Anxiety Disorders
Flip It Video: Anxiety Disorders
The anxiety disorders are marked by distressing, persistent anxiety or by dysfunctional anxiety-reducing behaviors. For example, people with social anxiety disorder become extremely anxious in social settings where others might judge them, such as parties, class presentations, or even eating in public. To stave off anxious thoughts and feelings (including physical symptoms such as sweating and trembling), they may avoid going out at all. Even though this behavior reduces their anxiety, it is maladaptive—it does not help them cope with their world.
Let’s take a closer look at three other anxiety disorders:
- Generalized anxiety disorder, in which a person is unexplainably and continually tense and uneasy.
- Panic disorder, in which a person experiences panic attacks—sudden episodes of intense dread—and fears the next episode’s unpredictable onset.
- Phobias, in which a person is intensely and irrationally afraid of a specific object, activity, or situation.
Generalized Anxiety Disorder
For two years, Tom, a 27-year-old electrician, was bothered by dizziness, sweating palms, and heart palpitations. He felt on edge and sometimes found himself shaking. Tom was fairly successful in hiding his symptoms from his family and co-workers. But he allowed himself few other social contacts, and occasionally he had to leave work. Neither his family doctor nor a neurologist was able to find any physical problem.
Tom’s unfocused, out-of-control, agitated feelings suggest generalized anxiety disorder, which is marked by excessive and uncontrollable worry that persists for six months or more. People with this condition (two-thirds are women) worry continually, and they are often jittery, agitated, and sleep-deprived (McLean & Anderson, 2009). Their gaze becomes fixated on potential threats (Pergamin-Hight et al., 2015). Concentration is difficult as attention switches from worry to worry. Their tension and apprehension may leak out through furrowed brows, twitching eyelids, trembling, perspiration, or fidgeting from autonomic nervous system arousal.
The person usually cannot identify, and therefore relieve or avoid, the tension’s cause. To use Sigmund Freud’s term, the anxiety is free-floating (not linked to a specific stressor or threat). Generalized anxiety disorder is often accompanied by depressed mood, but even without depression it tends to be disabling (Hunt et al., 2004; Moffitt et al., 2007). Moreover, it may lead to physical problems, such as high blood pressure. As time passes, however, emotions tend to mellow, and by age 50, generalized anxiety disorder becomes fairly rare (Rubio & López-Ibor, 2007).
Panic Disorder
Many people can experience an intense anxiety that escalates into a terrifying panic attack—a minutes-long episode of intense fear that something horrible is about to happen. Irregular heartbeat, chest pains, shortness of breath, choking, trembling, or dizziness may accompany the panic. One woman recalled suddenly feeling
hot and as though I couldn’t breathe. My heart was racing and I started to sweat and tremble and I was sure I was going to faint. Then my fingers started to feel numb and tingly and things seemed unreal. It was so bad I wondered if I was dying and asked my husband to take me to the emergency room. By the time we got there (about 10 minutes) the worst of the attack was over and I just felt washed out (Greist et al., 1986).
For the 3 percent of people with panic disorder, panic attacks are recurrent. These anxiety tornados strike suddenly, wreak havoc, and disappear, but are not forgotten. Ironically, worries about anxiety—perhaps fearing another panic attack, or fearing anxiety-related symptoms in public—can amplify anxiety symptoms (Olatunji & Wolitzky-Taylor, 2009). After several panic attacks, people may avoid situations where panic might strike. If their fear is intense enough, people may develop agoraphobia—fear or avoidance of public situations from which escape might be difficult. Given such fear, people may avoid being outside the home, in a crowd, or in an elevator. Smokers have at least a doubled risk of panic disorder and greater symptoms when they do have an attack (Knuts et al., 2010; Zvolensky & Bernstein, 2005). Because nicotine is a stimulant, lighting up doesn’t lighten us up.
Charles Darwin began suffering from panic disorder at age 28, after spending five years sailing the world. He moved to the country, avoided social gatherings, and traveled only in his wife’s company. But the relative seclusion did free him to develop his evolutionary theory. “Even ill health,” he reflected, “has saved me from the distraction of society and its amusements” (quoted in Ma, 1997).
Panic on the course Golfer Charlie Beljan experienced what he later learned were panic attacks during an important tournament. His thumping heartbeat and shortness of breath led him to think he was having a heart attack. But hospital tests revealed that his symptoms were not related to a physical illness. He recovered, went on to win $846,000, and has become an inspiration to others.
Phobias
We all live with some fears. But people with phobias are consumed by a persistent, irrational fear and avoidance of some object, activity, or situation. Specific phobias may focus on animals, insects, heights, blood, or close spaces (Figure 66.1). Many people avoid the triggers (such as high places) that arouse their fear, and they manage to live with their phobia. Others are incapacitated by their efforts to avoid the feared situation. Marilyn, an otherwise healthy and happy 28-year-old, so feared thunderstorms that she felt anxious as soon as a weather forecaster mentioned possible storms later in the week. If her husband was away when a storm was forecast, she often stayed with a close relative. During a storm, she hid from windows and buried her head to avoid seeing the lightning.
Figure 66.1 Some common and uncommon specific fears
Researchers surveyed Dutch people to identify the most common events or objects they feared. A strong fear becomes a phobia if it provokes a compelling but irrational desire to avoid the dreaded object or situation.