Dementia & Alzheimer's Disease

Dementia is a reference to impaired memory and other cognitive deficits that accompany brain degeneration, as well as interference with normal functioning. There are more than a dozen types and causes of dementia.

Dementia is more prevalent among the elderly. However, it can occur at any point in life. In dementia, cognitive abilities are gradually lost, accompanied by brain degeneration. In people with dementia, there is an occurrence of abnormal progressive degeneration of brain tissue as a result of disease or injury.

Dementia is most common in late adulthood. The term Senile Dementia refers to dementia that begins after the age of 65. Alzheimer's Disease is the most common cause of senile dementia, but Parkinson’s Disease, Huntington Disease and Creutzfeldt-Jakob Disease are other common causes. Complications from high blood pressure and strokes may also cause it.

Scientific Studies

A large Canadian study has found an overall rate of senile dementia of around 8 percent, as well as a female-to-male ratio of about 2:1. Whereas 2 percent of 65- to 74-year-olds are estimated to have dementia, there is an increase in rate to 11 for 75- to 84-year-olds, as well as 34 percent for people who are 85 and above.

Impaired memory, in particular, for very recent events, is typically one of the first symptoms of dementia. Poor judgement, language problems and disorientation may appear gradually or sporadically, and people who develop dementia typically have distress episodes due to confusion. Their behaviour may become uninhibited, they may lose the ability to perform familiar tasks, and they may experience a significant physical decline in addition to cognitive impairments.

Comparing with adults aged 65 and older, those who are more frequently engaged in activities that stimulate cognitive functioning show a lower risk of subsequently developing Alzheimer's disease; but whether this truly reflects a causal relationship remains to be seen. However, one thing is certain: as people live longer lives, the need to find a cure for Alzheimer’s disease and other forms of senile dementia becomes a matter of urgency. Until then, many of us can expect our family members to become Alzheimer’s patients.

Caregiving

Being a caregiver for a spouse or elderly parent with dementia can, unfortunately, be a stressful and psychologically painful experience. Over half of the patients diagnosed with senile dementia show a combination of depression, anxiety, agitation, paranoid reactions, as well as disordered thinking, which may resemble schizophrenia. Ultimately, it could result in the inability to walk, talk, or recognise family members or close friends.

In-depth studies done in Finland, the United States, and Germany, have found that among adults above the age of 65 not suffering from dementia, 20 to 25 percent do have mild cognitive impairment. Combining cases of mild impairment and dementia, some experts have estimated that 79 percent of 65- to 74-year-olds; and 45 percent of people aged 85 and older, remain cognitively normal.

Though these are not pleasant statistics, they make it clear that even well into old age, cognitive impairment isn’t inevitable; and that even with the decrease of some mental abilities with age, more knowledge and wisdom could still be accumulated.        

Alzheimer's Disease (AD)

Alzheimer's disease is a progressive brain disorder which is the most common cause of dementia among adults over the age of 65, according to around 50 to 60 percent of such cases. An overall of 2 to 4 percent of the elderly is estimated to have AD.

The early symptoms AD, which worsen gradually over a period of years, include forgetfulness, poor judgement, confusion, and disorientation. Often, memory of recent events and new information is especially impaired. Forgetfulness by itself is not necessarily a sign of a person developing AD; however, memory happens to be the first psychological function that is affected, as AD initially attacks the subcortical temporal lobe regions—areas near the hippocampus, as well as the hippocampus itself—that help in the conversion of short-term memory into long-term memory.

Alzheimer's disease spreads across a person’s temporal lobes and then to the frontal lobes, as well as to other cortical regions. According to a German physician Alois Alzheimer, who first noticed the disease a century ago, patients afflicted with this disease have an abnormal amount of plaques and tangles in their brains. Plaques happen to be clumps of protein fragments which happen to build up on the outside of the neurons, whereas tangles are fibres that get twisted and wound up together within the neurons.

Neurotransmitter Systems

Neurons tend to become damaged and die, brain tissues shrink, and communication between the neurons is impaired as AD disrupts several neurotransmitter systems, especially the acetylcholine system. Acetylcholine plays a key role in synaptic transmission in several brain areas involved in memory, and drugs that help maintain acetylcholine functioning have had some temporary success in improving cognitive functioning in AD patients.

As AD progresses, working memory and long-term memory worsen. For example, if you read a list of just three words to a healthy 80-year-old and test his recall after a brief time delay, they tend to typically remember at least 2 words if not all three. On the other hand, a patient with AD will recall 1 or none.

Anterograde and retrograde amnesia become more severe and procedural, semantic, episodic, and prospective memory can all be affected. Patients may lose the ability to learn new tasks or remembering new information or experiences, as well as forget how to perform familiar tasks and have trouble recognising even close family members.

Genetic Causes

What causes AD and its characteristic plaques and tangles? According to scientific identification, several genes contribute to early-onset AD; an inherited form of the disease which develops before the age of 65 and as early as 30, but only accounts to about 5 to 10 percent of AD cases.

However, the precise cause of the more typical, late-onset AD remains elusive; but researchers have identified one genetic risk factor. This gene helps direct the production of proteins which carry cholesterol in the blood plasma, and high cholesterol and other risk factors for cardiovascular disease may likewise increase the risk of developing AD. A recent study found that even healthy elderly adults who carried this particular gene, as compared to peers that did not, performed more poorly on prospective memory tasks.

If you know anyone with AD, you are aware that it involves much more than memory loss. These patients experience language issues, disorganised thinking, and changes in mood as well as personality. Ultimately, they may lose the ability to speak and walk, and may also lose control over bladder and bowel functioning.

The Decay of Memory

Decay Theory

Information in sensory memory and short-term memory decays quickly with time, but does long term memory decay as well? An early explanation for forgetting was Decay Theory, which proposed that as time passed and being disused, long-term physical memory traces in the nervous system can fade away. But Decay Theory soon fell into disfavour as scientists were unable to locate neither physical memory traces nor measure physical decay.

However, of recent decades, scientists have begun unravelling the manner in which neural circuits change with the formation of a long-term memory formation, sparking new interests in examining the way these changes might decay over time.

Unfortunately, Decay Theory’s prediction of; the longer the time interval of disuse between learning and recall, the less should be recalled; is problematic. For example, some professional actors tend to display perfect memory for words last used by them on stage two years ago despite having moved on to new acting roles and scripts.

Moreover, when research participants learn a list of words or a set of visual patterns and are retested at two different times, they, at times, recall material during the second resting that they were unable to remember during the first. This phenomenon, called Reminiscence, seems inconsistent with the concept that a memory trace decays over time. To sum up, scientists still debate the validity of Decay Theory.

Motivted Forgetting

Psychologists propose that people, at times, are consciously or unconsciously motivated to forget. According to Sigmund Freud, it was often observed that during therapy sessions, his patients remembered long-forgotten traumatic or anxiety-arousing events. For example, one of his patients suddenly remembered with great shame such an event in which she, while standing beside her sister's coffin, thought: "Now my brother-in-law is free to marry me."

Freud's conclusion was that the thought was so shocking and anxiety-arousing that the woman had repressed it and pushed it down into her unconscious mind, and left it there to remain until it was later uncovered during a therapy session. Repression is a motivational process which protects us by blocking the conscious recall of anxiety-arousing memories.

The concept of repression is controversial, with some evidence supporting it while others disreputing it. People do tend to forget unpleasant events—even traumatic events—yet they can forget very pleasant ones as well. If a person can't recall a negative experience, is it due to repression or to normal information processing failures? Overall, it has been difficult to demonstrate experimentally that a special process akin to repression is the cause of memory loss in the case of anxiety-arousing events.

Prospective Memory

Have you ever forgotten things like mailing a letter, turning off your oven, purchasing a thing you need from the market, or keeping an appointment? In contrast to Retrospective Memory, which is a reference to events of the past, Prospective Memory concerns remembering to perform an activity in the future. That individuals forget to do things as often as they do is interesting, because prospective memory typically involves little content.

Often we need only to recall that we must perform an event-based task ("Remember to mail the letter on your way home" or "Remember to buy milk when you are at the supermarket") or a time-based tasks ("Remember to take your medication at 5:00 pm" or "Remember to keep your doctors appointment at 2:00 pm").

Successful prospective memory, however, draws on cognitive abilities such as planning and allocation of attention while performing other tasks.

During adulthood, do we become increasingly absentminded about remembering to do things, as suggested by a common stereotype? Numerous laboratory experiments support this view. Typically, participants are asked to perform a task requiring their ongoing attention while trying to remember to signal the experimenter at certain time intervals or whenever specific events take place.

Older adults, in general, tend to display poorer prospective memory, especially when the signalling is time-based. However, when prospective memory is tested outside the laboratory using tasks such as simulated pill-taking, healthy adults in their 60s to 80s often perform as well as—or even better than—adults in their 20s. Perhaps older adults feel more motivated to remember in such situations, or maybe they rely more on habit and on setting up of a standard routine.

Amnesia

As  H.M.'s case illustrates, the most dramatic instances of forgetting occur in amnesia. The term Amnesia is commonly referred to as memory loss due to special circumstances such as brain injury, illness, or psychological trauma. However, as we'll see shortly, there is one type of amnesia experienced by everyone.

Amnesia takes several forms: Retrograde Amnesia represents memory loss for events that took place sometime before the onset of amnesia. For example, H.M.'s brain operation, which took place at age 27, caused him to experience mild memory loss for events in life that had occurred during the preceding year or two. For example, when he was 25 to 26 years old.

Football players experience retrograde amnesia when they are knocked out by a concussion; they regain consciousness and cannot remember the events that had occurred just before being hit.

Anteretrogade Amnesia refers to memory loss for events that occur after the initial onset of amnesia. H.M.'s brain operation and, pratricularly the removal of much of his hippocampus, produced severe anterograde amnesia, robbing him of the ability to consciously remember new experiences and facts.

Similarly, the woman whose hand was pinpricked by Swiss psychologist Edouard Claparède during a handshake also suffered from anterograde amnesia; moments later, she could not consciously remember the episode. But, unlike HM's anterograde amnesia, hers was caused by Korsakoff's Syndrome, which can result from chronic alcoholism. It may also cause retrograde amnesia.

Introduction to Mood Disorders

Mood disorders are a set of emotion-based disorders including depression and mania (excessive excitement). Mood disorders, together with anxiety disorders, are the most frequently experienced psychological disorders. Co-occurrence is high in mood and anxiety disorders and around half of depressed individuals suffer from an anxiety disorder as well.

Depression

Almost everyone has experienced some form of depression in the wake of loss or pain, which is an inevitable part of life. When this happens, we tend to be sad, apathetic, passive, and discouraged. The future may look bleak and we may feel that life is worthless. This is a normal reaction and not necessarily a depressive disorder unless an individual has an underlying depressive disorder. Twenty-five to 30% of college undergraduates are said to experience mild depression (Seligman). As the events pass or this person gets accustomed to the new situations, feelings of depression tend to disappear.

In clinical depression, however, it’s not that simple. When a person is clinically-depressed, the intensity, frequency and duration of depressive symptoms tend to be out of proportion to the person’s life situation. For some, even a minor setback or loss can bring about major depression. This can cause an intense state of depression, making it hard to function effectively in their lives.

Dysthymia

This is a less intense form of depression, with less dramatic effects on a personal and occupational function. However, it is a more chronic and long form of misery that can last for years, with some intervals of normal mood that don't last for more than a few weeks or months.

This negative state of mood is the core feature of depression. When questioned about the way they feel, depressed people would report sadness, misery and loneliness. While people with anxiety disorders are capable of retaining a capacity to experience pleasure, depressed people are unable to do so (Mineka). For the depressed, activities that used to bring them satisfaction and happiness tend to be dull and flat. Even biological pleasures such as food and sex lose their appeal.

Even though depression is primarily a mood or emotional disorder, there are three other types of symptoms which are cognitive, motivational, and somatic.

Cognitive Symptoms

Cognitive symptoms are a central part of depression. This makes it hard for depressed people to concentrate and make decisions. They usually have low self-esteem, and tend to believe themselves to be inferior, incompetent and inadequate. When they suffer setbacks, they blame themselves. They even blame themselves for failures that have not yet even occurred. They expect it to occur and believe it to be due to their own inadequacies.

Motivational Symptoms

Motivational symptoms in depression involve an inability to start and perform tasks that can produce pleasure or accomplishment. A student who is depressed may find it hard to get themselves out of bed in the morning, let alone go to class or study. Everything may seem to need too much of an effort. When extreme depressive reactions are present, the person may have to be pushed out of bed, clothed and fed. In severe cases of depression, the person’s movements are slowed down, making him or her talk and walk slowly, with excruciating effort.

Somatic Symptoms

Somatic (bodily) symptoms often include loss of appetite and even weight loss. In mild depression, sometimes there is weight gain due to compulsive eating, as well as sleep disturbances, particularly insomnia. Sleep disturbance and weight loss lead to weakness and hence, adding to the feelings of depression. Depression can also cause loss of sexual desire and response.

Bipolar disorder

When a person only experiences depression, it’s called unipolar depression. In bipolar disorder, depression (which usually is the dominant state), alternates with periods of mania, which is a state of highly-excited mood and behaviour. When in a manic state, mood is euphoric and cognition is grandiose. They see no limit to possible accomplishments and fail to consider negative consequences that may result if their grandiose plans are acted on.

Considering at a motivational level, manic behaviour is hyperactive. A manic person tends to engage in frenetic activities. This can be at work, sexual relationships, or in other areas of life. For example, 19th century composer Robert Schumann produced 27 works during a one-year manic phase, but his productivity ground to a halt when he sank into a depressive phase due to his bipolar disorder (Jamison). People with manic disorder can become very irritable and aggressive when their momentary goals make them frustrated.

When in manic state, speech tends to be rapid or pressured, as if the person needs to utter many words as possible in allotted time With this surge of activity, the need for sleep is lessened. When in a manic state, a person may go on for days continually without sleep, until exhaustion sets in and slows down the mania.

There is no specific age group that suffers the effects of depression. Infants as young as six months who have been separated from their mothers for prolonged periods of time can suffer from depression as well. Symptoms of depression in children and adolescents are as high as adults (Esau & Petermann). According to data from numerous studies, the rate of depression is indicated to be on the rise among young people, with a dramatic increase in onset of depression among 15 to 19-year-olds (Burke). This shows that lifetime prevalence of major depression has increased over decades.

Prevalence

Prevalence of depressive disorders across socioeconomic and ethnic groups are similar, yet there is a major sex difference according to cultures. Although the prevalence of bipolar doesn't differ according to sex, women appear to be as twice as likely as men to suffer from unipolar depression. Women most likely suffer their first episode of depression in their 20’s and men in their 40’s (Keyes & Goldman).

Many people with depressive disorders never seek treatment. The positive aspect of depression is that it usually dissipates over time. After the initial episode, which typically comes on suddenly after a stressful experience, depression typically lasts around 5 to 10 months if untreated (Tollefson).

When a suppressive episode occurs, one in three patterns may follow. In 40% of all cases, clinical depression may not reoccur following recovery. Many other cases show a second pattern: recovery with recurrence. On average, they will remain symptom-free for a possible three years before another depressive episode about the same severity and duration occurs. Over time, the intervals between subsequent episodes tend to become shorter (Rubin).

Manic episodes, though less common than depressive reactions, has a more chance of recurrence. Mania is experienced in less than 1 percent of the population, but more than 90 percent experience recurrence.

Anxiety and Somatoform

Anxiety inferred

Anxiety disorders are usually considered to involve anxiety and stress reactions which are vividly experienced by people who suffer from such conditions, and they are often observable. However, in certain other conditions, the underlying anxiety is largely inferred or assumed to be only present rather than being expressed outward.

For example, in somatoform and dissociative disorders, the person affected may not consciously feel anxious because the function of the disorders is to protect the person involved from strong psychological conflict. According to the beliefs of psychodynamic theorists, whatever may be the distress experienced by the person in such disorders, it is less stressful than the underlying anxiety it is being defended against itself.

Somatoform Disorders

Somatoform disorders involve physical complaints or disabilities suggestive of a medical condition but not present with a biological cause and are not voluntarily produced by the patient. People with hypochondriasis become unduly alarmed about any given physical symptom they feel is convincing them of being seriously ill or about to be. People who suffer from pain disorders experience intense pain that is either out of proportion to whatever medical condition they presume to have for which physical basis is unfounded.

Somatoform disorders differ from psychological disorders in which psychological factors cause or contribute to actual medical conditions such as asthma, migraine headaches, hypertension (chronic high blood pressure), cardiac problems, and peptic ulcers. For example, in a person with a peptic ulcer, stress can produce an outpour of peptic acid, causing an actual lesion in the stomach wall resulting in pain, which is caused by actual physical damage. In somatoform disorders, however, no physical basis for pain can be found.

Conversion Disorder

Conversion disorder may be the most fascinating somatoform disorder, in which serious neurological symptoms such as paralysis, blindness, or loss of sensation suddenly occur. Electrophysiological recordings and brain-imaging of such patients indicates that sensory and motor pathways in the brain are intact. People with conversion disorder often exhibit la belle indifference, which is a strange lack of concern of one's symptoms and its implications.

In some cases, the complaint by the patient themselves is psychologically impossible. An example of this is glove anaesthesia, in which a person loses all sensations below the wrist. The hand is served by nerves, which also provide sensory input to the arm and wrist, making glove anaesthesia anatomically impossible.

Trauma-induced Blindness

Even though psychogenic blindness is rare in the general population, researchers have discovered the largest-known civilian group of people in the world with trauma-induced blindness. These people were refugees who had escaped from Cambodia and had later settled in California. They are survivors of the killing fields of Cambodia who were subjected to unspeakable horror at the hands of the Khmer Rouge in the years that followed the Vietnam War.

More than a 150 of these people were functionally blind, even though their eyes appeared intact and electrophysiological monitoring showed stimuli registered to their visual cortex. Many of them reported that the blindness came on suddenly after they witnessed traumatic scenes of murder, meaning this was a psychological manifestation to past trauma.

Underlying Conflict

According to Freud, conversion symptoms are a symbolic expression of an underlying conflict which aroused a tremendous amount of anxiety, causing the ego to keep the conflict in the unconscious, thereby converting the anxiety into a physical symptom. For example, in one of Freud's cases, a young woman who was forced to care for her hostile, verbally abusive, and unappreciative father, had suddenly developed paralysis in her arm. According to Freud, this had occurred when her repressed hostile impulses threatened to break through and caused her to strike her father with that arm.

A combination of psychological and biological vulnerabilities may cause a person to have a predisposition to somatoform disorders. Somatoform disorders tend to run in families, but it isn't clear whether it's a reflection of the role of genetic factors, environmental learning, and social reinforcement for bodily symptoms or both.

Cultural Influence

In addition, some may experience internal sensations more vividly than others, or they may focus more attention on those symptoms. Patients with somatoform disorders are also very suggestible. In one study, somatoform patients were found more responsive to hypnotic suggestions than matched controls. Furthermore, the hypnotic susceptibility scores of conversion patients significantly correlated with the number of conversion symptoms reported by them.

Somatoform disorders have a higher prevalence in cultures that discourage open discussions on emotions or stigmatise psychological disorders. In Western culture subgroups such as the police or the military, discussing feelings and self-disclosing of psychological problems are frowned upon.

In such situations, somatic symptoms may begin to appear as the only acceptable outlet for feelings of emotional distress in such persons. The same may occur in people who are subjected to severe emotional constrictions, making them unable to acknowledge their emotions or verbally communicate them to others.

Dynamics of Anxiety

Anxiety is a complex condition with psychological, biological and environmental factors causing predisposition to stress.

Psychological Factors

psychodynamic theories

Anxiety is a central concept in psychoanalytic conceptions of abnormal behaviour. According to Sigmund Freud, anxiety-based disorders, or neurotic disorders, are called neuroses. Psychodynamic Theory is a concept that explains a person's personality in terms of conscious and unconscious ways such as unconscious desires and beliefs.

Freud said our personality develops from the interactions of three fundamental structures of the human mind: the id, ego, and superego. Our efforts to find balance among the conflicts and desires of these structures determine our behaviour and approach of the world. The way we balance any situation determines our manner of resolving a conflict between two overreaching behavioural tendencies: our biological aggressive and pleasure-seeking drives vs. our socialised internal control over those drives.

Psychoanalysts believe obsessions and compulsions as ways of handling anxiety. According to Freud, obsessions are symbolically related to, but not as terrifying, as the underlying impulses. A compulsion is a way of taking back or undoing one's unacceptable urges, as with obsessive thoughts of dirt and compulsive handwashing are used to deal with one's dirty sexual impulses. Generalized anxiety and panic attacks are believed to occur when one's defences are too weak to control or contain neurotic anxiety, but strong enough to hide the underlying conflict.

The Id

The id is the most primitive form of the three structures; its only concern is of instant gratifications of its physical urges and needs. Its behaviour is entirely unconscious; outside of unconscious thought, for example; if it saw someone having something it likes, it would grab it for itself without knowing or caring that it's being rude. Its only concern would be of itself.

The Superego

The superego cares about social rules and morals, similar to what some people call a moral compass or conscience. This develops as a child considers right and wrong according to its cultural background. For this reason, unlike the id, the superego wouldn't take what's not belonging to it even if it needs it as it would be rude.

On the other hand, if both the id and the superego were involved and the id was strong enough to override the super ego's moral compass, it would take what it wants with no knowledge or concern about being rude but would feel shame and regret in the aftermath.

The Ego

The ego; in contrast to the id, who is all instinctual and superego, who is all about morals; is the rational pragmatic part of our personality. It's less primitive than the id and is partly conscious and unconscious. This is what Freud considered to be the 'Self'.

The ego's job is to balance the superego's and id's demands in a practical sense of reality. In the sense of the conflict between taking or not taking another person's thing, the ego would decide to buy what he needs instead. While this takes more time, the ego decides to make the sacrifice as an effort of compromise, which is satisfying your need for the thing you desire without taking part in an unpleasant social situation that could make you feel regret and shame in the aftermath.

Freud believed that the ego, superego, and id were constantly in conflict, resulting in adult personality and behaviour being rooted as a result of these internal struggles throughout childhood. Freud believed that a person with a strong ego has a healthy personality—and that imbalances in this system can cause neurosis (now thought as anxiety and depression, as well as certain unhealthy behaviours).

Cognitive Factors

Cognitive theorists stress that maladaptive thought patterns and beliefs associated with anxiety tend to magnify a situation worse than it is, causing people with anxiety to anticipate the worst outcome and making them powerless to cope effectively. Invasive thoughts about previous traumatic events are the main feature of posttraumatic stress disorder (PTSD). The presence of these thoughts after a traumatic event predicts later development of PTSD.

Cognitive processes play an important role in panic disorders. According to David Barlow, panic attacks are triggered by exaggerated normal misinterpretations of normal anxiety symptoms such as dizziness, heart palpitations, and breathlessness. A person misinterprets these as signs as a pending heart attack or psychological loss of control, creating more anxiety which spirals out of control, causing a full-blown panic attack. Helping panic-attack patients realize that it's just a bit of anxiety and not a heart attack can reduce the patient's anxiety and in turn, reduce panic-attacks.

The Role of Learning

From a behavioural perspective, classical conditioning observational learning or operant conditioning can contribute to the development of an anxiety disorder. Some fears are associated with traumatic experiences, which is a classical fear of response for a person who has had a traumatic experience like a fall from a height or almost drowning, which could cause fear of heights, or getting into a pool or other source of water.

However, classical conditioning cannot be the only case; there are people who have never been in a plane crash that are afraid of flying and people who have never had a bad fall, but fear heights (observational phobia). Seeing a random plane crash could trigger a fear in some people like some are afraid of spiders although they have never been bitten or there aren't any poisonous spiders in their counties. 

Yet, most people don't develop phobias through observation. It could be a biological and cognitive fact that causes some to develop phobias from observing or hearing while others don't. Once anxiety is learnt classically or vicariously, it could be triggered by cues from the environment or internal cues such as thoughts and images. In phobic reactions, the cues tend to be external, relating to feared objects or situations; whereas in panic disorders, the cues to the arousal of anxiety are internal bodily sensations such as one's heart rate, mental images of collapsing, and having a seizure in a public place.

In addition to classical conditioning and learning, operant conditions also play a role in motivating people with anxiety to avoid or escape it due to the unpleasant emotional state behaviour successful in reducing anxiety such as compulsions, or phobic avoidance responses become stronger through negative reinforcement.

Sociocultural Factors

Social and cultural factors can play a role in anxiety disorder development. The role of culture is not shown in culture-bound disorders that only occur in certain locales. One such phobia is found in Japan called 'Tianjin Kyofushu'. People affected by this disorder are pathologically frightened of offending others by emitting offensive odours, staring inappropriately, blushing or having a blemish, or improper facial expressions. This condition has been attributed to the Japanese cultural value of extreme interpersonal sensitivity and cultural prohibitions against expressing negative emotions or causing discomfort in others.

Another culture-bound disorder is 'koro'; a South-east Asian anxiety disorder in which a man thinks that his penis will retract into his abdomen and kill him. Western culture has culture-specific anxiety reactions too. Formally classified as an eating disorder, anorexia nervosa has a strong phobic component (fear of weight gain) and so also obsessive-compulsive elements. 

This eating disorder is mostly found in Western countries due to the cultural obsession of being thin. Causes of anxiety are complex and often interact with each other. These conditions can be viewed at biological, psychological, and environmental levels.

Anxiety Disorders

The anxious mind

Anxiety is a psychological disorder. We all tend to get anxious at some point in our lives; waiting for a test result of an underlying health condition, results from a college examination or job interview; any number of things can make us anxious, which is normal in stressful situations.
However, people with anxiety disorders tend to worry about everything. The slightest issue makes them anxious. People who do not understand this condition may ridicule the person who suffers from the disorder, causing them even more anguish.

For a person with anxiety, the frequency and intensity of response to problems are magnified. A person with anxiety gets emotional and tense easily. They tend to have worrying thoughts which make them unable to cope with life. It results in increased heart rate, the rise of blood pressure, rapid breathing, muscle tension, nausea, dry mouth, frequent urination and diarrhoea. There are behavioural changes too; they tend to avoid certain situations and lack task performance. Anxiety disorders come in so many different forms, and they are as follows:

• Post-traumatic Stress Disorder (PTSD)
• Obsessive-compulsive Disorder (OCD)
• Panic Disorder
• Generalised Anxiety Disorder (GAD)
• Phobic disorders

The most common psychological disorder is GAD. People with anxiety disorders are affected throughout their life, while women are more likely to develop anxiety disorders than men. In many cases, anxiety disorders are considered clinically significant, which means that they interfere in a person's life, or cause them to seek medical or psychological treatment. Phobias are also a part of anxiety disorders.

What's a phobia?

phobias are irrational fears; be it a fear of an object or situation. People with phobias understand that their fears aren't natural, but their condition still makes them helpless, making it impossible for them to do anything about it. It's like knowing what to do yet being forced to do the opposite. All they can do is try their best to avoid the said object or situation.

The most common phobia is agoraphobia, which is the fear of public places where escape is improbable. Social phobia, which is a fear of being evaluated and embarrassed by others.
Specific phobias are fear of spiders, snakes, dogs, enclosed spaces, water, germs, injections, and heights. Phobias are mostly developed during childhood, adolescence, and early adulthood, but there is a chance of phobias arising later in life as well. According to the situation experienced, phobias rarely subside.

GAD

In most cases of phobia, they intensify with time. With frequent encounters of the said situation or object, the phobia tends to intensify, which is the reason they avoid such situations and objects. GAD is a chronic state of anxiety not attached to a specific situation or object. This anxiety can continue from weeks to months without any symptoms present. When affected by this disorder, it makes the person unable to concentrate, as well as make decisions and commitments.

Panic Disorder

Panic Disorder is unpredictable. Even when there is no identifiable danger, the patients can have panic attacks. This makes it terrifying as it can make them feel that they are on the verge of death. A panic attack can occur when the said person is asleep or wide awake. When it happens when the person is asleep, he or she can wake up, but find themselves unable to move or even speak. This is called sleep paralysis; the person is not actually paralysed but feels so. They fear that death has come to take them. This can be infuriating to the sufferer.

The fear of such panic attacks occurring keep them from leaving familiar surroundings; they often isolate themselves at home. Panic Disorder is diagnosed when recurrent attacks are not tied to any stimuli followed by psychological or behavioural issues caused by a persistent fear of future attacks or agoraphobic response. Panic Disorder emerges during adolescence or early adulthood, which may or may not accompany agoraphobia.

OCD

Obsessions, or unwelcome thoughts, images or impulses, often invade a person's consciousness and are hard to dismiss or control. This could make a person compulsive. As a result, this person will often repeat the same things; such as washing and cleaning, rechecking if the door was locked, or the stove was switched off over and over.
This helps relieve the anxiety caused by the obsessive-compulsion for a while, but not indefinitely. Being unable to perform this compulsive act can aggravate the person's anxiety, which can result in a panic attack. Therefore, it's best not to interfere and let this person carry on with their rituals. The onset of OCD starts when a person is in their 20's.

PTSD

PTSD is a severe anxiety disorder which occurs when a person is exposed to severe trauma. The symptoms are anxiety, distress and arousal that wasn't present before being exposed to trauma. This person tends to relive the trauma recurrently as dreams and flashbacks. The victim tries to avoid situations that stimulate anxiety by numbing themselves to the world.

This person tends to suffer from survivor's guilt, where he survived while others were killed. PTSD was first diagnosed in soldiers who survived the horrors of war; who had either been injured and or had lost their comrades. Civilians who had been subjected to war could be affected by PTSD as well. Compared to men, women's levels of PTSD is higher when exposed to traumatic events. The psychological issues caused by PTSD can result in other psychological disorders as well. Women have a higher chance than men to develop depressive disorders and alcoholism when suffering from PTSD.