Download 11-3-anxiety_disorders

WHS AP Psychology
Unit 11: Mental Illness and Therapies
Essential Task 11-3:Discuss the major diagnostic
category of anxiety disorders with specific attention
to the diagnoses of panic disorder, agoraphobia,
social phobia, specific phobias, OCD, GAD and PTSD,
detail the defining symptoms of each and identify the
best approach(es) for explaining the cause(es) of
each.
Mood
Disorders
Personality
Disorders
Unit 11
Anxiety
Disorders
Abnormal
Psych:
Disorders
Schizophrenia
History,
DSM
Somatoform
Disorders
Childhood
Disorders
Dissociative
Disorders
Electroconvulsive
Therapy
We are
here
Psychosurgery
Psychoanalysis
Biological
Insight
Therapies
Treatments
ClientCentered
Gestalt
Unit 11:
Treatment of
Psychological
Disorders
Antipsychotic
Drugs
Behavior
Token
Economy
Therapies
Stress
Inoculation
Cognitive
Therapies
Beck’s
Cognitive
Therapy
Rational
Emotive
Therapy
Aversion
Therapy
Classical
Systematic
Desensitization
Flooding
Operant
Behavior
Contracting
Anxiety Disorders
Panic Disorder
Agoraphobia
Social Phobia
Specific Phobia
Obsessive Compulsive Disorder
Generalized Anxiety Disorder
(PTSD & Acute Stress Disorder)
Panic Attack (not a diagnosis)
A. Discrete period of intense fear or discomfort, in which
4 or more of the following develop abruptly and reach
a peak within 10 minutes
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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
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
Some help…
Panic Attacks
NO
NO
Agoraphobia
YES
YES
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
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
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
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
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
Subtypes of Specific Phobia
• Animal type
• Natural environment type
• Blood-Injection-Injury type
• Situational type
• Other type
Phobia
Marked by a persistent and irrational fear of an
object or situation that disrupts behavior.
Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Hemophobia
Phobia of open places.
Phobia of heights.
Phobia of closed spaces.
Phobia of blood.
Don’t concept map this
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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
Good Question…
If phobias are learned behaviors,
why don’t they extinguish on their own???
Answer to the Good Question…
• Avoidance works!
• Fear is never tested
Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions) and
urges to engage in senseless rituals (compulsions) that
cause distress.
Obsessive-Compulsive Disorder
A. Either obsessions or compulsions:
Obsessions as defined by 1, 2, 3, and 4
1. 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
2. The thoughts, impulses, or images are not simply
excessive worries about real-life problems
3. The person attempts to ignore or suppress such
thoughts, impulses, or images or tries to
neutralize them with some other thought or
action
4. The person recognizes that the obsessional
thoughts, impulses, or images are a product of his
or her own mind
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
Obsessive-Compulsive Disorder
Compulsions as defined by 1 and 2
1. 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
2. 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
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.
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
OCD in Children
• Children have an average of 4
obsessions and 4 compulsions at any
given time
• Often comorbid with Tourette’s
syndrome and/or ADHD
Generalized Anxiety Disorder (GAD)
A. Excessive anxiety and worry occurring more days
than not for at least 6 months, about a number of
events
B. The person finds it difficult to control the worry
C. The anxiety and worry are associated with 3 or more
of the following symptoms
1.
2.
3.
4.
5.
6.
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep Disturbance
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
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
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.
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.
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
Anxiety Disorders
Cultural 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
Dhat (India), Jiryan (India), Sukra Prameha (Sri
Lanka), & Shen-k’uei (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 one’s vital
essence and can thereby be life threatening
Koro (South and Southeast Asia)
• Sudden and intense anxiety that one’s
genitalia will recede into the body and
possibly cause death
• Can occur in epidemics
Taijin Kyofusho (Japan)
• An intense fear that one’s body, its
parts, or its functions (sweating, body
odor, facial expressions, etc.)
displease, embarrass, or are offensive
to other people
• Similar to the DSM’s Social Phobia
Explaining Anxiety Disorders
Freud suggested that we repress our painful and
intolerable ideas, feelings, and thoughts, resulting
in anxiety.
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
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.
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.
The Biological Perspective
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.
Generalized
anxiety, panic
attacks, and even
OCD are linked
with brain circuits
like the anterior
cingulate cortex.
Anterior Cingulate Cortex
of an OCD patient.
Panic Disorder
• What Causes Panic Disorder?
– We don’t really know; many factors.
• But: Strong evidence that
norepinephrine is involved.
• Norepinephrine: neurotransmitter
especially active in Locus ceruleus part
of the brain.
Models of Abnormality
Biological model: Anatomy (structures)
Neo-Cortex
Corpus
callosum
Amygdala
Locus
ceruleus
(Pons)
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
Obsessive-Compulsive Disorder
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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?
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
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
Caudate nucleus
Orbital
frontal
cortex