Please enable JavaScript.
Coggle requires JavaScript to display documents.
When Panic Attacks - Chapter 3 - Do you have an anxiety disorder? - Coggle…
When Panic Attacks - Chapter 3 - Do you have an anxiety disorder?
Anxiety Profile Chart
Lists the most common forms of anxiety
Along with their popular names
and official diagnostic labels
which come from
DSM-IV
Diagnostic and Statistical Manual of the American Psychiatric Association
what these labels mean
Helps doctors communicate about patients problems in a more precise way
Provide hints about what the most effective types of treatment will be
Lets patients be split into categories when researching new treatments
problems with these labels
Anxiety and worry are extremely common, so we risk “pathologising” people unnecessarily
You might already feel defective and ashamed, so being told you have an anxiety disorder could make those feelings more intense
You may jump to the conclusion you have a “brain disease” or mental illness. This probably isn’t true.
You may feel you’re the victim of forces beyond your control
At this point the author suggests you might conclude you’ll need to be treated with a pill in order to get better, and this isn’t true either
I think I get his point, but I don’t agree with the way he worded it
I personally would think there might be a danger of deciding since you “had a thing” maybe it was outwith your direct control to do anything about it. And therefore you’d give up trying to resolve it.
Not that you’d conclude you’d need a pill. Things like the author trying to upsell cognitive techniques and downplay medication clumsily makes him seem biased.
The Chart
Diagnostic Criteria
These can be confusing
For example, here’s what you need in order to qualify for Generalised Anxiety Disorder (GAD)
You have to worry about things excessively
“more days than not for at least six months”
You have to have trouble controlling your worrying
The worrying has to cause “significant distress” in your life
You have to experience the physical symptoms of anxiety, such as muscle tension
These criterial sound reasonable until you think about them critically
For example
You're not allowed to have GAD unless you've been worrying about things "excessively"
How much worrying is excessive?
Why does your worrying have to last six months before you can call it GAD?
Why not four months, two months, or two days?
If you worry for five months and 29 days, you don't have GAD?
And then at the stroke of midnight at the end of six months, you suddenly develop GAD
How do you determine whether you have trouble controlling your worrying?
Does it mean you have trouble controlling your worrying all of the time?
Or only some of the time?
The author has never had an anxious patient who didn't have some trouble controlling their anxiety.
You're not allowed to have GAD unless the worrying causes "significant distress" in your life.
How much distress is "significant"?
And what if you worry constantly, but the worrying isn't distressing to you
Some people seem to like to worry
Or what about a mother who thinks constantly worrying about her children will protect them from danger and is part of her role as a loving mother
Does that mean she doesn't have GAD?
Medical doctors don't diagnose "real" illnesses with such subjective and vague criteria
If you went into A&E with a high fever, coughing, shortness of breath and the X-Ray confirmed pneumonia
Your pneumonia would be treated right away
You wouldn't hear "oh you're only had the symptoms for two days. I'm not allowed to diagnose pneumonia unless you've had symptoms for a week"
Obviously that would be nonsensical - pneumonia is pneumonia, even if it's only been present for a day, an hour, or a minute.
To the author
These diagnostic criteria don't make a lot of sense
They're somewhat arbitrary
GAD isn't a real disease in the same sense that pneumonia is a real disease
Worrying exists, but GAD doesn't.
Shyness exists, but social anxiety disorder doesn't
Where did these come from?
They weren't decided on strictly scientific grounds
Committees of psychiatrists get together from time to time to vote on the latest versions of the diagnostic criteria
So, "six months" isn't "correct" in any ultimate sense - it's just the time period the committee voted on the last time they met
Why are they so arbitrary?
Because most of the feelings that psychitrists classify as "anxiety disorders" are simply normal feelings we experience from time to time
Trying to convert our constantly changing feelings into a series of "disorders" that we could "have" or "not have" leads to severe conceptual problems
You have to create arbitrary cutoff points where none exist
There's no doubt that some people experience substantially more anxiety and self-doubt than the average person
While others experience very little anxiety, and almost seem to have been born happy, confident, and outgoing.
Scientists don't know why some people are more anxiety-prone
But think genetic and environmental factors undoubtedly play important roles
If you have a tendency to be anxious, it doesn't mean you have a brain disease or an anxiety disorder
These all-or-nothing labels simply don't map onto human feelings in a meaningful way
The author wants to be clear
Anxiety and depression are real
Those feelings can be painful and disabling
People who struggle with anxiety and depression deserve treatment
New, effective, drug-free treatments now exist, and the prognosis for full recovery is outstanding
It's not necessary or desirable to transform these feelings into a series of "disorders" or "brain diseases" in order to deal with them effectively
Of course
True brain diseases do exist
Some severe psychiatric problems such as schizophrenia and bipolar illness undoubtedly result from a biological defect in the brain
But for the most part, these labels are arbitrary
Still, labels carry a lot of authority in people's minds
If your doctor tells you that you have pneumonia
You have a real illness with real pathology, that requires medical treatment
You believe what the doctor is telling you because the doctor has a lot of training and knowledge that you don't have.
But if the doctor tells you that you have GAD, obsessive-compulsive disorder, post-traumatic stress disorder, or social anxiety disorder
They are simply telling you something that you already knew
Namely, that you've been feeling anxious
Once you know what types of anxiety you have, and how severe the anxiety is, then we can roll up our sleeves and get to work
If we take the next step and say that you have an anxiety disorder, we haven't added any new information that we didn't already have.
However, we have create the impression that your anxiety results from a chemical imbalance in your brain and that a pill will cure you.
We'll examine this seductive idea in Chapter 4
Again, the author is maybe going a bit far here, in railing so hard against medication? Elsewhere he states it can be useful, but by this point you get the impression it is the most evil thing ever?