Are psychological disorders such as anxiety and depression truly different from each other? Or might they be part of the same syndrome?
A recent paper, by David Barlow and colleagues from Boston University, published in the October 2021 issue ofCurrent Directions in Psychological Science, suggests some psychological disorders (or “emotional disorders” as they call them)—such as anxiety disorders, mood disorders, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and dissociative disorders—are variations of the same syndrome. And central to this syndrome is neuroticism.
What is neuroticism?
In an interview, David Barlow defined neuroticism as “the tendency to experience frequent and intense negative emotions in response to various sources of stress along with a general sense of inadequacy and perceptions of lack of control over intense negative emotions and stressful events.”
Naturally, when someone believes challenging and potentially stressful events are unpredictable and uncontrollable, they are more likely to avoid the events or respond negatively both to the events and to the negative emotional experiences.
One way neurotic people try to reduce or prevent negative emotions is through avoidant coping (also called avoidance coping). Some examples of avoidant coping are distraction, reassurance-seeking, avoidance of anxiety-provoking activities or situations, and engaging in safety behaviors. Even worrying may be associated with avoidant coping, since a function of worry is to protect the individual from directly experiencing unpleasant emotions.
Because avoidant coping temporarily reduces discomfort, it may seem like a good long-term strategy for reducing negative emotions. But it is not. In the long run, people who use avoidant coping often experience more frequent or intense aversive emotions.
In addition, engaging in behavioral avoidance means there are fewer opportunities to challenge one’s erroneous beliefs. So, corrective learning never occurs. For example, a person with a phobia of dogs who avoids dogs all the time never learns that most dogs are harmless.
A new model of emotional disorders
What maintains both neuroticism and emotional disorders, then, is “emotion-motivated avoidant coping.” As the authors note, “it is this aversive reactivity to emotional experiences and resultant emotion-motivated avoidant coping that form the bridge from neuroticism to the emotional disorders and that are…the transdiagnostic functional mechanism fundamental to all disorders of emotion.”
But the nature of avoidant coping and the particular emotions avoided are not the same in different people. As you can see in Figure 1, a person’s unique learning experiences (left part of the figure) interact with the trigger or focus of their emotional experiences, which then causes a particular negative emotional response. This response, depending on the individual’s genetic predisposition (i.e. their level of neuroticism), may result in an emotional disorder (or no disorder at all).