Download Anxiety Disorders

Anxiety Disorders, Obsessive
Compulsive Disorders and Post
Traumatic Stress Disorder
Anxiety Disorders
Anxiety disorders→ a class
of disorders marked by
feelings of excessive
apprehension and anxiety;
characterized by distressing,
persistent anxiety or
maladaptive behaviors that
reduce anxiety
Generalized Anxiety Disorders

Generalized anxiety disorder→
disorder marked by a chronic, high level of
anxiety that is not tied to any specific
threat
– Sometimes called “free-floating anxiety”
because it is nonspecific
– People with this disorder worry about almost
everything- In particular, they worry about
minor matters related to family, finances,
work and personal illness
– Are often jittery, agitated and sleep deprived
– Often dread decisions and brood over them endlessly
– Anxiety is commonly accompanied by physical
symptoms, such as trembling, muscle tension,
diarrhea, dizziness, faintness, sweating, and heart
palpitations.
– Tends to have a gradual onset
– Seen more frequently in females than in males
Specific Phobias

Specific phobia→ marked by a persistent and
irrational fear of an object or situation that
presents no realistic danger; irrational fear
causes the person to avoid some object activity
or situation
– People are said to have phobic disorder only when
their fears seriously interfere with their everyday
behavior
– Phobic reactions are typically accompanied by
physical symptoms of anxiety, such as trembling and
palpitations
– Phobias are irrational fears that disrupt behavior
– People can develop phobias to almost anything
– Some specific phobias are incapacitating
– Common phobias include fear of flying,
heights, animals (e.g. spiders, dogs, insects),
receiving an injection, seeing blood
– Social anxiety disorder→ a marked and persistent fear
of social or performance situations in which
embarrassment may occur; involves and intense fear of
being scrutinized by others and an avoidance of
potentially embarrassing social situations, such as
speaking up, eating out, or going to parties (or may
sweat and tremble when doing so)
 Exposure to the social or performance situation almost
invariably provokes an immediate anxiety response
 The anxious person will avoid potentially
embarrassing social situations
 Shyness taken to a really far
extreme.
Agoraphobia

Agorophobia→ fear or avoidance of
situations in which escape might be
difficult or help unavailable when panic
strikes; often involves a fear of leaving a
familiar environment, especially home or a
fear of going out into public places (fear of
open places)
– Characterized by marked fear or anxiety about two or
more of the following five situations:
 Using public transportation (e.g. automobiles, buses,
trains, ships, planes)
 Being in open spaces (e.g. parking lots, marketplaces,
bridges)
 Being in enclosed spaces (e.g. shops, theaters,
cinemas)
 Standing in line of being in a crowd
 Being outside of the home alone
– For some, this fear may cause some to become
prisoners confined to their homes, although some
may venture out if accompanied by a close
companion
Panic Disorder

Panic disorder→ involves recurrent and
unexpected panic attacks; marked by unpredictable,
minutes-long episodes of intense dread in which a
person experiences terror and accompanying chest
pain, choking or other frightening sensations.
– Anxiety suddenly escalates into paralyzing panic
attacks accompanied by physical symptoms of anxiety
such as heart palpitations, shortness of breath,
choking sensations, trembling, or dizziness.
– During a panic attack, the abrupt surge of intense
fear or intense discomfort reaches a peak within
minutes
Panic Disorder
– After a number of panic attacks victims often
become apprehensive about when their next
attack will occur
– Females are affected more than males, at a
rate of approximately 2:1
– Onset of panic disorder typically occurs during
late adolescence or early adulthood
– About 2/3 of those who suffer from panic
disorder are female
– Onset of panic disorder typically occurs during
late adolescence or early adulthood

Which of the following is classified as an
anxiety disorder according to the DSM-V?
a)
b)
c)
d)
e)
Agoraphobia
Post-traumatic stress disorder
Hoarding
Attention-deficit/ hyperactivity disorder
Delirium
Obsessive-Compulsive Disorder

Obsessive-compulsive disorder→
marked by persistent, uncontrollable
intrusions of unwanted thoughts
(obsessions) and urges to engage in
senseless rituals (compulsions)
– Obsessions→ persistent thoughts, ideas,
impulses, or images that are experienced as
intrusive and inappropriate and that cause
marked anxiety or distress
 Common obsessions are repeated thoughts
about contamination (e.g. becoming
contaminated by shaking hands), repeated
doubts (e.g. wondering if you left a door
unlocked), a need to have things in a particular
order (e.g. intense distress when objects are
disordered or asymmetrical), aggressive or
horrific impulses (e.g. to hurt someone or shout
an obscenity in church), and sexual imagery (e.g.
a recurrent pornographic image)
 May also center on inflicting harm on others,
personal failures, suicide, or sexual acts.
 Obsessions are NOT simply excessive worries
about real life problems
 People troubled by obsessions may feel that they
have lost control of their mind.
– Compulsions→ repetitive behaviors (e.g. hand
washing, ordering, checking) or mental acts
(e.g. praying, counting, repeating words
silently) the goal of which is to prevent or
reduce anxiety or distress, not to provide
pleasure or gratification.
 People feel driven to perform the compulsion to
reduce the distress that accompanies an obsession
or to prevent some dreaded event or situation
 Most common compulsions include washing and
cleaning, hand washing, counting, checking,
requesting, or demanding assurances, repeating
actions and ordering.
– Specific types of obsessions tend to be
associated with specific types of
compulsions.
– Adults with OCD recognize that their
obsessions or compulsions are excessive or
unreasonable.
– The obsessions and compulsions must cause
marked distress, be time consuming (take
more than 1 hour per day), or significantly
interfere with the individual’s normal routine,
occupational functioning, or usual social
activities or relationships with others.

DSM-V added specifiers to allow for
determination of the degree of insight persons
have as to the severity of their condition. This
modification was made to better accommodate
the degree to which persons may be aware of
their condition- ranging from fully aware to
completely unaware
– OCD occurs in roughly 1.2% of the population
– Prevalence of OCD seems to be increasing
– Most cases of OCD emerge before the age of 35.
More common among teens and young adults than
among older people
Post-Traumatic Stress Disorder (under category
of Trauma & Stressor-Related Disorders)

Post-traumatic stress disorder→ a
disorder characterized by haunting
memories, nightmares, social withdrawal,
jumpy anxiety, numbness of feeling, and/
or insomnia that lingers for four weeks or
more after a traumatic experience
– PTSD symptoms have been reported by
soldiers, as well as survivors of accidents,
disasters and violent sexual assaults
Post-Traumatic Stress
Disorder
– Key symptoms of PTSD include:
 Exposure to a traumatic event- actual or
threatened death, serious injury or sexual violation
 One or more of the following intrusive symptoms:
recurrent, involuntary and distressing memories,
recurrent distressing dreams, dissociative
reactions, such as flashbacks, significant distress
at exposure to cues of the event, marked
physiological reactions to reminders of the events
Post-Traumatic Stress
Disorder
 Persistent avoidance of stimuli associated with the
event
 Negative changes in cognitions and moods, such
as the inability to remember important aspects of
the event, exaggerated negative beliefs about
oneself, or persistent negative emotions
 Marked changes in arousal and reactivity, such as
hypervigilance, extreme startle response or sleep
disturbances
 Significant distress or impairment lasting more
than one month
Etiology of Anxiety Disorders

Biological Factors
– Natural selection can explain some phobias.
Humans seem biologically prepared to fear
threats faced by our ancestors. Phobias tend
to focus on such specific fears: spiders,
snakes, and other animals; close spaces and
height; storms and darkness. Those fearless
to occasional threats were less likely to
survive and leave descendants.

Genes
– Some people tend to be more anxious than others.
– Concordance rate→ indicates the percentage of
twin pairs or other pairs of relatives who exhibit
the same disorder
 If relatives who share more genetic similarity show
higher concordance rates than relatives who share
less genetic overlap, this finding supports the
genetic hypothesis.
 Results of both twin studies and family studies
suggest that there is a moderate genetic
predisposition to anxiety disorders
– One research team has identified 17 genes that
appear to be expressed with typical anxiety disorder
symptoms. Other teams have found genes
associated specifically with OCD.
– Genes influence disorders by regulating
neurotransmitters. Some studies point to an anxiety
gene that affects brain levels of serotonin, a
neurotransmitter that influences sleep and mood.
Other studies implicate genes that regulate the
neurotransmitter glutamate. With too much
glutamate, the brain’s alarm centers become
overactive.
– Anxiety sensitivity may make people
vulnerable to anxiety disorders.
 People highly sensitive to the internal physiological
symptoms of anxiety are prone to overreact with
fear when they experience these symptoms.
 Anxiety sensitivity may fuel an inflationary spiral in
which anxiety breeds more anxiety.
– A link may exist between anxiety disorders
and neurochemical activity in the brain.
 Generalized anxiety, panic attacks, PTSD, and
even obsessions and compulsions are manifested
biologically as an overarousal of brain areas
involved in impulse control and habitual behaviors.
 Brain scans of people with OCD reveal elevated
activity in specific brain areas, such as the anterior
cingulate cortex, a brain region in the frontal lobe
that monitors our actions and checks for errors
 Disturbances in neural circuits using GABA (low
levels) may play a role in some types of anxiety
disorders, such as Generalized Anxiety Disorder
– Therapeutic drugs (such as Valium) that reduce
excessive anxiety appear to alter neurotransmitter
activity at GABA synapses.
 Abnormalities in neural circuits using serotonin
(low levels) have recently been implicated in panic
and obsessive-compulsive disorders.
 Fear-learning experiences can traumatize the
brain, by soldering fear circuits within the
amygdala.

Conditioning and learning
– Many anxiety responses may be acquired through
classical conditioning and maintained through operant
conditioning.
 An originally neutral stimulus, may be paired with a
frightening event so that it becomes a conditioned stimulus
eliciting anxiety.
 Once a fear is acquired through classical conditioning the
person may start avoiding the anxiety producing stimulus.
The avoidance response is negatively reinforced because it is
followed by a reduction in anxiety.
 A substantial portion of people suffering with phobias can
identify a traumatic conditioning experience that probably
contributed to their anxiety disorder.
– There is an increased emphasis on how
observational learning may lead to the
development of conditioned fears.
 Observational learning→ occurs when a new
response is acquired through watching the
behavior of another and imitating their behavior
 Studies suggest that conditioned fears may be
acquired through observational learning.
– Example- parents frequently pass on their anxieties to
their children.

Cognitive Factors
– Cognitive theorists maintain that certain styles
of thinking make some people particularly
vulnerable to anxiety disorders. People with
anxiety disorders tend to be hypervigilant.
According to cognitive theorists, some people
are more likely to suffer from problems with
anxiety because they tend to:
 Misinterpret harmless situations as threatening,
 Focus excessive attention on perceived threats, and
 Selectively recall information that seems
threatening.

Stress
– Studies have supported the long-held
suspicion that anxiety disorders and stress are
related.
– High stress often helps precipitate the onset
of anxiety disorders
Anxiety Disorder Questions
1)
2)
3)
4)
5)
Chewing food exactly 25 times before
swallowing
Being suddenly overcome by a racing
heart, difficulty breathing and a feeling of
impending doom for no apparent reason
Intense fear of leaving home
Feeling constantly apprehensive and
anxious for no apparent reason
Facing major anxiety every time you see
a clown