What is anxiety?
All of us at one time or another experience anxiety, a feeling of apprehension or tension, in reaction to stressful situations. There is nothing “wrong” with such anxiety. It is a normal reaction to stress that often helps rather than hinders our daily functioning. Without some anxiety, for instance, most of us probably would not have much motivation to study hard, undergo physical exams, or spend long hours at our jobs. But some people experience anxiety in situations in which there is no external reason or cause for such distress. When anxiety occurs without external causative cation and begins to affect people’s daily functioning, mental health professionals consider it a psychological problem is known as an anxiety disorder. We’ll discuss the four major types of anxiety disorders: phobic disorder, panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder.
PHOBIC DISORDER (anxiety)
It’s not easy moving through the world when you’re terrified of electricity. “Donna,” 45, a writer knows that better than most. Get her in the vicinity of an appliance or a light switch or—all but unthinkable—a thunderstorm, and she is overcome by a terror so blinding she can think of nothing but fleeing. That, of course, is not always possible, so over time, Donna has come up with other answers. When she opens the refrigerator door, rubber-sole shoes are a must.
If a light bulb blows, she will tolerate the dark until someone else changes it for her. Clothes shopping is done only when necessary, lest static on garments send her running from the store. And swimming at night is absolutely out of the question, lest underwater lights electrocute her. Donna suffers from a phobia, an intense, irrational fear of a specific object or situation. For example, claustrophobia is a fear of enclosed places, acrophobia is a fear of high places, xenophobia is a fear of strangers, social phobia is the fear of being judged or embarrassed by others, and—as in Donna’s case—electro phobia is a fear of electricity.
The objective danger posed by an anxiety-producing stimulus (which can be just about anything, as you can see in Figure 1 ) is typically small or nonexistent. However, to someone suffering from the phobia, the danger is great, and a full-blown panic attack may follow exposure to the stimulus. Phobic disorders differ from generalized anxiety disorders and panic disorders in that there is a specific c, identify the able stimulus that sets off the anxiety reaction.
Phobias may have only a minor impact on people’s lives if those who suffer from them can avoid the stimuli that trigger fear. For example, a fear of heights may have little impact on people’s everyday lives (although it may prevent them from living on a high floor in an apartment)—unless they are firefighters or window-washers.
On the other hand, a social phobia, or a fear of strangers, presents a more serious problem. In one extreme case, a Washington woman left her home just three times in 30 years—once to visit her family, once for an operation, and once to purchase ice cream for adding a companion.
PANIC DISORDER (anxiety)
In another type of anxiety disorder, panic disorder, panic attacks occur that last from a few seconds to several hours. Unlike phobias, which are stimulated by specific objects or situations, panic disorders do not have any identifiable stimuli. Instead, during an attack such as those Sally experienced in the case described earlier, anxiety suddenly—and often without warning—rises to a peak, and an individual feels a sense of impending, unavoidable doom.
Although the physical symptoms differ from person to person, they may include heart palpitations, shortness of breath, unusual amounts of sweating, faintness and dizziness, gastric sensations, and sometimes a sense of imminent death.
After such an attack, it is no wonder that people felt exhausted (Rachman &deSilva, 2004; Laederach-Hofmann & Messerli-Buergy, 2007). Panic attacks seemingly come out of nowhere and are unconnected to any specific stimulus. Because they don’t know what triggers their feelings of panic, victims of panic attacks may become fearful of going places.
In fact, some people with panic disorder develop a complication called agoraphobia, the fear of being in a situation in which escape is difficult and in which help for a possible panic attack would not be available. In extreme cases, people with agoraphobia never leave their homes (Marcaurelle, Bélanger, &Marchand, 2005; Herrán, Carrera, & Sierra-Biddle, 2006; Wittchen et al., 2008).
In addition to the physical symptoms, the panic disorder affects how the brain processes information. For instance, people with panic disorder have reduced reactions in the anterior cingulate cortex to stimuli (such as viewing a fearful face) that normally produce a strong reaction in those without the disorder. It may be that recurring high levels of emotional arousal that patients with panic disorder experience desensitize them to emotional stimuli (Pillay et al., 2006; Pillay et al., 2007)
People with generalized anxiety disorder experience long-term, persistent anxiety and uncontrollable worry. Sometimes their concerns are about identifiable issues involving family, money, work, or health. In other cases, though, people with the disorder feel that something dreadful is about to happen but can’t identify the reason and thus experience “free-floating” anxiety. Because of persistent anxiety, people with generalized anxiety disorder can not concentrate or set their worry and fears aside; their lives become centred on their worry. Furthermore, their anxiety is often accompanied by physiological symptoms. such as muscle tension, headaches, dizziness, heart palpitations, or insomnia(Starcevic et al., 2007). Figure 2 shows the most common symptoms of generalized anxiety disorder.
Obsessive-Compulsive Disorder. In obsessive-compulsive disorder (OCD). People are having unwanted thoughts, called obsessions, or feel that they must carry out behaviours, termed compulsions. An obsession is a persistent, unwanted thought or idea that keeps recurring.
For example, a student may be unable to stop thinking that she has neglected to put her name on a test and may think about it constantly for the two weeks it takes to get the paperback. A man may go on vacation and wonder the whole time whether he locked his house. A woman may hear the same tune running through her head over and over.
In each case, the thought or idea is what we don’t want and difficult to put out of mind. Of course, many people suffer from mild obsessions from time to time. But usually, such thoughts persist only for a short period. For people with serious obsessions, however, the thoughts persist for days or months and may consist of bizarre, troubling images (Lee & Kwon, 2003, Lee et al., 2005; Rassin & Muris, 2007).
As part of an obsessive-compulsive disorder. People may also experience compulsions, irresistible urges to repeatedly carry out some act. Such acts which seem strange and unreasonable even to them. Whatever the compulsive behaviour is, people experience extreme anxiety. If they cannot carry it out even if it is something they want to stop.
The acts may be relatively trivial, such as repeatedly checking the stove to make sure it turns all the burners off, or more unusual, such as washing one’s hands so much that they bleed (Frost & Steketee, 2002; Clark, 2007; Moretz & McKay, 2009). For example, consider this passage from the autobiography of a person.
obsessive-compulsive disorder: (anxiety)
I thought my parents would die if I didn’t do everything in exactly the right way. When I took my glasses off at night, I’d have to place them on the dresser at a particular angle. Sometimes I’d turn on the light and get out of bed seven times until I felt comfortable with the angle. If the angle wasn’t right, I feel my parents would die.
The feeling ate up my insides. If I didn’t grab the moulding on the wall just the right way as I entered or exited my room. I didn’t hang a shirt in the closet perfectly, I didn’t read a paragraph a certain way; if my hands and nails weren’t perfectly clean, I thought my incorrect behaviour would kill my parents (Summers, 2000, p. 42). Although carrying out compulsive rituals may lead to some immediate reduction of anxiety, in the long run, the anxiety returns. In fact, people with severe cases lead lives filled with unrelenting tension (Goodman, Rudorfer, &Maser, 2000; Penzel, 2000).