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CHAPTER 4
ANXIETY, TRAUMA-AND STRESSOR-RELATED,
AND OBSESSIVE-COMPULSIVE AND
RELATED DISORDERS
CHAPTER OVERVIEW
This chapter outlines the concept of anxiety, fear, and its related disorders. Anxiety is a
future-oriented state characterized by negative affect in which a person focuses on the possibility
of uncontrollable danger or misfortune. Fear is a present-oriented mood state characterized by
strong urges to escape and a surge of the sympathetic branch of the autonomic nervous system.
This chapter provides detailed descriptions of the nature and phenomenology of anxiety and
panic attacks, and each of the major anxiety disorders (generalized anxiety disorder, panic
disorder and agoraphobia, specific phobias, and social anxiety disorder (social phobia) the
trauma-and stressor-related disorders (acute stress disorder and posttraumatic stress disorder),
and obsessive-compulsive and related disorders (obsessive-compulsive disorder and body
dysmorphic disorder). For each, case examples are provided as well as summaries of
symptomatology, course, prevalence, and etiological factors. Psychological and drug treatments
are also discussed, along with the diagnostic changes that have occurred in the DSM-5 revision
and how it will affect our understanding of these disorders moving forward.
LEARNING OBJECTIVES
1.
2.
3.
4.
5.
6.
7.
8.
Describe psychological and biological similarities and differences among anxiety,
fear, and panic attacks.
Identify the genetic and biological vulnerability factors that are known to
influence the development of anxiety disorders.
Describe the essential features of generalized anxiety disorder, its proposed causal
factors and integrative model, and available treatment approaches.
Describe the essential features of panic disorder and agoraphobia.
Identify the principal causes of specific phobias and the most typical strategies
used to treat them.
Identify the principal causes of social anxiety disorder (social phobia) and the
most typical strategies used to treat it.
Describe the essential features of posttraumatic stress disorder, its proposed
causal factors, and available treatment approaches.
Describe the symptoms of obsessive-compulsive disorder and available treatment
approaches.
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CHAPTER OUTLINE
THE COMPLEXITY OF ANXIETY DISORDERS
Anxiety, Fear, and Panic: Some Definitions
Causes of Anxiety and Related Disorders
Comorbidity of Anxiety and Related Disorders
ANXIETY DISORDERS
GENERALIZED ANXIETY DISORDER
Clinical Description
Statistics
Causes
Treatment
PANIC DISORDER AND AGORAPHOBIA
Clinical Description
Statistics
Causes
Treatment
SPECIFIC PHOBIA
Clinical Description
Statistics
Causes
Treatment
Separation Anxiety Disorder
SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)
Clinical Description
Statistics
Causes
Treatment
Selective Mutism
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TRAUMA- AND STRESSOR-RELATED DISORDERS
POSTTRAUMATIC STRESS DISORDER
Clinical Description
Statistics
Causes
Treatment
OTHER TRAUMA- AND STRESSOR-RELATED DISORDERS
OBSESSIVE-COMPULSIVE AND RELATED DISORDERS
OBSESSIVE-COMPULSIVE DISORDER
Clinical Description
Statistics
Causes
Treatment
BODY DYSMORPHIC DISORDER
Clinical Description
Statistics
Causes and Treatment
Plastic Surgery and Other Medical Treatments
OTHER OBSESSIVE-COMPULSIVE AND RELATED DISORDERS
Hoarding Disorder
Trichotillomania (Hair Pulling Disorder) and Excoriation (Skin Picking Disorder)
DETAILED OUTLINE
The Complexity of Anxiety Disorders
What are the similarities and differences among anxiety, fear, and panic attacks?
 Anxiety is a future-oriented state characterized by negative affect in which a person focuses
on the possibility of uncontrollable danger or misfortune; in contrast, fear is a presentoriented state characterized by strong and immediate escapist tendencies and a surge in the
sympathetic branch of the autonomic nervous system in response to current danger.
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 A panic attack represents the alarm response of real fear, but there is no actual danger.
 Panic attacks may be (1) unexpected (without warning) or (2) expected (always occurring in
a specific situation), the distinction between which is whether or not the context of the attack
can be predicted based on past panic experiences.
 Panic and anxiety combine to create different anxiety and related disorders. Several disorders
are grouped under the heading Anxiety Disorders.
 Research evidence exists to support multiple causes of anxiety, including biological models
that identify brain circuit and neurotransmitter involvement as well as psychological and
social contributions. An integrated model of these factors considers how they all contribute
simultaneously to the presence of abnormal, potentially pathological levels of anxiety.
 DISCUSSION POINT:
How could the “triple vulnerability” theory be used to explain the development of panic
disorder?
Be sure that students can generate examples of generalized psychological vulnerability versus
specific psychological vulnerability.
ANXIETY DISORDERS
Generalized Anxiety Disorder
What are the essential features, possible causes, and available treatment approaches for
generalized anxiety disorder?
 In generalized anxiety disorder (GAD), anxiety focuses on minor, everyday events, and not
on one major worry or concern.
 Both genetic and psychological vulnerabilities seem to contribute to the development of
GAD. In particular is the fact that individuals with GAD seem to be more sensitive to threat
in general, particularly when the threat has some personal relevance.
 Although drug and psychological treatments may be effective in the short term, most drug
treatments are no more effective in the long term than placebo treatments. The most
successful long-term treatment may help individuals with GAD focus on what is really
threatening to them in their lives. While benzodiazepine medications are useful for an acute,
crisis stage of a week or two, recent evidence suggests that antidepressant medications such
as Paxil and Effexor provide superior symptoms relief past that initial stage.
Panic Disorder and Agoraphobia
What are the essential features of panic disorder and agoraphobia?
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 Panic disorder is marked by repeated panic attacks (attacks of debilitating, overwhelming
fear often accompanied by a myriad of physical symptoms) and anxiety about future attacks.
It is sometimes, but not always, accompanied by agoraphobia (a fear and avoidance of
situations considered to be “unsafe”). For some people, agoraphobia develops in the absence
of panic attacks or panic-like symptoms.
 DISCUSSION POINT:
What is the relationship between agoraphobia and panic disorder? How might these
conditions also lead to other comorbid conditions?
This discussion could include how having a panic attack in a situation may make a person feel
more vulnerable in that location, which could generalize to other situations as well. Because
of agoraphobia, people limit their experiences with the outside world, which prevents them
from being able to find out what would happen if they were to confront the fear. Comorbid
depression and alcohol and substance use disorders may develop if the person has limited
skills for coping with anxiety and distress.
 We all have some genetic vulnerability to stress, and many of us have had a neurobiological
overreaction to some stressful event—that is, a panic attack. Individuals who develop panic
disorder then develop anxiety over the possibility of having another panic attack.
 Both drug and psychological treatments have proved successful in the treatment of panic
disorder. One psychological method, panic control treatment (PCT), concentrates on
exposing patients to clusters of sensations that remind them of their panic attacks. The
symptoms of agoraphobia that can accompany panic disorder can be effectively treated with
gradual exposure exercises, sometimes combined with anxiety-reducing coping mechanisms.
These approaches do not “cure” the issue, however, as the panic attacks may persist,
although at a less severe level.
Specific Phobia
What are the principal causes of specific phobia?
 In phobic disorders, the individual avoids situations that produce severe anxiety, panic, or
both. In specific phobia, the fear is focused on a particular object or situation.
 DISCUSSION POINT:
How might a parent seek to determine if a child’s fears are reasonable, ordinary responses
to the world or the beginning of an anxiety disorder?
 DISCUSSION POINT:
Do you have any severe fears? What would you use as a way of assessing whether that fear
is or is not a phobia?
Students should be able to refer back to the discussion of the distinction between normal,
abnormal, and pathological and should integrate several of those criteria into their evaluation
of what escalates a fear into a phobia. Encourage students to participate only to their own
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level of comfort and appropriate self-disclosure. The instructor may want to have several
hypothetical examples ready in case students are reticent to participate.
 Phobias can be acquired by experiencing some traumatic event; they can also be learned
vicariously or even be taught.
What strategies are typically used to treat specific phobia?
 Treatment of phobias is rather straightforward, with a focus on structured and consistent
exposure-based exercises.
Social Anxiety Disorder (Social Phobia)
What are the principal causes of social anxiety disorder (social phobia)?
 Social anxiety disorder (SAD) is a fear of being around others, particularly in situations that
call for some kind of “performance” in front of other people. The fear often centers on a
worry of behaving in some embarrassing or humiliating way that may bring negative
judgment from others.
 One model for how people acquire SAD suggests that those with the condition may be
predisposed to be highly sensitive to negative messages from others, including anger,
rejection, and criticism. These signals may be perceived in subtle facial expressions,
contributing to the symptoms of the disorder.
What strategies are used to treat social anxiety disorder (social phobia)?
 Although the causes of SAD are similar to those of specific phobias, treatment has a different
focus that includes rehearsing or role-playing socially phobic situations. In addition, drug
treatments have been effective.
 Selective mutism is a condition now categorized as an anxiety disorder, and is closely related
to social anxiety disorder. It involves a lack of speech in situations where speaking is
expected, and has a high level of comorbidity with SAD, and the treatment is similar to that
of SAD with a greater emphasis on speech.
 Several disorders are also grouped under the heading Trauma- and Stressor-Related
Disorders.
TRAUMA- AND STRESSOR-RELATED DISORDERS
Posttraumatic Stress Disorder
What are the essential features and possible causes of posttraumatic stress disorder?
 Posttraumatic stress disorder (PTSD) focuses on avoiding thoughts or images of past
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traumatic experiences. It is diagnosed when the symptoms emerge more than one month after
the traumatic event, or if the symptoms persist for longer than one month. If the symptoms
occur within the first month, the diagnosis is acute stress disorder.
 The precipitating cause of PTSD is obvious—a traumatic experience. But mere exposure to
trauma is not enough. The intensity of the experience seems to be a factor in whether an
individual develops PTSD; biological vulnerabilities, as well as social and cultural factors,
appear to play a role as well.
What treatment approaches are available for posttraumatic stress disorder?
 Treatment involves reexposing the victim to the trauma and reestablishing a sense of safety
to overcome the debilitating effects of PTSD.
 DISCUSSION POINT:
What are some other challenges a therapist might confront when treating a client for
PTSD using imaginal exposure?
Possibilities include a tendency for the client to want to leave therapy, difficulty selecting
one event for exposure if the client has had a history of multiple traumas, difficulty getting
the client to engage emotionally with the memory, and an increase in anxiety symptoms in
early stages of the therapy.
Other Trauma- and Stressor-Related Disorders
 Other conditions that are included in trauma and stressor-related disorders are adjustment
disorders, attachment disorders, reactive attachment disorder, and disinhibited social
engagement disorder.
What are the origins of other trauma- and stressor-related disorders?
Adjustment Disorders
 Adjustment disorder is the development of anxiety or depression in response to stressful, but
not traumatic life events.
 Individuals prone to anxiety or depression generally may experience increases during
stressful life events.
Attachment Disorders
 Children experiencing inadequate, abusive, or absent caregiving in early childhood fail to
develop normal attachment relationships with caregivers, resulting in two different disorders.
 Reactive attachment disorder describes children who are inhibited and emotionally
withdrawn and unable to form attachment with caregivers.
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 Disinhibited social engagement disorder describes children who inappropriately approach all
strangers, behaving as if they had always had strong loving relationships with them.
 Several disorders are grouped under the heading of Obsessive-Compulsive and Related
Disorders.
OBSESSIVE-COMPULSIVE AND RELATED DISORDERS
Obsessive-Compulsive Disorder
What are the symptoms of obsessive-compulsive disorder?
 Obsessive-compulsive disorder (OCD) focuses on avoiding frightening or repulsive intrusive
thoughts (obsessions) or neutralizing these thoughts through the use of ritualistic behavior
(compulsions).
 As with all anxiety disorders, biological and psychological vulnerabilities seem to be
involved in the development of OCD.
How is obsessive-compulsive disorder treated?
 Drug treatment seems to be only modestly successful in treating OCD. The most effective
treatment approach is a psychological treatment called exposure and ritual prevention (ERP).
Medication has not been found to be superior to this intervention, either in terms of efficacy
or relapse prevention. In very severe cases of OCD that have not responded to other
interventions and are causing significant life interruption, psychosurgery may be considered
as a last resort.
Body Dysmorphic Disorder
What are the features of body dysmorphic disorder and how is it treated?
 In body dysmorphic disorder (BDD), a person who looks normal is obsessively preoccupied
with some imagined defect in appearance (imagined ugliness). It was previously considered a
somatoform disorder because of the focus on a “body” issue. However, more recently the
emphasis on the intrusive and repetitive preoccupations caused by the exaggerated or
imagined defect, as well as potential, accompanying repetitive behaviors, has caused BDD to
be placed in the obsessive-compulsive and related disorders category.
 Patients suffering from BDD often turn to plastic surgery or other medical interventions,
which more often than not increase their preoccupation and distress.
 Psychological treatment approaches are similar to those for OCD and approximately equally
successful.
 DISCUSSION POINT:
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How do cultural standards of beauty influence BDD? What other disorders share
similarity with BDD, and why might the suicide rate in this disorder be so high?
Other Obsessive-Compulsive and Related Disorders
What are the other obsessive-compulsive and related disorders and how are they treated?
 Hoarding disorder is marked by a compulsive tendency to collect objects – often of no
sentimental or material value – and to have tremendous difficulty with discarding any
possession, as well as living with excessive clutter and disorganization, often to dangerous
extremes.
 Hoarding disorder was previously thought of as an extreme variation of OCD, but has
recently been separated into its own diagnosis. Treatments may involve encouraging people
to assign numerical values to specific objects, followed by discarding those that fall below a
specific value. This can help to reduce anxiety that something truly important will be thrown
away.
 Trichotillomania (hair pulling disorder) involves pulling out one’s own hair from anywhere
on the body, including the head, eyebrows, arms, or other locations. It can lead to great
embarrassment as a result of appearance-related issues, along with one going to great lengths
to cover up the actions. Research suggests that there may be a genetic mutation that explains
many cases of this disorder.
 Excoriation (skin picking disorder) is repetitive and compulsive picking on or at one’s skin,
which can lead to bruises, scabbing, scarring, and damage.
 Both trichotillomania and excoriation were previously labeled as impulse-control disorders.
However, their high rates of comorbidity with OCD, BDD, and each other, as well as their
inclusion of repetitive and compulsive behaviors, have caused them to be recategorized in
DSM-5. Psychological treatments seem to be the most useful for bringing about improvement
in both disorders.
KEY TERMS
anxiety, 115
fear, 116
panic, 116
panic attack, 116
behavioral inhibition system (BIS), 118
fight/flight system (FFS), 118
generalized anxiety disorder (GAD), 121
panic disorder (PD), 125
agoraphobia, 125
panic control treatment (PCT), 131
specific phobia, 133
blood-injection-injury phobia, 134
situational phobia, 134
natural environment phobia, 134
animal phobia, 135
separation anxiety disorder, 138
social anxiety disorder (social phobia), 139
selective mutism disorder, 143
trauma- and stressor-related disorders, 144
posttraumatic stress disorder (PTSD), 144
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acute stress disorder, 145
adjustment disorders, 150
attachment disorders, 151
reactive attachment disorder, 151
disinhibited social engagement disorder, 151
obsessive-compulsive disorder (OCD), 152
obsessions, 152
compulsions, 152
body dysmorphic disorder (BDD), 156
trichotillomania, 161
excoriation, 161
IDEAS FOR INSTRUCTION
1.
Activity: Preparedness and the Pathways to Phobic Fear Acquisition. Objects of
phobic fear are nonrandomly distributed to objects or situations that were threatening to
the survival of the species throughout the course of evolution. This evolutionary
perspective is described under the concept of preparedness. That is, we are prepared to
more readily associate fear with some objects or situations (e.g., snakes, heights) than
others (e.g., pajamas, electrical outlets), even though both may be associated with panic
or trauma. Moreover, we know that fears may be acquired via direct conditioning or
indirectly through observational learning or information transmission. To illustrate both
concepts, have students write down an object or situation that they are particularly afraid
of, including what event(s) they think led to the development of this top fear. Then,
collect the sheets and categorize and tally the lists (or a representative sample thereof,
particularly for large classes) on the board or via a projector. What you should find is that
most students report fearing objects or situations that have some prepared evolutionary
basis. You should also be able to illustrate that few student can recall actual direct
conditioning events to explain how their fears developed and that many may simply say
“I can’t remember how my fear started.” This exercise is a good springboard to a
discussion of the nature and etiology of phobias, including the relation between phobias
and impairment in life functioning.
2.
Activity: Demonstrating What Panic Attacks Are Like. This exercise is designed to
help students appreciate what it might be like to have breathing difficulties and other
autonomic symptoms associated with a panic attack. You will need 4" coffee-stirring
straws with a tiny lumen (obtained from restaurants, grocery stores, or your campus food
court/cafeteria). Before beginning this exercise, inform students that this activity may lead
to shortness of breath and may not be appropriate for those with respiratory difficulties
due to colds, asthma, or other problems. Also inform students that this exercise is entirely
voluntary, though participation is encouraged. Distribute one straw to each student. While
seated, students should practice breathing only through the straw. They should avoid
breathing through their noses or around the straw. Have students stand and, while
continuing to breathe only through the straw, run in place for five minutes. Discuss the
students’ experiences after running. Many find they become so short of breath they cannot
continue to exercise as designed. Many will also report feeling light-headed, dizzy, tingly,
and some may experience increased perspiration. Explore what it might be like to
experience shortness of breath and the related sensations, particularly out of the blue in the
course of their daily routine (e.g., going to class, when out on a date, at the library, a party,
a movie, driving in a car, to name a few). Could they imagine how a panic attack might
66
follow or coincide with the experience of these kinds of physical symptoms? Finally, it is
important to have students understand that panic attacks are often very sudden events and
that their physical and psychological experience at the end of the straw exercise would
happen much more abruptly during an actual panic attack. I often illustrate the concept of
abruptness by asking students whether they have ever been pulled over for speeding.
Many students will report yes. I then ask them to imagine how they felt when they looked
into their rear-view mirror and saw flashing blue lights and a police car riding their tail.
Most report feeling gripped by fear, including a sinking feeling in the stomach,
nervousness, and the like. The immediacy of this reaction is analogous to a panic attack.
3.
Activity: Demonstration of Graduated Exposure for Phobias or Panic. Students often
appreciate being able to see what treatment might look like. Devise a hypothetical
hierarchy of exposure for a common specific phobia or for panic disorder. Then, ask for a
student volunteer and demonstrate how you would proceed to conduct exposure therapy
including the therapist-client issues you would consider as you move up the rungs of the
fear hierarchy.
4.
Activity: Narrative Therapy and Exposure for PTSD. Students often have a difficult
time understanding why one would want to have a patient suffering from PTSD relive
memories and emotions associated with their trauma in therapy. Ask students to think
about something moderately upsetting that happened in the past month. Stress that you do
not want them to select an actual trauma, but instead pick an event that they have thought
about and that they feel is not completely resolved in their minds. Have the students write
about this event for 10 minutes, describing it in detail, including their reactions, thoughts,
and feelings. Do not have the students turn it in, but have them discuss if the experience of
writing changed their perception of the event.
5.
Activity: Student Debate on the Efficacy of Medications vs. Psychological
Interventions in the Treatment of Anxiety-Related Disorders. Have students select an
anxiety disorder of interest. Then, for each anxiety disorder, have students divide into
debate teams. One team is to take a pro-medication perspective for a particular anxiety
disorder and the other a pro-psychotherapy perspective. Have the respective teams go to
the library and research the evidence and arguments favoring their positions. During class,
follow discussion of each anxiety disorder with the corresponding debate. For example,
after you cover panic disorder, have the debate teams present their cases for either drug
treatment or psychotherapy. Use the debate as a springboard for class discussion about the
current state of the art regarding treatment efficacy, including how taking a one-sided
position can be problematic when devising treatment.
6. Systematic Desensitization. Systematic desensitization is a technique used to treat
phobias and other extreme or erroneous fears based on principles of behavior
modification. Develop a lecture on this topic using the information at
http://www.minddisorders.com/Py-Z/Systematic-desensitization.html as a basis of your
classroom discussion. Show this short video on virtual reality and systematic
desensitization http://www.youtube.com/watch?v=CQgKEp_NhHk.
67
7. Anxiety Disorders and the DSM-5. Develop a lecture on the changes that have taken
place in DSM-5 and how they affect our understanding and diagnoses of anxiety
disorders.
SUPPLEMENTARY READING MATERIAL
Additional Readings:
Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the
perspective of emotion theory. American Psychologist, 55, 1247-1263.
Barlow, D. H. (2001). Anxiety and its disorders: The nature and treatment of anxiety and
panic, 2nd ed. New York: Guilford.
Barlow, D. H., Brown, T. A., & Craske, M. G. (1994). Definitions of panic attacks and
panic disorder in the DSM-IV: Implications for research. Journal of Abnormal
Psychology, 103, 553-564.
Bouton, M. E., Mineka, S., & Barlow, D. H. (2001). A modern learning theory
perspective on the etiology of panic disorder. Psychological Review, 108, 4-32.
Clark, D. M (1988). A cognitive model of panic attacks. In S. Rachman & J. D. Maser
(Eds.), Panic: Psychological perspectives. Hillsdale, NJ: Lawrence Erlbaum, 71-89.
McNally, R. J. (1987). Preparedness and phobias: A review. Psychological Bulletin, 100,
283-303.
Clipson, C. & Steer, J. (1998). Case studies in abnormal psychology. Boston, MA:
Houghton Mifflin Company. Chapter 2, Panic Disorder. Chapter 3, ObsessiveCompulsive Disorder. Chapter 4, Posttraumatic Stress Disorder.
Craske, M. G. (2003). The origins of phobias and anxiety disorders: Why more women
than men? Amsterdam: Elsevier.
Craske, M. G., & Barlow, D. H. (2000). Mastery of your anxiety and panic, 3rd ed. New
York: The Psychological Corporation.
Eisen, A. R., Kearney, C. A., & Schaefer, C. E. (Eds.) (1995). Clinical handbook of
anxiety disorders in children and adolescents. Northvale, NJ: Jason Aronson.
McCann, I. L., & Pearlman, L. A. (1990). Psychological trauma and the adult survivor:
Theory, therapy and transformation. New York: Brunner/Mazel.
68
Neal, A., & Turner, S. M. (1991). Anxiety disorder research with African-Americans:
Current status. Psychological Bulletin, 109, 400-410.
Phillips, K. A. (1991). Body dysmorphic disorder: The distress of imagined ugliness.
American Journal of Psychiatry, 148, 1138-1149.
Pynoos, R. S., Frederick, C., Nader, K., Arroyo, W., Steinberg, A., Eth, S., Nunez, F., &
Fairbanks, L. (1987). Life threat and posttraumatic stress in school age children. Archives
of General Psychiatry, 44, 1057-1063.
Turner, S. M., Beidel, D. C., & Nathan, R. S. (1985). Biological factors in
obsessive-compulsive disorders. Psychological Bulletin, 97, 430-450.
Sattler, D., Shabatay, V., & Kramer, G. (1998). Abnormal psychology in context: Voices
and perspectives. Boston, MA: Houghton Mifflin Company. Chapter 1, Anxiety
Disorder.
Steketee, G. S. (1996). Treatment of obsessive-compulsive disorder. New York:
Guilford.
Tuma, A. H., & Maser, J. D. (Eds.) (1985). Anxiety and the anxiety disorders. Hillsdale,
NJ: Erlbaum.
Walker, J. R., Norton, G. R., & Ross, C. A. (Eds.) (1991). Panic disorder and
agoraphobia: A comprehensive guide for the practitioner. Pacific Grove, CA:
Brooks/Cole.
SUGGESTED VIDEOS
Abnormal psychology Inside/Out. (Available through your Cengage Learning
representative). Steve reported his first panic attack while driving at the age of 39. At the time,
he thought it was a heart attack and felt many of the typical symptoms associated with an attack.
He also describes nocturnal panic attacks and has experienced at least 6 months of depression.
Steve’s panic attacks resulted in agoraphobic tendencies to avoid certain situations, including
fear of heights. (3 min)
The case of Chuck, diagnosed with obsessive-compulsive disorder, illustrates constant
checking and intruding thoughts. He has a long history of depression, and the OCD and
depression have coexisted since he was a child. When questioned about his current state of
depression, he humorously states that seven years of drugs and psychotherapy have helped. (13
min)
Katherine A. Phillips of Brown University interviews one of her clients suffering from
body dysmorphic disorder to show the nature of the disorder, its symptoms, and the devastating
impact it had on his life—his marriage, his work, and his family relationships.
69
As Good As It Gets. Jack Nicholson portrays a homophobic, racist novelist with
obsessive-compulsive disorder.
Born on the fourth of July. Tom Cruise depicts a paralyzed Vietnam veteran coping with
re-integration into post-war life. The film has particularly compelling scenes of VA hospitals
during that time.
Chattahoochee. Korean War veteran with posttraumatic stress disorder is hospitalized and
treated. Dennis Hopper plays a major role as a fellow patient.
Cognitive therapy for panic disorder. (APA Psychotherapy Videotape Series II: Specific
Treatments for Specific Problems, American Psychological Association). This video illustrates
the process of cognitive therapy for panic disorder. (45 min)
Copycat. Sigourney Weaver stars as criminal psychologist Helen Hudson who is involved
in unlocking the psyches of her previous client (an incurable psychotic who almost murdered
her). Now she’s an agoraphobic, living a terrified existence defined by the walls of her
apartment, with her computer modem and her loyal and compassionate assistant, Andy, her only
links to the outside world. This film provides an excellent depiction of extreme agoraphobia.
Cyrano de Bergerac. This film depicts Cyrano, a man obsessed with the size of his nose
and who is convinced that he is forever unlovable because of this presumed defect.
Extending the boundaries of treatment for panic. (Insight Media). This video explains the
clinical goals of treatment of panic disorder, including the alleviation of attacks and relief of such
symptoms as agoraphobia, anticipatory anxiety, phobic avoidance, and effective treatment
strategies. It assesses the relative benefits of pharmacotherapy, cognitive-behavioral therapy, and
combined regimens. (90 min)
Fear and anxiety. (Films for the Humanities and Sciences). In this program, expert
panelists discuss symptoms of anxiety disorders, how anxiety impacts everyday life, the
relationship between fear and emotional memory, and new developments in treatment. (56 min)
Fear itself: Agoraphobia. (Films for the Humanities and Sciences). Explores the organic
causes of phobias as well as possible treatments, focusing on agoraphobia. (26 min)
Obsessive-compulsive disorder: The boy who couldn’t stop washing. (Films for the
Humanities and Sciences). Adapted Phil Donahue show with Dr. Judith Rapport, author of the
book by the same title. Considers symptoms, diagnosis, and possible cures of OCD. (28 min)
Panic attacks. (Films for the Humanities and Sciences, Princeton). Covers the diagnosis
and treatment of panic attacks and related disorders. (15 min)
Posttraumatic stress disorder (Films for the Humanities and Sciences).
70
Roxanne. This film is a modern adaptation of Cyrano de Bergerac starring Steve Martin
and Darryl Hannah.
Things that go bump: Facing our fears. (Prime Post). This multi-part series that aired on
the Discovery Health Channel covers the etiology and treatment of specific phobias, social
phobia, and panic disorder.
Treatment and assessment of childhood depression and anxiety. (Insight Media). Focusing
on the broadening pharmacological treatment options for childhood depression and anxiety
disorders, this video examines diagnostic criteria, epidemiology, and known neurobiological
factors. It also discusses separation anxiety disorder, selective mutism, posttraumatic stress
disorder, and generalized anxiety disorder. (120 min)
ONLINE RESOURCES
Agoraphobia
http://www.mentalhealth.com/home/dx/agoraphobia.html
Provides a description of agoraphobia and a set of related links.
Anxiety and Depression Association of America (ADAA)
http://www.adaa.org/
This is the official website of the Anxiety and Depression Association of America
(ADAA). The ADAA promotes the prevention and cure of anxiety disorders and depression and
works to improve the lives of all people who suffer from them.
Generalized Anxiety Disorder
http://www.mentalhealth.com/home/dx/generalizedanxiety.html
This page provides information specific to generalized anxiety disorder, including
treatments, research references, books, magazine articles, and other related links.
Mental Help Net
http://www.mentalhelp.net/
This site may be the largest mental health site on the Internet. Includes links to other
mental health-related sites, an online magazine for self-help organizations, plus a directory for
therapists.
International Obsessive-Compulsive Disorder Foundation (IOCDF)
http://www.ocfoundation.org/
This web page, developed by the International Obsessive-Compulsive Disorder
Foundation and the Mend Association, includes information on support groups, services, and
publications on this disorder.
The Phobia List
http://phobialist.com/
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This site provides a comprehensive list of the names of all phobias, including additional
links to other phobia sites.
The National Center for PTSD
http://www.ptsd.va.gov/
This website provides a wealth of information about PTSD, including current research and
available treatments.
Anxiety Disorder
http://algy.com/anxiety/wordpress/
An anxiety panic Internet resource.
NIMH
http://www.nimh.nih.gov
The National Institute of Mental Health homepage, which offers information about
diagnosis, treatment, and research into anxiety disorders, obsessive-compulsive disorder, and
phobias.
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WARNING SIGNS
FOR GENERALIZED ANXIETY DISORDER
 Continuous worry about major and minor events without just cause
 Headaches and other aches and pains for no apparent reason
 Constant bodily tension, feelings of fatigue, and difficulty relaxing
 Difficulty focusing on one thing or task at a time
 Frequent irritability (i.e., getting crabby or grouchy)
 Trouble falling asleep or staying asleep
 Experience excessive sweatiness or hot flashes
 Feeling of having a lump in throat or feeling the need to vomit when worried
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WARNING SIGNS
FOR PANIC DISORDER
 Repeated experience of sudden bursts of fear for no reason
 Experience of chest pains or a racing heart
 Feeling dizzy, difficulty breathing, or experiencing excessive sweating
 Frequent stomach problems and the feeling to vomit
 Shaking, trembling, or tingling sensations
 Feeling out of control
 Feeling that one’s reactions are unreal
 Fear of dying or going crazy
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WARNING SIGNS
FOR SPECIFIC PHOBIAS
 Feelings of panic, dread, horror, or terror in response to thoughts, images, or
exposure to a specific object or situation (e.g., snakes, heights, planes)
 Recognition that the fear goes beyond normal boundaries and the actual
threat of danger
 Reactions that are automatic and uncontrollable, practically taking over the
person’s thoughts
 Rapid heartbeat, shortness of breath, trembling, and an overwhelming desire
to flee the situation—all the physical reactions associated with extreme fear
 Extreme measures taken to avoid the feared object or situation
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WARNING SIGNS
FOR SEPARATION ANXIETY DISORDER
 Child feels unsafe staying in a room by him/herself
 Child displays clinging behavior
 Child displays excessive worry and fear about parents or about harm to
him/herself
 Child shadows the mother or father around the house
 Child has difficulty going to sleep
 Child has frequent nightmares
 Child has exaggerated, unrealistic fears of animals, monsters, burglars, fear
of being alone in the dark, or severe tantrums when forced to go to school
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WARNING SIGNS
FOR SOCIAL ANXIETY DISODER
(SOCIAL PHOBIA)
 Feeling afraid or uncomfortable around other people
 Difficulty being in situations where other people are involved
 Intense fear of embarrassment
 Constant fear of making a mistake and being watched and judged by others
 Fear of embarrassment results in avoidance of important social activities
 Excessive worry about upcoming social situations
 Frequent blushing, sweating, trembling, or nausea before or after a social
event
 Avoidance of social situations (e.g., school events, making speeches)
 Consumption of alcohol as a means to reduce such social fears
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WARNING SIGNS
FOR POSTTRAUMATIC STRESS DISORDER
 Recurring thoughts or nightmares about the event
 Having trouble sleeping or changes in appetite
 Experiencing anxiety and fear, especially when exposed to events or
situations reminiscent of the trauma
 Being on edge, being easily startled, or becoming overly alert
 Feeling depressed, sad, and having low energy
 Experiencing memory problems including difficulty in remembering aspects
of the trauma
 Feeling “scattered” and unable to focus on work or daily activities
 Having difficulty making decisions
 Feeling irritable, easily agitated, or angry and resentful
 Feeling emotionally numb, withdrawn, disconnected, or different from
others
 Spontaneously crying; feeling a sense of despair and hopelessness
 Feeling extremely protective of, or fearful for, the safety of loved ones
 Not being able to face certain aspects of the trauma, and avoiding activities,
places, or even people that remind you of the event
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WARNING SIGNS
FOR OBSESSIVE-COMPULSIVE DISORDER
 Feeling of being trapped in a pattern of unwanted and upsetting thoughts
 Feeling a need to repeat thoughts/behaviors over and over for no good
reason
 Upsetting thoughts or images repeatedly enter one’s mind
 Feeling an inability to stop thoughts or images
 Difficulty stopping oneself from doing things again and again (e.g.,
counting, checking on things, washing hands, re-arranging objects, doing
things until it feels right, collecting useless objects)
 Excessive worry that terrible things will happen if not careful
 Fear that one will harm someone one cares about
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WARNING SIGNS
FOR BODY DYSMORPHIC DISORDER
 Constant and excessive use or avoidance of mirrors
 Spending lots of time (i.e., 1+ hours) grooming every day
 Attempts to hide parts of body that one does not like
 Experience of distress over performing grooming rituals that one feels
compelled to do
 Constant seeking of reassurance about looks and subsequent discounting of
the feedback
 Anxiety or depression about one’s appearance
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