Types of Anxiety Disorders

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Types of Anxiety Disorders
Chapter 12 Psychological Disorders
stereotypes affect human thinking to some extent in virtually every social situation. It
is not surprising, then, that they operate in diagnosis as well. Diagnostic bias does not
necessarily reflect deliberate discrimination, however. At least one study has shown that,
like the processes of prejudice discussed in the social psychology chapter, diagnostic
bias based on ethnicity can operate unconsciously, without the diagnostician’s being
aware of it (Abreu, 1999). So no matter how precisely researchers specify the criteria
for assigning diagnostic labels, biases and stereotypes are likely to threaten the objectivity of the diagnostic process (Funtowicz & Widiger, 1999; Trierweiler et al., 2000).
Minimizing diagnostic bias requires a better understanding of it. Hope Landrine
(1991) suggests that diagnosticians should focus more intently than ever on the fact that
their concepts of “normality” and “abnormality” are affected by sociocultural values that
a given client might not share. Steven Lopez (1989) argues that mental health professionals must become more aware that the same cognitive shortcuts and biases that affect
everyone else’s thinking and decision making can impair their own clinical judgments. In
fact, future research on memory, problem solving, decision making, social attributions,
and other aspects of culture and cognition may turn out to hold the key to reducing bias
in the diagnosis of psychological disorders. Meanwhile, perhaps the best way to counteract clinicians’ cognitive shortcomings is to teach them to base their diagnoses solely on
standard diagnostic criteria and decision rules rather than relying on their (potentially
biased) clinical impressions (Garb, 1997; Bernstein, Kramer, & Phares, in press).
We do not have space to cover all the DSM-IV categories, so we focus on several of
the most prevalent and socially significant examples. As you read, try not to catch “medical student’s disease.” Just as medical students often think that they have the symptoms
of every illness they read about, some psychology students worry that certain aspects
of their behavior (or that of a relative or friend) might reflect a mental disorder.
Remember that everyone has problems sometimes. Before deciding that you or someone you know needs psychological help, consider whether the content, context, and
functional impairment associated with the behavior would qualify it as abnormal
according to the criteria of the practical approach.
Anxiety Disorders
䉴 What is a phobia?
If you have ever been tense before an exam, a date, or a job interview, you have some
idea of what anxiety feels like. Increased heart rate, sweating, rapid breathing, dry mouth,
and a sense of dread are all common features of anxiety. Brief episodes of moderate anxiety are a normal part of life for most people. But when anxiety is so intense and longstanding that it disrupts a person’s daily functioning, it is called an anxiety disorder.
Types of Anxiety Disorders
anxiety disorder A condition in which
intense feelings of fear and dread are
long-standing or disruptive.
phobia An anxiety disorder that involves strong, irrational fear of an
object or situation that does not objectively justify such a reaction.
Here, we discuss four types of anxiety disorders: phobia, generalized anxiety disorder,
panic disorder, and obsessive-compulsive disorder. Another type, called posttraumatic
stress disorder, is described in the chapter on health, stress, and coping. Together, these
are the most common psychological disorders in North America.
Phobia An intense, irrational fear of an object or situation that is not likely to be
dangerous is called a phobia. Even though people who experience phobias may real-
ize that their fears are groundless, their efforts to avoid some object or event greatly
interfere with daily life. Thousands of phobias have been described; some of them are
listed in Table 12.3.
Anxiety Disorders
Some Phobias
Phobia, the Greek word for “morbid fear,”
refers to Phobos, the Greek god of terror.
The names of most phobias begin with the
Greek word for the feared object or
Feared Stimulus
Enclosed places
Crossing a bridge
Empty rooms
DSM-IV classifies phobias into three subtypes: specific phobia, social phobia, and
agoraphobia. Specific phobias are fear and avoidance of heights, blood, animals, automobile or air travel, and other specific stimuli and situations. In the United States and
other developed nations, they are the most prevalent of the anxiety disorders, affecting 7 to 11 percent of adults and children (American Psychiatric Association, 2000;
Kessler et al., 1994; Lichtenstein & Annas, 2000; U.S. Surgeon General, 1999). Here is
an example:
Mr. L., a fifty-year-old office worker, became terrified whenever he had to drive over
a bridge. For years, he avoided bridges by taking roundabout ways to and from work,
and he refused to be a passenger in anyone else’s car, in case they used a bridge. Even
these inconvenient strategies failed when Mr. L. was transferred to a job requiring frequent automobile trips, many of which were over bridges. He refused the transfer and
lost his job.
Social phobias involve anxiety about being criticized by others or acting in a way
that is embarrassing or humiliating. The anxiety is so intense and persistent that it
impairs the person’s normal functioning. Common social phobias include fear of public speaking or performance (“stage fright”), fear of eating in front of others, and fear
of using public restrooms (Kleinknecht, 2000). Generalized social phobia is a more
severe form of social phobia in which fear occurs in virtually all social situations
(Mannuzza et al., 1995). Sociocultural factors can alter the form of social phobias. For
example, in Japan, where cultural training emphasizes group-oriented values and goals,
a common social phobia is tai-jin kyofu sho, fear of embarrassing those around you
(Kleinknecht, 1994).
Agoraphobia is a strong fear of being away from a safe place, such as home; of
being away from a familiar person, such as a spouse or close friend; or of being in
crowds or in other situations that are difficult to leave. People who suffer from agoraphobia prefer to stay at home, thus avoiding the intense anxiety associated with shopping, driving, or using public transportation. In Western cultures, agoraphobia is more
often reported by women, many of whom are totally homebound by the time they seek
help. In other cultures, such as India, where homebound women are considered less
unusual than in the United States, those diagnosed as agoraphobic tend to be male
(Raguram & Bhide, 1985). Although agoraphobia occurs less frequently than specific
phobias (affecting about 5 percent of the U.S. population), it is the phobia that most
often leads people to seek treatment—mainly because it so severely disrupts everyday
life (U.S. Surgeon General, 1999).
Strong and long-lasting anxiety that is not
focused on any particular object or situation marks generalized anxiety disorder.
Because the problem occurs in virtually all situations and because the person cannot
pinpoint its source, this disorder is sometimes called free-floating anxiety. For weeks at
a time, the person feels anxious and worried, sure that some disaster is about to occur.
The person becomes jumpy and irritable and cannot sleep soundly. Fatigue, inability
to concentrate, and physiological signs of anxiety are also common. Generalized anxiety disorder affects about 3.4 percent of the U.S. population in any given year and about
5 percent of the population at some point in their lives (Kessler, Keller, & Wittchen,
2001; U.S. Surgeon General, 1999). It is more common in women, often accompanying other problems such as depression or substance abuse (Wittchen & Hoyer, 2001).
Generalized Anxiety Disorder
specific phobias Phobias that involve
fear and avoidance of heights, blood,
animals, and other specific stimuli and
social phobias Strong, irrational fears
relating to social situations.
agoraphobia A strong fear of being
alone or away from the safety of home.
generalized anxiety disorder A condition that involves long-lasting anxiety
that is not focused on any particular object or situation.
panic disorder Anxiety in the form of
severe panic attacks that come without
warning or obvious cause.
Panic Disorder For some people, anxiety takes the form of panic disorder. Like
José, whom we met at the beginning of this chapter, people suffering from panic disorder experience recurrent, terrifying panic attacks that seem to come without warning or
obvious cause. These attacks are marked by intense heart palpitations, pressure or pain
in the chest, sweating, dizziness, and feeling faint. Often, victims believe they are having
a heart attack. They may worry so much about having panic episodes that they limit
their activities to avoid possible embarrassment. In fact, it is the fear of experiencing
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