Facts and Fictions in Mental Health

Hal Arkowitz, Scott O. Lilienfeld

• Publisher: Wiley-Blackwell
• Year: 2017
• Print ISBN: 9781118311295, 9781118311301
• eBook ISBN: 9781118311318
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Written in a lively and entertaining style, Facts and Fictions in Mental Health examines common conceptions and misconceptions surrounding mental health and its treatment. Each chapter focuses on a misconception and is followed by a discussion of related findings from scientific research.

• A compilation of the authors' "Facts and Fictions" columns written for Scientific American Mind, with the addition of six new columns exclusive to this book
• Written in a lively and often entertaining style, accessible to both the undergraduate and the interested general reader
• Each chapter covers a different "fiction" and allows readers to gain a more balanced and accurate view of important topics in mental health
• The six new columns examine myths and misconceptions of considerable interest and relevance to undergraduates in abnormal psychology courses
• Introductory material and references are included throughout the book

Section 1
Anxiety‐Related Disorders

Introduction

Most of us know at least one person who has been afflicted with an anxiety‐related disorder. In many cases, it’s the person staring back at us in the mirror. Approximately 3 out of every 10 people in the United States will suffer from one of these disorders at some point in their lives. Because these problems cause so much distress in so many people, it is imperative that we have a correct understanding of their nature and treatments.

Anxiety disorders are characterized by expectations that distressing or dangerous events may occur in certain situations, even when there is little or no chance they will. These expectations are often associated with pronounced physiological arousal and strong tendencies to avoid the feared situations. Anxiety is also part of the symptom picture of several anxiety‐related disorders including posttraumatic stress disorder (PTSD), obsessive‐compulsive disorder (OCD), and hoarding disorder.

The fifth edition of the American Psychiatric Association’s diagnostic manual (DSM‐5), published in 2013, lists several anxiety disorders including specific phobias; social phobia; panic disorder; agoraphobia; and generalized anxiety disorder.

People with specific phobias usually experience anxiety about one particular situation (e.g., driving on freeways), object (e.g., needles), or living creatures (e.g., snakes). Often, phobias are given names derived from Greek. One of our favorites is hexakosioihexekontahexaphobia, which refers to a fear of the number 666, biblically associated with Satan. Try pronouncing that! Social anxiety disorder is an intense and often paralyzing fear of situations involving scrutiny by others, as in having a conversation or giving a speech in public. A diagnosis of panic disorder requires recurrent panic attacks with a fear of having more in the future. The name of this disorder also owes its origins to ancient Greece, in this case the mythical Greek god Pan, whose main diversion was scaring travelers in the forest, preferably at night. Apparently, Pan was good at his job. Panic attacks are terrifying experiences involving an abrupt surge of intense fear accompanied by physical symptoms that include accelerated heart rate, chest pain, shortness of breath, and trembling, as well as mental symptoms like a fear of losing control, going crazy, or dying. People diagnosed with agoraphobia become anxious in and avoid situations perceived as difficult to escape, embarrassing, or in which help would be unavailable in case of panic‐like symptoms. Examples are crowded places, movie theaters, or being alone and away from home. Generalized anxiety disorder is characterized by excessive and pervasive worry, usually in several areas such as work, school, finances, and the safety of oneself or loved ones.

Several anxiety‐related disorders appear in other sections of the DSM. These include PTSD, OCD, and hoarding disorder. In order to receive a diagnosis of PTSD, a person must experience exposure to traumas such as actual or threatened death, serious injury, or sexual violence. Exposure to trauma can be direct, as in the case of a victim of torture, or indirect, as in observing a fatal automobile crash. Common symptoms include trauma‐related distressing and intrusive memories, flashbacks, or dreams; distress at exposure to cues relating to the trauma (e.g., media depictions of similar events); sleep disturbances; inability to experience positive emotions; and irritability and anger. Recently, researchers have found that this disorder is even more prevalent than previously thought, with rates of at least 7%.

A diagnosis of OCD requires the presence of either obsessions, which are persistent and intrusive thoughts, urges, or images recalled that cause anxiety, or compulsions, which are maladaptive attempts to reduce that anxiety. In most cases, both obsessions and compulsions are present. A common example of OCD is when a person engages in excessive and frequent hand washing to reduce the anxiety caused by obsessions about dirt and contamination. In some cases, people with this disorder wash their hands so much that they rub off several layers of skin. A particularly good portrayal of a person with OCD was by Jack Nicholson in the 1997 movie As Good as It Gets. In contrast, people with hoarding disorder experience excessive anxiety about parting with possessions regardless of their value or utility. They retain them in an attempt to reduce anxiety. Some keep so much that it may be difficult for them to move around comfortably in their living quarters. A 2004 movie entitled The Aviator portrayed Howard Hughes, who was one of the wealthiest people in the world, and who developed a severe hoarding disorder.

There are a number of treatments that have been employed to treat anxiety. While the one that has shown the most success involves a number of methods that fall under the rubric of cognitive‐behavior therapy, and to some extent psychoanalytically oriented psychotherapy. Others have also been used. They include anti‐anxiety medication, herbal remedies, a form of meditation known as mindfulness, and a recently developed treatment known as eye movement desensitization and processing (EMDR). In the latter, the therapist asks clients to think of memories of anxiety‐provoking events while tracing the therapist’s back‐and‐forth finger movements with their eyes.

A number of questions have been raised about the nature and treatment of anxiety‐related disorders. In this section, we will examine some of them, including:

• Do panic attacks come out of the blue?
• Do most people who experience trauma develop PTSD?
• Is trauma involving physical threat necessary to trigger PTSD?
• In DSM‐5, is hoarding a symptom of obsessive‐compulsive disorder?
• Are there any down sides to using anti‐anxiety medications?
• How effective are herbal remedies, mindfulness meditation, and EMDR in the treatment of anxiety‐related disorders?

1
Why Do We Panic?

“I was driving home after work,” David reported. “Things had been very stressful there lately. I was tense but looking forward to getting home and relaxing. And then, all of a sudden – boom! My heart started racing, and I felt like I couldn’t breathe. I was sweating and shaking. My thoughts were racing, and I was afraid that I was going crazy or having a heart attack. I pulled over and called my wife to take me to the emergency room.”

David’s fears turned out to be unjustified. An emergency room doctor told David, a composite of several therapy patients seen by one of us (Hal Arkowitz), that he was suffering from a panic attack.

The current edition of the Diagnostic and Statistical Manual (DSM‐5) defines a panic attack as “An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes.” In addition, 4 out of a list of 13 symptoms must be present. Some of these symptoms are: trembling or shaking; sensation of shortness of breath or smothering chest pain or discomfort; feelings of unreality or detachment; and fears of dying or losing control and “going crazy.” Most attacks occur without obvious provocation, making them even more terrifying. Some 8%–10% of the population experience an occasional attack, but only 5% develop panic disorder. Contrary to common misconception, these episodes aren’t merely rushes of anxiety that most of us experience from time to time. Instead patients who have had a panic attack typically describe it as the most frightening event they have ever undergone.

Research has provided important leads to explain what causes a person’s first panic attack – clues that can help ward off an attack in the first place. When stress builds up to a critical level, a very small additional amount of stress can trigger panic. As a result, the person may experience the event as coming out of the blue.

Some people may have a genetic predisposition toward panic, as psychologist Regina A. Shih, then at Johns Hopkins University, and her colleagues described in a review article. The disorder runs in families, and if one identical twin has panic disorder, the chance that the other one also has it is two to three times higher than for fraternal twins, who are genetically less similar. Although these findings do not rule out environmental factors, they do strongly suggest a genetic component.

Panic disorder imposes serious restrictions on patients’ quality of life. They may be plagued by a persistent concern about the possibility of more attacks. Agoraphobia involves fear of specific situations in which escape might be difficult or help might not be available in the event of panic‐like or other anxiety‐related symptoms. The feared situations include using public transportation, being in enclosed places, and being outside of the home alone. In the most severe cases, sufferers may even become housebound.

From Normal Anxiety to Crippling Fear

What are the roots of these incapacitating panic attacks? Psychologist David H. Barlow of Boston University, who has conducted pioneering research on understanding and treating panic disorder and related disorders, and others believe that panic attacks result when our normal “fight‐or‐flight” response to imminent threats – including increased heart rate and rapid breathing – is triggered by “false alarms,” situations in which real danger is absent. (In contrast, the same response in the face of a real danger is a “true alarm.”)

When we experience true or false alarms, we tend to associate the biological and psychological reactions they elicit with cues that were present at the time. These associations become “learned alarms” that can evoke further panic attacks.

Both external situations and internal bodily cues of arousal (such as increased breathing rate) can elicit a learned alarm. For example, some people experience panic attacks when they exercise because the physiological arousal leads to bodily sensations similar to those of a panic attack.

Why do some people experience only isolated attacks, whereas others develop full‐blown panic disorder? Barlow has synthesized his research and that of...

Table of contents

• Cover
• Title Page
• Table of Contents
• Notes on Authors
• Preface
• Acknowledgments
• Section 1 Anxiety-Related Disorders
• Section 2 Mood Disorders
• Section 3 Child and Adolescent Disorders
• Section 4 Addictions
• Section 5 Externalizing Problems
• Section 6 Personality Disorders
• Section 7 Shattered Selves
• Section 8 Popular Myths About the Brain and Behavior
• Section 9 Psychotherapy and Other Approaches to Change
• Section 10 Other Myths
• Postscript A Reader’s Guide to Baloney Detection
• Index
• End User License Agreement