ANXIETY DISORDERS – WHEN FEAR TAKES OVER
Anxiety is a set of symptoms: emotional (e.g. fear, worry) physical (e.g. shortness of breath, heart pounding, sweating, upset stomach) cognitive (e.g. fear of dying, losing control, going crazy).
When someone experiences this cluster of symptoms, it is often called a panic attack.
Like depressed mood, anxiety is a common experience – almost everyone has felt some level of anxiety in their lives. In many circumstances, it is a normal adaptive experience, physiologically preparing our bodies to respond when we sense danger. Our autonomic nervous system (see chapter 3) gets us ready for fight or flight and then, when the danger has passed, calms us back down again so that we can go back to normal functioning.
So how do we differentiate ‘normal’ fear from an anxiety disorder?
In addition to the level of impairment caused by the anxiety, a disorder often involves fear and anxiety in response to something that is not inherently frightening or dangerous. For example, it is normal to feel anxiety in response to poisonous snakes, but it less normal to feel anxiety in response to pictures of snakes.
Anxiety disorders have four things in common:
1. each is defined by a specific target of fear (the thing the person is afraid of );
2. anxiety or panic attacks are experienced in response to the target of fear;
3. the target of fear is avoided by the sufferer; and
4. anxiety disorders tend to be chronic – they tend to persist rather than come in episodes.
Symptoms and course of anxiety disorders
1 Specific phobias The most common and straightforward of the anxiety disorders are specific phobias – fear and avoidance of a particular object or situation (e.g. dogs, heights, flying). This anxiety may be very circumscribed, occurring only in response to the target of fear, and may result in impairment in only a very specific domain.
For example, someone who is afraid of flying may lead a very normal, productive life but simply isn’t able to fly. This may impair their work if they are expected to travel for business, or Pioneer Kay Redfield Jamison (1946– ), Professor of Psychiatry at Johns Hopkins University School of Medicine, is an awardwinning psychologist and expert in the field of bipolar disorder, a condition from which she suffers. With Frederick K. Goodwin, she wrote one of the classic texts on bipolar disorder, Manic-depressive Illness. Her autobiography, An Unquiet Mind, has made a lasting impact because of the candid and caring manner in which she describes life with bipolar disorder. She has also produced three television programmes about bipolar disorder. Jamison has served on the first National Advisory Council for Human Genome Research, and is clinical director for the Dana Consortium on the Genetic Basis of Manic-Depressive Illness.David Barlow (1942– ), Professor of Psychology and Director of the Center for Anxiety and Related Disorders
at Boston University, is an expert on the nature and treatment of anxiety and related disorders (e.g. sexual dysfunction). In his classic text, Anxiety and its Disorders, he describes the predominant cognitive-behavioural approach to understanding anxiety disorders. He has developed a series of empirically supported cognitive-behavioural treatments for various anxiety disorders and is particularly well known for his panic control treatment.
Anxiety is a set of symptoms: emotional (e.g. fear, worry) physical (e.g. shortness of breath, heart pounding, sweating, upset stomach) cognitive (e.g. fear of dying, losing control, going crazy).
When someone experiences this cluster of symptoms, it is often called a panic attack.
Like depressed mood, anxiety is a common experience – almost everyone has felt some level of anxiety in their lives. In many circumstances, it is a normal adaptive experience, physiologically preparing our bodies to respond when we sense danger. Our autonomic nervous system (see chapter 3) gets us ready for fight or flight and then, when the danger has passed, calms us back down again so that we can go back to normal functioning.
So how do we differentiate ‘normal’ fear from an anxiety disorder?
In addition to the level of impairment caused by the anxiety, a disorder often involves fear and anxiety in response to something that is not inherently frightening or dangerous. For example, it is normal to feel anxiety in response to poisonous snakes, but it less normal to feel anxiety in response to pictures of snakes.
Anxiety disorders have four things in common:
1. each is defined by a specific target of fear (the thing the person is afraid of );
2. anxiety or panic attacks are experienced in response to the target of fear;
3. the target of fear is avoided by the sufferer; and
4. anxiety disorders tend to be chronic – they tend to persist rather than come in episodes.
Symptoms and course of anxiety disorders
1 Specific phobias The most common and straightforward of the anxiety disorders are specific phobias – fear and avoidance of a particular object or situation (e.g. dogs, heights, flying). This anxiety may be very circumscribed, occurring only in response to the target of fear, and may result in impairment in only a very specific domain.
For example, someone who is afraid of flying may lead a very normal, productive life but simply isn’t able to fly. This may impair their work if they are expected to travel for business, or Pioneer Kay Redfield Jamison (1946– ), Professor of Psychiatry at Johns Hopkins University School of Medicine, is an awardwinning psychologist and expert in the field of bipolar disorder, a condition from which she suffers. With Frederick K. Goodwin, she wrote one of the classic texts on bipolar disorder, Manic-depressive Illness. Her autobiography, An Unquiet Mind, has made a lasting impact because of the candid and caring manner in which she describes life with bipolar disorder. She has also produced three television programmes about bipolar disorder. Jamison has served on the first National Advisory Council for Human Genome Research, and is clinical director for the Dana Consortium on the Genetic Basis of Manic-Depressive Illness.David Barlow (1942– ), Professor of Psychology and Director of the Center for Anxiety and Related Disorders
at Boston University, is an expert on the nature and treatment of anxiety and related disorders (e.g. sexual dysfunction). In his classic text, Anxiety and its Disorders, he describes the predominant cognitive-behavioural approach to understanding anxiety disorders. He has developed a series of empirically supported cognitive-behavioural treatments for various anxiety disorders and is particularly well known for his panic control treatment.
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