Anxiety DisordersAnxiety Disorders
WEBWEB
Anxiety as a Normal and an Abnormal Response
• Some amount of anxiety is “normal” and is associated with optimal levels of functioning.
• Only when anxiety begins to interfere with social or occupational functioning is it considered “abnormal.”
The Fear and Anxiety Response Patterns
• Fear
• Panic
• Anxiety
• Anxiety Disorder
The Bell Curve
An Important Law- The Yerkes Dodson Law
Another Bell Curve- Courtesy of Our Good Buddies Yerkes-Dodsen
Phobic Disorders
• Phobias
1. Specific phobias
2. Social phobia
3. Agoraphobia
Specific Phobias
Specific Phobias
• Psychosocial causal factors
• Genetic and temperamental causal factors
• Preparedness and the nonrandom distribution of fears and phobias
• Treating specific phobias
Social Phobia
• General characteristics
Fear of being in social situations in which one will be embarrassed or humiliated
Social Phobia
• Interaction of psychosocial and biological causal factors– Social phobias as learned behavior– Social fears and phobias in an evolutionary
context– Preparedness and social phobia
Social Phobia
• Interaction of psychosocial and biological causal factors– Genetic and temperamental factors– Perceptions of uncontrollability– Cognitive variables
Panic Disorder With and Without Agoraphobia
• Panic disorder
• Panic versus anxiety
• Agoraphobia
• Agoraphobia without panic
Panic Disorder
• Prevalence and age of onset
• Comorbidity with other disorders
• Biological causal factors
• The role of Norepinephrine and Serotonin
Panic and the Brain
Panic Disorder
• Genetic factors
• Cognitive and behavioral causal factors
• Interoceptive fears
Panic Disorder: The Cognitive Theory of Panic
Panic Disorder: The Cognitive Theory of Panic
• Perceived control and safety• Anxiety sensitivity as a vulnerability factor
for panic• Safety behaviors and the persistence of
panic• Cognitive biases and the maintenance of
panic
Treating Panic Disorder and Agoraphobia
• Medications
• Behavioral and cognitive-behavioral treatments
Generalized Anxiety Disorder
• General characteristics
• Prevalence and age of onset
• Comorbidity with other disorders
Generalized Anxiety Disorder:Psychosocial Causal Factors
• The psychoanalytic viewpoint• Classical conditioning to many stimuli• The role of unpredictable and uncontrollable
events• A sense of mastery: immunizing against
anxiety
Generalized Anxiety Disorder:Biological Causal Factors
• Genetic factors
• A functional deficiency of GABA
• Neurobiological differences between anxiety and panic
Obsessive-Compulsive Disorder
• Obsessions- repetitive unwanted ideas that the person recognizes are irrational
• Compulsions- repetitive, often ritualized behavior whose behavior serves to diminish anxiety caused by obsessions
Obsessive-Compulsive Disorder
• Prevalence and age of onset
• Characteristics of OCD
• Types of compulsions
• Comorbidity with other disorders
Obsessive-Compulsive Disorder:Psychosocial Causal Factors
• Psychoanalytic viewpoint
• Behavioral viewpoint
• The role of memory
• Attempting to suppress obsessive thoughts
Obsessive-Compulsive Disorder:Biological Causal Factors
• Genetic influences
• Abnormalities in brain function
• The role of serotonin
Post-Traumatic Stress Disorder
• Critical Component – Symptoms occurs AFTER a traumatic stressor
Symptoms Categories
• Intrusive– distressing recollections– dreams– flashbacks– psychological trigger reactions– physiological trigger reactions
Symptoms Categories
• Avoidance– avoid thoughts, feelings or discussions– avoid activities, places– memory blocks– anhedonia (without pleasure)– numb– alexithymia (emotions unknown)– feeling of doom
Symptom Categories
• Hyperarousal Symptoms– sleep disturbance– anger problems– concentration– startle response– “on guard” hypervigilence
Diagnoses
• Acute Stress Disorder– new to DSM-IV (1994)– symptoms 2 days to 4 weeks following
traumatic event
• PTSD– new to DSM-III (1980)– symptoms beyond 4 weeks– delayed onset
Who Is Vulnerable?
• All ages
• Both genders
• Across Cultures and ethnic groups
Some StatsAndrews, Wahlberg, Montgomery (1993)
0
10
20
30
40
50
60
70
Black Hispanic NativeAmerican
White
Frequency
Employment
0
10
20
30
40
50
60
Employed Umemployed
Frequency
Depression
0
5
10
15
20
25
30
35
Total Group Severe PTSD Moderate PTSD
EnterExit
Types of Traumas
• Natural– earthquakes– floods– fires
• Human induces– war– crimes of violence
Co-Morbid Diagnoses
• Alcoholism– 75% for Vietnam Veterans with PTSD
• Depression– 77% of firefighters with PTSD also have
depression
• Generalized Anxiety
• Panic Attacks