Stress and Adjustment Disorders

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Stress and Adjustment Disorders

• Acute Stress Disorders
• Adjustment Disorder
• PTSD
• Major Anxiety Disorder
• Phobic Disorders
• Generalized Anxiety Disorder
• Obsessive-Compulsive
• Eating Disorders

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Major Anxiety Disorder

• Fear and Panic
• basic emotion that involves activation of the
  fight-or-flight response in the sympathetic
  nervous system.
• Anxiety
• General feeling of apprehension about possible
  danger.
• Oriented to the future
• Cognitive/subjective, physiological, and
  behavioral components
• Typically involves unrealistic, irrational fears
  or anxieties of disabling intensity as their most
  obvious manifestation.

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Major Anxiety Disorder

• DSM-IV-TR Anxiety Types
• Phobic disorders of the specific type
• Phobic disorders of the social type
• Panic disorder with agoraphobia
• Panic disorder without agoraphobia
• Generalized anxiety disorder
• Obsessive-compulsive disorder
• Post-traumatic stress disorder

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Major Anxiety Disorder

• Similarities among anxiety disorders
• The basic biological causes of these disorders
• The basic psychological causes of these disorders
• The effective treatments for these disorders

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Major Anxiety DisorderPhobia

• Defined
• Persistent and disproportionate fear of some
  specific object or situation that presents little
  or no actual danger
• The DSM-IV-TR lists three main categories of
  phobias
• Specific phobia
• Social phobia
• Agoraphobia

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Major Anxiety DisorderPhobia

• Specific Phobia
• Blood-injection-injury phobia occurs in about
  34 of the population
• 16 of women and 7 of men suffer from some form
  of specific phobia in their life
• The age of onset for different phobias varies
  widely
• Genetic and temperamental factors are known to
  affect the speed and strength of conditioning of
  fear.
• Treatment
• Exposure therapy
• Other therapies include
• Participant modeling
• Virtual reality therapies
• Combining cognitive techniques with
  exposure-based therapies

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Major Anxiety DisorderPhobia

• Social Phobia
• Involves disabling fears of one or more discrete
  social situations in which a person fears that
  she or he may be exposed to the scrutiny and
  potential negative evaluation of others.
• Involve learned behaviors shaped by evolutionary
  factors.
• Such learning is most likely to occur in people
  who are genetically or temperamentally at risk.
• Treatment
• Behavior therapy
• Cognitive-behavioral therapy
• Medications

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Major Anxiety DisorderPhobia

• Panic Disorder (with/without Agoraphobia)
• Characterized by the occurrence of unexpected
  panic attacks.
• Many people with panic disorder also develop an
  agoraphobic fear of situations in which they
  might have an attack.
• 3.5 percent of the adult population have had
  panic disorder at some time in their lives
• Its twice as prevalent in women as men
• 50 of people with panic disorder have additional
  diagnoses
• Panic disorder has a moderate heritable component
• Limbic System
• Hippocampus
• Amygdala

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Major Anxiety DisorderPhobia

• Behavioral/Cognitive Causal Factors
• The fear of fear model
• The comprehensive learning theory of panic
  disorder
• The cognitive theory of panic
• Perceived control and anxiety sensitivity
• Safety behaviors and the persistence of panic
• Cognitive biases and the maintenance of panic

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Major Anxiety DisorderPhobia

• Treatment (panic and agoraphobia)
• Medications
• Minor tranquilizers
• Antidepressants
• Behavioral and cognitive-behavioral treatments

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Major Anxiety DisorderGeneralized Anxiety

• Defined
• Characterized by chronic or excessive worry about
  a number of events and activities
• Each year 3 of the population experiences GAD
• It is twice as common in women as in men
• It often co-occurs with other AXIS I disorders
• Causal Factors
• It may occur in people who have had extensive
  experience with uncontrollable events
• Anxiety is associated with an automatic
  attentional bias toward threatening information
  in the environment
• Genetic
• Neurotransmitters
• GABA
• 5-HT
• Norepinephrine
• Glucocorticoids

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Major Anxiety DisorderGeneralized Anxiety

• Treatment
• Valium
• Often misused
• Buspirone
• Effective
• nonaddictive
• Cognitive-behavioral therapy

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Major Anxiety DisorderObsessive-Compulsive

• Defined
• Occurrence of unwanted and intrusive obsessive
  thoughts or distressing images.
• Usually accompanied by compulsive behaviors
  performed to
• Neutralize the obsessive thoughts or images
• Prevent some dreaded event or situation
• One-year prevalence 1.6
• Lifetime prevalence 2.5
• Affects both genders equally.

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Major Anxiety DisorderObsessive-Compulsive

• Obsessions consist most often of
• Contamination fears
• Fears of harming oneself or others
• Lack of symmetry
• Pathological doubt
• Compulsions include
• Cleaning
• Checking
• Repeating
• Ordering/arranging
• Counting

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Major Anxiety DisorderObsessive-Compulsive

• Psychosocial Causal Factors
• Response to loss of control over ones life.
• Obsessions with contamination and dirt appear to
  have evolutionary roots.
• Attempting to suppress unwanted thoughts may
  increase those thoughts.
• People with OCD seem to think bad thoughts are
  equivalent to bad deeds.
• Attention is drawn to disturbing material
  relevant to their obsessive concerns.
• Biological causal Factors
• Moderately heritable
• Abnormalities in brain function may include
• Slight structural abnormalities in the caudate
  nucleus
• high metabolic levels in other parts of the brain
• 5-HT

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Major Anxiety DisorderObsessive-Compulsive

• Treatment
• Exposure Therapy
• SSRIs
• ECT
• Modifying social environment