Anxiety Disorders (College Board AP® Psychology): Study Guide

Symptoms of anxiety disorders

• Anxiety disorders are characterized by excessive fear and/or anxiety that disrupts behaviour and functioning

  • Fear is an emotional response to a real or perceived present threat

    • it triggers the fight-flight-freeze response

  • Anxiety is the anticipation of a future threat

    • it is a state of worry, dread, or unease about something that may happen

• All anxiety disorders involve heightened anxiety, but differ in what triggers it and how it is expressed

• Five anxiety disorders include:

  • specific phobia

  • agoraphobia

  • panic disorder

  • social anxiety disorder

  • generalized anxiety disorder

Specific phobia

• Specific phobia involves intense fear of a specific object or situation, which is out of proportion to actual danger

  • Exposure to the phobic stimulus triggers immediate fear

  • The person avoids the stimulus or endures it with intense distress

• Common specific phobias include:

  • Acrophobia: fear of heights

  • Arachnophobia: fear of spiders

  • Claustrophobia: fear of enclosed spaces

  • Cynophobia: fear of dogs

Agoraphobia

• Agoraphobia involves intense fear of social situations where escape may be difficult or help unavailable if panic occurs

  • Situations that typically trigger agoraphobia include:

    • using public transportation

    • being in open spaces

    • being in enclosed spaces (e.g. shops, theaters)

    • standing in a line or being in a crowd

    • being outside the home alone

• In severe cases, the person may become unable to leave their home

  • E.g. a person with agoraphobia who used to commute freely now cannot enter the subway system and eventually cannot leave their apartment

Panic disorder

• Panic disorder involves the experience of recurrent, unexpected panic attacks and fear of future attacks

  • A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes and involves:

    • rapid heart rate, shortness of breath

    • dizziness, sweating, trembling

    • feelings of unreality

    • fear of losing control or dying

• Ataque de nervios is a culture-bound variant of panic disorder experienced mainly by people of Caribbean or Iberian descent

  • It involves uncontrollable shouting, crying, trembling, and a sense of heat rising in the chest; it may include dissociative experiences

Social anxiety disorder

• Social anxiety disorder involves intense fear of being judged, negatively evaluated, or watched by others in social situations

  • Social situations are avoided or endured with intense distress

    • E.g. a person with social anxiety avoids restaurants, job interviews, parties, and public speaking because of overwhelming fear of others' judgment

• Social anxiety disorder is distinct from but may include agoraphobia

  • The fears overlap in some cases

• Taijin kyofusho is a culture-bound variant experienced mainly by Japanese people:

  • It involves the fear that one's own body or its functions are offensive, embarrassing, or displeasing to others

    • E.g. fear that one's appearance, body odor, or facial expressions will make others uncomfortable

  • in contrast to Western social anxiety, taijin kyofusho focuses on concern for the discomfort of others, rather than the fear of embarrassing oneself

Generalized anxiety disorder (GAD)

• Generalized anxiety disorder (GAD) involves prolonged, excessive, and uncontrollable anxiety about a wide range of everyday events and activities

  • The anxiety is diffuse and uncontrollable and the person worries about many different things, most of the time

    • E.g. a person with GAD constantly worries about whether they locked the door, whether their children are safe, whether they will meet a deadline, and whether their health is declining

• GAD is associated with physical symptoms including:

  • muscle tension

  • fatigue

  • difficulty concentrating

  • sleep disturbance

Causes of anxiety disorders

• Anxiety disorders arise from interacting behavioral, cognitive, biological and cultural factors

Behavioral causes

• Anxiety can be learned through conditioning:

  • Classical conditioning: a neutral stimulus becomes associated with a threatening event and elicits a fear response

    • E.g. a child who is bitten by a dog develops a conditioned fear of all dogs

  • Operant conditioning: avoidance of the feared stimulus reduces anxiety and is negatively reinforced, maintaining the disorder

    • E.g. a person with agoraphobia who avoids the subway feels temporary relief, which reinforces avoidance

  • Observational learning: fears can be acquired by observing others show fear toward a stimulus

    • E.g. a child who watches a parent respond with intense fear to spiders may develop the same fear vicariously

Cognitive causes

• Maladaptive thinking patterns contribute to anxiety disorders:

  • Cognitive distortions: a person may overestimate the probability of threat, catastrophize the consequences or underestimate their ability to cope

  • In GAD, people engage in persistent worry as a cognitive coping strategy

    • Worry is negatively reinforced as it creates a false sense of control

  • In social anxiety, the person focuses on their own performance and assumes others are judging them negatively

    • This is self-focused attentional bias

Biological & genetic causes

• Genetic factors: anxiety disorders are heritable

  • Twin studies show higher concordance in identical than fraternal twins

• Neurochemical factors: Low levels of GABA (an inhibitory neurotransmitter that normally reduces neural firing and produces calm) is associated with anxiety disorders

  • Deficient GABA activity produces heightened neural excitability and anxiety

• Biological preparedness: humans are predisposed to fears evolutionary relevant threats, e.g. snakes, spiders, heights, strangers

  • This explains why certain specific phobias are far more common than others

Cultural context

• Culture shapes how anxiety is experienced and expressed

  • Culture-bound syndromes (e.g. ataque de nervios, taijin kyofusho) show variation in symptom expression

• Cultural norms influence what is considered disordered

• Diagnosis requires cultural sensitivity , as applying Western diagnostic criteria without cultural awareness can lead to misdiagnosis