Anxiety%20Disorders

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Anxiety Disorders

• Panic Disorder
• Agoraphobia
• Social Phobia
• Specific Phobia
• Obsessive Compulsive Disorder
• Generalized Anxiety Disorder
• (PTSD Acute Stress Disorder)

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Panic Attack (not a diagnosis)

• A. Discrete period of intense fear or discomfort,
  in which 4 or more of the following Six develop
  abruptly and reach a peak within 10 minutes
• Palpitations
• Sweating
• Trembling/aching
• Sensations of shortness of breath or smothering
• Feeling of choking
• Chest pain/discomfort
• Nausea/abdominal distress
• Feeling dizzy/unsteady/lightheaded/faint
• Derealization/depersonalization
• Fear of losing control/going crazy
• Fear of dying
• Paresthesias (numbness or tingling sensation)
• Chills/hot flushes

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Agoraphobia (not a diagnosis)

• A. Anxiety about being in places or situations
  from which escape might be difficult or in which
  help may not be available in the event of having
  an unexpected or situationally predisposed panic
  attack or panic-like symptoms.
• B. The situations are avoided or are endured with
  marked distress
• C. Not better accounted for by another mental
  disorder

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Some help
Panic Attacks
NO
YES
NO
Agoraphobia
YES
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Panic Disorder without Agoraphobia

• A. Both 1 and 2
• 1. Recurrent, unexpected panic attacks
• 2. At least one of the attacks has been followed
  by 1 or more months of 1 or more of the following
• a. Persistent concern about having additional
  attacks
• b. Worry about the implications of the attack or
  its consequences
• c. Significant change in behavior related to the
  attacks
• B. Absence of agoraphobia
• C. Panic attacks are not due to a GMC or
  substance
• D. Panic Attacks are not better accounted for by
  another mental disorder

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Panic Disorder with Agoraphobia

• A. Both 1 and 2
• 1. Recurrent, unexpected panic attacks
• 2. At least one of the attacks has been followed
  by 1 or more months of 1 or more of the following
• a. Persistent concern about having additional
  attacks
• b. Worry about the implications of the attack or
  its consequences
• c. Significant change in behavior related to the
  attacks
• B. Presence of agoraphobia
• C. Panic attacks are not due to a GMC or
  substance
• D. Panic Attacks are not better accounted for by
  another mental disorder

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Agoraphobia without History of Panic Disorder

• A. Presence of Agoraphobia related to fear of
  developing panic-like symptoms
• B. Criteria have never been met for Panic
  Disorder
• C. Disturbance is not due to a GMC or substance
• D. If an associated GMC is present, the
  agoraphobia is in excess of that usually
  associated with the condition

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Social Phobia

• A. Marked, persistent fear of one or more social
  or performance situations in which the person is
  exposed to unfamiliar people or to possible
  scrutiny by others. The individual fears that he
  or she will act in a way that will be humiliating
  or embarrassing.
• B. Exposure to the feared social situation almost
  invariably provokes an anxiety response
• C. The person recognizes that the fear is
  excessive or unreasonable
• D. The phobic stimulus is avoided or endured with
  intense anxiety or distress
• E. There is significant distress or an impairment
  in functioning

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Specific Phobia

• A. Marked, persistent fear that is excessive or
  unreasonable, cued by the presence or
  anticipation of a specific object or situation
• B. Exposure to the phobic stimulus almost always
  provokes an immediate anxiety response
• C. The person recognizes that the fear is
  excessive or unreasonable
• D. The phobic stimulus is avoided or endured with
  intense anxiety or distress
• E. There is significant distress or an impairment
  in functioning due to the phobia
• F. The phobia is not better accounted for by
  another mental disorder

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Subtypes of Specific Phobia

• Animal type
• Natural environment type
• Blood-Injection-Injury type
• Situational type
• Other type

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Phobia

• Marked by a persistent and irrational fear of an
  object or situation that disrupts behavior.

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Kinds of Phobias
Phobia of open places.
Agoraphobia
Phobia of heights.
Acrophobia
Phobia of closed spaces.
Claustrophobia
Phobia of blood.
Hemophobia
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Dont concept map this

• Acrophobia Heights Aquaphobia Water
• Gephyrophobia Bridges Ophidiophobia Snakes
• Aerophobia Flying Arachnophobia Spiders
• Herpetophobia Reptiles Ornithophobia Birds
• Agoraphobia Open spaces Astraphobia Lightning
• Mikrophobia Germs Phonophobia Speaking aloud
• Ailurophobia Cats Brontophobia Thunder
• Murophobia Mice Pyrophobia Fire
• Amaxophobia Vehicles, driving Claustrophobia
  Closed spaces
• Numerophobia Numbers Thanatophobia Death
• Anthophobia Flowers Cynophobia Dogs

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Good Question

• If phobias are learned behaviors,
• why dont they extinguish on their own???

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Answer to the Good Question

• Avoidance works!
• Fear is never tested

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Obsessive-Compulsive Disorder

• Persistence of unwanted thoughts (obsessions) and
  urges to engage in senseless rituals
  (compulsions) that cause distress.

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Obsessive-Compulsive Disorder

• A. Either obsessions or compulsions
• Obsessions as defined by 1, 2, 3, and 4
• Recurrent, persistent thoughts, impulses, or
  images that are experienced at some time during
  the disturbance, as intrusive and inappropriate
  and that cause marked anxiety or distress
• The thoughts, impulses, or images are not simply
  excessive worries about real-life problems
• The person attempts to ignore or suppress such
  thoughts, impulses, or images or tries to
  neutralize them with some other thought or action
• The person recognizes that the obsessional
  thoughts, impulses, or images are a product of
  his or her own mind

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Typical Obsessions

• Doubts (e.g. Did I turn off the stove? Did I
  lock the door? Did I hurt someone?)
• Fears that someone else has been hurt or killed
• Fears that one has done something criminal
• Fears that one may accidentally injure someone
• Worry that one has become dirty or contaminated
• Blasphemous or obscene thoughts
• NOT just excessive worries about real-life
  problems

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Obsessive-Compulsive Disorder

• Compulsions as defined by 1 and 2
• Repetitive behaviors or mental acts that the
  person feels driven to perform in response to an
  obsession or according to rules that must be
  applied rigidly
• The compulsions are aimed at preventing or
  reducing distress or preventing some dreaded
  event or situation however, these behaviors or
  mental acts are not connected in a realistic way
  with what they are designed to neutralize or
  prevent or are clearly excessive

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Typical Compulsions

• Checking
• Cleaning/washing
• Doing things a certain number of times in a row
• Doing and then undoing things
• Doing things in a certain order, with symmetry
• Mental acts such as praying, counting, etc.

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Obsessive-Compulsive Disorder

• B. The person has recognized that the obsessions
  or compulsions are excessive or unreasonable
• C. There is significant distress or an impairment
  in functioning due to the obsessions or
  compulsions
• D. If another Axis I disorder is present, the
  content of the obsessions or compulsions is not
  restricted to the other Axis I disorder
• E. The disturbance is not due to a GMC or
  substance

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OCD in Children

• Children have an average of 4 obsessions and 4
  compulsions at any given time
• Often comorbid with Tourettes syndrome and/or
  ADHD

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Generalized Anxiety Disorder (GAD)

• Excessive anxiety and worry occurring more days
  than not for at least 6 months, about a number of
  events
• The person finds it difficult to control the
  worry
• The anxiety and worry are associated with 3 or
  more of the following symptoms
• Restlessness or feeling keyed up or on edge
• Being easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep Disturbance

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Generalized Anxiety Disorder (GAD)

• D. The focus of the anxiety and worry is not
  confined to features of another disorder and do
  not occur exclusively during PTSD
• E. There is clinically significant distress or
  impairment in functioning
• F. Not due to a GMC or substance

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Post-Traumatic Stress Disorder

• A. The person has been exposed to a traumatic
  event and have experienced four or more weeks of
  one or more of the following symptoms

1. Haunting memories

2. Nightmares
3. Social withdrawal
4. Jumpy anxiety
5. Sleep problems
Bettmann/ Corbis
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Resilience to PTSD

• Only about 10 of women and 20 of men react to
  traumatic situations and develop PTSD.

Holocaust survivors show remarkable resilience
against traumatic situations.
All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
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Resilience to PTSD

• Only about 10 of women and 20 of men react to
  traumatic situations and develop PTSD.

Holocaust survivors show remarkable resilience
against traumatic situations.
All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
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Anxiety Disorders - Overview

• Most common mental disorders in the U.S.
• At least 19 of the adult population suffer from
  at least one anxiety disorder in any given year
• All are more common in women, except for OCD
• Except for Panic Disorder, ages of onset are most
  likely going to be in childhood or adolescence
  (but do not have to be)
• Anxiety Disorders cost 42 billion each year in
  health care, lost wages, and lost productivity

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Anxiety DisordersCultural Variations

• Fear, Anxiety, and Anxiety Disorders exist in all
  cultures
• Prevalence rates vary, but are generally the most
  common mental illness in all countries
• Low rates China (2.4), Japan, Nigeria, and
  Spain
• High rates U.S. (19), France, Colombia, and
  Lebanon
• Fear stimulus and content of anxiety differ
  greatly between cultures

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Dhat (India), Jiryan (India), Sukra Prameha (Sri
Lanka), Shen-kuei (China)

• Severe anxiety, panic symptoms, somatic
  complaints, hypochondriachal symptoms associated
  with the discharge of semen
• Excessive semen loss is feared because of the
  belief that it represents the loss of ones vital
  essence and can thereby be life threatening

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Koro (South and Southeast Asia)

• Sudden and intense anxiety that ones genitalia
  will recede into the body and possibly cause
  death
• Can occur in epidemics

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Taijin Kyofusho (Japan)

• An intense fear that ones body, its parts, or
  its functions (sweating, body odor, facial
  expressions, etc.) displease, embarrass, or are
  offensive to other people
• Similar to the DSMs Social Phobia

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Explaining Anxiety Disorders
Freud suggested that we repress our painful and
intolerable ideas, feelings, and thoughts,
resulting in anxiety.
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The Learning Perspective
Learning theorists suggest that fear conditioning
leads to anxiety. This anxiety then becomes
associated with other objects or events (stimulus
generalization) and is reinforced.
John Coletti/ Stock, Boston
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The Learning Perspective
Investigators believe that fear responses are
inculcated through observational learning. Young
monkeys develop fear when they watch other
monkeys who are afraid of snakes.
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The Biological Perspective
Natural Selection has led our ancestors to learn
to fear snakes, spiders, and other animals.
Therefore, fear preserves the species.
Twin studies suggest that our genes may be partly
responsible for developing fears and anxiety.
Twins are more likely to share phobias.
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The Biological Perspective
Generalized anxiety, panic attacks, and even OCD
are linked with brain circuits like the anterior
cingulate cortex.
S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones,
C.S. Carter (2003). Overactive action monitoring
in obsessive-compulsive disorder. Psychological
Science, 14, 347-353.
Anterior Cingulate Cortex of an OCD patient.
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Panic Disorder

• What Causes Panic Disorder?
• We dont really know many factors.
• But Strong evidence that norepinephrine is
  involved.
• Norepinephrine neurotransmitter especially
  active in Locus ceruleus part of the brain.

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Models of Abnormality

• Biological model Anatomy (structures)

Neo-Cortex
Corpus callosum
Amygdala
Locus ceruleus (Pons)
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Panic Disorder

• Anti-depressant drugs that regulate
  norepinephrine successful in treating panic
• When Locus ceruleus stimulated in monkeys ? panic
  like behavior
• Locus ceruleus rich in norepinephrine carrying
  neurons
• Hypothesis Norepinephrine dysregulation may well
  be implicated in Panic Disorder

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Obsessive-Compulsive Disorder
Psychodynamic Perspective

• Anxiety rooted in repressed ID impulses
• Impulses obsessive thoughts
• Compulsions ego defenses against them
• E.g. Lady Macbeth Anxiety/guilt over her part
  in a murder ? compulsive hand washing to get rid
  of the imagined blood.
• How would you treat Lady Macbeth?

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Obsessive-Compulsive Disorder
Behavioral Perspective

• Focus on compulsions, not obsessions
• Theory association forms randomly between
  fear/anxiety reduction and the compulsive
  behavior
• Compulsive behavior becomes reinforcing because
  it reduces anxiety
• Therefore compulsion increases in frequency

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Obsessive-Compulsive Disorder
Biological Perspective

• Drugs that increase Serotonin activity are
  somewhat effective in treating OCD
• Serotonin is also active in 2 brain areas that
  have been associated with OCD the orbital region
  of the frontal cortex and caudate nucleus

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Caudate nucleus
Orbital frontal cortex