Anxiety DisordersPanic DisorderAgoraphobiaSocial Phobia

Specific PhobiaObsessive Compulsive DisorderGeneralized Anxiety Disorder

(PTSD & Acute Stress Disorder)

Panic AttackA. Discrete period of intense fear or discomfort, in

which 4 or more of the following Six develop abruptly and reach a peak within 10 minutes 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 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.

A. 2 or moreExperiences required

B. The situations are avoided or are endured with marked distress

C. Not better accounted for by another mental disorder

Social Phobia (LINK)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 PhobiaA. 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 (LINK) Animal type

Natural environment type

Blood-Injection-Injury type

Situational type

Other type

PhobiaMarked by a persistent and irrational fear of an

object or situation that disrupts behavior.

Common Phobias 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???

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.Realize the obsession is unreasonable

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

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.

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. Restlessness or feeling keyed up or on edge2. Being easily fatigued 3. Difficulty concentrating or mind going blank4. Irritability5. Muscle tension6. 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

Bettm

ann/ Corbis

Resilience to PTSDOnly 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 DisordersCultural 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 DisordersFreud suggested that we repress our painful and

intolerable ideas, feelings, and thoughts, resulting in anxiety.

OCD = Anxiety rooted in repressed ID impulsesImpulses = obsessive thoughtsCompulsions = ego defenses against themE.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?

The Learning PerspectiveLearning 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, B

oston

The Learning PerspectiveInvestigators 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 PerspectiveNatural 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 PerspectiveGeneralized anxiety,

panic attacks, and even OCD are linked with brain circuits like the

anterior cingulate cortex.

Anterior Cingulate Cortexof an OCD patient.

S. U

rsu, V.A

. Stenger, M

.K. Shear, M

.R. Jones, &

C.S. C

arter (2003). Overactive action

monitoring in obsessive-com

pulsive disorder. Psychological Science, 14, 347-353.

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 AbnormalityBiological 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

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

Behavioral Perspective

Obsessive-Compulsive Disorder

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

Biological Perspective

Caudate nucleus

Orbital frontal cortex