Psychology 101: Intro to Psychology

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When do we cross the boundary between natural worry and the debilitating types of anxiety associated with disorders? In this lesson, you'll explore some common anxiety disorders and their potential causes.

Have you ever felt anxious, maybe before a big test or an important job interview? A half an hour, or even an hour before, you get butterflies in your stomach or find yourself nervously pacing your living room. You go over questions and answers in your head, and despair that you should have started prepping months ago instead of just last week. Once the test or interview is over, you feel relieved; it went fine, you remembered everything you needed to and your heart rate's returned to normal. This kind of anxiety is a natural and normal response to a stressor like an interview. But imagine if you'd started worrying about that interview a week in advance and had been unable to concentrate on anything else in the meantime; imagine if afterward, instead of feeling relieved, you continued to worry. This kind of anxiety is out of proportion to the stressor that triggered it and represents one kind of anxiety disorder, a disruptive condition that can interfere with functioning in daily life.

Generalized Anxiety Disorder

There are many types of anxiety disorder. The kind we just described, which would cause you to worry for weeks about an interview, is known as Generalized Anxiety Disorder, abbreviated GAD. GAD affects approximately 3% of American adults and is characterized by excessive and uncontrollable worry that is disproportionate to circumstances; it's fine to worry about the interview, but it's worrying all week that is the symptom of the disorder. GAD can also cause physical symptoms like fatigue, headache, nausea, trembling and insomnia. You may have felt some of these in response to normal, passing anxiety. Maybe you've felt queasy before a big important test. But imagine feeling that way all the time, in response to little things, and you've got some idea of what it's like to live with GAD.

The disorder seems to have many possible causes. It's probably genetic, since it tends to run in families, but has environmental causes as well, since it's sometimes triggered by experiencing normal stress. It's also been associated with addictions to alcohol or sedatives. The part of the brain that processes fear, called the amygdala, has also been related to GAD; it seems like if its connections to the rest of the brain are interrupted, it can result in increased anxiety. But with all of these factors, it is difficult to tell if they cause GAD or if they are simply further symptoms of it.

Phobias

Another anxiety disorder you might be familiar with is called a phobia. You've probably heard some of the long, complicated names like arachnophobia and triskaidekaphobia which really just mean fear of spiders and fear of the number 13. These are known as specific phobias. Someone with arachnophobia has an out-of-proportion anxious response to a specific trigger--spiders--but not in other situations. Indiana Jones isn't somebody we'd think of as having generalized anxiety, but he certainly has ophidiophobia: a fear of snakes.

Some people also have social phobias, or anxiety that is produced by having to interact with other people. Fear in general of social interactions is known as social anxiety. Have you ever felt nervous before going to a party where you might not know everybody? Or before you've had to go to an event where you were expected to network? If so, you've experienced mild (and temporary) social anxiety; like with GAD, social anxiety only becomes a disorder when it is out of proportion, constant or debilitating. If your anxiety actually prevented you from attending any social functions, you'd have 'social anxiety disorder.'

Just as people with a 'specific phobia'--like Indiana Jones' fear of snakes--experience anxiety only with certain triggers, some people have social anxiety set off by particular situations. This is known as a specific social phobia. You've probably felt uncomfortable using a public restroom at some point in your life--they're kind of gross, and the whole process is ripe for potential embarrassment. But for someone with paruresis, using public restrooms induces debilitating anxiety--they literally cannot use the bathroom while other people are around. This is played for laughs in a number of TV shows, like Buffy¸ Scrubs and Coupling, but it can really make life difficult for those whose activities are limited by needing to find a private restroom.

Phobias are often understood in terms of classical conditioning. Ever heard of Pavlov's dogs? Pavlov caused dogs to drool at the ring of a bell by presenting food and ringing the bell at the same time. Though the dogs initially drooled because of the food, they came to associate the presence of food with the bell's sound and would drool in anticipation when only the bell was rung. Some psychologists think that phobias may be formed by classical conditioning in a negative sense. Indiana Jones was fine with snakes as a child, but as a teenager fell into a cage filled with snakes during a stressful chase scene in the beginning of the Last Crusade. In his case, it only took one negative association to make him fear snakes the rest of his life.

Obsessive-compulsive disorder

The last anxiety disorder we'll discuss is obsessive-compulsive disorder, known as OCD. As portrayed in the media, OCD is the neat-freak's disease; TV characters like detective Adrian Monk are shown pouring boiling water over toothbrushes and carefully arranging rows of identical suits. It's true that many with obsessive-compulsive disorder are overly concerned about germs and need to keep their things tidy, but these are just some of the many manifestations of the basic condition. At its heart, OCD is characterized by both--wait for it--obsessions and compulsions. Obsessions are intrusive ideas and thoughts that a person with OCD can't stop thinking about. Imagine what it feels like to have a song stuck in your head; now imagine if that song were instead a worry that you'd forgotten to turn off the oven. Being unable to get rid of these kinds of thoughts can understandably cause anxiety, and that's where the compulsions come in. Compulsions are behaviors that are used to cope with anxiety. They're often ritualistic, like washing your hands seven times or tapping your doorknob three times before you leave the house. These rituals can become extremely disruptive, even causing anxiety that they are supposed to relieve.

OCD is the fourth most-common psychological disorder, affecting approximately one in fifty American adults. Psychologists have offered many potential causes. The neurotransmitter serotonin is often present at abnormal levels in the brain in people with OCD, and the disease seems to be somewhat heritable--especially if it develops early during childhood. Some psychologists speculate that OCD may represent the extreme forms of behaviors that are normally evolutionarily adaptive; being persistent enough to check under every bush--not just some of them--for snakes, for example, is a useful trait that could develop into the kind of compulsive behavior that people with OCD display today.

Review

We've gone over some of the major anxiety disorders: generalized anxiety disorder and specific phobias and their equivalents in the social realm, social anxiety and specific social phobias. These disorders represent a normal response to stress gone haywire, to the point where normal functioning is impaired. We've also talked about obsessive-compulsive disorder, which causes patients to have intrusive, repetitive thoughts about often inappropriate things and to develop often bizarre, repetitive rituals to deal with the resulting stress and anxiety.

Anxiety is more than just feeling nervous or worried before a test--it can be a serious condition that makes life really difficult.