Anxiety and Related Disorders
Fear vs. Anxiety
● Fear:
○ An alarm reaction triggered by immediate danger.
○ It activates the “fight-or-flight” response in the autonomic nervous system.
○ It’s an instantaneous reaction to an obvious threat (e.g., predator or weapon).
○ Cognitive component: “I am in danger.”
○ Physiological component: Increased heart rate, sweating.
○ Behavioral component: Strong urge to escape or flee.
● Anxiety:
○ A feeling of apprehension about possible future danger.
○ It is a more complex, diffuse emotional response compared to fear.
○ Cognitive component: Worry about potential threats or danger, inability to predict or
control it.
○ Physiological component: Chronic tension, overarousal.
○ Behavioral component: Avoidance of potential danger, but no immediate urge to flee.
○ Unlike fear, there is no fight-or-flight activation in anxiety, though it primes the body for
it if necessary.
Key Points on Anxiety Disorders
● Prevalence:
○ Anxiety disorders affect approximately 29% of the U.S. population at some point.
○ They are the most common mental disorders in women and the second most common in
men.
○ About 18% of adults experience at least one anxiety disorder annually.
○ These disorders cause significant personal, economic, and healthcare issues.
● Health Impacts:
○ Anxiety disorders are associated with higher rates of medical conditions such as asthma,
chronic pain, hypertension, arthritis, cardiovascular disease, and irritable bowel
syndrome.
○ People with anxiety disorders frequently utilize medical services.
● Historical Perspective:
○ Previously, anxiety disorders were categorized as "neurotic disorders"—maladaptive
behaviors, not out of touch with reality.
○ Freud believed these disorders arose from intrapsychic conflict between primitive desires
(id) and prohibitions (ego/superego).
, ○ The term “neurosis” was dropped in DSM-III in 1980.
○ Some disorders were moved to dissociative or somatoform categories, while others (like
obsessive-compulsive disorder) were reclassified.
● Evolution in Classification:
○ In DSM-5, OCD is no longer classified under anxiety disorders. It now belongs to a
separate category of obsessive-compulsive and related disorders.
Fear and Anxiety Response Patterns
● Fear:
○ A basic emotion triggered by imminent danger.
○ Involves the fight-or-flight response, an immediate reaction to a threat.
○ Symptoms: Cognitive (e.g., “I’m going to die”), physiological (e.g., increased heart rate),
and behavioral (e.g., urge to escape).
● Panic (related to fear):
○ A state of fear without external danger.
○ Symptoms are similar to fear but with added cognitive symptoms like fears of dying or
losing control.
○ Panic attacks share the same physiological and behavioral responses but have additional
fears.
● Anxiety:
○ More complex and future-oriented, characterized by worry and self-preoccupation.
○ There is no immediate fight-or-flight activation, though anxiety primes the body for such
a response.
○ Symptoms: Cognitive (worry about future threats), physiological (tension and chronic
overarousal), and behavioral (avoidance).
○ Anxiety helps with planning and preparing for potential threats, but when chronic, it
becomes maladaptive.
Conditioning of Fear and Anxiety
● Fear and anxiety responses can be conditioned:
○ Initially neutral stimuli (like a car arriving) can become associated with threats and start
eliciting anxiety or fear.
○ This learned response is an adaptive process, helping individuals anticipate and prepare
for danger.
○ However, it can also lead to the development of clinically significant fears and anxieties.
Essential Features of Anxiety Disorders:
, ● Anxiety disorders involve unrealistic or irrational fears causing distress and/or functional
impairment.
● DSM-5 recognizes five primary anxiety disorders:
○ Specific Phobia
○ Social Anxiety Disorder (Social Phobia)
○ Panic Disorder
○ Agoraphobia
○ Generalized Anxiety Disorder
● Differences in Symptoms:
○ Specific and Social Phobias: Fear or panic is triggered by encountering the phobic
object or situation, or even by the possibility of encountering it.
○ Panic Disorder: Characterized by frequent panic attacks and intense anxiety about
having another attack.
○ Agoraphobia: Avoidance of feared situations such as crowded places or open spaces.
○ Generalized Anxiety Disorder: General anxiety and worry about potential bad
outcomes, with occasional panic attacks.
● Comorbidity: Anxiety disorders often co-occur with depression or other anxiety disorders.
Common Causal Factors in Anxiety Disorders:
● Biological Factors:
○ Genetics play a role in the development of anxiety disorders, with nonspecific genetic
vulnerabilities shared across disorders.
○ Neuroticism: A personality trait linked to heightened vulnerability to anxiety and mood
disorders.
○ Brain Structures: The limbic system and certain cortex regions are central to anxiety
disorders.
○ Neurotransmitters: GABA, norepinephrine, and serotonin are involved in the brain's
anxiety response.
● Psychological Factors:
○ Classical Conditioning: Fear or anxiety conditioned to specific stimuli is common across
many anxiety disorders.
○ Perceptions of Lack of Control: A perceived lack of control over environments or
emotions increases vulnerability to anxiety disorders.
○ Cognitive Distortions: Faulty or distorted thinking patterns can contribute to the
development of anxiety disorders.
● Sociocultural Factors:
○ The social environment, including parenting styles, plays a significant role in the
development of anxiety disorders.
○ Cultural factors influence what individuals become anxious about or afraid of.
, Common Effective Treatments for Anxiety Disorders:
● Graduated Exposure: Gradual exposure to feared situations or objects until anxiety diminishes
is a core therapeutic method.
● Cognitive Restructuring: Helps individuals recognize and change distorted thinking patterns
about anxiety-provoking situations.
● Medication: Antianxiety medications (anxiolytics) and antidepressants are used, except for
specific phobias.
DSM-5 Criteria for Specific Phobia:
● A: Marked fear or anxiety about a specific object or situation (e.g., heights, animals, injections).
● B: Immediate fear or anxiety provoked by the phobic object or situation.
● C: Active avoidance or enduring the situation with intense fear or anxiety.
● D: Fear or anxiety is disproportionate to the actual danger posed by the object or situation.
● E: The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
● F: Causes significant distress or impairment in social, occupational, or other important areas.
● G: Not better explained by another mental disorder (e.g., social anxiety disorder, PTSD).
Clinical Features of Specific Phobias:
● Normal Fear vs. Specific Phobia: Normal fears (e.g., of clowns or scary movies) become a
specific phobia when the fear is strong, persistent, and significantly impairs functioning.
● Fear Response: Immediate fear response, often resembling a panic attack, triggered by the
phobic stimulus.
Fear vs. Anxiety
● Fear:
○ An alarm reaction triggered by immediate danger.
○ It activates the “fight-or-flight” response in the autonomic nervous system.
○ It’s an instantaneous reaction to an obvious threat (e.g., predator or weapon).
○ Cognitive component: “I am in danger.”
○ Physiological component: Increased heart rate, sweating.
○ Behavioral component: Strong urge to escape or flee.
● Anxiety:
○ A feeling of apprehension about possible future danger.
○ It is a more complex, diffuse emotional response compared to fear.
○ Cognitive component: Worry about potential threats or danger, inability to predict or
control it.
○ Physiological component: Chronic tension, overarousal.
○ Behavioral component: Avoidance of potential danger, but no immediate urge to flee.
○ Unlike fear, there is no fight-or-flight activation in anxiety, though it primes the body for
it if necessary.
Key Points on Anxiety Disorders
● Prevalence:
○ Anxiety disorders affect approximately 29% of the U.S. population at some point.
○ They are the most common mental disorders in women and the second most common in
men.
○ About 18% of adults experience at least one anxiety disorder annually.
○ These disorders cause significant personal, economic, and healthcare issues.
● Health Impacts:
○ Anxiety disorders are associated with higher rates of medical conditions such as asthma,
chronic pain, hypertension, arthritis, cardiovascular disease, and irritable bowel
syndrome.
○ People with anxiety disorders frequently utilize medical services.
● Historical Perspective:
○ Previously, anxiety disorders were categorized as "neurotic disorders"—maladaptive
behaviors, not out of touch with reality.
○ Freud believed these disorders arose from intrapsychic conflict between primitive desires
(id) and prohibitions (ego/superego).
, ○ The term “neurosis” was dropped in DSM-III in 1980.
○ Some disorders were moved to dissociative or somatoform categories, while others (like
obsessive-compulsive disorder) were reclassified.
● Evolution in Classification:
○ In DSM-5, OCD is no longer classified under anxiety disorders. It now belongs to a
separate category of obsessive-compulsive and related disorders.
Fear and Anxiety Response Patterns
● Fear:
○ A basic emotion triggered by imminent danger.
○ Involves the fight-or-flight response, an immediate reaction to a threat.
○ Symptoms: Cognitive (e.g., “I’m going to die”), physiological (e.g., increased heart rate),
and behavioral (e.g., urge to escape).
● Panic (related to fear):
○ A state of fear without external danger.
○ Symptoms are similar to fear but with added cognitive symptoms like fears of dying or
losing control.
○ Panic attacks share the same physiological and behavioral responses but have additional
fears.
● Anxiety:
○ More complex and future-oriented, characterized by worry and self-preoccupation.
○ There is no immediate fight-or-flight activation, though anxiety primes the body for such
a response.
○ Symptoms: Cognitive (worry about future threats), physiological (tension and chronic
overarousal), and behavioral (avoidance).
○ Anxiety helps with planning and preparing for potential threats, but when chronic, it
becomes maladaptive.
Conditioning of Fear and Anxiety
● Fear and anxiety responses can be conditioned:
○ Initially neutral stimuli (like a car arriving) can become associated with threats and start
eliciting anxiety or fear.
○ This learned response is an adaptive process, helping individuals anticipate and prepare
for danger.
○ However, it can also lead to the development of clinically significant fears and anxieties.
Essential Features of Anxiety Disorders:
, ● Anxiety disorders involve unrealistic or irrational fears causing distress and/or functional
impairment.
● DSM-5 recognizes five primary anxiety disorders:
○ Specific Phobia
○ Social Anxiety Disorder (Social Phobia)
○ Panic Disorder
○ Agoraphobia
○ Generalized Anxiety Disorder
● Differences in Symptoms:
○ Specific and Social Phobias: Fear or panic is triggered by encountering the phobic
object or situation, or even by the possibility of encountering it.
○ Panic Disorder: Characterized by frequent panic attacks and intense anxiety about
having another attack.
○ Agoraphobia: Avoidance of feared situations such as crowded places or open spaces.
○ Generalized Anxiety Disorder: General anxiety and worry about potential bad
outcomes, with occasional panic attacks.
● Comorbidity: Anxiety disorders often co-occur with depression or other anxiety disorders.
Common Causal Factors in Anxiety Disorders:
● Biological Factors:
○ Genetics play a role in the development of anxiety disorders, with nonspecific genetic
vulnerabilities shared across disorders.
○ Neuroticism: A personality trait linked to heightened vulnerability to anxiety and mood
disorders.
○ Brain Structures: The limbic system and certain cortex regions are central to anxiety
disorders.
○ Neurotransmitters: GABA, norepinephrine, and serotonin are involved in the brain's
anxiety response.
● Psychological Factors:
○ Classical Conditioning: Fear or anxiety conditioned to specific stimuli is common across
many anxiety disorders.
○ Perceptions of Lack of Control: A perceived lack of control over environments or
emotions increases vulnerability to anxiety disorders.
○ Cognitive Distortions: Faulty or distorted thinking patterns can contribute to the
development of anxiety disorders.
● Sociocultural Factors:
○ The social environment, including parenting styles, plays a significant role in the
development of anxiety disorders.
○ Cultural factors influence what individuals become anxious about or afraid of.
, Common Effective Treatments for Anxiety Disorders:
● Graduated Exposure: Gradual exposure to feared situations or objects until anxiety diminishes
is a core therapeutic method.
● Cognitive Restructuring: Helps individuals recognize and change distorted thinking patterns
about anxiety-provoking situations.
● Medication: Antianxiety medications (anxiolytics) and antidepressants are used, except for
specific phobias.
DSM-5 Criteria for Specific Phobia:
● A: Marked fear or anxiety about a specific object or situation (e.g., heights, animals, injections).
● B: Immediate fear or anxiety provoked by the phobic object or situation.
● C: Active avoidance or enduring the situation with intense fear or anxiety.
● D: Fear or anxiety is disproportionate to the actual danger posed by the object or situation.
● E: The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
● F: Causes significant distress or impairment in social, occupational, or other important areas.
● G: Not better explained by another mental disorder (e.g., social anxiety disorder, PTSD).
Clinical Features of Specific Phobias:
● Normal Fear vs. Specific Phobia: Normal fears (e.g., of clowns or scary movies) become a
specific phobia when the fear is strong, persistent, and significantly impairs functioning.
● Fear Response: Immediate fear response, often resembling a panic attack, triggered by the
phobic stimulus.
