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Using frameworks like the DSM, psychologists diagnose mental health conditions based on symptom patterns, duration, and functional impairment. Disorders are grouped into several categories that include Neurodevelopmental Disorders; Schizophrenia Spectrum Disorders; Depressive Disorders Bipolar Disorders; and Anxiety Disorders, which are described in this section of this study guide—as well as Obsessive-Compulsive and Related Disorders; Dissociative Disorders; Trauma and Stressor-Related Disorders; Feeding and Eating Disorders; and Personality Disorders, which are describe in the next section of this guide.
Psychologists also aim to understand the biological, psychological, and social factors that contribute to the development of these disorders.
Neurodevelopmental Disorders
Neurodevelopmental disorders are conditions that develop during early life stages, typically before a child enters grade school, and can affect multiple areas of functioning. These disorders involve challenges in personal, social, academic, or occupational functioning, which may persist into adolescence and adulthood. Symptoms vary widely but generally involve challenges in communication, motor skills, learning, or behaviors that are inconsistent with what is expected for the individual’s age or developmental stage. Two key neurodevelopmental disorders that typically develop in childhood are attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).
Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is characterized by persistent patterns of inattention (difficulty focusing, forgetfulness, losing items), hyperactivity (excessive fidgeting, difficulty staying seated, talking excessively), and/or impulsivity (interrupting others, difficulty waiting one’s turn, acting without thinking) that interfere with daily functioning. For example, a child with ADHD might struggle to follow instructions in school, often appearing distracted or overly active compared to peers. Symptoms of ADHD have been shown to be linked to differences in brain structure and function, particularly in areas like the prefrontal cortex, which is involved in attention and impulse control. ADHD often runs in families, which suggests a hereditary component. Treatment typically involves medication, such as stimulants (e.g., Adderall or Ritalin) and non-stimulants as well as behavioral therapy, including strategies to improve organization, time management, and self-regulation.
Autism Spectrum Disorder (ASD): ASD includes a range of conditions involving challenges in social skills, communication, and behavior in unpredictable situations. Symptoms may include difficulty interpreting social cues, limited eye contact, repetitive movements, or intense focus on specific interests. Individuals with ASD vary widely in abilities, ranging from those who require significant assistance to those with high-functioning skills for daily life. Early signs of ASD include lack of eye contact, delayed speech development, or failure to engage in typical back-and-forth play during infancy or early childhood. ASD has been associated with genetic mutations and differences in brain development and neural connectivity. Treatment typically involves behavioral interventions, speech and occupational therapy, and supportive therapies. Behavioral interventions often include applied behavior analysis (ABA) to improve communication and social skills. Speech and occupational therapy can address communication challenges and assist with sensory integration. Supportive therapies are tailored to individual needs, often involving educational support and social skills training.
Possible Causes of Neurodevelopmental Disorders
While the specific causes of neurodevelopmental disorders are not fully understood, they are believed to involve a combination of biological and environmental factors. For example, research suggests that ADHD may be linked to differences in brain structure and neurotransmitter function, while ASD has been associated with genetic mutations and prenatal factors.
Environmental factors play a significant role, particularly during prenatal, perinatal, and early childhood periods. Maternal behaviors or conditions, such as smoking, alcohol consumption, drug abuse, poor nutrition, or infections during pregnancy, can disrupt normal brain development. Birth complications, including low birth weight, oxygen deprivation, or premature birth, may also increase the risk of neurodevelopmental disorders. Additionally, exposure to environmental toxins like lead or mercury during early developmental stages can impair neurological and cognitive functioning.
Physiological factors are often linked to abnormalities in brain structure or function. For example, differences in brain connectivity, reduced activity in specific brain regions, or atypical neural development have been associated with conditions like autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Similarly, neurotransmitter imbalances, such as irregularities in dopamine or serotonin systems, are thought to contribute to these disorders by affecting mood, attention, and behavior regulations.
Genetic factors also play a significant role, with many neurodevelopmental disorders showing strong hereditary components. Family studies have demonstrated that disorders like ASD and ADHD often run in families, suggesting a genetic predisposition. Additionally, specific genetic mutations, such as those affecting brain development or synaptic function, have been linked to these conditions. In some cases, gene-environment interactions occur, where an individual’s genetic vulnerabilities interact with environmental stressors, such as prenatal toxin exposure, to trigger the onset of a disorder.
Schizophrenia Spectrum Disorders
Schizophrenia spectrum disorders are a group of mental health conditions characterized by disturbances in thought, perception, behavior, and emotional expression. These disorders are defined by the presence of both positive and negative symptoms. Positive symptoms involve the presence of altered behaviors. Examples of positive symptoms include delusions, hallucinations, disorganized thinking or speech, and disorganized motor behavior.
Delusions are false beliefs that are strongly held despite contradictory evidence. Common types of delusions include delusions of persecution, where a person believes they are being targeted, spied on, or harmed by others, and delusions of grandeur, where an individual believes they possess extraordinary abilities, wealth, or power. Hallucinations are sensory or perceptual experiences that happen without any external stimulus. Hallucinations can occur in any sensory modality, but auditory hallucinations are the most common. Auditory hallucinations entail hearing voices that others cannot hear, often critical or commanding in nature. Other types of hallucinations include visual hallucinations (seeing things that aren’t there), tactile hallucinations (feeling sensations, like bugs crawling on skin), and olfactory or gustatory hallucinations (smelling or tasting nonexistent substances).
Disorganized thinking or speech, another positive symptom, involves patterns of thought that are incoherent or illogical and difficult to follow, leading to difficulty communicating. This can manifest as a word salad, where an individual strings together words in nonsensical or unrelated ways, making his or her speech incomprehensible. For example, a person might say, “Blue runs faster than the chair because happiness is a number.” Other signs of disorganized speech include frequent derailment (shifting abruptly between unrelated topics) or tangential wording (providing answers that are loosely or completely unrelated to the question). Disorganized motor behavior includes unpredictable or inappropriate physical actions, ranging from agitation to catatonia, which refers to abnormalities in movement or behavior. Catatonia can manifest as excitement, characterized by excessive or purposeless motor activity (a positive symptom) or as stupor, marked by a lack of movement or responsiveness to the environment (a negative symptom). In the excited form, individuals may exhibit agitation, repetitive movements, or unusual postures, while in stupor, they may remain immobile, mute, or appear disconnected from their surroundings.
Negative symptoms refer to diminished emotional expression or lack of motivation and interest in activities. One common negative symptom is flat affect, where little or no emotional expression is exhibited in a person’s face, voice, or gestures, even when discussing emotional topics. Avolition, or lack of motivation, leads to difficulty initiating or completing tasks, such as maintaining personal hygiene or pursuing goals. Anhedonia, the inability to experience pleasure, results in a loss of interest in previously enjoyable activities. Alogia, or reduced speech output, manifests as limited verbal communication, often with brief or empty responses. Finally, catatonic stupor, a state of immobility and unresponsiveness, expresses as an extreme reduction in movement and interaction with the environment.
Schizophrenia can be experienced as an acute condition, with symptoms occurring in episodic flare-ups that may respond to treatment. Alternatively, it may become a chronic condition involving persistent symptoms and long-term functional impairment. The chronic form often requires ongoing management with medication, therapy, and support services.
Treatments for schizophrenia spectrum disorders typically involve a combination of antipsychotic medications and psychotherapy. Antipsychotics help manage symptoms like delusions, hallucinations, and disorganized thinking by regulating dopamine activity in the brain. Psychotherapy, including cognitive behavioral therapy (CBT), helps individuals develop coping strategies, improve social skills, and address distorted thoughts. Supportive interventions, such as family therapy and psychoeducation, are also important for creating a stable environment and improving long-term outcome.
Possible Causes of Schizophrenia
The causes of schizophrenia are complex, with research suggesting a strong genetic and biological link. These factors interact to influence brain development and function, contributing to the onset of the disorder. While the exact causes are still uncertain, several key biological influences have been identified.
Genetic factors are known to play a significant role in schizophrenia, as the disorder tends to run in families. Studies on identical twins show a higher concordance rate for schizophrenia compared to fraternal twins or siblings, indicating a strong hereditary component. Additionally, individuals with first-degree relatives who have schizophrenia are at an increased risk of developing the disorder themselves, suggesting that genetic predispositions contribute to vulnerability.
The dopamine hypothesis is one of the best-supported biological explanations for schizophrenia. It suggests that an overactivity of the dopamine pathways in certain areas of the brain, particularly the mesolimbic pathway, contributes to the positive symptoms of schizophrenia, such as delusions and hallucinations. Conversely, underactivity in dopamine pathways in other parts of the brain, such as the prefrontal cortex, may contribute to negative symptoms like flat affect and avolition. Other neurotransmitters, such as glutamate, are also believed to play a role in the disorder, indicating a broader disruption in brain chemistry.
Prenatal factors may also increase the risk of schizophrenia. Research suggests that exposure to viruses or infections during pregnancy, such as influenza, can affect fetal brain development and increase the likelihood of schizophrenia later in life. Additionally, complications during birth, such as oxygen deprivation, may contribute to the development of the disorder by affecting neural pathways.
Depressive Disorders
Depressive disorders are mental health conditions characterized by the presence of a sad, empty, or irritable mood, accompanied by physical and cognitive changes that significantly impair an individual’s ability to function. These disorders vary in severity and duration, but they commonly disrupt daily activities, relationships, and overall well-being. Two common disorders are major depressive disorder and persistent depressive disorder.
Major depressive disorder (MDD) is characterized by at least one major depressive episode, defined as a period of at least two weeks in which a person experiences five or more major depressive symptoms. Emotional symptoms include a persistent low mood, feelings of worthlessness or hopelessness, and a loss of interest or pleasure in previously enjoyable activities (anhedonia). Physical symptoms are also common, such as fatigue, changes in appetite or weight, and disruptions in sleep patterns (e.g., insomnia or hypersomnia). Cognitive symptoms may include difficulty concentrating, indecisiveness, and recurring thoughts of death or suicide. Additionally, at least one of the following core symptoms must be present: depressed mood (e.g., sadness or irritability in children/adolescents) or loss of interest or pleasure in most or all activities (anhedonia). MDD is episodic, meaning that symptoms occur in discrete episodes rather than being constant. MDD is much more common in women than in men.
Treatment for MDD often includes antidepressant medications and psychotherapy. Medications such as selective serotonin reuptake inhibitors (SSRIs) help regulate mood by increasing serotonin levels in the brain. Psychotherapies, including cognitive behavioral therapy (CBT), focus on identifying and reframing negative thought patterns. In severe cases, treatments like electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) may be used when other interventions prove ineffective.
Persistent depressive disorder (PDD), also known as dysthymia, is a chronic form of depression lasting for at least two years in adults, or one year in children and adolescents. While the symptoms are generally less severe than those of MDD, individuals with PDD experience a consistently depressed mood along with other symptoms, rather than experiencing depressive symptoms episodically as with MDD. Common symptoms include low energy, poor self-esteem, difficulty concentrating or making decisions, changes in appetite or sleep patterns, and feelings of hopelessness. The long-term depressive symptoms of PDD may fluctuate in intensity, but they never fully resolve during the diagnostic period.
Treatments for PDD may include antidepressant medications, such as SSRIs or SNRIs, and psychotherapy, particularly cognitive behavioral therapy (CBT). Medications help regulate mood, while psychotherapy focuses on addressing negative thought patterns and developing coping strategies for managing chronic symptoms. Long-term treatment is often necessary to improve mood stability and overall functioning.
People who are extremely depressed typically do not commit suicide. In the depths of a depressive episode, people usually feel too unmotivated and apathetic to form a suicide plan and carry it out. Suicide is more likely when a depressed person begins the process of recovery and becomes more energetic. Research shows that women are more likely to attempt suicide than men, but men are more likely to be successful at carrying out suicide.
MDD and PDD share common physical and cognitive changes, such as fatigue, difficulty concentrating, and disruptions in sleep patterns. However, they differ in terms of duration and severity, with MDD being more acute and episodic and PDD being more chronic and persistent.
Possible Causes of Depressive Disorders
The possible causes of depressive disorders involve a combination of biological, genetic, social, cultural, behavioral, and cognitive factors. These factors interact in various ways to contribute to the development and maintenance of depression.
From a biological perspective, depressive disorders are often linked to imbalances in neurotransmitters such as serotonin, norepinephrine, and dopamine, which regulate mood and emotional responses. Dysregulation of these chemicals can lead to the persistent low mood and anhedonia that typically accompanies depression. Hormonal changes, such as those involving the hypothalamic-pituitary-adrenal (HPA) axis, may also play a role by increasing cortisol levels during periods of chronic stress. Additionally, genetic predispositions are significant, as depression tends to run in families, suggesting that hereditary factors increase vulnerability to the disorder.
Social and cultural influences also contribute to depressive disorders. Social isolation, lack of supportive relationships, and stressful life events such as loss, financial difficulties, or trauma can all act as triggers for depression. Cultural factors, including societal stigma and differing attitudes toward emotional expression, can shape how depression is experienced and addressed. For example, some cultures may emphasize physical symptoms of distress over emotional ones, influencing how depression is diagnosed and treated. Additionally, depressed people tend to have less social support than other people. The relationship between social support and depression is most likely two-way: people with poor social skills may be more likely to develop depression, and once people are depressed, they tend to be unpleasant companions, which further reduces their social support.
From a behavioral perspective, depression is thought to result from learned patterns of helplessness and avoidance. Martin Seligman’s learned helplessness theory suggests that individuals may develop depression after repeatedly experiencing situations where they feel unable to control outcomes, leading to a sense of hopelessness. Additionally, a lack of positive reinforcement for adaptive behaviors may exacerbate depressive symptoms.
The cognitive perspective focuses on how maladaptive thinking patterns contribute to depression. Aaron Beck’s cognitive theory of depression identifies the negative cognitive triad: negative views about the self, the world, and the future. Distortions in thinking, such as catastrophizing or overgeneralization, perpetuate feelings of worthlessness and hopelessness, worsening the disorder. Rumination, or brooding about problems, is associated with longer periods of depression. Some researchers believe that women have higher rates of depression because they tend to ruminate more than men. Although many researchers believe negative thinking makes people susceptible to depression, most also acknowledge a two-way relationship between depression and negative thinking: negative thinking makes people susceptible to depression, and depression makes people more likely to think negatively.
Bipolar Disorders
Bipolar disorders are mood disorders characterized by alternating periods of mania and depression, known as bipolar cycling. These mood episodes vary in duration and intensity, with cycles lasting anywhere from days to months. The dramatic shifts in mood, energy, and behavior must significantly affect an individual’s ability to function to meet the criteria for a bipolar disorder diagnosis. There are two types of bipolar disorder: bipolar I and bipolar II.
Bipolar I disorder involves at least one manic episode, which may or may not be followed by a depressive episode. Mania is defined as a period of an abnormally elevated, expansive, or irritable mood, coupled with increased energy or activity. Symptoms of mania include inflated self-esteem, decreased need for sleep, rapid or pressured speech, racing thoughts, impulsivity, and engagement in risky behaviors, such as excessive spending or reckless driving. In bipolar I disorder, manic episodes can cause significant damage to one’s life (losing a job or housing, ruining relationships, spending savings, etc.) or require hospitalization. Depressive episodes, when present, include symptoms like persistent sadness, fatigue, feelings of worthlessness, and a loss of interest in everyday activities. It is important to note that while most individuals diagnosed with bipolar I disorder will experience episodes of depression as well as mania, depressive episodes are not necessary for a diagnosis of bipolar I disorder. Essentially, bipolar I involves mania, while bipolar II involves hypomania and major depression.
Bipolar II disorder requires at least one hypomanic episode and one major depressive episode for diagnosis. Hypomania is a less severe form of mania, involving elevated mood and increased productivity, but without the extreme impairment or damage to one’s life or need for hospitalization associated with full mania. However, the depressive episodes in bipolar II disorder are typically more severe and longer-lasting than those in bipolar I disorder, often causing significant distress and disruption to daily life.
Bipolar cycling refers to the pattern of alternating mood episodes. Some individuals experience rapid cycling, defined as four or more episodes of mania, hypomania, or depression within a single year. Rapid cycling is more common in individuals with bipolar II disorder than bipolar I, and is often associated with a poorer prognosis. The frequency and duration of cycles vary widely among individuals, and not all people with bipolar disorder experience a predictable cycling pattern. Both bipolar I and bipolar II disorders typically require medication (e.g., mood stabilizers like lithium or antipsychotics) in conjunction with therapy to manage symptoms.
Possible Causes of Bipolar Disorders
The causes of bipolar disorders involve a combination of biological, genetic, social, cultural, behavioral, and cognitive factors. Furthermore, these factors can interact to create vulnerabilities and trigger mood episodes, such as mania and depression.
From a biological perspective, bipolar disorders are strongly linked to neurochemical imbalances and hereditary factors. Research suggests that disruptions in neurotransmitters, particularly dopamine, serotonin, and norepinephrine, negatively affect mood regulation. For example, elevated dopamine activity is associated with the heightened energy and impulsivity of manic episodes, while low levels of serotonin are linked to depressive symptoms. Studies of identical twins and families show a high genetic heritability of bipolar disorders, indicating that individuals with a family history are at significantly greater risk.
Social and cultural factors may also contribute to the development and course of bipolar disorders. Stressful life events, such as trauma, relationship conflicts, or financial instability, can act as triggers for mood episodes. Additionally, cultural attitudes toward mental health can influence whether or not individuals seek treatment for symptoms, potentially delaying diagnosis and treatment.
From a behavioral perspective, patterns of reinforcement may exacerbate bipolar symptoms. For instance, the euphoric feelings of mania might encourage risky behaviors, such as excessive spending or substance abuse, which can reinforce and prolong manic episodes. Conversely, the lack of motivation and withdrawal seen in depressive episodes can lead to further isolation and a cycle of negative reinforcement.
The cognitive perspective focuses on the thought patterns that accompany mood episodes. During manic phases, individuals may experience grandiose or overly optimistic thoughts, contributing to risky decision-making. During depressive phases, negative thinking patterns, such as feelings of hopelessness or worthlessness, can perpetuate low mood and reduced functioning.
The diathesis-stress model is often used to explain how these factors interact. A genetic or biological predisposition (diathesis) increases vulnerability, while environmental stressors or life events trigger the onset or worsening of symptoms. This interaction highlights the need for both biological and psychological approaches to treatment.
Anxiety Disorders
Anxiety disorders are mental health conditions characterized by excessive fear and/or anxiety, often accompanied by disturbances in behavior that interfere with daily functioning. Fear refers to the emotional response to an immediate threat, while anxiety involves anticipation of future danger or stress. Anxiety is a common and normal occurrence. However, a chronically high level of anxiety indicates an anxiety disorder. Anxiety disorders vary in their specific symptoms but are comparable in their impact on emotional regulation and behavior. Common anxiety disorders include specific phobia, agoraphobia, panic disorder, social anxiety disorder, and generalized anxiety disorder.
Specific Phobia
Specific phobia involves intense fear or anxiety centered on a specific object or situation, which is out of proportion to the actual danger. The fear or anxiety is persistent, typically lasting six months or more. Exposure to the feared object or situation typically triggers immediate anxiety, which can result in avoidance behavior. For instance, someone with a phobia of flying might refuse to travel by airplane. The DSM-5 identifies several subtypes based on the focus of fear:
Animal type: Fear of animals or insects, such as arachnophobia (fear of spiders)
Natural environment type: Fear of natural phenomena, such as acrophobia (fear of heights)
Blood-injection-injury type: Fear of medical procedures or seeing blood, often accompanied by fainting
Situational type: Fear of specific situations, such as claustrophobia (fear of enclosed spaces) or fear of flying
Other type: Phobias that don’t fit into the above categories (e.g., fear of choking or vomiting)
Exposure therapy, a type of behavioral therapy, is the most effective treatment for specific phobias. It involves gradually and systematically exposing the individual to the feared stimulus in a controlled environment, allowing them to desensitize over time. Other treatments may include cognitive behavioral therapy (CBT) to address irrational thoughts or relaxation techniques to manage physiological fear responses.
Agoraphobia
Agoraphobia involves anxiety about losing control in public places, being in situations from which escape would be difficult or embarrassing, or being in places where there might be no one to help if a panic attack occurred. These situations often include using public transportation, being in open spaces (e.g., parking lots), enclosed spaces (e.g., shops or theaters), standing in line, being in a crowd, or being outside of the home alone. To meet diagnostic criteria, individuals must experience fear or anxiety in at least two or more of these situations. Furthermore, the fears must persist for six months or more, cause significant distress, lead to avoidance behaviors, or require a companion for feared situations. In some cases, avoidance behaviors may become so extreme that individuals with agoraphobia may become housebound to minimize exposure to feared situations.
Agoraphobia often comes with physical symptoms of fear or anxiety, such as a rapid heartbeat, sweating, dizziness, or shortness of breath when encountering feared situations. People with agoraphobia will also often experience anticipatory anxiety, where just the thought of encountering a feared situation triggers distress. Agoraphobia frequently develops in conjunction with panic disorder, because individuals begin to avoid situations where they fear a panic attack might occur. However, agoraphobia can also be diagnosed independently.
Treatments for agoraphobia include exposure therapy, cognitive behavioral therapy (CBT) and medication. Gradual exposure to feared situations, in the form of exposure therapy, is a common and effective treatment for agoraphobia. CBT can help individuals address irrational fears and develop coping strategies. Medications, such as antidepressants (e.g., SSRIs) or antianxiety medications, are sometimes prescribed to manage symptoms.
Panic Disorder
Panic disorder involves recurrent, unexpected panic attacks, which are overwhelming, acute episodes of fear or anxiety accompanied by physical, cognitive, and emotional symptoms. During a panic attack, individuals may experience:
- rapid heartbeat or chest pain
- shortness of breath or a choking sensation
- dizziness, sweating, trembling, or nausea
- feelings of unreality (derealization) or detachment from oneself (depersonalization)
- fear of dying, losing control, or going insane
These episodes can occur without warning and are often misinterpreted as life-threatening. To meet the diagnostic criteria, individuals must experience persistent concern or worry about future attacks or their consequences, and/or exhibit significant changes in behavior to avoid triggering an attack. Panic disorder can lead to avoidance behaviors as individuals may begin to avoid situations or places where they fear a panic attack might occur, which can sometimes develop into agoraphobia. Panic disorder may also manifest in culture-bound anxiety disorders such as ataque de nervios, experienced primarily by individuals of Caribbean or Iberian descent, which include crying, trembling, or outbursts of emotion as part of the panic response.
Treatments for panic disorder include cognitive behavioral therapy (CBT), exposure therapy, and medication. Cognitive behavioral therapy (CBT) teaches individuals to reframe catastrophic thoughts and understand that panic symptoms are not life-threatening. Exposure therapy gradually exposes individuals to feared sensations or situations to reduce avoidance behaviors. Medication, such as antidepressants (e.g., SSRIs) and antianxiety medications (e.g., benzodiazepines) may be prescribed to manage symptoms.
Social Anxiety Disorder
Social anxiety disorder involves an intense fear of being watched, judged, or embarrassed in social situations. This fear often leads to avoidance of social interactions. Common situations that cause social anxiety include public speaking, eating or drinking in front of others, meeting new people, attending social gatherings, and performing tasks in front of others (e.g., taking a test or working). To meet diagnostic criteria, the fear must be persistent, lasting about months or longer, and cause significant impairment in daily functioning. Physical symptoms include blushing, sweating, trembling, nausea, or a racing heart when in social situations. Cognitive symptoms involve excessive worry about embarrassing oneself or being negatively evaluated. Emotional symptoms include intense anxiety or panic before, during, or after social interactions. Social anxiety disorder differs from agoraphobia but may overlap in some cases. A culture-bound form of social anxiety disorder is taijin kyofusho, seen mainly in Japan, where individuals fear offending others or being judged negatively due to their physical appearance, body odor, or facial expressions.
Treatments for social anxiety disorder include cognitive behavioral therapy (CBT), exposure therapy, and medication. CBT helps individuals identify and challenge negative thoughts and develop more realistic appraisals of social situations. Gradual exposure to anxiety-inducing social situations allows individuals to build confidence and reduce avoidance behaviors. Medication such as antidepressants (e.g., SSRIs) and antianxiety medications can be prescribed to help manage symptoms.
Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder (GAD) is characterized by prolonged and excessive anxiety or worry about various aspects of life, such as work, school, relationships, or personal safety. Unlike other anxiety disorders, the worry in GAD is nonspecific and not tied to a particular situation or event. To meet the diagnostic criteria for GAD, the worry must occur on most days for at least six months and significantly impair daily functioning. Individuals with GAD often report difficulty controlling their worry, even when they recognize that it may be disproportionate. Physical symptoms include muscle tension, restlessness, fatigue, difficulty sleeping (insomnia), headaches, and gastrointestinal issues. Cognitive symptoms involve difficulty concentrating, indecisiveness, and persistent worry. Emotional symptoms include irritability, a constant sense of unease, and feeling overwhelmed. Unlike other anxiety disorders, the anxiety in GAD is broad and pervasive, making it difficult to identify specific triggers.
Treatments for generalized anxiety disorder (GAD) include cognitive behavioral therapy (CBT), relaxation techniques, and medication. CBT focuses on identifying and challenging irrational beliefs and thought patterns, replacing them with healthier ways of thinking. Relaxation techniques, such as deep breathing, progressive muscle relaxation, or mindfulness meditation, help reduce physical tension and emotional distress. Medication, such as antidepressants (e.g., SSRIs) and antianxiety medications (e.g., benzodiazepines) may be used to manage symptoms.
Possible Causes of Anxiety Disorders
From a behavioral perspective, anxiety disorders are often explained through learned associations such as through classical conditioning. For instance, a person bitten by a dog (unconditioned stimulus) might develop a specific phobia of dogs (conditioned response) due to the association of dogs with fear and pain. Agoraphobia and social anxiety disorder can likewise be explained by classical conditioning. When a negative experience occurs in a particular setting, such as a panic attack in a crowded mall, this can lead to avoidance of malls and similarly crowded spaces out of fear of experiencing another panic attack. Or when a humiliating event occurs in a social setting, this can lead to future anxiety in similar contexts. Panic responses that accompany panic disorder can also be conditioned if a specific situation or trigger becomes associated with a panic attack.
Additionally, operant conditioning can reinforce anxiety through avoidance behaviors. For instance, when individuals avoid feared situations or objects, they experience temporary relief, which negatively reinforces the behavior, making it more likely to persist. In the case of general anxiety disorder, chronic worry may develop as a learned response to stress or uncertainty. Reinforcement occurs when worrying is perceived as a way to prepare for or avoid potential threats. Finally, observational learning has also been used to explain anxiety disorders, such as in the case of specific phobias. Watching someone else react fearfully to an object or situation can lead to the development of a phobia.
The cognitive perspective focuses on maladaptive thinking patterns that contribute to anxiety. Individuals with anxiety disorders often engage in catastrophic thinking, overestimating the likelihood or severity of a threat, or selective attention, focusing on perceived dangers while ignoring safety cues. For example, someone with social anxiety disorder might assume they will embarrass themselves in every social interaction, which continues the feelings of fear and avoidance. For those with panic disorder, catastrophic thinking amplifies fear and physical symptoms, creating a cycle of panic. From a cognitive perspective, misinterpretations of bodily sensations or fear of losing control in public settings contribute to the development of agoraphobia and can trigger panic attacks.
Emotional responses also play a role in anxiety disorders. Heightened sensitivity to perceived threats or an inability to regulate emotions can lead to excessive fear or worry. This emotional dysregulation often amplifies both cognitive and behavioral symptoms, creating a cycle of anxiety.
From a biological perspective, anxiety disorders are linked to neurotransmitter imbalances and brain structure abnormalities. Poor regulation of chemicals like serotonin, norepinephrine, and GABA (which helps calm the nervous system) is associated with heightened anxiety responses, as seen in individuals with panic disorder and general anxiety disorder. Overactivity in brain regions like the amygdala, which processes fear, and reduced activity in the prefrontal cortex, which regulates emotional responses, also contribute. For example, agoraphobia, social anxiety disorder, and general anxiety disorder have been linked to overactivity in the amygdala, but in response to different triggers. Dysregulation of the amygdala and fear-processing pathways in the brain also contributes to heightened panic responses as seen in panic disorder.
Additionally, anxiety disorders, such as agoraphobia, panic disorder, social anxiety disorder, and general anxiety disorder, often run in families, suggesting a genetic predisposition. Regarding specific phobias, evolutionary psychology suggests that humans are biologically predisposed to fear certain objects or situations that pose threats to survival, which could explain why some specific phobias (e.g., snakes, heights) are more common than others, such as a fear of clowns, which does not have a clear evolutionary basis.
It is important to remember that multiple factors can be at work. For instance, a genetic predisposition to a heightened fear response (biological) combined with a traumatic experience that creates a learned association (behavioral) and catastrophic thinking (cognitive) can contribute to the development of an anxiety disorder.
