NEW INSIGHTS INTO ANXIETY DISORDERS Edited by Federico Durbano New Insights into Anxiety Disorders http://dx.doi.org/10.5772/46003 Edited by Federico Durbano Contributors Clare S Rees, Rebecca Anderson, Guillem Pailhez, Antonio Bulbena, Daisuke Nishi, Yutaka Matsuoka, Richard Servatius, Meghan Caulfield, John Scott Price, Federico Durbano, Roberta Anniverno, Anna Boyajyan, Gohar Mkrtchyan, Lilit Hovhannisyan, Diana Avetyan, Ghassan El-Baalbaki, Veronique Palardy, Claude Belanger, Catherine Fredette, Sylvain Neron, Antonio Armario, Kevin Beck, Jennifer Catuzzi, Contreras, Nesrin Dilbaz, Aslı Enez Darcin, Jorge Javier Caraveo- Anduaga, Maria Michail, Ebru Salcioglu, Metin Basoglu, Jasminka Juretić, Ivanka Zivcic Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2013 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. 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Publishing Process Manager Iva Simcic Technical Editor InTech DTP team Cover InTech Design team First published March, 2013 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com New Insights into Anxiety Disorders, Edited by Federico Durbano p. cm. ISBN 978-953-51-1053-8 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Section 1 General Issues 1 Chapter 1 An Evolutionary Perspective on Anxiety and Anxiety Disorders 3 John Scott Price Chapter 2 Anxiety: An Adaptive Emotion 21 Ana G. Gutiérrez-García and Carlos M. Contreras Section 2 Basic Research 39 Chapter 3 Focusing on the Possible Role of the Cerebellum in Anxiety Disorders 41 Meghan D. Caulfield and Richard J. Servatius Chapter 4 Searching for Biological Markers of Personality: Are There Neuroendocrine Markers of Anxiety? 71 Antonio Armario and Roser Nadal Chapter 5 Alterations in the Immune Response, Apoptosis and Synaptic Plasticity in Posttraumatic Stress Disorder: Molecular Indicators and Relation to Clinical Symptoms 105 Anna Boyajyan, Gohar Mkrtchyan, Lilit Hovhannisyan and Diana Avetyan Chapter 6 Understanding the Causes of Reduced Startle Reactivity in Stress-Related Mental Disorders 135 Kevin D. Beck and Jennifer E. Catuzzi Section 3 Clinical Issues: Old Problems New Ideas 171 Chapter 7 Social Anxiety Disorder in Psychosis: A Critical Review 173 Maria Michail Chapter 8 Social Anxiety, Beliefs About Expressing Emotions and Experiencing Positive Emotions 189 Jasminka Juretić and Ivanka Živčić-Bećirević Chapter 9 Co-Morbid Anxiety and Physical Disorders: A Possible Common Link with Joint Hypermobility Syndrome 213 Guillem Pailhez and Antonio Bulbena Chapter 10 Anxiety Syndromes and Their Correlates in Children and Adolescents: A Two-Year- Follow-Up Study at Primary Health Care in Mexico City 233 Jorge Javier Caraveo-Anduaga, Alejandra Soriano Rodríguez and Jose Erazo Pérez Chapter 11 Anxiety Disorders in Pregnancy and the Postpartum Period 259 Roberta Anniverno, Alessandra Bramante, Claudio Mencacci and Federico Durbano Chapter 12 Understanding and Treating Anxiety Disorders in Presence of Personality Disorder Diagnosis 287 Véronique Palardy, Ghassan El-Baalbaki, Claude Bélanger and Catherine Fredette Section 4 Therapies: New Approaches and Insights 325 Chapter 13 Treatment of Generalized Anxiety Disorders: Unmet Needs 327 Nesrin Dilbaz and Aslı Enez Darcin Chapter 14 Using Hypnosis in the Treatment of Anxiety Disorders: Pros and Cons 343 Catherine Fredette, Ghassan El-Baalbaki, Sylvain Neron and Veronique Palardy ContentsVI Chapter 15 Current State of the Art in Treatment of Posttraumatic Stress Disorder 379 Ebru Şalcıoğlu and Metin Başoğlu Chapter 16 PTSD and the Attenuating Effects of Fish Oils: Results of Supplementation After the 2011 Great East Japan Earthquake 407 Daisuke Nishi, Yuichi Koido, Naoki Nakaya, Toshimasa Sone, Hiroko Noguchi, Kei Hamazaki, Tomohito Hamazaki and Yutaka Matsuoka Chapter 17 New Approaches to the Psychological Treatment of Obsessive- Compulsive Disorder in Adults 427 Clare Rees and Rebecca Anderson Contents VII Preface The contributing authors have done their best to be clear and exhaustive enough about their topics. I will give a brief panorama on the structure of the work, just to introduce the chapters accepted for this publication. Anxiety and panic disorders have now reached the size of a pandemic: a third of the western world and a substantial part of that global world that is facing to the modern (western) world suffer of pathological anxiety more or less seriously. According to NIMH data, onset of anxiety disorders is the earliest of all mental disorders (11 yrs age), and the 12-months prevalence in USA is 18.1% of adult population (of them, about 23% is graded serious or very serious). Women overtake men by 60%. And in the last decade, the whole world has experienced a series of man-made and natural disasters. Large numbers of people have therefore been exposed directly or (peculiarity of the modern world) via mass-media to potentially traumatic events, increasing dramatically the im‐ portance of anxiety in modern world. According to these data, the questions about what is the meaning of the phenomenon and what should be its management is an increasing measure of the inefficiency of the current therapeutic approaches, individually oriented and based on old approaches to an expanding and less and less individual problem. We must bear in mind, however, that fear and anxiety are normal part of life. You may feel anxious before you take a test or walk down a dark street. This kind of anxiety is useful and adaptive - it makes you more alert or careful, saving your life in certain circumstances. Normally, it ends soon after you are out of the situation that caused it. But for millions of people, this anxiety does not go away, and gets worse over time, leading to a general malfunctioning of their somatopsychic integrity. The first part of this book therefore describes very well and very deeply the evolutionary meaning of anxiety and the adaptive value of anxious emotions. According to ethology, anxiety is a normal reaction to stress being actually beneficial in some situations. For some people, however, anxiety can become excessive, and while the person suffering may realize it is excessive they may also have difficulty controlling it and it may negatively affect their day-to-day living. The chapters of the second part of the book are centered on the biological basis of anxi‐ ety, specifically on the role of the increasingly understood role of the “black box” cere‐ bellum and of the alert circuits, of the disregulation of neuroendocrine functioning in personality disorders associated with anxiety behaviors, and of the role of inflammatory mediators in anxiety reactions; these are the most recent evidences on the developments of basic research on anxiety disorders, and are all written by clinical psychiatrist, under‐ lining the importance that basic research has gained in recent years for an effective and efficient clinical practice. After that, a third section explores some emerging clinical problems associated with anxi‐ ety disorders. A very interesting one is the description and discrimination of social anxi‐ ety and psychosis, very often social anxiety being confused with interpersonal hypersensitivity and some forms of paranoia. But also social anxiety is a dimension of paranoia, and a correct definition of the problem is of main interest for a correct therapeu‐ tic intervention. Being social anxiety an increasing problem affecting modern society, and being at the basis of drug abuse consumption and of other dissocial behaviors in order to counteract it, great efforts have spent to understand the concept of social anxiety, and a very important issue of research is about expressing and understanding emotions. The theme is very well developed in the third part of this book, exploring the peculiar modali‐ ties with which social anxious people express negative emotions and are unable to under‐ stand their inner positive emotions and beliefs. Another important issue regards the connection between anxiety and physical illness, specially because the main symptomatic expression of anxiety is physical (muscular tension, cardiovascular hyperactivation, vege‐ tative symptoms). A particular aspect of modern psychosomatic research is the etiopatho‐ genetic correlation between anxiety development and expression in some “medical” illnesses: one chapter of this book describes the correlation between inflammatory diseas‐ es of connective tissue (joint hypermobility syndrome), another one describes the peculiar manifestations of anxiety in prepartum and puerperium (exploring the most recent data on pharmacological treatment in these delicate periods of women life), and another chap‐ ter presents the problems of treating anxiety in personality disorders. The last part of the book is therapeutically oriented. A lot of efforts have spent to ach‐ ieve some results in PTSD, facing the increasing exposure to dramatic and terrifying events in modern world (television transmitted wars and natural disaster has a great role in the exploding and expanding manifestations of PTSD, or at least in hypersensibi‐ lize people). Here a clinical research group faced the consequences of Japanese tsunami, and tried to found an efficient and efficacious treatment to be administered in a short time to a great number of people in order to counteract the potentially pathological ef‐ fects of a disaster. Another chapter describes the state of the art of hypnosis, trying to give some explanations about its mechanisms of action and efficacy; another one de‐ scribes the psychological treatments of OCD, with a clear CBT oriented position, but de‐ scribing also the limitations of some cognitive-behavioral approaches using evidence based methods. Last but not least, a chapter is centered on the unmet needs of the treat‐ ment of anxiety. As the reader can see, there is a sort of red line which connects the different topics covered by this publication: anxiety as a normal psychological condition, but with po‐ tential pathological outcomes especially in the social domain (relational – social anxi‐ ety; functional – personality disorders; ambiental – PTSD), not forgetting the ones in physical functioning. All the authors (all clinicians, I wish to remember) made their best to fulfill the objec‐ tives of this collaborative publication, and to all of them a special thanks for their work and for their contribution to an increase of scientific knowledge deeply rooted in clinical practice, which is what everyone of us needs in his daily practice. Preface X [...]... will be aware that in question time 7 8 New Insights into Anxiety Disorders after a scientific paper, the people who ask questions are those who have social confidence and like the sound of their own voices, regardless of their knowledge of the subject, whereas many of those with something important to say remain silent because of SAD 3 Anxiety in other species Anxiety is the emotion associated with... to take the middle course, but sometimes the middle course is ineffective In summary, anxiety evolved to keep us out of danger, to obey the rules of our group, and to treat each other with respect If we have too much anxiety, we suffer, if we have too little, we may become insufferable 17 18 New Insights into Anxiety Disorders Author details John Scott Price Retired psychiatrist, UK References [1] Belsky,... Kendler KS (2005) The structure of genetic and environmental risk factors for anxiety disorders in men and women Ar‐ chives of General Psychiatry, 182-189 An Evolutionary Perspective on Anxiety and Anxiety Disorders http://dx.doi.org/10.5772/52902 [11] Hofer, M A (2002) Evolutionary concepts of anxiety, In: Textbook of Anxiety Disor‐ ders, D.J.Stein & E.Hollander, (Eds.), American Psychiatric Publishing... Cory GA Jr & Gardner R Jr (eds) The Evolutionary Neuroethology of Paul 19 20 New Insights into Anxiety Disorders MacLean: Convergences and Frontiers Westport, CT: Praeger 107-117 The text of this and some of my other papers can be read on my website: www.john‐ price.me.uk) [27] Price, J S (2003) Evolutionary aspects of anxiety disorders Dialogues in Clinical Neu‐ roscience, 5, 223-236, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181631/... Arjuna no longer needs the anxiety which arose from his emotional mind due to the initial failure of the rational mind to deal with the problem (by taking Krishna’s advice) An Evolutionary Perspective on Anxiety and Anxiety Disorders http://dx.doi.org/10.5772/52902 5.1 Anxiety and art Although artists can portray frightening scenes, it is less easy for them to depict the anxiety response Here is a... novels of Georgette Hayer Anxious young people may hide their anxiety from their parents, perhaps hiding scars on 13 14 New Insights into Anxiety Disorders their forearms with long sleeves, and this may lead to further parental pressure to succeed academically which, of course, makes the anxiety worse I described this situation in some detail in my previous paper (Price, 2003), and here I reproduce the... individuals, the amount of bad news they could generate was limited, even if we add in bad news from neighbouring groups Now, we have available the bad news of many billions of people Since news of death or other dis‐ aster may presage the nearby existence of a predator or of raiding parties from neighbouring tribes, or of disease, it must have been adaptive for bad news to increase anxiety and pro‐ mote activities... reproduction in any medium, provided the original work is properly cited 4 New Insights into Anxiety Disorders the evolution of alternative behavioural strategies (Troisi, 2005) The other question is its phylogenetic origin How did it evolve in our ancestors, and does it occur in other species? Clearly the fossil record does not record anxiety, and whether it occurs in our immediatereturn hunter-gatherer... generalised anxiety disorder and to panic disorder There was some overlap with social anxiety dis‐ order and agoraphobia, but the genetic predisposition to specific phobias was separate This means that if one is predisposed by genetics to major depressive disorder, one is An Evolutionary Perspective on Anxiety and Anxiety Disorders http://dx.doi.org/10.5772/52902 equally predisposed to general anxiety. .. (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited 22 New Insights into Anxiety Disorders 2 Expression of fear and anxiety as emotions Emotions are transient events generated in response to some stimuli that produce arousal reactions and changes in motor behavior, subjective feelings, . NEW INSIGHTS INTO ANXIETY DISORDERS Edited by Federico Durbano New Insights into Anxiety Disorders http://dx.doi.org/10.5772/46003 Edited by. www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com New Insights into Anxiety Disorders, Edited by Federico Durbano p. cm. ISBN 978-953-51-1053-8 free online editions. Therapies: New Approaches and Insights 325 Chapter 13 Treatment of Generalized Anxiety Disorders: Unmet Needs 327 Nesrin Dilbaz and Aslı Enez Darcin Chapter 14 Using Hypnosis in the Treatment of Anxiety