by Sandi Mann
Phobias
A phobia is an extreme form of anxiety that is directed towards a particular object. A severe phobic reaction is a classic ‘stress’ reaction. To call something a ‘phobia’, most practitioners follow the diagnostic guidelines set in the Diagnostic and Statistical Manual (known in the trade as DSM-V, to designate the fifth edition of the manual), which is published by the American Psychiatric Association. These guidelines point out that, in order to be classified as a phobia, four conditions must be met:
1 There must be a marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation.
2 Exposure to this stimulus almost invariably provokes an immediate anxiety response, which may take the form of a panic attack.
3 The person recognizes that the fear is excessive or unreasonable.
4 The phobic response interferes significantly with the person’s normal routine or social activities.
Phobias can be classified into two broad types:
• Specific or simple phobias
• Complex phobias (e.g. social phobia or agoraphobia).
Specific phobias can be further classified into four main categories:
• Animal phobias (fear of animals or creatures)
• Environmental phobias (fear of environmental events such as thunder, lightening, heights and the dark)
• Medical phobias (fear of blood, injections, vomiting, injury, etc.)
• Situational phobias (fear of certain situations such as crowded places, public transport, flying, driving, etc.).
There are a range of reasons why people might develop a phobia:
CONDITIONING
It is possible to induce a phobia, especially in children (see the case study on Little Albert below), by simply pairing a harmless stimulus with one that naturally instils fear. For example, if we were to present a cuddly teddy bear to a small child while at the same time screaming at them, they would most likely become fearful of the teddy. That fear might generalize to other soft toys, too.
LEARNING FROM OTHER PEOPLE
So-called vicarious learning means that we can also learn to be phobic. Thus, phobias are often transmitted from parent to child. Studies have shown that parents who show their fear more often to their children have more fearful children than those who hide their fears. This happens because children 1) use the information given to them by parents to develop their own fear and 2) they learn to copy or model their parent’s behaviours. In addition, 3) observing someone else’s fear can also induce fear.
THE THEORY OF PREPAREDNESS
In 1971 the psychologist Martin Seligman suggested that some things or stimuli are ‘evolutionally predisposed’ to evoke fear. This goes some way to explaining why some phobias are more common than others, such as spider phobia (one of the most common phobias). Presumably, in our evolutionary past, our ancestors would have encountered deadly spiders so a healthy fear of them might have saved their lives. This, though, doesn’t explain why not everyone is phobic of spiders. The Theory of Preparedness goes further, then, by suggesting that some people are more biologically ‘prepared’ to have phobias than others. It is even possible that this ‘preparedness’ trait gave an evolutionary advantage, in that more fearful people may have had better survival rates as they avoided more of the dangerous stimuli in life. Indeed, most specific phobias do involve situations that might have posed a threat in some way at some point in our evolutionary past.
FIRST CONTACT THEORY
This theory is related to the above in that it builds on evolutionary principles. Many people have not any traumatic episode that can account for their phobia, neither have they learned it from their parents. These sufferers often report having ‘always’ been phobic since they were small children, without an obvious cause. The theory goes that it is in our best interests of survival to be afraid of something the first time we meet it (or contact it). This makes us wary until we know whether the new object is safe. This explains why children are often scared of new things or experiences, such as water, thunder and dogs. While most children overcome their fear, some get ‘stuck’ and remain fearful for life.
Case study: Little Albert
In 1920 the behavioural psychologist John B. Watson carried out a (highly unethical, by today’s standards) experiment to show that a child can learn a phobia. Nine-month-old ‘Albert’ was an emotionally stable child with no history of fearful reactions. A white laboratory rat was placed near Albert and he was allowed to play with it. At this point, the child showed no fear of the rat. Later, however, Watson and his colleague Rosalie Rayner made a loud sound behind Albert’s back when the baby touched the rat. Little Albert responded to the noise by crying and showing fear. After several such pairings of the two stimuli, Albert was again presented with only the rat. Now, however, he became very distressed as the rat appeared in the room; he had learned to associate the white rat (originally a neutral stimulus, now a conditioned stimulus) with the loud noise (an unconditioned stimulus) and was producing the fearful or emotional response of crying (originally the unconditioned response to the noise, now the conditioned response to the rat) – see Chapter 5 for more on conditioning.
Little Albert seemed to generalize his fear response to furry objects so that when Watson sent a non-white rabbit into the room 17 days after the original experiment, Albert also became distressed. He showed similar reactions when presented with a furry dog, a sealskin coat, and even when Watson appeared in front of him wearing a Santa Claus beard.
No attempts were made to cure poor Little Albert of the phobias that had been experimentally induced.
Spotlight: Who was Little Albert?
In 2009 the psychologist Hall P. Beck and colleagues published the results of their efforts to solve the mystery of the boy’s true identity in American Psychologist. There, Beck et al. presented compelling evidence that Little Albert was a little boy named Douglas Merritte, the son of a wet-nurse, Arvilla Merritte, who was employed at the paediatric hospital at John Hopkins University where Watson also worked.
Sadly, the researchers discovered that the child had died at age six of hydrocephalus after contracting meningitis.
Obsessive–compulsive disorder (OCD)
Obsessive–compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts that produce discomfort, apprehension, fear or worry; the sufferer often performs repetitive behaviours aimed at reducing the associated anxiety. According to OCD-UK, it affects about 1.2 per cent of the population and it can be so debilitating and disabling that the World Health Organization (WHO) ranked OCD in the top ten of the most disabling illnesses of any kind, in terms of lost earnings and diminished quality of life.
Obsessions are involuntary, seemingly uncontrollable thoughts, images or impulses that occur over and over again in the sufferer’s mind. Sufferers do not want to have these ideas but they cannot stop them. These obsessive thoughts are often disturbing and distracting.
Compulsions are behaviours or rituals that the sufferer feels driven to act out again and again, and often these compulsions are performed in an attempt to make the obsessions go away or become more manageable. For example, if a person is afraid of contamination with germs and fears catching something, they might develop obsessive hand-washing rituals in order to reduce their ongoing worries that they have not washed their hands. However, the relief from washing the hands never lasts, and, in fact, the obsessive thoughts may even come back more strongly. In order to cope with the obsessional thoughts and to reduce the associated anxiety, the hand-washer has to then repeat the hand-washing ritual – and the cycle continues.
The compulsive behaviours often end up causing anxiety themselves as they become more demanding and time-consuming. If the sufferer simply does not ‘obey’ their thoughts (by carrying out compulsions), they will also get more and more anxious, leaving them in a no-win situation, trapped by the cycle of obsessions and compulsions.
Post-traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one’s own or someone else’s physical, sexual or psychological well-being, overwhelming the ability to cope. According to NHS Direct, PTSD affects up to 30 per cent of people who experience a traumatic event. It affects around 5 per cent of men and 10 per cent of women at some point during their life. PTSD can occur at any age, including during childhood.
The diagnostic criteria for PTSD, stipulated in the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), suggest that in order to be diagnosed with PTSD, the sufferer should:
1 have had exposure to a traumatic event: this must have involved both (a) loss of ‘physical integrity’ or risk of serious injury or death, to self or others, and (b) a response to the event that involved intense fear, horror, or helplessness
2 persistently replay the event in their mind: for example flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or an intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event(s)
3 suffer persistent avoidance and emotional numbing following the event. This involves a sufficient level of:
– avoidance of stimuli associated with the trauma, such as certain thoughts or feelings, or talking about the event(s)
– avoidance of behaviours, places, or people that might lead to distressing memories as well as the disturbing memories, dreams, flashbacks, and intense psychological or physiological distress
– inability to recall major parts of the trauma(s), or decreased involvement in significant activities
– decreased capacity (down to complete inability) to feel certain feelings
– an expectation that one’s future will be somehow constrained in ways not normal to other people.
4 experience persistent symptoms of increased arousal not present before: these include difficulty falling or staying asleep, or problems with anger, concentration or hyper-vigilance
5 have symptoms lasting for more than one month
6 show significant impairment: the symptoms reported must lead to ‘clinically significant distress or impairment’ of major domains of life activity, such as social relations, occupational activities, or other ‘important areas of functioning’.
‘While severity of combat exposure was the strongest predictor of whether the soldiers developed the syndrome, pre-war vulnerability was just as important in predicting the persistence of the syndrome over the long run.’
B. P. Dohrenwend, T. J. Yager, M. M. Wall and B. G. Adams, ‘The roles of combat exposure, personal vulnerability, and involvement in harm to civilians or prisoners in Vietnam War-related posttraumatic stress disorder’, Clinical Psychological Science (2013)
Depression
According to the Royal College of Psychiatrists, one in five people become depressed at some point in their lives and it is thought to be the number-one psychological disorder in the Western world. Ten times more people suffer from major (or clinical) depression now than in 1945 (suggesting that most causes of depression are not biological) and the average age of first onset of major depression is 25–29. Up to 80 per cent of suicide deaths are among sufferers of major depression.
‘Depression is more than just sadness. People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide.’
www.apa.org, adapted from A. E. Kazdin (ed.), The Encyclopedia of Psychology (Washington, DC: APA, 2000)
There are four main groups of depressive symptoms:
• Those to do with feelings: e.g. feeling sad and miserable
• Physical symptoms: e.g. lack of appetite or sleeping difficulties
• Thoughts/cognitions: e.g. ‘I am worthless’, ‘No one likes me’
• Those to do with behaviour: e.g. staying in bed.
Only around 10 per cent of depressive cases are caused by biological factors; clinical depression is often said to be caused by a chemical imbalance in the brain, and, indeed, this is what most drug treatments are based on. Certainly, in many cases, the amount of certain neurotransmitters (such as serotonin and norepinephrine) is reduced in depressed people (see Chapter 17). However, low serotonin levels may simply be another symptom of depression, not a cause. Depressed people tend to engage in fewer pleasure-seeking activities and this lowers serotonin levels in the brain.
Most depression is caused by unhelpful thinking styles or cognitive distortions (which can be learned from other family members) rather than other factors such as genetics or hormone imbalance (although people may have a genetic predisposition to depression). This table shows examples of these patterns of thinking.
Unhelpful thinking style Example
Predicting the future Depressed people tend to spend a lot of time thinking about the future and predicting what could go wrong.
Mindreading Here, assumptions are made about what other people are thinking, e.g. ‘They must think I am so stupid’, ‘Everyone will think I am an idiot.’
Catastrophizing Depressed people often blow things out of all proportion. Things are always ‘terrible’, rather than just ‘not very good’. They also assume that catastrophes will result from minor mistakes.
‘Should’-ing ‘Should’ statements are commonly used by depressed people to refer to how badly things have gone and to take the blame for what happened: ‘I should have done this or that.’ All this serves to make the person feel even worse about themselves and adds to their depressed state.
Over-generalizing This is where one incident that didn’t go well is used as a basis for assuming everything else will follow a similar pattern.
Ignoring the positives Depressed people often ignore or don’t notice when things go well and only focus on when things go badly.
Labelling Finally, depressed people are more likely to label themselves as ‘rubbish’, ‘a failure’, ‘boring’, etc. Labelling like this can add to their feelings of poor self-worth.
Eating disorders
Eating disorders are psychological illnesses defined by abnormal eating habits that may involve either insufficient or excessive food intake. Bulimia nervosa and anorexia nervosa are the most common specific forms of eating disorders. Bulimia nervosa is a disorder characterized by binge eating and purging (e.g. self-induced vomiting, over-exercising and the use of laxatives). Anorexia nervosa is characterized by extreme food restriction to the point of self-starvation and excessive weight loss.
There are many possible causes of eating disorders, including biological, psychological and/or environmental:
• Genetic: individuals with a first-degree relative who has a history of an eating disorder are more likely than individuals without such a relative, to themselves develop an eating disorder, suggesting that there may be a genetic link (though this could be learned behaviour, too).
• Family/home influence: research shows that mothers who diet or worry excessively about their weight may trigger their child to develop an abnormal attitude towards food, as may a father or sibling (or even classmate) who teases an individual about their weight or shape.
• Personality: people with eating disorders tend to have low self-esteem, a high need for perfectionism and for the approval of others, and other characteristics.
• Psychological factors: psychological conditions such as post-traumatic stress disorder, anxiety, phobias and depression have all been associated with eating disorders, as have life stressors such as job loss, divorce, or coping with bullying or a learning difficulty such as dyslexia.
• Body image disorders: many people with ea
ting disorders suffer also from body dysmorphic disorder, which is an altered way of a person seeing him or herself. Studies have found that 15 per cent of individuals diagnosed with body dysmorphic disorder also have either anorexia nervosa or bulimia nervosa.
• Biological factors: abnormalities of chemical messengers such as serotonin and norepinephrine that help control appetite, anxiety and reward systems may play a role in eating disorders.
Dig deeper
Watch the ‘Little Albert’ experiments:
http://www.bing.com/videos/search?q=little+albert+experiment&qpvt=little+albert+experiment&FORM=VDRE#view=detail&mid=A47FD8E6F5C2332BA6ACA47FD8E6F5C2332BA6AC
Anxiety website:
https://anxietyuk.org.uk/
Depression self-help guide:
http://www.moodjuice.scot.nhs.uk/depression.asp
Fact-check
1 Which of the following statements about stress is not true?
a Stress is an adaptive response designed to save our lives
b Stress makes us ill by lowering our immunity
c Stress can cause heart attacks
d Stress is never good for us any more
2 Which of the following is not a symptom of anxiety?
a Palpitations
b Heart attack
c Dizziness
d Dry mouth
3 Which of these theories might explain how GAD develops?