41-1 How do generalized anxiety disorder, panic disorder, and phobias differ?

The anxiety disorders are marked by distressing, persistent anxiety and often dysfunctional anxiety-reducing behaviors. These include:

Tom was a 27-year-old electrician. For two years, he had been bothered by dizziness, sweating palms, and irregular heartbeat. He felt on edge and sometimes found himself shaking. Tom had been reasonably successful in hiding his symptoms from his family and co-workers, but occasionally he had to leave work. He allowed himself few other social contacts. Neither his family doctor nor a neurologist had been able to find any physical problem.

Tom’s unfocused, out-of-control, agitated feelings suggest a generalized anxiety disorder. The symptoms of this disorder are commonplace; their persistence, for six months or more, is not. People with this condition (two-thirds women) worry continually, and they are often jittery, on edge, and sleep deprived (McLean & Anderson, 2009). Concentration is difficult as attention switches from worry to worry. Their tension and apprehension may leak out through furrowed brows, twitching eyelids, trembling, perspiration, or fidgeting from autonomic nervous system arousal.

People may not be able to identify the cause of their anxiety, and therefore cannot relieve or avoid it. To use Sigmund Freud’s term, the anxiety is free-floating (not linked to a specific stressor or threat). Generalized anxiety disorder and depression often go hand in hand, but even without depression, this disorder tends to be disabling (Hunt et al., 2004; Moffitt et al., 2007b). Moreover, it may lead to physical problems, such as high blood pressure.

For the 1 person in 75 with panic disorder, anxiety suddenly escalates into a terrifying panic attack—a minutes-long episode of intense fear that something horrible is about to happen. Physical symptoms, such as irregular heartbeat, chest pains, shortness of breath, choking, trembling, or dizziness may accompany the panic. One woman recalled suddenly feeling

hot and as though I couldn’t breathe. My heart was racing and I started to sweat and tremble and I was sure I was going to faint. Then my fingers started to feel numb and tingly and things seemed unreal. It was so bad I wondered if I was dying and asked my husband to take me to the emergency room. By the time we got there (about 10 minutes) the worst of the attack was over and I just felt washed out (Greist et al., 1986).

These anxiety tornados strike suddenly, wreak havoc, and disappear, but they are not forgotten. Ironically, worries about anxiety—perhaps fearing another panic attack, or fearing anxiety-related symptoms in public—can amplify anxiety symptoms (Olatunji & Wolitzky-Taylor, 2009). After several panic attacks, people may come to fear the fear itself. This may trigger agoraphobia—fear or avoidance of public situations from which escape might be difficult. People with agoraphobia may avoid being outside the home, in a crowd, on a bus, or in an elevator.

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Charles Darwin began suffering from panic disorder at age 28, after spending five years sailing the world. As a result, he moved to the country, avoided social gatherings, and traveled only in his wife’s company. But the relative seclusion did free him to develop his evolutionary theory. “Even ill health,” he reflected, “has saved me from the distraction of society and its amusements” (quoted in Ma, 1997).

Smokers have at least a doubled risk of panic disorder (Zvolensky & Bernstein, 2005). They also show greater panic symptoms in situations that often produce panic attacks (Knuts et al., 2010). Because nicotine is a stimulant, lighting up doesn’t help us lighten up.

We all live with some fears. But people with phobias are consumed by a persistent, irrational fear and avoidance of some object, activity, or situation. Specific phobias may focus on particular animals, insects, heights, blood, or closed spaces (FIGURE 41.1). Many people avoid the triggers, such as high places, that arouse their fear. Marilyn², an otherwise healthy and happy 28-year-old, so feared thunderstorms that she felt anxious as soon as a weather forecaster mentioned possible storms later in the week. If her husband was away and a storm was forecast, she would often stay with a close relative. During a storm, she hid from windows and buried her head to avoid seeing the lightning.

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Not all phobias are so specific. Social anxiety disorder (formerly called “social phobia”) is shyness taken to an extreme. People with this disorder have an intense fear of other people’s negative judgments. They may avoid social situations, such as speaking up in a group, eating out, or going to parties. Finding themselves in such a situation, they may experience symptoms of their anxiety, such as sweating or trembling.