psychological and physical factors

anxiety disordersvague, negative, high arousal state, often intrusive thoughts
of possible futures, helplessness.
too much of a good thing- anxiety is useful response system
to threats (evolutionarily adaptive) motivate for change.
generalized anxiety disorder- 5% lifetime risk, prolonged
(>6 months), vague, distress. not connected to life
events. worry, vigilance, bodily tension and reactivity.
panic disorder- 1.5%, intense, relatively brief wave of
feeling ‘out of control’, high arousal, sweating/shortness
of breath, fear of death/losing mind, fear of future panic,
associated stimuli- agoraphobia.
comorbidity/overlap with depressionover half mood disordered folks meet criteria for an anxiety
disorder (an especially close link with G.A.D.)
high negative affect common to both, low positive affect more
specific to depression. anxious folks also hyperaroused.
anxiety gives way to depression (future anticipation of loss vs.
perceived past loss)
phobias-unlike GAD, the feared objects are known. often
evolutionarily relevant- specific phobias (11%): spiders,
dogs, snakes, heights, but also social (2.7%): fear of
blushing and eating in public are difficult to treat.
agoraphobia (5.6%) fear of the marketplace. role of
learning: event X paired with anxiety-->avoidance--> reduced
anxiety. So you learn to avoid X.
~exposure treatment.
panic disorder with agoraphobia (Lundh et al., 1999)
stroop color naming task- delayed color naming for words
specific to disorder but less so for threatening words (social,
automatic attention grabbing- unconscious (17ms) subliminal
findings related to trait anxiety- preattentive bias for panic
related words.
obsessive-compulsive disorder (2-3%) identified by Freud (1894)
thoughts and behaviors- sexual, religious, aggressive,
threatened harm (symbolic nature).
obsessions-doubting, contamination, fear of aggression
compulsions-counting, ordering, checking, touching &
washing.--compulsions protective against anxiety.
 undoing- a conflict (ambivalence) between two opposing impulses of
equal strength where the second magically ‘undoes’ the first. chronic
indecision [These thoughts are condensed from Shapiro (1965)].
 reaction formation-reversed of repressed impulse- sympathy rather than
sadistic, bashful rather than exhibitionistic
 isolation of affect-isolating thoughts or behaviors so that links to other
thoughts or affective context are removed. Rituals, formulas, thought
stopping. akin to the repression of hysterics- separating affect from
thought-thought remains. ‘living machines’: ‘I must be in love with her-she has all the qualities I want in a wife.’
 intellectual rigidity, sharp, intense focus-insensitive to the tone of social
 good workers (often) more or less continuously active (even in play)-- “I
should be doing _____”. tolerate no interference .
 they are not delusional- they don’t say ‘I have cancer, I have been
contaminated’ but ‘I’m worried I have cancer…’ (obsessional doubt and
dogma). Lost capacity for conviction.
post-traumatic stress disorder (1-14%)
fear, hopelessness, or horror. re-experiencing, emotional
numbness, hypervigilance, startle.
 risks-depression, alcohol abuse, dissociative style, inhibited
Treatments for many anxiety disorders:
behavioral- exposure, flooding, in-vivo, etc.
cognitive- restructuring, thought stopping, rehearsal
biological- benzodiazepines-librium,valium, -addictive
antidepressants drugs of choice now
psychosurgery (making a comeback?)