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The DSM-IV Anxiety Disorders
Panic Disorder with/without Agoraphobia
Specific Phobia
Social Phobia
Obsessive Compulsive Disorder (OCD)
Generalized Anxiety Disorder (GAD)
Post Traumatic Stress Disorder (PTSD)
Criteria for a Panic Attack
Discrete period of intense fear/discomfort in which at least 4 symptoms
developed abruptly and reached a peak within 10 minutes
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palpitations, pounding/racing heart
sweating
trembling/shaking
shortness of breath/smothering sensations
feeling of choking
chest pain/discomfort
nausea or abdominal distress
feeling dizzy, unsteady, faint or lightheaded
derealization or depersonalization
fear of losing control or going crazy
fear of dying
paresthesias (numbness or tingling sensations)
chills or hot flushes
Panic Disorder
• recurrent, unexpected panic attacks
• AND one month of concern about additional attacks
• OR... worry about the implications of the attack or its
consequences
• OR... a significant change in behaviour related to the
attacks
Agoraphobia
• anxiety about being in places/situations from which
escape might be difficult or embarrassing in the event of a
panic attack
• situations are avoided or endured with marked distress or
anxiety about having a panic attack OR require the
presence of a companion
Specific Phobia
• marked and persistent fear that is excessive or
unreasonable, cued by a specific object or situation
• exposure to the phobic stimulus almost invariably provokes
an immediate anxiety response (e.g., a panic attack)
• phobic situation/object is avoided or endured with intense
anxiety and distress
Specific Phobia - Types
1. Animal
2. Natural Environment (e.g., heights, water)
3. Blood-Injection-Injury Type
4. Situational (e.g., planes, elevators, driving)
5. Other (e.g., choking, vomiting)
Social Phobia
• marked and persistent fear of social or performance
situations
• situations involve exposure to unfamiliar people or to
possible evaluation by others
• individual fears that he/she may do something
humiliating or embarrassing.
Obsessive-Compulsive Disorder
• recurrent and persistent obsessions and/or
compulsions
• symptoms cause marked distress
• time consuming (more than 1 hour/day)
• interfere significantly with person’s normal routine
OBSESSIONS
• persistent and intrusive thoughts, impulses, images
• inappropriate, cause marked anxiety or distress
• person usually attempts to ignore or suppress them
• ...OR neutralize them with some other thought or action
COMPULSIONS
• repetitive behaviors or mental acts
• performed to prevent or reduce anxiety/distress, not to
provide pleasure or gratification
Mood Disorders
Lifetime prevalence rates of
depressive disorders:
13% men
25% women
Lifetime prevalence rates of bipolar
disorders:
less than 1% for men and women
15% complete suicide
DSM-IV Mood Disorders
Mood Disorders
Unipolar Depression
Major Depressive Disorder
Dysthymic Disorder
Bipolar Disorder
Bipolar I Disorder
Bipolar II Disorder
Cyclothymia
Mood Episodes
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Major Depressive Episode
Manic Episode
Hypomanic Episode
Mixed Episode
1. Major Depressive Episode
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Depressed mood
Loss of interest (anhedonia)
Significant weight loss or gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Worthlessness or guilt
Diminished ability to concentrate, indecisiveness
2. Manic Episode
- Abnormally and persistently elevated, expansive,
or irritable mood
- Inflated self-esteem and grandiosity
- Requiring very little sleep
- Talkativeness
- Flight of ideas
- Distractibiltiy
- Psychomotor agitation
- Buying sprees, sexual indiscretions, foolish
business investments
3. Hypomanic Episode
Symptoms are milder than a Manic Episode
• Less intense and last at least four days
4. Mixed Episode
Both a Major Depressive Episode and a
Manic Episode nearly everyday for at least
a one week period
Major Depressive Disorder
• One or more Major Depressive Episodes
• No history of Manic, Hypomanic or Mixed
Episodes
Dysthymic Disorder
• Less severe but more chronic than Major
Depressive Disorder
• Symptoms are milder but remain unchanged over
long periods of time
Bipolar I Disorder
• One or more Manic or Mixed Episodes
• Often individuals have also had one or more
Major Depressive Episodes
Bipolar II Disorder
• Presence (or history) of one or more Major
Depressive Episodes
• Presence (or history) of at least one
Hypomanic Episode
• There has never been a Manic Episode or a
Mixed Episode
Cyclothymic Disorder
• Less severe but more chronic than Bipolar
Disorder
• Symptoms of hypomania and depression are
milder but remain unchanged over long
periods of time
DSM-IV Specifiers
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Chronic
Psychotic
Melancholic
Atypical
Catatonic
Postpartum Onset
Seasonal Pattern
Rapid Cycling Pattern
Eating Disorders
• Females 10 x more likely to develop an eating
disorder
• Around 5% of young women will develop an
eating disorder
• Course and outcome of eating disorders is highly
variable
• Eating disorders are associated with serious
complications, and have the highest mortality rate
DSM-IV Diagnostic criteria for
Anorexia Nervosa
A. Low body weight
B. Fear of gaining weight or becoming fat
C. Weight-related self-evaluation, or denial
of the seriousness of the low body weight
D. Amenorrhea
RESTRICTING TYPE
BINGE EATING/PURGING TYPE
DSM-IV: Diagnostic criteria for
Bulimia Nervosa
A. Binge eating
B. Inappropriate compensatory behavior
C. Both occur, at least 2/ week for 3 months
D. Weight-related self-evaluation
PURGING TYPE
NON PURGING TYPE
Physical Complications
• Menstrual
Dysfunction
• Hypothermia
• Hypotension
• Tiredness, Lethargy
• Headaches
• Hair Loss
• Dental Problems
• Electrolyte
Abnormalities
• Parathesias
• Acute Gastric Dilation
• Delayed Gastric
Emptying
• Constipation
• Swollen salivary gland
• Kidney Dysfunction
Psychological Complications
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Depression
Anxiety
Mood swings
Food Preoccupation
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Social Isolation
Sleep Disturbances
Self-Esteem Deficits
Impulsive Behaviors
Schizophrenia
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Delusions and Irrational thought
Deterioration of Adaptive Behaviors
Hallucinations
Disturbed Emotion
Paranoid, Catatonic, Disorganized,
Undifferentiated
• Positive vs. Negative symptoms
• Chronic, resistant to treatment