Anxiety Disorders

Module 48

What is anxiety?

• Anxiety is the CNS’s physiological and emotional response to a vague sense of threat or danger.

• Fear is the CNS’s physiological and emotional response to a serious threat to one’s well being.

• Anxiety is a natural reaction to danger or new situations.

• When does it become maladaptive?

Psychological Disorders

Anxiety Disorders Generalized Anxiety Disorder

and Panic Disorder

Phobias

Obsessive-Compulsive Disorders

Post-Traumatic Stress Disorders

Explaining Anxiety Disorders

General Anxiety Disorder

• DSM Checklist• Excessive or ongoing anxiety and worry, for

at least six months, about numerous events or activities.

• Difficulty controlling worry• Significant distress or impairment.• At least three of the following symptoms:

restlessness, easily fatigued, irritability, muscle tension, sleep disturbance.

Demographics

• Women outnumber men 2 to 1• About 3.1% of the population suffers it in

any given year.• It may emerge at any time but usually

appears in childhood or adolescence• Consistent across western societies• Close to 6% of the population will develop

it across they lifetimes• Higher mortality rates

Panic Disorders

• DSM Checklist• Recurrent unexpected panic attacks• A month or more of one of the following after

at least one of the attacks:– Persistent concern about having additional

attacks– Worry about implications or consequences of the

attack.– Significant change in behavior related to the

attacks

Secondary Disorders

• Panic attacks can lead to secondary disorders, such as agoraphobia.

• Not everyone with panic disorder develops agoraphobia but many do.

• DSM distinguishes between panic disorder without agoraphobia and with agoraphobia.

What is Panic Attack?• Intense period in which at least four of the following

symptoms develop suddenly and reach a peak within 10 minutes.

• Sweating• Trembling or shaking• Palpitations, pounding heart, or accelerated heart

rate• A feeling of choking• Chest pain or discomfort• Nausea• Feeling dizzy, unsteady, lightheaded• Numbness• Chills, hot flashes• Fear of dying

Phobias

• Phobias are an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object or situation.

Phobias

• Specific phobias• Social phobias: a

fear of social or performance situations in which embarrassment may occur. Agoraphobia falls into this category.

Specific Phobias

• DSM Checklist• Marked and persistent fear of a specific object or

situation that is excessive or unreasonable, lasting at least six months.

• Immediate anxiety usually produced by exposure to the object.

• Recognition that the fear is excessive or unreasonable.

• Avoidance of the feared situation.• Significant distress or impairment.• Social phobia: add fear of embarrassment to the

above symptoms

Demographics

• Specific phobias: female to male ratio 2:1

• Social phobia: female to male 3:2

Obsessive Compulsive Disorder

• Obsessions are persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness

• Compulsions: are repetitive and rigid behaviors or mental acts that people feel they must perform in order to prevent or reduce axxiety.

Obsessive Compulsive Disorder

• DSM Checklist

• Recurrent obsessions or compulsions

• Past or present recognition that the obsessions or compulsions are excessive or unreasonable.

• Significant distress or impairment, or disruption by symptoms for more than one hour per day

Obsessions

• Wishes

• Impulses

• Images

• Ideas

• doubts

Compulsions

• Cleaning compulsions

• Checking compulsions

• Seek order and balance

• Touching, verbal, and counting compulsions.

• Compulsive acts are usually a response to obsessive thoughts

• 14,075.50/28,851

Common Examples of OCD

Common Obsessions:Common

Compulsions:

Contamination fears of germs, dirt, etc.

Washing

Imagining having harmed self or others

Repeating

Imagining losing control of aggressive urges

Checking

Intrusive sexual thoughts or urges

Touching

Excessive religious or moral doubt

Counting

Forbidden thoughts Ordering/arranging

A need to have things "just so" Hoarding or saving

A need to tell, ask, confess Praying

Post Traumatic Stress Disorder

• The person has been exposed to a traumatic event in which both of the following were present:

• The person experienced , witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

• The person’s response involved intense fear, helplessness or horror

DSM Checklist• Recurrent and intrusive distressing recollections

of the event, including images, thoughts and perceptions

• Recurrent distressing dreams of the events• Acting or feeling as if the traumatic event was

recurring.• Intense psychological distress at exposure to

internal or external cues that symbolize or resemble an aspect of the traumatic event..

• Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

Resilience to PTSD

Only about 10% of women and 20% of men react to traumatic situations and develop PTSD.

Holocaust survivors have shown remarkable resilience against traumatic situations.

All major religions of the world suggest surviving a trauma leads to

growth of the individual.

Explaining Anxiety Disorders

Freud suggested that we repress our painful intolerable, ideas, feelings and

thoughts resulting in anxiety.

The Learning Perspective

Learning theorists suggest that fear

conditioning leads to anxiety. This

anxiety then gets associated with other objects or events (stimulus

generalization) and gets reinforced.

John Coletti/ Stock, B

oston

The Learning Perspective

Fear responses, investigators believe, are inculcated through observational learning.

Young monkeys develop fear when they watch other monkeys fear snakes.

The Biological Perspective

Natural Selection has led our ancestors to learn to fear snakes,

spiders, and other animals. So fear preserves the species.

Twins studies suggest that our genes may be partly responsible for

developing fears and anxiety. Twins are more likely to share phobias.

The Biological Perspective

Generalized anxiety, panic attacks, and even OCD is linked with brain circuits like the anterior cingulate cortex.

Anterior Cingulate Cortexof an OCD patient.

S. U

rsu, V.A

. Stenger, M

.K. S

hear, M.R

. Jones, & C

.S. Carter (2003). O

veractive action m

onitoring in obsessive-compulsive disorder. P

sychological Science, 14, 347-353.