Fear vs anxiety

 Fear: response to real and present danger

o Helps organize responses to threat, like "fight or flight"
o Useful b/c helps channel and organize our thoughts
o Ex. Want to run from a bear, fear helps us to run really fast
o Fear motivates us
 Anxiety: apprehension about anticipated events
o Future threats
o Forward looking
o Ex. Anxiety about potential thunderstorms

Anxiety:
 Much physical in mental disorders
 Anxiety is a profoundly physical experience
 Physiological changes
o Heart rate
o Sweaty
o Pulse quickens
o Tremble
 Difficult to control thoughts in state of anxiety
o Not in a psychotic way, but difficult for a person to control what they are thinking about
 Want to stop thinking about something but they can't
o Halo effect
 Surrounds the way you think about the world
 Not just anxious about events that are coming in the future but it changes how you
think about yourself
 One reason why anxiety is powerful
 Changes your perception (sometimes even perception of the past)
 Sometimes anxiety gets targeted as a negative emotion
o But anxiety can motivate us, ensure we are prepared
o There are positive uses of anxiety (up to a point)… without exceptionality becomes
problematic
 Can become problematic when it over takes your whole world
o But becomes tricky b/c if you're living in a war zone, it will obviously over take and shape
your life

Classification of anxiety disorders:

 Emerged as distinct group of disorders in DSM-III
 Took anxiety are broke it off into its own category (before was group together with other
disorders known as "neuroses"- emotional disturbances with awareness)
 Anxiety got its own new "space" in the DSM
 With neuroses, individuals could understand that their thoughts were irrational (not like psychosis
where individuals do not know their thoughts are irrational)
 Is this separation of human experiences into discrete categories necessary? Or should we
understand them as metaphors?
o A lot of symptom overlap with many other disorders
o Causes us to ask if these disorders are separate
  Awareness dropped in DSM-5, now merely necessary for fear and worry to be "disproportionate
to the situation"
o Who judges this?
o Problematic b/c everyone has different opinions
o What one person thinks is reasonable isn't the same as what someone else thinks is
reasonable
 Splitting movement has divided anxiety disorders; share core symptoms- intense worry
disproportionate to actual environmental danger
o Taken the idea of anxiety disorder and split it into many categories
o Medical model= new diseases of anxiety
o Judge has to decide if how the person feels about the situation is too much anxiety
o Individual may have information that the clinician doesn't have (changing what may be seen
as rational or irrational)
o Need to knowledge that we are trusting the clinician to know how much anxiety should or
should not be there

Rise of interest in anxiety:

 Asylums primarily housed psychotic individuals and those deemed too dangerous to remain in
community
 Anxiety didn’t really fit into that equation
 Mental hospitals were mainly for those with psychosis
 Freud's emphasis on neuroses helped reshape 20C as the age of anxiety
o Helped popularized the idea of neuroses
o Some kind of unconscious anxiety- things we are worried about but don’t know we are and
so they come out in some kind of other way
 Ex. Obsessions are manifestations of some underlying anxiety
o Anxiety resulted in the transformation of ones temperament or experience of life to
suddenly be seen as their psychological health- now see it as a mental illness (rather than
just a feeling)

Panic disorder:
 Involves people who have panic attacks on multiple occasions, they don’t know they're coming
 Characterized by recurrent, unexpected panic attacks- similar to a heart attack; usually occurs
without warning and finishes within ten minutes
 Many physical symptoms
 Preponderance of physical symptoms: palpitations; ponding heart, sweating, trembling/ shaking,
shortness of breath, feeling of chocking, cheat pain or discomfort, nausea, feeling dizzy/ faint
 Derealisation (unreality)- like watching a movie, not living in reality
 Depersonalization (detachment from oneself)- like leaving your body
 Person may obsessively worry about another attack
o Think its embarrassing, problematic
o Can think about this in terms of obsessiveness (someone obsessing about a future attack-
kind of like OCD, think about the two blurring in some sense, are the two connected)
 May lead to avoidance strategies… avoidance works
o Avoiding the thing that may prompt the panic attack
o Self reinforcing, the more you avoid the thing you're anxious about the worse the thing will
become for you- b/c continue to avoid b/c feels good
  Panic attacks are episodes, they are necessary to have for panic disorder (but just b/c you have a
panic attack doesn’t mean you have panic disorder)- panic attack is a symptom

Specific (simple) phobia:

 Persistent, excessive, narrowly defined fears associated with specific object or situation
 Specific object or specific thing
 Phobias are "irrational and unreasonable"
 When we talk about phobias, needs to be judged as unreasonable
 Must always occur when exposed to source
o May respond with panic attack but usually respond with discomfort
 Phobias can work on many different levels
 Daily life consumed on some level with avoidance, fear, dread
o Thinking about how they can avoid it
 Common phobias?
o Spiders, airplanes, the dark

Agoraphobia:
 Most phobias are about proximity to the object but with this phobia it is the opposite (about the
distance away from an object)
 Extreme fear about situations where escape is difficult or embarrassing- crowded shops, theaters,
tunnels
o Not the same as claustrophobia
 "home bodies and aisle huggers"
o Home is where they feel safe- leaving home is difficult
o Staying in one place all the time
 Unlike other phobias, not closeness to a specific object but distance from "safety" that's the
problem
o Usually their actual home but could also be a person
 "most complex and incapacitating phobic disorder"
 Theorized as a different disorder (or as medical model would say a different disease)

Social anxiety disorder:

 How does social phobia differ from specific phobia?
 More prevalent now (people are diagnosed with this all the time)
 Focused on performance or interpersonal interactions
o Performance involves other people- but its not a general desire to avoid other humans, its
about doing things such as engaging in chit chat at a party
o Prompt feelings of discomfort
 Originates in fear of being humiliated or embarrassed
 If anxiety related to a specific situation (ex. Speech), anxiety disappears if task performed privately
 If you remove the audience, they're fine- its when they are confronted with other people that
things become problematic
 Introduced in DSM-III:
o 1980s= 0.5%
o 1994= 13%
o Huge rise, why?
 Some say huge change in our lives that caused this
  Popularized a concept, people didn’t think about this before
 Trends come and go (spikes in trends)
o Criteria expanded to be more inclusive with subsequent editions- way you get a diagnosis is
easier
 Symptom lists are growing- naturally more people "become mentally ill" b/c more
people match the criteria of what we call mentally ill
 Don’t have a way to objectively make these decisions- so criteria really matters
o Culture bound?
 Unknown in most parts of the world (like France, Italy)- not that they don’t know
about it, but clinicians don’t believe in it
 Shows that what counts as a mental disorder is cultural