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phobias & panic disorderss

Psychology of mental health
Are phobias and panic disorders best conceptualised as psychological or biological disorders?
Within this essay I will evaluate and discuss whether it is best to conceptualise, phobias and panic
disorders as psychological or biological disorders. This in turn will help me to explain the aetiology of
both disorders and the main elements, enabling me to distinguish between the two. I will also show
my knowledge of the clinical symptoms, within the context of the DSM-IV-TR classification.
Phobias and panic disorders are classified as two of the most common types of anxiety disorders,
when experienced they show excessively high or frequent levels of anxiety. Close to 29% of all
people develop one disorder at least some point in there lives. (As cited in Comer, 2007, p.127)
According to the DSM-IV-TR to be diagnosed for phobic disorder the patient fits the criteria
consisting of:
Persistent fear of a situation out of proportion to reality of danger.
Great anxiety and panic produced by actual exposure to situation.
Recognition that the fear is excessive/ unreasonable.
Significant distress.
Avoidance of phobic situation.
Symptoms not due to another disorder.
(Kring et al., 2007, p.125)
Phobias are an intense irrational fear of objects, activities, situations that are persistent and pose an
exaggerated threat. Most phobias are categorised under specific-phobia, in addition to this there are
two broader functions such as social-phobia and agoraphobia. Social phobia is the fear of
embarrassment in social or performance situations. Agoraphobia is the fear of venturing alone into
public places. (Maj, et al., 2004, p.1)
Agoraphobia is usually experienced with episodes of ‘panic attacks’. According to Comer, panic
attacks are usually sudden bursts of fear; they are short lived and tend to be periodic. The disorder
shows signs of distressing physical symptoms of anxiety. (2007, p.135)
Prevalence of phobia usually begins in early childhood, the adolescence stages. This poses the
question; is this disorder biological or psychological? There are many factors that suggest biological;
according to Kendler et al. we know that monozygotic twins are more likely to inherit the disorder. A
study was based on a thousand female twin pairs, which revealed concordance rates of 24% in
identical and 15% in fraternal twin pairs. (1992, p.462) These findings are interesting because the
Psychology of mental health
difference in percentage show that it is highly prevalent genetically, within identical twins. In addition
to this Mancini et al. (1996, p.462) found that the children of the adults who had social phobia, also
met similar criteria for the same disorder. These concordance rates show that 23% of children
approximately around the age of 11 met the criteria. With first degree relatives that have specific
phobia, there is a risk of up to three times of susceptibility to inherit the disorder. This shows strong
causation for phobic disorder being hereditary.
On the other hand psychologically, studies such as Bagby (1922) and the case of fearing running
water show that phobias can be learned. For example two events that occur close together in the same
time. Being entrapped may create a fear response, but the participant has no stimuli to attach a feared
response to (unconditioned response). Bagby suggested that running water (conditioned stimuli)
resulting with a fear response will show a conditioned response of fear to water.
Antony & Barlow (2002) show that phobia differs among race and ethnic minorities. This disorder
also shows that employment, work productivity and increased financial dependency all play a part in
building phobias and anxious type behaviour. Some individuals even take job roles that offer little or
no stimulation for their talents simply because of the extremity of their social fears. (As cited in Kring
et al., 2007, p.123-24)
Panic disorders have a strong biological precedent, as many studies have proven. This conclusion is
supported by many theorists. For example animal behaviourists have proved that it is possible to
breed emotionality in rats and dogs. (As cited in Barlow, 2004, p.181) “Emotionality” is deemed to be
the analogue of anxiety in humans, showing a possible link for genetic contributions. (2004, p.181)
Similar to phobic disorder, identical twins are more susceptible to panic disorder (25-30%) as opposed
to fraternal twins (11%). According to Crowe et al. Almost thirty percent of first degree relatives of a
person with panic disorder, also have panic disorder. (As cited in Martin et al., 2007, p.851)
Some scholars found that by the understanding of the use and effects of antidepressant drugs, they
could understand panic disorders. Redmond (1981) found that when the Locus Coeruleus is
stimulated, affecting the activity of nor-epinephrine, monkeys express panic like reactions. Norepinephrine is linked to panic disorder, as studies show that people who suffer from panic disorders
suffer from irregular nor-epinephrine activity. (Cited from Comer, 2007, p.136)
Psychology of mental health
For a patient to be diagnosed with panic disorder the criteria follows:
Recurrent panic attacks.
One of the attacks a month or more of following:
Persistent concern about having more attacks.
Worry about implications of attack.
Significant change in behaviour.
Presence/ absence agoraphobia.
Not due to other conditions/ medication
(Kring et al., 2007, p.126)
Even though a lot of evidence points towards the biological aspect, there is however probable cause
for psychological factors. Panic is suggested to be the lapse of security mechanisms, which Walker
and colleagues suggested loss events or separations precede the first panic attack. (Cited in Baker,
1989, p.334) This notion suggests that mentally, a traumatic experience could contribute to panic
disorders. A number of studies suggests months before the appearance of the first panic attack the
individual had an onset of psychological crises or conflicts, drug administration, psychological or
physical trauma, withdrawal or rebound, or organic illness. (1989, p.335)
Ley (2004) suggests that individuals have a sensitivity to bodily sensations, leading them to have a
misinterpretation of somatic sensations. Introceptive conditioning reinforces this; experiencing a
negative life event evokes psychological and biological vulnerability to anxiety. This in turn produces
anxiety and somatic symptoms. As the individual perceives it to be dangerous they develop the panic
disorder due to the anxiousness about the perceived ‘dangerous’ somatic symptoms and the onset of
the first panic attack.
Interoceptive Conditioning
Negative life event
Psychological and biological vulnerability to anxiety
Somatic symptoms, like increased heart rate
Belief that somatic symptoms are dangerous
First panic attack
Anxious apprehension about somatic symptoms
Panic disorder
Psychology of mental health
A current biological theme that has became apparent to me when discussing the conceptualisation of
phobia and panic disorders, is the study of ‘vulnerability’ otherwise known as the diathesis theory.
Beck found that a state of vulnerability interacting with the stressor paradigm equates to distress. For
example social roles, class, gender roles. The diathesis theory showed that the schema, when activated
projects a set of negative thoughts and experiences, if the schema is depressogenic.
Becks cognitive triad shows that individuals with a negative evaluation of themselves resulted to
increased dependency avoidance of others. The vulnerability factor leads us to believe that an
individual’s genetic makeup can be the reason for susceptibility in phobic and panic disorder. As we
can see from the theory it potentially creates an avoidance mechanism.
Factors such as negative live events, neuroticism, negative conditions or lack of social support all act
as triggers. Abrahamson et al. (1989, p.878) stated that people who experience significant or frequent
life stressors are those who have a pessimistic attribution style. This reinforces the notion that
individuals do have levels of vulnerability biologically, giving strong causation to believe that these
anxiety disorders stem from genetics.
To counteract this argument in regards to specific phobia, social influence or modelling is sufficient to
encourage a mimicked severe fear response. (Barlow, 2004, p.182) so this potentially means twin
studies or people who have first degree relatives with the disorder, the data could be invalid. Due to
the fact that there surroundings may have been influenced by the environment, or subject to the same
life events. Moran and Andrews (1985) reinforced this idea, suggesting that whilst diathesis or
vulnerability can be inherited, the expression of the disorder is due to environmental factors. (As cited
in Barlow, 2004, p.184)
So in summary is phobic and panic disorder best conceptualised as biological or psychological? I
believe that whilst there are many factors involved, biological precedence is the main candidate as the
inheritance of vulnerability seems to become on an onset to contracting the disorder
Psychology of mental health
Barlow, D. H. (2004). Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic.
Guilford Press.
Baker, R. (1991). Panic Disorder (Wiley Series in Clinical Psychology). John Wiley and Sons Ltd.
Comer, R. J. (2007). Abnormal Psychology: Chapter 11: Anxiety Disorders. New York: Worth
Spielberger, D. C. (1966). Anxiety and Behaviour. New York: Academic Press
Kring, A. M., Davison, G. C., Neale, J. M. & Johnson, S. L. (2007). Abnormal Psychology:
Chapter 5: Anxiety Disorders. (10th Edition) New York: Wiley.