1. © 2005 John Wiley & Sons, Inc. Chapter Five: Anxiety and the Anxiety Disorders The Core Concepts

2. © 2005 John Wiley & Sons, Inc. The Importance of Context Disordered anxiety occurs in contexts in which anxiety doesn’t make sense  Extreme anxiety in the presence of a minor threat (as in phobias)  Extreme anxiety when no danger is present (as in flashbacks)

3. © 2005 John Wiley & Sons, Inc. The Continuum Between Normal and Abnormal Anxiety Anxiety is an expectable part of everyday life Pathological anxiety is on the extreme end of the continuum for  Trait anxiety: how anxious a person feels in general (as in generalized anxiety disorder) and/or  State anxiety: how anxious a person feels in response to specific events (as in phobias)

4. © 2005 John Wiley & Sons, Inc. The Advantages the DSM-IV-TR Anxiety Disorder Diagnoses Strong reliability  Anxiety disorder diagnoses are likely to be applied consistently Strong validity  Anxiety disorder diagnoses are likely to be applied accurately

5. © 2005 John Wiley & Sons, Inc. The Limitations of the DSM-IV-TR Anxiety Disorder Diagnoses High Comorbidity  20%-82% of people with an anxiety disorder warrant at least one other DSM-IV-TR diagnosis Applying an anxiety disorder diagnosis may  Artificially divide complex clinical conditions  Arbitrarily emphasize anxiety symptoms over other relevant symptoms

6. © 2005 John Wiley & Sons, Inc. Classification in Demographic Context - Age Adults tend to describe anxiety in terms of their emotional experience Children often exhibit anxiety behaviorally (or through physical symptoms Children are not always bothered by their anxiety symptoms Anxiety disorders are underdiagnosed among older adults

7. © 2005 John Wiley & Sons, Inc. Classification in Demographic Context - Gender Five out of six of the anxiety disorders are 2-3 times more common in women OCD occurs equally in women and men Gender disparity explanations:  Differences in socialization  Genetic vulnerabilities  Hormonal differences  Women experience higher rates of victimization

8. © 2005 John Wiley & Sons, Inc. Classification in Demographic Context - Class People living in poor, urban environments are at heightened risk for PTSD because they are:  More likely to experience trauma  More likely to have additional risk factors for PTSD (low social support, high psychological stress) The impoverished are also at heightened risk for GAD

9. © 2005 John Wiley & Sons, Inc. Cultural Relativism in Defining and Classifying Anxiety The expression of anxiety is culturally relative  Nervios: Generalized anxiety symptoms in Latino populations (often with somatic features)  Ataque de nervios: Panic symptoms in Latino populations (often with behavioral features)  Shenjing shuairuo: Mixed anxiety, mood, and physical symptoms in Chinese populations  Taijin kyofusho: Social phobia symptoms in Japanese populations (focus on bodily appearance or functioning)

10. © 2005 John Wiley & Sons, Inc. Historical Relativism in Defining and Classifying Anxiety PTSD not recognized by the DSM until 1980 (in the DSM-III)  PTSD symptoms generally seen as signs of malingering or cowardice during the American Civil War and both World Wars  PTSD ultimately added to the DSM in response to research and clinical knowledge gained from Vietnam War veterans

11. © 2005 John Wiley & Sons, Inc. The Multiple Causality of Anxiety Disorders Cognitive and behavioral components are often combined to explain and treat anxiety disorders  Maladaptive cognitions are often reinforced by maladaptive behaviors  Cognitive-behavioral interventions are especially effective for treating OCD and panic disorder Many theoretical perspectives emphasize facing fears in order to overcome them

12. © 2005 John Wiley & Sons, Inc. The Connection Between Mind and Body The HPA axis:  Regulates the release of stress hormones  May be damaged by sustained stress during critical developmental periods  HPA damage may lead to chronic anxiety PTSD appears to be related to changes in the hippocampus and Broca’s area Psychotherapy for OCD appears to have same neural effects as medications for OCD