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12.2: Anxiety and Dissociative Disorders: Fearing the World Around Us

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    Learning Objectives

    1. Outline and describe the different types of anxiety disorders.
    2. Outline and describe the different types of dissociative disorders.
    3. Explain the biological and environmental causes of anxiety and dissociative disorders.

    Anxiety, the nervousness or agitation that we sometimes experience, often about something that is going to happen, is a natural part of life. We all feel anxious at times, maybe when we think about our upcoming visit to the dentist or the presentation we have to give to our class next week. Anxiety is an important and useful human emotion; it is associated with the activation of the sympathetic nervous system and the physiological and behavioral responses that help protect us from danger. But too much anxiety can be debilitating, and every year millions of people suffer from anxiety disorders, which are psychological disturbances marked by irrational fears, often of everyday objects and situations (Kessler, Chiu, Demler, & Walters, 2005).

    Generalized Anxiety Disorder

    Consider the following, in which “Chase” describes her feelings of a persistent and exaggerated sense of anxiety, even when there is little or nothing in her life to provoke it:

    For a few months now I’ve had a really bad feeling inside of me. The best way to describe it is like a really bad feeling of negative inevitability, like something really bad is impending, but I don’t know what. It’s like I’m on trial for murder or I’m just waiting to be sent down for something. I have it all of the time but it gets worse in waves that come from nowhere with no apparent triggers. I used to get it before going out for nights out with friends, and it kinda stopped me from doing it as I’d rather not go out and stress about the feeling, but now I have it all the time so it doesn’t really make a difference anymore. (Chase, 2010)

    Chase is probably suffering from a generalized anxiety disorder (GAD), a psychological disorder diagnosed in situations in which a person has been excessively worrying about money, health, work, family life, or relationships for at least 6 months, even though he or she knows that the concerns are exaggerated, and when the anxiety causes significant distress and dysfunction.

    In addition to their feelings of anxiety, people who suffer from GAD may also experience a variety of physical symptoms, including irritability, sleep troubles, difficulty concentrating, muscle aches, trembling, perspiration, and hot flashes. The sufferer cannot deal with what is causing the anxiety, nor avoid it, because there is no clear cause for anxiety. In fact, the sufferer frequently knows, at least cognitively, that there is really nothing to worry about.

    About 10 million Americans suffer from GAD, and about two thirds are women (Kessler, Chiu, Demler, & Walters, 2005; Robins & Regier, 1991). Generalized anxiety disorder is most likely to develop between the ages of 7 and 40 years, but its influence may in some cases lessen with age (Rubio & Lopez-Ibor, 2007).

    Panic Disorder

    When I was about 30 I had my first panic attack. I was driving home, my three little girls were in their car seats in the back, and all of a sudden I couldn’t breathe, I broke out into a sweat, and my heart began racing and literally beating against my ribs! I thought I was going to die. I pulled off the road and put my head on the wheel. I remember songs playing on the CD for about 15 minutes and my kids’ voices singing along. I was sure I’d never see them again. And then, it passed. I slowly got back on the road and drove home. I had no idea what it was. (Ceejay, 2006)

    Ceejay is experiencing panic disorder, a psychological disorder characterized by sudden attacks of anxiety and terror that have led to significant behavioral changes in the person’s life. Symptoms of a panic attack include shortness of breath, heart palpitations, trembling, dizziness, choking sensations, nausea, and an intense feeling of dread or impending doom. Panic attacks can often be mistaken for heart attacks or other serious physical illnesses, and they may lead the person experiencing them to go to a hospital emergency room. Panic attacks may last as little as one or as much as 20 minutes, but they often peak and subside within about 10 minutes.

    Sufferers are often anxious because they fear that they will have another attack. They focus their attention on the thoughts and images of their fears, becoming excessively sensitive to cues that signal the possibility of threat (MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002). They may also become unsure of the source of their arousal, misattributing it to situations that are not actually the cause. As a result, they may begin to avoid places where attacks have occurred in the past, such as driving, using an elevator, or being in public places. Panic disorder affects about 3% of the American population in a given year.


    A phobia (from the Greek word phobos, which means “fear”) is a specific fear of a certain object, situation, or activity. The fear experience can range from a sense of unease to a full-blown panic attack. Most people learn to live with their phobias, but for others the fear can be so debilitating that they go to extremes to avoid the fearful situation. A sufferer of arachnophobia (fear of spiders), for example, may refuse to enter a room until it has been checked thoroughly for spiders, or may refuse to vacation in the countryside because spiders may be there. Phobias are characterized by their specificity and their irrationality. A person with acrophobia (a fear of height) could fearlessly sail around the world on a sailboat with no concerns yet refuse to go out onto the balcony on the fifth floor of a building.

    A common phobia is social phobia, extreme shyness around people or discomfort in social situations. Social phobia may be specific to a certain event, such as speaking in public or using a public restroom, or it can be a more generalized anxiety toward almost all people outside of close family and friends. People with social phobia will often experience physical symptoms in public, such as sweating profusely, blushing, stuttering, nausea, and dizziness. They are convinced that everybody around them notices these symptoms as they are occurring. Women are somewhat more likely than men to suffer from social phobia.

    The most incapacitating phobia is agoraphobia, defined as anxiety about being in places or situations from which escape might be difficult or embarrassing, or in which help may not be available (American Psychiatric Association, 2000)1. Typical places that provoke the panic attacks are parking lots; crowded streets or shops; and bridges, tunnels, or expressways. People (mostly women) who suffer from agoraphobia may have great difficulty leaving their homes and interacting with other people.

    Phobias affect about 9% of American adults, and they are about twice as prevalent in women as in men (Fredrikson, Annas, Fischer, & Wik, 1996; Kessler, Meron-Ruscio, Shear, & Wittchen, 2009). In most cases phobias first appear in childhood and adolescence, and usually persist into adulthood. Table 12.4 “The Most Common Phobias” presents a list of the common phobias that are diagnosed by psychologists.

    Table 12.4 The Most Common Phobias

    Name Description
    Acrophobia Fear of heights
    Agoraphobia Fear of situations in which escape is difficult
    Arachnophobia Fear of spiders
    Astraphobia Fear of thunder and lightning
    Claustrophobia Fear of closed-in spaces
    Cynophobia Fear of dogs
    Mysophobia Fear of germs or dirt
    Ophidiophobia Fear of snakes
    Pteromerhanophobia Fear of flying
    Social phobia Fear of social situations
    Trypanophobia Fear of injections
    Zoophobia Fear of small animals