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  • Ever heard a really good joke about polio? Or made a casual reference to someone having

  • hepatitis? Or maybe teased your buddy by saying he has muscular dystrophy?

  • Of course you have never done that, because you are not a terrible person. You'd never

  • make fun of someone for having a physical illness, but folks make all kinds of offhand

  • remarks about people having mental illnesses and never give it a second thought.

  • How often have you heard a person say that someone's psycho, or schizo, or bipolar, or

  • OCD? I can pretty much guarantee that the people who used those terms had no idea what they actually meant.

  • We've talked about how psychological disorders and the people who have them have often been stigmatized.

  • But at the same time, we tend to minimize those disorders, using them as nicknames for

  • things that people do, think, or say, that may not exactly be universal, but are still basically healthy.

  • And we all do it, but only because we don't really understand those conditions.

  • But that's why we're here, because as we go deeper into psychological disorders, we get

  • a clearer understanding of their symptoms, types, causes, and the perspectives that help explain them.

  • And some of the most common disorders have their root in an unpleasant mental state that's

  • familiar to us all: anxiety.

  • It's a part of being human, but for some people it can develop into intense fear, and paralyzing

  • dread, and ultimately turn into full-fledged anxiety disorder.

  • Defining psychological disorders again: a deviant, distressful, and dysfunctional pattern

  • of thoughts, feelings, or behaviors that interferes with the ability to function in a healthy way.

  • So when it comes to anxiety, that definition is the difference between the guy you probably

  • called phobic because he didn't like Space Mountain as much as you did, and the person

  • who truly can't leave their house for fear of interacting with others.

  • It's the difference between the girl who's teased by her friends as being OCD because

  • she does her laundry every night and the girl who has to wash her hands so often that they bleed.

  • Starting today, you're going to understand all of those terms you've been using.

  • We commonly equate anxiety with fear, but anxiety disorders aren't just a matter of fear itself.

  • A key component is also what we do to get rid of that fear.

  • Say someone almost drowned as a kid and is now afraid of water.

  • A family picnic at the river may cause that anxiety to bubble up, and to cope, they may

  • stay sequestered in the car, less anxious but probably still unhappy while the rest

  • of the family is having fun.

  • So, in clinical terms, anxiety disorders are characterized not only by distressing, persistent

  • anxiety but also often by the dysfunctional behaviors that reduce that anxiety.

  • At least a fifth of all people will experience a diagnosable anxiety disorder of some kind

  • at some point in their lives. That is a lot of us.

  • So I want to start out with a condition that used to be categorized as an anxiety disorder

  • but is now considered complex enough to be in a class by itself, Obsessive-Compulsive

  • Disorder or OCD.

  • You probably know that condition is characterized by unwanted repetitive thoughts, which become

  • obsessions, which are sometimes accompanied by actions, which become compulsions.

  • And it is a great example of a psychological disorder that could use some mental-health myth busting.

  • Being neat, and orderly, and fastidious does not make you OCD.

  • OCD is a debilitating condition whose sufferers take normal behaviors like, washing your hands,

  • or double checking that you turned off the stove and perform them compulsively.

  • And they often use these compulsive, even ritualistic behaviors to relieve intense and unbearable anxiety.

  • So, soon they're scrubbing their hands every five minutes, or constantly checking the stove,

  • or counting the exact number of steps they take everywhere they go.

  • If you're still unclear about what it means for disorders to be deviant, distressful and

  • dysfunctional, OCD might help you understand.

  • Because it is hard to keep a job, run a household, sit still, or do much of anything if you feel

  • intensely compelled to run to the kitchen twenty times an hour.

  • And both the thoughts and behaviors associated with OCD are often driven by a fear that is itself

  • obsessive, like if you don't go to the kitchen right now your house will burn down and your

  • child will die which makes the condition that much more distressing and self-reinforcing.

  • There are treatments that help OCD including certain kinds of psychotherapy and some psychotropic drugs.

  • But the key here is that it is not a description for your roommate who cleans her bathroom

  • twice a week, or the guy in the cubicle next to you, who only likes to use green felt tip pens.

  • And even though OCD is considered its own unique set of psychological issues, the pervasive

  • senses of fear, worry, and loss of control that often accompany it, have a lot in common

  • with other anxiety disorders.

  • The broadest of these is Generalized Anxiety Disorder or GAD.

  • People with this condition tend to feel continually tense and apprehensive, experiencing unfocused,

  • negative, and out-of-control feelings.

  • Of course feeling this way occasionally is common enough, but feeling it consistently

  • for over six months - the length of time required for a formal diagnosis - is not.

  • Folks with GAD worry all the time and are frequently agitated and on edge, but unlike

  • some other kinds of anxiety, patients often can't identify what's causing the anxiousness, so

  • they don't even know what to avoid.

  • Then there's Panic Disorder, which affects about 1 in 75 people, most often teens and young adults.

  • It's calling card is Panic Attacks or sudden episodes of intense dread or sudden fear that

  • come without warning.

  • Unlike the symptoms of GAD which can be hard to pin down, Panic Attacks are brief, well-defined,

  • and sometimes severe bouts of elevated anxiety.

  • And if you've ever had one, or been with someone who has, you know that they call these attacks

  • for good reason.

  • They can cause chest pains and racing heartbeat, difficulty breathing and a general sense that

  • you're going crazy or even dying. It's as awful as it sounds.

  • We've talked a lot about the body's physiological fight or flight response and that's definitely

  • part of what's going on here, even though there often isn't an obvious trigger.

  • There may be a genetic pre-disposition to panic disorder, but persistent stress or having

  • experienced psychological trauma in the past can also set you up for these attacks.

  • And because the attacks themselves can be downright terrifying, a common trigger for

  • panic disorder is simply the fear of having another panic attack.

  • How's that for a kick in the head?

  • Say you have a panic attack on a bus, or you find yourself hyperventilating in front of

  • dozens of strangers with nowhere to go to calm yourself down, that whole ordeal might

  • make you never want to be in that situation again, so your anxiety could lead you to start

  • avoiding crowded or confined places.

  • At this point the initial anxiety has spun of into a fear of anxiety which means, welcome

  • you've migrated into another realm of anxiety disorder, Phobias.

  • And again this is a term that's been misused for a long time to describe people who, say,

  • they don't like cats, or are uncomfortable on long plane trips.

  • Simply experiencing fear or discomfort doesn't make you phobic.

  • In clinical terms, phobias are persistent, irrational fears of specific objects, activities,

  • or situations, that also, and this is important, leads to avoidance behavior.

  • You hear a lot about fears of heights, or spiders, or clowns, and those are real things.

  • They're specific phobias that focus on particular objects or situations.

  • For example, the Chesapeake Bay Bridge in Maryland is a seven-thousand meter span that

  • crosses the Chesapeake Bay, if you want to get to or from Eastern Maryland that's pretty

  • much the only way to do it, at least in a car, but there are thousands of people who

  • are so afraid of crossing that bridge that they simply can't do it.

  • So, to accommodate this avoidance behavior, driver services are available.

  • For $25 people with Gephyrophobia, a fear of bridges, can hire someone to drive themselves, and their kids,

  • and dogs, and groceries across the bridge in their own car, while trying not to freak out.

  • But other phobias lack such specific triggers, what we might think of as social phobia, currently

  • known as social anxiety disorder, is characterized by anxiety related to interacting or being

  • seen by others, which could be triggered by a phone call, or being called on in class,

  • or just thinking about meeting new people.

  • So you can probably see at this point how anxiety disorders are related and how they

  • can be difficult to tease apart.

  • The same thing can be said about what we think causes them.

  • Because much in the same way anxiety can show up as both a feeling like panic, and a thought,

  • like is my kitchen on fire, there are also two main perspectives on how we currently view anxiety

  • as a function of both learning and biology.

  • The learning perspective suggests that things like, conditioning, and observational learning

  • and cognition, all of which we've talked about before best explain the source of our anxiety.

  • Remember our behaviorist friend, John B. Watson and his conditioning experiments with poor

  • little Albert, by making a loud scary noise every time you showed the kid a white rat,

  • he ended up conditioning the boy to fear any furry object, from bunnies, to dogs, to fur coats.

  • That conditioning used two specific learning processes to cement itself in Little Albert's young mind.

  • Stimulus Generalization, expanded or generalized his fear of the rat to other furry objects,

  • the same principle holds true if you were, like, attacked by your neighbours mean parrot

  • and subsequently fear all birds.

  • But then the anxiety is solidified through reinforcement, every time you avoid or escape

  • a feared situations, a pair of fuzzy slippers or a robin on the street, you ease your anxiety,

  • which might make you feel better temporarily, but it actually reinforces your phobic behavior,

  • making it stronger.

  • Cognition also influences our anxiety, whether we interpret a strange noise outside as a

  • hungry bear, or a robber, or merely the wind, determines if we roll-over and keep snoring,

  • or freak out and run for a kitchen knife.

  • And we might also acquire anxiety from other people through observational learning.

  • A parent who's terrified of water may end up instilling that fear in their child by

  • violently snatching them away from kiddie pools or generally acting anxious around park

  • fountains and duck ponds.

  • But there're also equally important biological perspectives. Natural selection, for instance,

  • might explain why we seem to fear certain potentially dangerous animals, like snakes, or why fears

  • of heights or closed in spaces are relatively common.

  • It's probably true that our more wary ancestors who had the sense to stay away from cliff

  • edges and hissing serpents were more likely to live another day and pass along their genes,

  • so this might explain why those fears can persist, and why even people who live in places

  • without poisonous snakes would still fear snakes anyway.

  • And then you got the genetics and the brain chemistry to consider.

  • Research has shown for example that identical twins, those eternal test subjects, are more

  • likely to develop phobias even if they're raised apart.

  • Some researchers have detected seventeen different genes that seem to be expressed with various

  • anxiety disorders.

  • So it may be that some folks are just naturally more anxious than others and they might pass

  • on that quality to their kids.

  • And of course individual brains have a lot to say about how they process anxiety.

  • Physiologically, people who experience panic attacks, generalized anxiety, or obsessive

  • compulsions show over-arousal in the areasof the brain that deal in impulse control

  • and habitual behaviors.

  • Now we don't know whether these irregularities cause the disorder or are caused by it, but

  • again, it reinforces the truism that everything that is psychological is simultaneously biological.

  • And that holds true for many other psychological disorders we'll talk about in the coming weeks,

  • many of which have names that you've also heard being misused in the past.

  • Today you learned what defines an anxiety disorder, as well as the symptoms of obsessive