ANXIETY

DISORDERS &
OBSESSIVE-
COMPULSIVE
DISORDER
JULYSSA JUAREZ, JIN LEE, ALAYNA MENDOZA,
CLAIRE RODRIAN,KELSEY TRINH
(GUEST STARRING DR. BUSSE)
 Agenda
Class Activity
DSM-5 Diagnosis and Prevalence Rates
Biological Theories
Medications
Research on Effectiveness
Resources

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Class Activity
 Anxiety Disorders
Fear is the emotional response to Anxiety is the anticipation of future
real or perceived imminent threat threat
Surges of autonomic arousal: fight Muscle tension
or flight Vigilance in preparation for future
Thoughts of immediate danger danger
Escape behaviors Cautious or avoidant behaviors

Prevalence Rates

affects 40 million adults, or 18.1% of the U.S. population

36.9% suffering receive treatment
develop from genetics, brain chemistry personality, and life events
very common to also be diagnosed with depression
(ADAA, 2021; American Psychiatric Association, 2013)
 DSM-5 Subtypes
Separation Anxiety
Selective Mutism Specific Phobia
Disorder

Social Anxiety Disorder Panic Disorder Agoraphobia

(Social Phobia)

Generalized Anxiety Substance/Medication- Anxiety Disorder Due to

Induced Anxiety Disorder Another Medical Condition
Disorder

Other Specified Anxiety Unspecified Anxiety

Disorder Disorder
(American Psychiatric Association, 2013)
 Social Anxiety Disorder
(Social Phobia)
Diagnostic Criteria Symptoms

Social situations with Persistent for 6 months or

exposure to scrutiny by others
Symptoms will be negatively
evaluated
Social situations provoke
fear/anxiety
Social situations are avoided
Out of proportion to the
actual threat by the social
situation
more
Impairment in social and
Crying Clinging
occupational areas
Tantrums Freezing
Not attributable to the
effects of a substance
Not better explained by
Sweating
another mental disorder
Unrelated to a present
medical condition Blushing Trembling
Staring Stumbling over words
(American Psychiatric Association, 2013)
Social Anxiety Disorder
(Social Phobia)
Prevalence Rates

Affects 15 million Equally common Typically begins around

adults, or 6.8% of the among men and age 13
U.S. population women

Fewer than 5% of 36% of people with SAD

people with SAD seek report experiencing
treatment in the year symptoms for 10 or more
following initial onset years before seeking
help

(ADAA, 2021; American Psychiatric Association, 2013)

Generalized Anxiety Disorder
Diagnostic Criteria Symptoms

Excessive anxiety of worry that occurs more days

than not for at least 6 months about numerous
events or activities
Difficult to control the worry
Associated with 3 out 6 symptoms for the past 6 Restlessness Easily Difficulty
months On edge fatigued concentrating
Cause clinically significant impairment in
important areas of functioning
Not attributable to the physiological effects of a
substance or another medical condition Muscle Sleep
Irritability
Not better explained by another mental disorder tension disturbance

(American Psychiatric Association, 2013)

Generalized Anxiety Disorder
Prevalence Rates

Affects 6.8 million Women are 2x as Risk is highest

adults, or 3.1% of the likely to be between childhood
U.S. population affected as men and middle age

Only 43.2% are Often co-occurs with

receiving treatment Major Depression

(ADAA, 2021;(American
American Psychiatric
Psychiatric Association,
Association, 2013)
2013)
DSM-5 Obsessive-Compulsive
and Related Disorders
Obsessive-Compulsive Body Dysmoprhic
Hoarding Disorder
Disorder (OCD) Disorder

Substance/Medication-
Trichotillomania Excoriation (Skin-
Induced Obsessive-Compulsive
(Hair-Pulling Disorder) Picking) Disorder and Related Disorder

Obsessive-Compulsive and Other Specified Obsessive- Unspecified Obsessive-

Related Disorder Due to Compulsive and Related Compulsive and Related
Another Medical Condition Disorder Disorder

(American Psychiatric Association, 2013)

 Obsessive-Compulsive
Disorder
Diagnostic Criteria Symptoms

Presence of obsessions, compulsions or both

Obsessions: recurrent/persistent thoughts,
and urges that are intrusive and unwanted
Compulsions: repetitive behaviors or Cleaning Forbidden or
mental acts in response to an obsession taboo thoughts
Time-consuming or cause clinically significant
impairment in important areas of functioning
Hoarding
Not attributable to the physiological effects of
a substance or another medical condition
Symmetry Harm
Not better explained by another mental
disorder
(American Psychiatric Association, 2013)
Obsessive-Compulsive
Disorder
Prevalence Rates

Affects 2.2 million adults, 1/3 of affected adults

or 1.0% of the U.S. first experienced
population symptoms in childhood

The average age of Equally common among

onset is 19 years old men and women

(ADAA, 2021; American Psychiatric Association, 2013)

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 Biological Background
The Amygdala
Almond-shaped structure in the limbic
system

System for processing fearful and

threatening stimuli

Detection of threat and activation of

appropriate fear-related behaviors in
response to potentially dangerous stimuli

"Fight or flight" reponse

(Jie et al., 2018)
 Biological Background
Normal Modulation of Anxiety
γ-aminobutyric acid-ergic (or GABAergic)
is the central nervous system’s primary
inhibitory neurotransmitter

GABAergic binds to the amygdala through

neurotransmitters in the synapse

Inhibits the amygdala and slows down the

hyperactivity

Reduces anxiety and prevents us from

generating inappropriate emotional and
behavioral responses
(Jie et al., 2018)
 Biological Theories
Generalized Anxiety Disorder
Destruction of GABAergic inhibition in the amygdala can cause behavioral hyperexcitability

(Nitschke et al., 2009)

 Biological Theories
Generalized Anxiety Disorder

Some evidence that the amygdalas of

people with generalized anxiety disorder
(GAD) may be abnormally active

Participants with GAD had significantly

greater activation in the amygdala on
both sides of the brain compared to
healthy controls without GAD

Dysfunction in the modulation may be

caused by genetic and stress factors

(Nitschke et al., 2009)

 Biological Theories
Social Anxiety Disorder
In addition to the hyperactive amygdala response, individuals
with SAD display atypical activity in pathways implicated in:

Medial Prefrontal Cortex

Emotion & Reason Occipital Regions
Visual Processing

Ventrolateral Prefrontal Fusiform Gyrus

Cortex Face & Object Recognition
Emotion Regulation (Hiede & Fitzgerald, 2018)
 Biological Theories
Social Anxiety Disorder
Theories suggest individuals with SAD...

Failed to activate the medial Unable to form impressions about

prefrontal cortex others and maintain emotional info

Had low activity in the Low integration of emotional info and

ventrolateral prefrontal cortex regulation of emotional responses

Enhanced activation to threat cues in areas involved in perceptual processes

such as occipital regions and fusiform gyrus
(Hiede & Fitzgerald, 2018; Sripada et al., 2009; Yokoyama et al., 2015)
 Biological Theories
Obsessive-Compulsive Disorder
Faulty Brain Circuitry
Orbitofrontal Cortex (OFC)- responsible
for reward learning, emotion, and social
behaviors
Basal Ganglia- responsible for motor
control and behavioral sequences
Prefrontal Cortex (PFC)- plays a role in
the execution and performance of
complex behaviors; stores memories of
behavioral sequences called structured
event complexes (SECs)
(Bokor & Anderson, 2014;Huey et al., 2008)
Biological Theories
Obsessive-Compulsive Disorder

(Pittenger, 2014)
Biological Theories
Obsessive-Compulsive Disorder
Chemical Imbalance
Serotonin - involved in mood,
appetite, sleep, pain control, and
cerebral activation
Double-blind study
Dopamine - plays a role in motivation
and reward
basal ganglia heavily endowed
with dopaminergic fibers

(Koo et al., 2010; Westenberg, et al., 2007)