Download Anxiety and Somatoform Disorders

Adapted from an outline © 2009 American Psychological Association
Anxiety Disorders
 A. A diagnosis of anxiety disorder occurs when
overwhelming anxiety disrupts social or occupational
functioning or produces significant distress.
 Taylor Manifest Anxiety Scale
Anxiety Disorders
 B. Manifestations of anxiety
 1. Cognitive: Thought processes range from generalized
worry to overwhelming fear and often focus on various
possibilities of impending doom.
 2. Behavioral: The avoidance of an anxiety-provoking
situation may be practiced. For example, persons may be
unwilling to leave home.
 3. Somatic: Numerous physiological complaints are
experienced due to activation of the sympathetic nervous
system. Examples include stomach aches, headaches,
shakiness, and so forth.
Specific anxiety disorders
 A. Panic disorder
 1. Recurrent and unexpected panic attacks are severe
and involve feelings of terror and physiological
involvement, such as a pounding heart and difficulty
breathing.
 2. These attacks lead to concern about future attacks or
losing control, which may result in the individual
being fearful of having a panic attack in public or of
leaving home.
Specific anxiety disorders
 B. Generalized anxiety disorder
 1. This is characterized by persistent high levels of
anxiety and excessive worry with symptoms present for
at least six months.
 2. The physiological responses are similar to, although
not as severe as, those experienced in panic disorder,
but they are more persistent.
Specific anxiety disorders
 C. Phobia
 1. A persistent, irrational, unrealistic fear of specific objects or
situations.
 2. Exposure to a feared stimulus produces intense fear or panic.
The anxiety dissipates when the phobic situation is not being
confronted.
 3. Three subcategories include:
 a) Simple phobias, such as fear of closed spaces (claustrophobia) or
spiders (arachnophobia).
 b) Agoraphobia, which is the irrational fear of open spaces, leading
to a fear of leaving home or other safe havens.
 c) Social phobias involving social situations, such as public
speaking.
Specific anxiety disorders
 D. Obsessive-compulsive disorder (OCD)
 1. This involves both patterns of obsessions (thoughts,
images, or impulses that recur or persist despite a person’s
efforts to suppress them) and compulsions (repetitive,
purposeful, but undesired acts performed in a ritualized
manner in response to an obsession).
 2. Persons with the disorder acknowledge the senselessness
of their behavior; however, when anxiety rises, the
ritualized behavior to relieve the tension cannot be
resisted.
Added in the DSM-V
Trauma and stressor-related disorders
A. Posttraumatic stress disorder:
 A maladaptive reaction to actual or threatened death,
serious injury, or sexual violence characterized by
problems such as recurrent intrusive memories of the
event, flashbacks, fear of stimuli associated with the
event, negative changes in mood and ability to
concentrate, irritability, and feelings of detachment
Trauma and stressor-related disorders
B. Adjustment disorder:
 A person’s development of emotional or behavioral
problems within 3 months after experiencing a stressful
event
Causes of trauma and stress-related
disorders
A. Psychological: Negative appraisals, fatalistic beliefs,
apprehension, early childhood traumas, lack of
social support, poor coping skills, low efficacy,
limited self-capacities
B. Biological: Abnormal activity of cortisol and
norepinephrine; abnormal activity in a circuit
involving the hypothalamus and amygdala
Explaining anxiety disorders
 A. The learning perspective
 1. Generalized anxiety has been linked with a classical
conditioning of fear and the attendant stimulus.
 2. Avoidance relieves fear through negative
reinforcement.
Explaining anxiety disorders
 B. The cognitive perspective
 1. Observational learning can produce fear which
results in anxiety.
 2. For example, if a parent fears dogs, the child may
learn this fear through observation.
Explaining anxiety disorders
 C. The biological perspective
 1. Fears that represent age-old threats, such as heights
or spiders, may have contributed to our survival and
have an evolutionary basis.
 2. Some people are genetically predisposed to fears and
high anxiety. These disorders tend to run in families.
Explaining anxiety disorders
 D. The biopsychosocial perspective views anxiety as
having a biological involvement and learning
component, both of which are influenced by culture.
Somatoform Disorders
 A. These disorders are characterized by complaints of
physical symptoms that have no organic or
physiological explanation-they are psychologically
based.
 The symptoms are not considered voluntary or under
conscious control.
Specific somatoform disorders
 1. Somatization disorder is characterized by multiple
physical complaints with no organic explanation and an
onset before age 30.
 2. Conversion disorder is characterized by a specific
physical complaint, such as paralysis of the legs, or
blindness. Patients strongly believe there is impairment,
but may show less distress than with a real loss.
 3. Hypochondriasis is characterized by persistent
preoccupation with one's health and physical condition,
despite the fact that genuine symptoms of a disorder are
lacking.
Explaining somatoform disorders
 A. These disorders now constitute only 5% of all disorders
treated. Decreasing incidence seems linked to our growing
understanding of physiological and psychological
disorders.
 B. The behavioral perspective suggests that avoidance
behavior (becoming ill to avoid or reduce anxiety-arousing
stress) is reinforced in two ways:
 1. Anxiety is reduced.
 2. There are interpersonal gains in terms of sympathy and
support.