Generalized anxiety disorder

 Doesn’t have any very obvious attributes

 "chronic worries", distress/ impairment in occupational or social functioning
 Might shift topics as to what they're anxious about (ex. Anxious about exams and then their family
and then the environment)
o Other times feel a general state of anxiousness
 But many of us feel anxious throughout life so what's the difference?
o Some say if there is some kind of distress impacting ones ability to go on with everyday life
 But problematic b/c subjective opinion
 Worry not fixed, may not even have clear sources
 Accompanied by minor disturbances in sleep, irritability, concentration, restlessness
 But still have the question of when is part of life and when is it a disorder?
 Chronic, low-key, long lasting
 Controversial, why?
o Lower diagnostic reliability (asking multiple clinicians what they think the individual has)
 Lower= few clinicians agree on what it is
o Blends into normal life (so one clinician may see anxiety while another may see normal life)
o We live in a world that inspires worry- so is it just a response to the world we're in
o Far more common in women (Roles? Stereotypes? Hormones?)
 Stressful life structure (social environment creating anxiety)
 Changing diagnosis depending on gender (diagnostic bias)
o Overlap: a distinct disorder or just a symptom?
 Is this an illness in and of itself?
 Look at symptom list; looks a lot of depression
 Maybe it’s a symptom (so shouldn’t think of it as another kind of illness)
o If low key, is this really a distinct syndrome?
 Is this an example of medicalization? (something not thought of as a medical issue and
change how it's seen so it is seen as a medical disorder)
 Take a human trait and change how we understand it; so it's seen as a medical issues
 Generalizing the very act of worrying

Explanations for anxiety

 Many people with ideas, but little consensus
 Evolutionary: anxiety and phobias adaptive in some situations, would have granted selective
advantages
o Ex. Fearing heights is an adaptive trait- protecting us; those scared of heights lived longer
o Say it is no longer valuable to be fearful of heights
 Freud: anxiety a "warning sign" about id's impulses, we get anxious when we're about to do
something we "shouldn't do"
o Id, ego, superego
o Said when we want something that we shouldn't have (id), when the id has impulses it
comes out as anxiety
o Get anxious about things were should or shouldn't do
 Behavioural: learned behaviours acquired through conditioning and reinforcement, avoidance
rewards person by not experiencing negative reaction
o Ex. Having a horrible experience resulting in anxiety towards the thing that caused the
horrible experience
 o Avoiding something due to anxiety= anxiety towards that thing gets worse
 Life events: people who experience agoraphobia more likely to have faced "dangerous" situations,
like crime, conflict, serious arguments
o Difficult life events results in anxiety towards more things
 Genetics may play a role: perhaps panic disorder results from brain defect- when faced with
biologically dangerous situations (hyperventilation) misinterprets signals as genuinely life
threatening
o Brain kicks into over drive

Treating anxiety
 CBT
o Many of our symptoms stem from unhealthy thought patterns (automatic thinking
responses to things and the way we think about stuff is the problem)
o Want to change the cognitive part to change how one feels about something
o Type of psychotherapy
o Train someone that has these automatic thoughts surrounding a specific scenario
 Ask them if they have evidence for why they should feel this way
o Specific exponent is exposure therapy
 Just need to expose the individual to the thing their scared of
 Ex. Scared of going out- take them our for a walk then take them to the mall and so on
 Grounded in the idea that it is something learned
 Anxiolytics (type of medication)
o Benzodiazepine boom (such as valium, xanax, ativan)
o Experience a decrease in anxiety (almost immediately after taking it)
o Sense of calm, heart rate is no longer increased
o But when we speak of anxiety it is about future events- medication does not address any of
these things
o Doesn’t change the way one thinks about the situation
o Physiologically addictive, prompting withdrawal
o When they came out, sales sky rocked
 Prompted a backlash
 b/c of this, there was a move to other kinds of medication
o After 1970s and 1980s benzo backlash, SSRIs rebranded as anti-depressants in 1990s;
perceived as safer and "age of depression" replaces "age anxiety"
 Said to be safer (not as addictive compared to benzo)
 But are SSRIs addictive? (now an issue)
 Find that people going off their SSRIs are having trouble
 If for depression too, are they related?

Comorbidity
 When a person is diagnosed with multiple disorders at once (things co-exist together)
 Idea of this is interesting
o States they are two distinct, separate things
 50% of people that meet criteria for one anxiety disorder meet criteria for another
 Anxiety and mood disorders (based on emotion), high degree of comorbidity (61% of people with
MD qualify for anxiety)
 o Do they have one thing? Or both? Do they have neuroses? Or should we not speak of them
having anything at all?
o Maybe it is something they are experiencing- maybe they're not part of a discreet disease
 Experiences: does one have a condition or are they experiencing it?
 Ex. I am thirsty verse I have thirst
 Are these things that people have distinct? (Ex. Having a cup of tea is distinct but we
cannot know definitively if someone has a mental illness)
 Don't even know if there is a thing called anxiety or if it is an experience (it is a feeling)
 Those with anxiety disorders roughly 3x more likely to be diagnosed with substance abuse
disorder
o So do they have anxiety? Maybe they're anxious b/c they have problems with addiction
o Maybe they have an addiction b/c they are anxious
o We don’t know which came first
 Some argue that "splitting movement" is behind the high level of comorbidity between disorders
o Artificial divisions create overlapping disorders, "pure" cases of most types are very rare
o May be same fundamental underlying problem but the way they are seen is implying a
distinctness where there may not be one

Diagnostic growth
 Anxiety disorders at forefront of increase in prevalence of psychopathology; why?
o Medicalization of "uncomfortable" feelings into "ill" ones (give them medical label,
transforming them into mental disorders)
 Don’t actually feel worse, but changed how we understand bad feelings
 Ex. Shyness is no longer a personality trait, now it is an illness
o Blurred lines between wellness and disturbance, when does discomfort become disordered?
 Difficult with anxiety, b/c need to acknowledge that anxiety is part of life
 What was seen as wellness or normal one week, may be an seen as an illness the next
week from another perspective
 Nature of these things are very blurred
o Environmental shifts to produce stress?
 Intense globalization, surveillance (government, social media, work place, etc.)
 Social media is harmful
 Life is changing in such a way that it causes more anxiety
o Does greater awareness (of ourselves and the world) mean greater anxiety? Can this be
stopped?
o Medications produce clear effect- we can see them "work" and this validates diagnoses
 Ex. Taking a pill for anxiety and the anxiety is gone- this confirms the diagnosis to the
individual
 Don’t think about why it works (doesn’t matter if you have anxiety or not, it will
make you feel calmer)- so does not prove you have anxiety, is just proves that
the pill calms you
 Truth of the matter is that the medication is going to work regardless of the diagnosis
 Not like the medication only works for individuals with the diagnosis

Conclusion
 Understand the shared ground with mood disorders
 Think about how we draw the line
 Who is depressed verse who is anxious
 Boundaries between anxiety disorders are among the finest, target of much criticism
o A lot of profound similarities within these things (physical symptoms, disturbed sleep, etc.)
 Case for mental illness as a spectrum of normal human experience
o All individuals experience sadness, anxiety, difficult concentration- so it is just a matter of
degree?
 Widespread belief that we are becoming more anxious as a population