Ever heard a really good joke about polio? Or made a casual reference to someone having 00:04 hepatitis? Or maybe teased your buddy by saying he has muscular dystrophy? 00:07 Of course you have never done that, because you are not a terrible person. You’d never 00:10 make fun of someone for having a physical illness, but folks make all kinds of offhand 00:15 remarks about people having mental illnesses and never give it a second thought. 00:18 How often have you heard a person say that someone’s psycho, or schizo, or bipolar, or 00:23 OCD? I can pretty much guarantee that the people who used those terms had no idea what they actually meant. 00:29 We’ve talked about how psychological disorders and the people who have them have often been stigmatized. 00:33 But at the same time, we tend to minimize those disorders, using them as nicknames for 00:38 things that people do, think, or say, that may not exactly be universal, but are still basically healthy. 00:43 And we all do it, but only because we don’t really understand those conditions. 00:48 But that’s why we’re here, because as we go deeper into psychological disorders, we get 00:52 a clearer understanding of their symptoms, types, causes, and the perspectives that help explain them. 00:58 And some of the most common disorders have their root in an unpleasant mental state that’s 01:01 familiar to us all: anxiety. 01:04 It’s a part of being human, but for some people it can develop into intense fear, and paralyzing 01:09 dread, and ultimately turn into full-fledged anxiety disorder. 01:13 Defining psychological disorders again: a deviant, distressful, and dysfunctional pattern 01:17 of thoughts, feelings, or behaviors that interferes with the ability to function in a healthy way. 01:22 So when it comes to anxiety, that definition is the difference between the guy you probably 01:26 called phobic because he didn’t like Space Mountain as much as you did, and the person 01:31 who truly can’t leave their house for fear of interacting with others. 01:34 It’s the difference between the girl who’s teased by her friends as being OCD because 01:38 she does her laundry every night and the girl who has to wash her hands so often that they bleed. 01:42 Starting today, you’re going to understand all of those terms you’ve been using. 01:56 We commonly equate anxiety with fear, but anxiety disorders aren’t just a matter of fear itself. 02:00 A key component is also what we do to get rid of that fear. 02:03 Say someone almost drowned as a kid and is now afraid of water. 02:06 A family picnic at the river may cause that anxiety to bubble up, and to cope, they may 02:11 stay sequestered in the car, less anxious but probably still unhappy while the rest 02:16 of the family is having fun. 02:17 So, in clinical terms, anxiety disorders are characterized not only by distressing, persistent 02:22 anxiety but also often by the dysfunctional behaviors that reduce that anxiety. 02:27 At least a fifth of all people will experience a diagnosable anxiety disorder of some kind 02:32 at some point in their lives. That is a lot of us. 02:35 So I want to start out with a condition that used to be categorized as an anxiety disorder 02:38 but is now considered complex enough to be in a class by itself, Obsessive-Compulsive 02:43 Disorder or OCD. 02:44 You probably know that condition is characterized by unwanted repetitive thoughts, which become 02:49 obsessions, which are sometimes accompanied by actions, which become compulsions. 02:53 And it is a great example of a psychological disorder that could use some mental-health myth busting. 02:57 Being neat, and orderly, and fastidious does not make you OCD. 03:02 OCD is a debilitating condition whose sufferers take normal behaviors like, washing your hands, 03:07 or double checking that you turned off the stove and perform them compulsively. 03:12 And they often use these compulsive, even ritualistic behaviors to relieve intense and unbearable anxiety. 03:18 So, soon they’re scrubbing their hands every five minutes, or constantly checking the stove, 03:22 or counting the exact number of steps they take everywhere they go. 03:25 If you’re still unclear about what it means for disorders to be deviant, distressful and 03:29 dysfunctional, OCD might help you understand. 03:31 Because it is hard to keep a job, run a household, sit still, or do much of anything if you feel 03:36 intensely compelled to run to the kitchen twenty times an hour. 03:40 And both the thoughts and behaviors associated with OCD are often driven by a fear that is itself 03:45 obsessive, like if you don’t go to the kitchen right now your house will burn down and your 03:48 child will die which makes the condition that much more distressing and self-reinforcing. 03:52 There are treatments that help OCD including certain kinds of psychotherapy and some psychotropic drugs. 03:58 But the key here is that it is not a description for your roommate who cleans her bathroom 04:01 twice a week, or the guy in the cubicle next to you, who only likes to use green felt tip pens. 04:05 And even though OCD is considered its own unique set of psychological issues, the pervasive 04:10 senses of fear, worry, and loss of control that often accompany it, have a lot in common 04:15 with other anxiety disorders. 04:17 The broadest of these is Generalized Anxiety Disorder or GAD. 04:21 People with this condition tend to feel continually tense and apprehensive, experiencing unfocused, 04:26 negative, and out-of-control feelings. 04:29 Of course feeling this way occasionally is common enough, but feeling it consistently 04:32 for over six months – the length of time required for a formal diagnosis – is not. 04:37 Folks with GAD worry all the time and are frequently agitated and on edge, but unlike 04:42 some other kinds of anxiety, patients often can’t identify what’s causing the anxiousness, so 04:46 they don’t even know what to avoid. 04:48 Then there’s Panic Disorder, which affects about 1 in 75 people, most often teens and young adults. 04:53 It’s calling card is Panic Attacks or sudden episodes of intense dread or sudden fear that 04:59 come without warning. 05:00 Unlike the symptoms of GAD which can be hard to pin down, Panic Attacks are brief, well-defined, 05:06 and sometimes severe bouts of elevated anxiety. 05:08 And if you’ve ever had one, or been with someone who has, you know that they call these attacks 05:13 for good reason. 05:14 They can cause chest pains and racing heartbeat, difficulty breathing and a general sense that 05:19 you’re going crazy or even dying. It’s as awful as it sounds. 05:23 We’ve talked a lot about the body’s physiological fight or flight response and that’s definitely 05:27 part of what’s going on here, even though there often isn’t an obvious trigger. 05:31 There may be a genetic pre-disposition to panic disorder, but persistent stress or having 05:35 experienced psychological trauma in the past can also set you up for these attacks. 05:39 And because the attacks themselves can be downright terrifying, a common trigger for 05:43 panic disorder is simply the fear of having another panic attack. 05:47 How’s that for a kick in the head? 05:48 Say you have a panic attack on a bus, or you find yourself hyperventilating in front of 05:52 dozens of strangers with nowhere to go to calm yourself down, that whole ordeal might 05:56 make you never want to be in that situation again, so your anxiety could lead you to start 05:59 avoiding crowded or confined places. 06:01 At this point the initial anxiety has spun of into a fear of anxiety which means, welcome 06:07 you’ve migrated into another realm of anxiety disorder, Phobias. 06:10 And again this is a term that’s been misused for a long time to describe people who, say, 06:14 they don’t like cats, or are uncomfortable on long plane trips. 06:18 Simply experiencing fear or discomfort doesn’t make you phobic. 06:21 In clinical terms, phobias are persistent, irrational fears of specific objects, activities, 06:27 or situations, that also, and this is important, leads to avoidance behavior. 06:31 You hear a lot about fears of heights, or spiders, or clowns, and those are real things. 06:37 They’re specific phobias that focus on particular objects or situations. 06:40 For example, the Chesapeake Bay Bridge in Maryland is a seven-thousand meter span that 06:44 crosses the Chesapeake Bay, if you want to get to or from Eastern Maryland that’s pretty 06:49 much the only way to do it, at least in a car, but there are thousands of people who 06:53 are so afraid of crossing that bridge that they simply can’t do it. 06:57 So, to accommodate this avoidance behavior, driver services are available. 07:01 For $25 people with Gephyrophobia, a fear of bridges, can hire someone to drive themselves, and their kids, 07:08 and dogs, and groceries across the bridge in their own car, while trying not to freak out. 07:13 But other phobias lack such specific triggers, what we might think of as social phobia, currently 07:18 known as social anxiety disorder, is characterized by anxiety related to interacting or being 07:23 seen by others, which could be triggered by a phone call, or being called on in class, 07:28 or just thinking about meeting new people. 07:30 So you can probably see at this point how anxiety disorders are related and how they 07:34 can be difficult to tease apart. 07:36 The same thing can be said about what we think causes them. 07:39 Because much in the same way anxiety can show up as both a feeling like panic, and a thought, 07:44 like is my kitchen on fire, there are also two main perspectives on how we currently view anxiety 07:50 as a function of both learning and biology. 07:52 The learning perspective suggests that things like, conditioning, and observational learning 07:57 and cognition, all of which we’ve talked about before best explain the source of our anxiety. 08:01 Remember our behaviorist friend, John B. Watson and his conditioning experiments with poor 08:05 little Albert, by making a loud scary noise every time you showed the kid a white rat, 08:09 he ended up conditioning the boy to fear any furry object, from bunnies, to dogs, to fur coats. 08:15 That conditioning used two specific learning processes to cement itself in Little Albert’s young mind. 08:20 Stimulus Generalization, expanded or generalized his fear of the rat to other furry objects, 08:26 the same principle holds true if you were, like, attacked by your neighbours mean parrot 08:29 and subsequently fear all birds. 08:30 But then the anxiety is solidified through reinforcement, every time you avoid or escape 08:36 a feared situations, a pair of fuzzy slippers or a robin on the street, you ease your anxiety, 08:42 which might make you feel better temporarily, but it actually reinforces your phobic behavior, 08:46 making it stronger. 08:48 Cognition also influences our anxiety, whether we interpret a strange noise outside as a 08:52 hungry bear, or a robber, or merely the wind, determines if we roll-over and keep snoring, 08:58 or freak out and run for a kitchen knife. 08:59 And we might also acquire anxiety from other people through observational learning. 09:04 A parent who’s terrified of water may end up instilling that fear in their child by 09:08 violently snatching them away from kiddie pools or generally acting anxious around park 09:12 fountains and duck ponds. 09:14 But there’re also equally important biological perspectives. Natural selection, for instance, 09:18 might explain why we seem to fear certain potentially dangerous animals, like snakes, or why fears 09:23 of heights or closed in spaces are relatively common. 09:26 It’s probably true that our more wary ancestors who had the sense to stay away from cliff 09:30 edges and hissing serpents were more likely to live another day and pass along their genes, 09:35 so this might explain why those fears can persist, and why even people who live in places 09:40 without poisonous snakes would still fear snakes anyway. 09:43 And then you got the genetics and the brain chemistry to consider. 09:46 Research has shown for example that identical twins, those eternal test subjects, are more 09:49 likely to develop phobias even if they’re raised apart. 09:53 Some researchers have detected seventeen different genes that seem to be expressed with various 09:58 anxiety disorders. 09:59 So it may be that some folks are just naturally more anxious than others and they might pass 10:03 on that quality to their kids. 10:05 And of course individual brains have a lot to say about how they process anxiety. 10:10 Physiologically, people who experience panic attacks, generalized anxiety, or obsessive 10:14 compulsions show over-arousal in the areasof the brain that deal in impulse control 10:19 and habitual behaviors. 10:20 Now we don’t know whether these irregularities cause the disorder or are caused by it, but 10:24 again, it reinforces the truism that everything that is psychological is simultaneously biological. 10:30 And that holds true for many other psychological disorders we’ll talk about in the coming weeks, 10:34 many of which have names that you’ve also heard being misused in the past. 10:38 Today you learned what defines an anxiety disorder, as well as the symptoms of obsessive 10:43 compulsive disorder, generalized anxiety disorder, panic disorder and phobias. 10:46 You also learned about the two main perspectives on the origins of anxiety disorders, the learning 10:51 perspective and the biological perspective and hopefully you learned not to use “OCD” 10:56 as a punch line from now on. 10:58 Thanks for watching, especially to all of our Subbable subscribers who make Crash Course 11:01 available to them and also to everyone else. 11:04 To find out how you can become a supporter just go to subbable.com/crashcourse. 11:08 This episode was written by Kathleen Yale, edited by Blake de Pastino, and our consultant 11:12 is Dr. Ranjit Bhagwat. 11:13 Our director and editor is Nicholas Jenkins, the script supervisor is Michael Aranda who 11:17 is also our sound designer and the graphics team is Thought Cafe.