anxious about being in places or situations from
which escape would be difficult or embarrassing, or in which
immediate help would be unavailable if something bad happened.
Typically people with agoraphobia are also frightened by their own
bodily sensations, so they also avoid activities that will create arousal
such as exercising, watching scary movies, drinking caffeine, and
even engaging in sexual activity.
 BIOLOGICAL CAUSAL FACTORS

GENETIC FACTORS, According to family and twin studies, panic disorder has
a moderate heritable component (Maron et al., 2010; Norrholm & Ressler,
2009). ). In a large twin study, López-Solà and colleagues (2014) estimated that
30 to 34 percent of the variance in liability to panic symptoms is due to genetic
factors. As noted earlier, this genetic vulnerability is manifested at a
psychological level at least in part by the important personality trait called
neuroticism (which is in turn related to the temperamental construct of
behavioral inhibition). Several studies have begun to identify which specific
genetic polymorphisms are responsible for this moderate heritability (Strug et
al., 2010), either alone or in interaction with certain types of stressful life events
(Klauke et al., 2010).
PANIC AND THE BRAIN One relatively early prominent theory about the
neurobiology of panic attacks implicated the locus coeruleus in the brain stem
(see Figure 6.1) and a particular neurotransmitter—norepinephrine—that is
centrally involved in brain activity in this area (Goddard et al., 1996). However,
today it is recognized that it is increased activity in the amygdala that plays a
more central role in panic attacks than does activity in the locus coeruleus.
BIOCHEMICAL ABNORMALITIES This hypothesis initially appeared to be
supported by numerous studies during the past 40 years, showing that people
with panic disorder are much more likely to experience panic attacks when they
are exposed to various biological challenge procedures than are normal people
or people with other psychiatric disorders. For example, some of these
laboratory tests involve infusions of sodium lactate (a substance resembling the
lactate our bodies produce during exercise; Gorman et al., 1989), inhaling air
with altered amounts of carbon dioxide (Woods et al., 1987), or ingesting large
amounts of caffeine (Uhde, 1990). In each case, such procedures produce panic
attacks in panic disorder clients at a much higher rate than in normal subjects
(Barlow, 2002). There is a broad range of these so-called panic provocation
procedures.

 PSYCHOLOGICAL CAUSAL FACTORS

COGNITIVE THEORY OF PANIC The cognitive theory of panic disorder
proposes that people with panic disorder are hypersensitive to their bodily
sensations and are very prone to giving them the most dire interpretation
possible (Beck et al., 1985; D. M. Clark, 1986, 1997). Clark referred to this
as a tendency to catastrophize about the meaning of their bodily sensations.
For example, a person who develops panic disorder might notice that his
heart is racing and conclude that he is having a heart attack, or notice that he
is dizzy, which may lead to fainting or to the thought that he may have a
brain tumor.
COMPREHENSIVE LEARNING THEORY OF PANIC DISORDER A
comprehensive learning theory of panic disorder developed during the past
few decades suggests that initial panic attacks become associated with
initially neutral internal (interoceptive) and external (exteroceptive) cues
through an interoceptive conditioning (or exteroceptive conditioning)
process, which leads anxiety to become conditioned to these CSs, and the
more intense the panic attack, the more robust the conditioning that will
occur.
COGNITIVE BIASES AND MAINTAINANCE OF PANIC Many studies
have shown that people with panic disorder are biased in the way they
process threatening information. Such people not only interpret ambiguous
bodily sensations as threatening (D. A. Clark, 1997; Teachman et al., 2006),
but they also interpret other ambiguous situations as more threatening than
do controls. People with panic disorder also seem to have their attention
automatically drawn to threatening information in their environment such as
words that represent things they fear, such as palpitations, numbness, or
faint.

5) GENERALISED ANXIETY DISORDER- Everyone experiences

worry—a state of anxiety and uncertainty about something in the
future. Indeed, this is an adaptive emotional state that helps us plan
and prepare for possible threats. But for some people, worry about
many different aspects of life (including minor events) becomes
chronic, excessive, and unreasonable. In these cases, generalized
anxiety disorder (GAD) may be diagnosed. DSM-5 criteria specify
that the worry must occur on more days than not for at least 6 months
and that it must be experienced as difficult to control (see DSM-5
criteria box). The worry must be about a number of different events or
activities, and its content cannot be exclusively related to the worry
associated with another concurrent disorder, such as the possibility of
having a panic attack.

People suffering from GAD live in a relatively constant, future-oriented mood

state of anxious apprehension, chronic tension, worry, and diffuse uneasiness
that they cannot control. They also show marked vigilance for possible signs of
threat in the environment and frequently engage in subtle avoidance activities
such as procrastination, checking, or calling a loved one frequently to see if he
or she is safe (Barlow, 2002).
 PSYCHOLOGICAL CAUSAL FACTORS-
THE PSYCHOANALYTIC VIEWPOINT, According to this viewpoint,
generalized or free-floating anxiety results from an unconscious conflict
between ego and id impulses that is not adequately dealt with because the
person’s defense mechanisms have either broken down or have never
developed. Freud believed that it was primarily sexual and aggressive
impulses that had been either blocked from expression or punished upon
expression that led to free-floating anxiety. Defense mechanisms may
become overwhelmed when a person experiences frequent and extreme
levels of anxiety, as might happen if id impulses are frequently blocked from
expression (e.g., under periods of prolonged sexual deprivation).
THE REINFORCING PROPERTIES OF WORRY, Borkovec and colleagues
) investigated both what people with GAD think the benefits of worrying are
and what actual functions worry serves. Several of the benefits that people
with GAD most commonly think derive from worrying are:
• Superstitious avoidance of catastrophe (“Worrying makes it less likely that
the feared event will occur”)
• Avoidance of deeper emotional topics (“Worrying about most of the things
I worry about is a way to distract myself from worrying about even more
emotional things, things that I don’t want to think about”
• Coping and preparation (“Worrying about a predicted negative event helps
me to prepare for its occurrence”
COGNITIVE BIASES FOR THREATENING INFORMATION Not only do
people with GAD have frequent frightening thoughts, they also process
threatening information in a biased way, perhaps because they have
prominent danger schemas. Anxious people tend to preferentially allocate
their attention toward threatening cues when both threat and nonthreat cues
are present in the environment.
THE NEGATIVE CONSEQUENCES OF WORRY, worry itself is certainly
not an enjoyable activity and can lead to a greater sense of danger and
anxiety (and lower positive mood) because of all the possible catastrophic
outcomes that the worrier envisions (McLaughlin et al., 2007). In addition,
people who worry about something tend subsequently to have more negative
intrusive thoughts than people who do not worry.
 BIOLOGICAL FACTORS-
GENETIC FACTORS, Evidence for genetic factors in GAD is mixed, but
there does seem to be a modest heritability, although perhaps smaller than
that for most other anxiety disorders except phobias (Hettema, Prescott, &
Kendler, 2001). Part of the problem for research in this area has been the
evolving nature of our understanding of GAD and what its diagnostic criteria
should be. Several large twin studies have revealed that heritability estimates
vary as a function of one’s definition of GAD, and indicate that 15 to 20
percent of the variance in liability to GAD is due to genetic factors
NEUROTRANSMITTER AND NEUROHORMONAL ABNORMALITIES,
A Functional Deficiency in GABA In the 1950s, the benzodiazepine
category of medications was found to reduce anxiety. This discovery was
followed in the 1970s by the finding that these drugs probably exert their
effects by stimulating the action of GABA, a neurotransmitter now strongly
implicated in generalized anxiety (Davis, 2002; LeDoux, 2002; Nutt et al.,
2006). It appears that highly anxious people have a kind of functional
deficiency in GABA, which ordinarily plays an important role in the way our
brain inhibits anxiety in stressful situations.
NEUROBIOLOGICAL DIFFERENCES BETWEEN ANXIETY AND
PANIC, Fear and panic involve activation of the fight-or-flight response, and
the brain areas and neurotransmitters that seem most strongly implicated in
these emotional responses are the amygdala (and locus coeruleus) and the
neurotransmitters norepinephrine and serotonin. Generalized anxiety (or
anxious apprehension) is a more diffuse emotional state than acute fear or
phobia that involves arousal and preparation for possible impending threat;
and the brain area, neurotransmitters, and hormones that seem most strongly
implicated are the limbic system.