OCD and Anxiety Disorders: Crash Course Psychology #29


Transcript Provided by YouTube:

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


This post was previously published on YouTube.

Photo credit: Screenshot from video.