Abnormal Psychology

Modules in Abnormal Psychology First Semester S.Y.
2023-2024
UNIT THREE: Mild Mental Disorders
“The brighter the light, the darker the shadow.”

—Carl Jung
CHAPTER 1 Neurosis is a class of clinical

psychological disorders containing chronic
Objectives depression but no hallucinations or delusions.
Self-Assessment # 9 Neurosis refers to a mild mental disorder. Certain
Lesson One: Anxiety Disorders mental and physical disturbances and inner struggles
Common Symptoms of Anxiety Disorders describe the neurosis mental disorder. It is a term
which covers a whole array of mental health
Categories of Anxiety Disorders problems, ranging from anxiety and simple phobias
Anxiety Related Disorders to severe and long- standing obsessive/compulsive
Obsessive-Compulsive Related Disorders disorder.
Trauma and Stressors Related Disorders
This unit focuses on neurotic
disorders. It gives an introduction to anxiety
Self-Test # 11 disorders and then go on to give the various
categories of anxiety disorders. Discussing the
common symptoms of anxiety disorders, chapter 1
Learning Insights mentions specifically about the physiological and
psychological symptoms.
1.5.Chapter Questions
1. 6.Suggested Readings
1.1 Objectives
After reading this chapter, you will be able to:

1. Define anxiety disorders;
2. Describe the different types of these
disorders;
3. Explain the etiology (causes) of these
disorders; and
4. Describe the different types of treatment for
these disorders.
Abnormal Psychology 1
Modules in Abnormal Psychology First Semester S.Y. 2023-2024
1.2 Self-Assessment #9
Anxiety Disorders
Read the following account and reflect on the questions below.
Case 5
Butchoy, a 36-year-old teacher is referred
to a Community Mental Health Team by his
GP. He is worried about his physical
health, but physical examination and other
tests by his GP have found no
abnormalities. He describes episodes
where his heart pounds, he feels hot and
faint, and has an overwhelming need to
escape. This first happened during a staff
meeting at school, and again whilst in a
large supermarket.
Now he is apprehensive about going out in
case he experiences another attack.
Thought Questions:
1. Based on what has been stated above, what must be your preferred diagnosis of
Butchoy’s case?
2. What could be your treatment options?
3. What do you think would be the best predictors of a good case outcome
(prognosis)?
1.3 LESSON 1: Anxiety Disorders

Neurosis and Psychosis are
different types of mental disorders.
Neurosis refers to a moderate mental
disorder, a mild functional, neuro-
psychical disorders that confirm
themselves in specific cl inical
phenomena in the absence of
psychical phenomena. On the other hand,
psychosis is a major personality disorder
characterized by mental and emotional
disruptions, a severe mental illness
characterized by loss of contact with
reality and relationship with other people
causing social maladaptation.
Neurotic mental disorders are being
discussed in detail in this unit, starting with
anxiety disorders. The various causative
factors of anxiety disorders are presented
and different approaches to
intervention are d i s c u s s e d w h i c
h i n c l u d e s psychoanalytical,
cognitive, behavioural and
b i o l o g i c a l perspectives.
The term anxiety is mainly

defined as vague, diffuse and a very
unpleasant feeling of fear and
apprehension. The individual shows
combinations of the symptoms like rapid
heart rate, shortness of breath, diarrhea,
fainting, dizziness, sweating,
sleeplessness, frequent urination and
tremors. People who feel anxious are not aware of the reasons for their fear. Thus even though
fear and anxiety involve similar reactions , the cause of worry is readily apparent. Anxiety
disorders involve a state of distressing chronic but fluctuating nervousness that is
inappropriately severe for the person’s circumstances. These disorders are usually diagnosed
using specific established criteria.
1.3.1 Common Symptoms of Anxiety Disorders
All types of anxiety disorders have one common feature. This causes a general problem
with the persons ability to have a normal everyday routine and normal life. All of the anxiety
disorders lead to a pessimistic outlook on life and a feeling of a loss of control over an upcoming
bad situation. The symptoms of anxiety are:
• Nervousness
• Vigilance
• Sleeplessness
• Breathlessness
• Feeling faint
• Lack of concentration
• Trembling
• Sweating
• Feeling tired
• Frequency of urination
• Palpitation almost pounding of

heart
• Muscle tension
• Headaches
• Insomnia
• Restlessness
• Irritability
• Hot flashes or chills
• Hyperventilation
• Nausea or stomach cramps etc.
Thus on the whole even though the symptoms have been separately mentioned, they are
interrelated and affect the daily living of the individual. Despite no clear definition has been yet
formulated for anxiety disorder, most psychologists have made distinction
between normal anxiety and neurotic anxiety or anxiety disorders. Normal anxiety occurs when
people react appropriately to the anxiety causing situation. In contrast anxiety disorders are
disproportionately intense in which real danger is little or only posed by either situation. This
stimulates intense feelings of anxiety that can affect or derail a persons’ desires or obligations.
1.3.2 Categories of Anxiety Disorders

According to a standard manual for mental health clinicians the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5th Edition) categorizes anxiety disorders under the following
headings:
1.3.2.1 Anxiety Related Disorders
1. Separation Anxiety Disorder Separation anxiety is a normal

stage of development for infants and
toddlers. Young children often
experience a period of separation
anxiety, but most children outgrow separation anxiety by about 3 years of age. In some children,
separation anxiety is a sign of a more serious condition known as separation anxiety disorder,
starting as early as preschool age. Less often, separation anxiety disorder can also occur in
teenagers and adults, causing significant problems leaving home or going to work
Symptoms and Causes
Separation anxiety disorder is diagnosed when symptoms are excessive for the
developmental age and cause significant distress
in daily functioning. Symptoms may include:
• Recurrent and excessive distress about
anticipating or being away from home or
loved ones
• Constant, excessive worry about losing a
parent or other loved one to an illness or a
disaster
• Constant worry that something bad will
happen, such as being lost or kidnapped,
causing separation from parents or other
loved ones
• Refusing to be away from home because of
fear of separation
• Not wanting to be home alone and without a
parent or other loved one in the house
• Reluctance or refusing to sleep away from home without a parent or other loved one
nearby
• Repeated nightmares about separation
• Frequent complaints of headaches, stomachaches or other symptoms when
separation from a parent or other loved one is anticipated
Sometimes, separation anxiety disorder can be triggered by life stress that results in
separation from a loved one. Genetics may also play a role in developing the disorder. Risk
factors may include:
• Life stresses or loss that result in separation, such as the illness or death of a loved one, loss
of a beloved pet, divorce of parents, or moving or going away to school
• Certain temperaments, which are more prone to anxiety disorders than others are
• Family history, including blood relatives who have problems with anxiety or an
anxiety disorder, indicating that those traits could be inherited
• Environmental issues, such as experiencing some type of disaster that involves
separation.
Treatment
Separation anxiety disorder is usually treated with psychotherapy, sometimes along with
medication. Psychotherapy, sometimes called talk therapy or psychological counseling, involves
working with a therapist to reduce separation anxiety symptoms. Cognitive behavioral therapy
(CBT) is an effective form of psychotherapy for separation anxiety disorder. During therapy your
child can learn how to face and manage fears about separation and uncertainty. In addition, parents
can learn how to effectively provide emotional support and encourage age appropriate
independence. Sometimes, combining medication with CBT may be helpful if symptoms are
severe. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) may be an option for
older children and adults.
2. Selective Mutism Selective mutism (SM) is an

anxiety disorder in which a child is unable
to speak in some settings and to some
people. A child with SM may
talk normally at home, for instance, or when alone with her parents, but cannot speak at all, or
speak above a whisper, in other social settings—at school, in public, or at extended family
gatherings. Parents and teachers often think the child is willful and refuses to speak, or speak
loud enough to be heard,
but the child experiences it as an inability. It can
cause severe distress—she can’t communicate
even if she is in pain, or, say, needs to use the
bathroom—and prevents her from participating
in school and other age-appropriate activities. It
should not be confused with the reluctance to
speak a child adapting to a new language might
exhibit, or shyness in the first few weeks at a
new school.
Symptoms and Causes
If your child suffers from selective mutism, she may be freely verbal and even gregarious
at home—“chatterbox” is a description professionals often hear—but completely or mostly
nonverbal at school. Some children seem paralyzed with fear when they are unable to speak, and
have difficulty communicating even non-verbally. Others will use gestures, facial expressions,
and nodding to get by when they cannot speak. Even in the home, some will fall silent when
someone other than a family member is present. Parents often notice signs of SM when a child is 3
or 4 years old, but she may not be diagnosed until she gets to school, and efforts to get her to
speak up have failed.
Because of its overlap with social anxiety disorder, there may be genetic loading for
SM. Other risk factors are temperamental (negative affectivity, behavioral inhibition) and
environmental, including socially inhibited or overprotective parents.
Treatment
The most evidence-based recommended treatment for selective mutism is behavioral

therapy using controlled exposure. The therapist works with the child and her parents to gradually
and systematically approach the settings where she cannot speak, building her confidence one
situation at a time. The child is never pressured to speak, and is always encouraged with
positive reinforcement. Specialized techniques are used to guide the child’s increasing exposure
to difficult settings, and the therapist will teach parents and child how to use these techniques in
real-life settings. Newer approaches offer evidence that intensive treatment from the time of
diagnosis may prove more effective than traditional weekly sessions.
A specific phobia is any kind of

anxiety disorder that amounts to an
unreasonable or irrational fear related
3. Specific Phobia
to exposure to specific objects or
situations. As a result, the affected
person tends to avoid
contact with the objects or situations and, in severe cases, any mention or depiction of them. The
fear can, in fact, be disabling to their daily lives.
The fear or anxiety may be triggered both by

the presence and the anticipation of the specific
object or situation. A person who encounters that
of which they are phobic will often show signs
of fear or express discomfort. In some cases, it
can result in a panic attack. In most adults, the
person may logically know the fear is
unreasonable but still find it difficult to control
the anxiety. Thus, this condition may
significantly impair the person's functioning and
even physical health.
Symptoms and Causes
The main features of diagnostic criteria for specific phobia in the DSM-V includes:
• Fear or anxiety about a specific object or situation (In children fear/anxiety can be
expressed by crying, tantrums, freezing, or clinging)
• The phobic object or situation almost always provokes immediate fear or anxiety
• The phobic object or situation is avoided or
endured with intense fear or anxiety
• The fear or anxiety is out of proportion to the actual
danger posed by the specific object or situation
and to the sociocultural context
• The fear, anxiety, or avoidance is persistent,
typically lasting for 6 months or more
• The fear, anxiety, or avoidance causes clinically
significant distress or impairment in
social, occupational, or other important areas of
functioning
• The disturbance is not better explained by
symptoms of another mental disorder,
including fear, anxiety, and avoidance of
situations associated with panic-like
symptoms or other incapacitating
symptoms; objects or situations related to
obsessions; reminders of traumatic events;
separation from home or attachment
figures; or social situations.
Phobias can be classified under the

following general categories:
1. Animal type – Fear of dogs, cats, rats and/or

mice, pigs, cows, birds, spiders, or snakes.
2. Natural environment type – Fear of water
(aquaphobia), heights (acrophobia), lightning
and thunderstorms (astraphobia), or aging
(gerascophobia).
3. Situational type – Fear of small confined
spaces (claustrophobia), or the dark
(nyctophobia).
4. Blood/injection/injury type – this includes
fear of medical procedures, including
needles and injections (trypanophobia), fear
of blood (hemophobia) and fear of getting
injured.
5. Other – children's fears of loud sounds or
costumed characters.
Treatment
The following are two therapies normally

used in treating specific phobia:
• Cognitive behavioral therapy

(CBT), a short term, skills-focused therapy
that aims to help people diffuse unhelpful
emotional responses by helping people
consider them differently or change their
behavior, is effective in treating specific
phobias.
• Exposure therapy is a particularly
effective form of CBT for specific phobias.
Medications to aid CBT have not been

as encouraging with the exception of
adjunctive D-clycoserine. In general
anxiolytic medication is not seen as h e l
p f u l i n s p e c i f i c p h o b i a b u t
benzodiazepines are sometimes used to help
resolve acute episodes.
4. Social Anxiety Disorder
A person with social phobia m

a y b e e x t r e m e l y f e a r f u l o f
embarrassment in social situations. This fear
can affect personal and professional
relationships. Social anxiety often occurs early
in childhood as a normal part of social
development and may go unnoticed
until the person is older. The triggers and frequency of social anxiety vary depending on the
individual. Many people feel nervous in certain social situations, such as when giving a
presentation, going out on a date, or taking part in a competition. This is normal and would not
qualify as social anxiety disorder. Social anxiety becomes a medical condition when everyday
social interactions cause excessive fear, self-consciousness, and embarrassment.
Symptoms
There may be physical, emotional, and behavioral symptoms. Social anxiety can affect
daily tasks, including school life, work, and other activities. Behavioral and emotional signs and
symptoms include:
• avoiding situations where the individual feels they may be the center or focus of
attention
• fear of being in situations with strangers
• dread concerning how they will be presented to others
• excessive fear of embarrassment and humiliation, being teased and criticized, or other
people noticing that a person
with social anxiety disorder looks
anxious
• a fear of being anxious that makes the
anxiety worse
• fear of meeting people in authority
• severe anxiety or panic attacks
when experiencing the feared
situation
• refraining from certain activities or
talking to people because of a fear of
embarrassment
• a blank mind in social situations
that cause anxiety
Treatment
Therearemanytypesof
psychotherapy, including cognitive
the ra py, interpersonal therapy,
psychodynamic therapy, and family
therapy. A doctor may prescribe
serotonin and norepinephrine reuptake
inhibitors (SNRIs), such as venlafaxine
(Effexor, Effexor XR) for medications.
Panic disorder occurs when you experience

5. Panic Disorder recurring unexpected panic attacks. The DSM-5
defines panic attacks as abrupt surges of intense fear
or discomfort that peak within minutes.
People with the disorder live in fear of having a panic
attack. You may be having a panic attack when you feel sudden, overwhelming terror that has no
obvious cause. You may experience physical symptoms, such as a racing heart, breathing
difficulties, and sweating.
Symptoms and Causes
Symptoms of panic disorder often begin to appear in teens and young adults under
the age of 25. If you have had four or more panic attacks, or you live in fear of having another
panic attack after experiencing one, you may have a panic disorder.
Panic attacks produce intense fear that begins suddenly, often with no warning. An attack
typically lasts for 10 to 20
minutes, but in extreme cases,
symptoms may last for more than an hour.
The experience is different for everyone,
and symptoms often vary.
Common symptoms associated

with a panic attack include:
• racing heartbeat or palpitations

• shortness of breath
• feeling like you are choking
• dizziness (vertigo)
• lightheadedness
• nausea
• sweating or chills
• shaking or trembling
• changes in mental state,
including a feeling of
derealization (feeling of
unreality) or depersonalization
(being detached from oneself)
• numbness or tingling in your
hands or feet
• chest pain or tightness
• fear that you might die
The symptoms of a panic attack

often occur for no clear reason. Typically,
the symptoms are not proportionate to the
level of danger that exists in the
environment. Because these attacks
can’t be
predicted, they can significantly affect your functioning. Fear of a panic attack or recalling a panic
attack can result in another attack.
The causes of panic disorder are not clearly understood. Research has shown that panic
disorder may be genetically linked. Panic disorder is also associated with significant transitions
that occur in life. Leaving for college, getting married, or having your first child are all major
life transitions that may create stress and lead to the development of panic disorder.
Treatment
Treatment for panic disorder focuses on reducing or

eliminating your symptoms. This is achieved
through therapy with a qualified professional and in
some cases, medication. Therapy typically involves
cognitive-behavioral therapy (CBT). This therapy
teaches you to change your thoughts and actions so
that you can understand your attacks and manage
your fear.
Medications used to treat panic disorder can include
selective serotonin reuptake inhibitors (SSRIs), a
class of antidepressant. SSRIs prescribed for panic
disorder may include:
• fluoxetine
• paroxetine
• sertraline
Agoraphobia is a type of anxiety

disorder in which you fear and avoid places
or situations that might cause you to panic
6. Agoraphobia and make you feel trapped, helpless or
embarrassed. You fear an actual or
anticipated situation,
such as using public transportation, being in open or enclosed spaces, standing in line, or being in
a crowd.
The anxiety is caused by fear that there's no easy way to escape or get help if the anxiety
intensifies. Most people who have agoraphobia develop it after having one or more panic attacks,
causing them to worry about having another attack and avoid the places where it may happen
again.
People with agoraphobia often have a hard time feeling safe in any public place, especially
where crowds gather. You may feel that you need a companion, such as a relative or friend, to go
with you to public places. The fear can be so overwhelming that you may feel unable to leave your
home.
Symptoms and Causes
Typical agoraphobia symptoms include fear of:
• Leaving home alone

• Crowds or waiting in line
• Enclosed spaces, such as movie theaters, elevators or small stores
• Open spaces, such as parking lots, bridges or malls
• Using public transportation, such as a bus, plane or train
These situations cause anxiety because you fear you won't be able to escape or find help
if you start to feel panicked or have other disabling or embarrassing symptoms.
In addition:
• Fear or anxiety almost always results from exposure to the situation

• Your fear or anxiety is out of proportion to the actual danger of the situation
• You avoid the situation, you need a companion to go with you, or you endure the
situation but are extremely distressed
• You experience significant distress or problems with social situations, work or other
areas in your life because of the fear, anxiety or avoidance
• Your phobia and avoidance usually lasts six months or longer
Biology — including health conditions and

genetics — temperament, environmental stress
and learning experiences may all play a role in
the development of agoraphobia. It is
believed that gamma aminobutyric acid --
GABA -- is a chemical in the brain that
modulates anxiety. GABA counteracts
excitement in the brain by inducing relation and
suppressing anxiety. Research has indicated
that it may play a role in many mental health
issues including anxiety and mood disorders.
Anti-anxiety medications such as Xanax,
Ativan, or Klonopin, work because they target
GABA
receptors in the brain. These medications enhance the function of GABA resulting in a calm and
relaxed state.
Treatment
Agoraphobia treatment usually includes both psychotherapy and medication. It may

take some time, but treatment can help you get better.
Psychotherapy
Psychotherapy involves working with a therapist to set goals and learn practical skills
to reduce your anxiety symptoms. Cognitive behavioral therapy is one of the most
effective forms of psychotherapy for anxiety disorders, including agoraphobia. Generally a

short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to
better tolerate anxiety, directly
challenge your worries and gradually return
to the activities you've avoided because of
anxiety. Through this process, your
symptoms improve as you build on your
initial success.
You can learn:
• What factors may trigger a panic

attack or panic-like symptoms and
what makes them worse
• How to cope with and tolerate
symptoms of anxiety
• Ways to directly challenge your
worries, such as the likelihood of
bad things happening in social
situations
• That your anxiety gradually
decreases if you remain in
situations and that you can manage
these symptoms until they do
• How to change unwanted or
unhealthy behaviors through
desensitization, also called
exposure therapy, to safely face the
places and situations that cause fear
and anxiety.
Medications
Certain types of antidepressants are often used to treat agoraphobia, and sometimes anti-
anxiety drugs are used on a limited basis. Antidepressants are more effective than anti-anxiety
medications in the treatment of agoraphobia.
• Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors

(SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of
panic disorder with agoraphobia. Other types of antidepressants may also effectively treat
agoraphobia.
• Anti-anxiety medication. Anti-anxiety drugs called benzodiazepines are sedatives that,

in limited circumstances, your doctor may prescribe to temporarily relieve anxiety
symptoms. Benzodiazepines are generally used only for relieving acute anxiety on a short-
term basis. Because they can be habit-forming, these drugs aren't a good choice if you've
had long-term problems with anxiety or problems with alcohol or drug abuse.
Generalized Anxiety
7. Generalized Anxiety Disorder Disorder (GAD) is an anxiety disorder
that is characterized by excessive,
uncontrollable and often irrational worry a
bout everyday things that is
disproportionate to the actual source of worry. This excessive worry often
interferes with daily functioning, as individuals suffering GAD typically
anticipate disaster, and are overly concerned about everyday matters such
as health issues, money, death, family problems, friend problems,
relationship problems or work difficulties. Individuals often exhibit a
variety of physical symptoms, including fatigue, fidgeting, headaches,
nausea, numbness in hands and feet, muscle tension, muscle aches,
difficulty swallowing, bouts of difficulty breathing, difficulty
concentrating, trembling, twitching, irritability, agitation, sweating,
restlessness, insomnia, hot flashes, and rashes and inability to fully
control the anxiety. These symptoms must be consistent and on-going,
persisting at least six
months, for a formal diagnosis of GAD to be introduced.
Unlike a phobia, where your fear is connected to a specific thing or situation, the anxiety of
generalized anxiety disorder (GAD) is diffuse—a general feeling of dread or unease that colors
your whole life. This anxiety is less intense than a panic attack, but much longer lasting, making
normal life difficult and relaxation impossible.
A co-worker’s careless comment about the economy becomes a vision of an imminent pink
slip; a phone call to a friend that isn’t immediately returned becomes anxiety that the relationship
is in trouble. Sometimes just the thought of getting through
the day produces anxiety. You go about your activities filled with exaggerated worry and tension,
even when there is little or nothing to provoke them. Whether you realize that your anxiety is more
intense than the situation calls for or believe that your worrying protects you in some way, the end
result is the same. You can’t turn off your anxious thoughts. They keep running through your
head, on endless repeat.
Symptoms and Causes
Worries, doubts, and fears are a normal part of life. It’s

natural to be anxious about your upcoming midterm exam or
to worry about your finances after being hit by unexpected
bills. The difference between “normal” worrying and
generalized anxiety disorder (GAD) is that the worrying
involved in GAD is:
• excessive
• intrusive
• persistent
• debilitating
Physical symptoms of generalized anxiety disorder
• Feeling tense; having muscle tightness or body aches

• Having trouble falling asleep or staying asleep because your mind won’t quit
• Feeling edgy, restless, or jumpy
• Stomach problems, nausea, diarrhea
Emotional symptoms of generalized anxiety disorder
• Constant worries running through your head

• Feeling like your anxiety is uncontrollable; there is nothing you can do to stop the
worrying
• Intrusive thoughts about things that make you anxious; you try to avoid thinking about
them, but you can’t
• An inability to tolerate uncertainty; you need to know what’s going to happen in the future
• A pervasive feeling of apprehension or dreadBehavioral symptoms of generalized anxiety
disorder
• Inability to relax, enjoy quiet time, or be by
yourself
• Difficulty concentrating or focusing on things
• Putting things off because you feel
overwhelmed
• Avoiding situations that make you anxious
In children, excessive worrying centers on

future events, past behaviors, social acceptance, family
matters, their personal abilities, and school performance.
Unlike adults with GAD, children and teens with
generalized anxiety disorder often don’t
realize that their anxiety is disproportionate to the situation, so adults need to recognize their
symptoms. Along with many of the symptoms that appear in adults with generalized anxiety
disorder, some red flags for GAD in children are:
• “What if” fears about situations far in the future

• Perfectionism, excessive self-criticism, and fear of making mistakes
• Feeling that they’re to blame for any disaster, and their worry will keep tragedy from
occurring
• The conviction that misfortune is contagious and will happen to them
• Need for frequent reassurance and approval
Cognitive Theories. The core feature of GAD, worry, is regarded as maladaptive

information processing, biased in the direction of threat. The centrality of “threat” to everyday
events and possibilities clearly is mirrored in the concerns commonly expressed by individuals
with GAD—judging another's look of disapproval as a sign of personal social failure or judging
lateness as a sign of personal incompetence, but despite the flood of research in this area and
the
robust evidence for certain types of cognitive
biases in GAD, the empiric investigation of
threat-related information processing is in
its infancy. Most paradigms used to date fail
to test key assumptions of the cognitive
models of GAD. Also, testing of the extent to
which affect-related information-
processing biases are unique to GAD or are
common to all of the anxiety disorders
generally is absent.
Biologica l Theories . T h e
discovery in the 1950 ' s that the
benzodiazepines provide relief from
generalized anxiety has led to theories about
the neurotransmitters active in generalized
anxiety. The benzodiazepines increase the
activity of GABA, a neurotransmitter that
carries inhibitory messages from one neuron to
another. When GABA binds to a neuronal
receptor, it prevents the neuron from firing.
One theory is that people with GAD have a
deficiency of GABA or GABA receptors, which results in excessive firing of neurons through
many areas of the brain particularly the limbic system, which is involved in emotional, behavioral
and physiological responses to treat. As a result of excessive and chronic neuronal activity, the
person experiences chronic, diffuse symptoms of anxiety.
Treatments
The goal of treatment is to help the client function well during day-to-day life. A
combination of medicine and cognitive-behavioral therapy (CBT) works best. Medications are an
important part of treatment. Once you start them, do not suddenly stop taking them without
talking with your health care provider. Medications that may be used include:
• Selective serotonin reuptake inhibitors (SSRIs) are usually the first choice in
medications. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another choice.
• Other antidepressants and some antiseizure drugs may be used for severe cases.
• Benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), and lorazepam
(Ativan) may be used short-term if antidepressants don't help enough with symptoms.
Long-term use can lead to dependence on these drugs.
• A medication called buspirone may also be used.
Cognitive-behavioral therapy helps you understand your behaviors and how to gain control
of them. You will have 10 to 20 visits over a number of weeks. During therapy you will learn how
to:
• Understand and
gain control of your
distorted views of life
stressors, such as
other p e o p l e ' s
behavior or life events.
• Recognizeand
replace panic-causing
thoughts, decreasing the
sense of
helplessness.
• Manage stress
a n d r e l a x w h e n
symptoms occur.
• Avoid thinking that
minorworrieswill
develop into very bad
problems. Avoiding
caffeine, illicit drugs, and
even some cold medicines may also help reduce symptoms. A healthy lifestyle that includes
exercise, enough rest, and good nutrition can help reduce the impact of anxiety.
To Cope with Anxiety, Remember A-W-A-R-E
The key to switching out of an anxiety state is to accept it fully. Remaining in the present and
accepting your anxiety cause it to disappear.
A: Accept the anxiety. Welcome it. Don’t fight it. Replace your rejection, anger, and hatred
of it with acceptance. By resisting, you’re prolonging the unpleasantness of it.
Instead, flow with it. Don’t make it
responsible for how you think, feel, and
act.
W: Watch your anxiety. Look at it
without judgment – not good, not bad.
Rate it on a 0-to-10 scale and watch it go
up and down. Be detached. Remember,
you’re not your anxiety. The more you can
separate yourself from the experience, the
more you can just watch it.
A: Act with the anxiety. Act as if
you aren’t anxious. Function with it. Slow
down if you have to, but keep going.
Breathe slowly and normally. If you run
from the situation your anxiety will go
down, but your fear will go up. If you
stay, both your anxiety and your fear will
go down.
R: Repeat the steps. Continue to
accept your anxiety, watch it, and act with
it until it goes down to a comfortable
level. And it will. Just keep repeating
these three steps: accept, watch, and act
with it.
E: Expect the best. What you fear the
most rarely happens. Recognize that a
certain amount of anxiety is normal. By
expecting future anxiety you’re putting
yourself in a good position to accept it
when it comes again.
1.3.2.2 Obsessive-Compulsive and Related Disorders
Previously these disorders had been scattered in other areas of DSM-IV. In addition to
obsessive-compulsive disorder, which has been classified as an anxiety disorder until DSM-5, this
grouping now includes a separate diagnostic category for hoarding disorder, body dysmorphic
disorder previously located with the somatoform disorders, and trichotillomania previously
grouped with the impulse control disorders. Also, another new disorder in this group is
excoriation (skin picking) disorder.
Obsessions are intrusive and mostly nonsensical thoughts, images, or urges that the
individual tries to resist or eliminate. Compulsions are the thoughts or actions used to suppress
the obsessions and provide relief.
Obsessive-Compulsive
1. Obsessive-Compulsive Disorder disorder ( OCD ) is an anxiety
disorder in which time people have
recurring, unwanted thoughts, ideas or
sensations (obsessions) that make them
feel driven to do something
repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or
cleaning, can significantly interfere with a person’s daily activities and social interactions.
Among the persons suffering from anxiety and related disorders, a client who needs
hospitalization is likely to have obsessive-compulsive disorder (OCD). A client referred for
psychosurgery (neurosurgery for a psychological disorder) because every psychological and
pharmacological treatment has failed, and the suffering is unbearable, probably has OCD. OCD
is the devastating culmination of the anxiety disorders.
Types and Symptoms
OCD comes in many forms, but most cases fall into at least one of four general
categories:
• Checking, such as locks, alarm systems, ovens, or light switches, or thinking you have a
medical condition like pregnancy or schizophrenia
• Contamination, a fear of things that might be dirty or a compulsion to clean. Mental
contamination involves feeling like you’ve been treated like dirt.
• Symmetry and ordering, the need to have things lined up in a certain way
• Ruminations and intrusive thoughts, an obsession with a line of thought. Some of these
thoughts might be violent or disturbing.
Obsessive thoughts can include:
• Worries about yourself or other people getting hurt

• Constant awareness of blinking, breathing, or other body sensations
• Suspicion that a partner is unfaithful, with no
reason to believe it
Compulsive habits can include:
• Doing tasks in a specific order every time or a certain “good”

number of times
• Needing to count things, like steps or bottles
• Fear of touching doorknobs, using public toilets, or shaking hands
Treatments
Medication
Serotoninreuptake
inhibitors (SRIs), which include
selective serotonin reuptake
inhibitors (SSRIs) are used to help
reduce OCD symptoms. SSRIs
often require higher daily doses in
the treatment of OCD than of
depression and may take 8 to 12
weeks to start working, but some
patients e x p e r i e n c e more
r a p i d improvement.
Psychotherapy
Psychotherapy can be an
effective treatment for adults a n d
c h i l d r e n w i t h O C D . Research
shows that certain t y p e s o f p s
y c h o t h e r a p y, including
cognitive behavior therapy (CBT)
and other related therapies (e.g.,
habit reversal training) can be as
effective as medication for many
individuals.
Exposure And
Response Prevention (EX/RP)
is one of the recommended t
re a t m e nt s for Obsessive
Compulsive Disorder (OCD). In simple terms EX/RP involves exposing yourself to a
trigger for your obsessions and refraining from performing your usual compulsions. This often
involves tolerating anxiety, and you are encouraged to record the pattern of this over time as
you complete EX/RP. As with most mental disorders, treatment is usually personalized and might
begin with either medication or psychotherapy, or with a combination of both. For many patients,
EX/RP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat
OCD symptoms or vice versa for individuals who begin treatment with psychotherapy.
According to the Diagnostic and

2. Body Dysmorphic Disorder Statistical Manual of Mental
Disorders, Fifth Edition (DSM-5), one
may become diagnosed with body
dysmorphic disorder if he or
she has a strong obsession
with one or more perceived defects or flaws in physical appearance that are not visible or appear
minor to others. These perceived flaws can cause the individual to feel ugly and abnormal as well
as hideous or monster-like. Any body area can be the focus of concern, but individuals commonly
worry about their skin, hair, or nose.
Symptoms and Causes
It’s important to make certain specifications regarding body dysmorphic disorder in order
to gage different aspects such as seriousness of the condition. It should be specified if and when:
• An individual has muscle dysmorphia,
whereas the individual is consumed by the
idea that his or her physique is too small or
inadequately muscular (even if preoccupied
with other body areas as well).
• An individual has good or fair insight, and
he or she recognizes that the body
dysmorphic disorder beliefs are definitely or
probably false or that they could be false.
• An individual has poor insight, and he or she
thinks that the body dysmorphic disorder
beliefs are probably true.
• An individual has absent insight/
delusional beliefs and is without a doubt
convinced that the body dysmorphic disorder
beliefs are true.
Treatments
It’s important to first consider other disorders or explanations for feelings of body
dysmorphia, such as normal appearance concerns, eating disorders, anxiety disorders, other
obsessive-compulsive disorders, and so on. But if body dysmorphic disorder is diagnosed there are
a couple treatment options:
• Cognitive Behavioral Therapy: this will help individuals challenge negative thoughts about
their body image and adapt a more realistic way of thinking, as well as learn about alternate
ways to handle urges that come with the disorder such as excessive mirror-checking.
• Medications: medications, such as antidepressants, used to treat disorders such as depression
may be effective here.
3. Hoarding Disorder Hoarding disorder is a

mental health disorder in which people save a
large number of items whether they have
worth or not. Typical hoarded items include
newspapers, magazines,
paper products, household goods, and clothing. Sometimes people with hoarding disorder collect
a large number of animals.
Hoarding disorder can lead to dangerous clutter. The condition can interfere with quality of
life in many ways. It can cause people stress and shame in their social, family, and work lives. It
can also create unhealthy and unsafe living conditions.
Symptoms and Causes
People with hoarding disorder feel a strong need to save their possessions. Other
symptoms include:
• Inability to get rid of possessions
• Extreme stress about throwing out items
• Anxiety about needing items in the future
• Uncertainty about where to put things
• Distrust of others touching possessions
• Living in unusable spaces due to clutter
• Withdrawing from friends and family
The cause of hoarding disorder is

unknown. Doctors have identified several risk factors
associated with the condition. They include:
• Having a relative with the disorder

• Brain injury that triggers the need to save
things
• Traumatic life event
• Mental disorders such as depression or
obsessive-compulsive disorder
• Uncontrollable buying habits
• Inability to pass up free items such as coupons
and flyers
Treatments
Cognitive-behavioral therapy (CBT) is a common treatment for hoarding disorder. With

CBT, people learn to understand why they hoard and how to feel less anxiety when
throwing away items. Specialists also teach organization and decision-making skills. These skills
can help you better manage your possessions.Some doctors use medications called
antidepressants to treat hoarding disorder. These medicines, including venlafaxine (Effexor) and
paroxetine (Paxil), can improve the symptoms. Often, the combination of medications and
cognitive-behavioral therapy are utilized in order to reduce symptoms more effectively.
Tr i c h o t i l l o m a n i a , o
4. Trichotillomania r pathological hair pulling, is a
common but underdiagnosed
psychological disorder. People with
t r i c h o t i l l o m a n i a e x p e r i e n c e an
overwhelming urge to pull out their hair. Many people who have trichotillomania may not know
that they have a diagnosable condition. They may simply view their hair pulling as a bad habit.
Others may experience severe physical and psychological symptoms.
Symptoms and Causes
A person with trichotillomania may experience the

following behavioral and physical symptoms:
• repetitive pulling of their hair, often without any
awareness
• a sense of relief after pulling out hair
• inability to stop hair pulling, despite repeated
attempts to stop
• anxiety and stress related to hair pulling
• a need to perform other repetitive activities related to
the hair (e.g., counting or twisting hairs)
• trichophagia
• skin irritation or tingling at affected sites
• noticeable hair loss or bald patches due to hair
pulling
Doctors do not know what causes a person to develop

trichotillomania. Some people report that
hair pulling helps to alleviate boredom or stress. Some people may pull their hair as a way to
deal with adverse emotions. Certain factors can increase a person’s risk of developing
trichotillomania. These risk factors include:
• Genetic history: A person who has a first-degree relative (parent or sibling) with
trichotillomania is more likely to have the condition themselves.
• Childhood trauma: According to the National Organization for Rare Disorders, a person
who has experienced childhood trauma may be more likely to develop trichotillomania.
However, there is not enough research to support this idea.
Treatments
A 2012 case study indicates that habit reversal therapy (HRT), which is a type of
behavioral therapy, might be effective in treating trichotillomania. HRT involves five stages:
1. Awareness training: The person identifies the psychological and environmental factors that
can trigger an episode of hair pulling.
2. Competing response training: The person practices replacing the hair pulling behavior
with a different behavior.
3. Motivation and compliance: The
person engages in activities and behaviors
that remind them of the importance of
sticking with HRT. This may include
receiving praise from family and friends
for progress made during therapy.
4. Relaxation training: The person
practices relaxation techniques, such as
meditation and deep breathing. These help
to reduce stress and associated hair
pulling.
5. Generalization training: The person
practices their new skills in different
situations so that the new behavior
becomes automatic.
Excoriation disorder is an obsessive-

5. Excoriation compulsive spectrum mental disorder that is
characterized by the repeated urge or impulse to p i c
kat
o n e ' s
own skin to the extent that either psychological or
physical damage is caused.
Symptoms and Causes
Skin picking is usually chronic, with waxing

and waning of symptoms. Sites of skin picking may
change over time. Patterns of skin picking vary from
patient to patient. Some have multiple areas of
scarring; others focus on only a few lesions. Many
patients try to camouflage the skin lesions with
clothing or make-up. Skin picking may be
accompanied by a range of behaviors or rituals. Many
also have other body-focused repetitive
behaviors, such as hair pulling or nail biting.
Treatments
SSRIs may be useful for coexisting depression or anxiety

disorders, and some evidence suggests that these drugs can also
reduce skin picking to some degree, although data are limited.
Cognitive-behavioral therapy that is tailored to treat the
specific symptoms of excoriation disorder is currently the
psychotherapy of choice. Habit reversal, a predominantly
behavioral therapy, has been best studied; it includes the
following:
• Awareness training (eg, self-monitoring, identification of triggers for the behavior)

• Stimulus control (modifying situations—eg, avoiding triggers—to reduce the likelihood
of initiating pulling)
• Competing response training (teaching patients to substitute other behaviors, such as
clenching their fist, knitting, or sitting on their hands, for hair pulling)
1.3.2.3 Trauma and Stressors-Related Disorders
DSM-5 consolidates a group of formerly disparate disorders that all develop after a
relatively stressful life event, often an extremely stressful or traumatic life event. This set of
disorders— trauma and stressor-related disorders—include attachment disorders in
childhood following inadequate or abusive childrearing practices, adjustment disorders
characterized by persistent anxiety and depression following a stressful life event, and reactions
to trauma such as posttraumatic stress disorder and acute stress d i s o r d e r. I n v e s t i g a t o
rs
working in this area
concluded that these
disorders did not fit as neatly
with other classes of
disorders, such as the a n
xiety disorders aspre
v i o u s l y a s s u m e d .
Previously, trauma- and
stressor-related disorders were
considered anxiety disorders.
However, they are now
considered distinct because
many patients do not have
anxiety but instead h a v e s y m
p t o m s o f anhedonia or
dysphoria, a n g e r, a g g r e s
s i o n , o r dissociation.
1. Post-traumatic Stress Disorder PTSD is a mental disorder that can

develop after a person is exposed to a
traumatic event, such as sexual assault,
warfare, traffic collisions,
child abuse, or other threats on a person's life. Symptoms may include disturbing thoughts,
feelings, or dreams related to the events, mental or physical distress to trauma- related cues,
attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase
in the fight-or-flight response.
Symptoms and Causes
Symptoms of PTSD generally begin within the first 3 months after the inciting traumatic
event, but may not begin until years later. In the typical case, the individual with PTSD
persistently avoids either trauma-related thoughts and emotions or discussion of the traumatic
event, and may even have amnesia of the event. However, the event is commonly relived by the
individual through intrusive, recurrent recollections, dissociative episodes of reliving the trauma
("flashbacks"), and nightmares.
There are four main symptoms of post traumatic stress disorder that develop after
traumatic experiences. These symptoms last at least one month and include:
1. reliving the event: repeatedly re-experiencing the trauma in the form of nightmares or
upsetting dreams, flashbacks, and uncontrollable thoughts. When this happens, the body often
reacts by activating fight or flight.
2. avoidance: person avoids anything related to trauma. This includes avoiding situations
that could trigger flashbacks or uncontrollable thoughts, avoiding places, people, and activities
that remind them of what happened to them, and suppressing feelings or thoughts about the
trauma.
3. hyperarousal: heightened physiological arousal and increased reactivity to stress and

trauma. People with hyperarousal may be jittery and are startled easily. They often have
problems with concentration because they’re constantly alert and looking for danger.
Hyperarousal often leads to irritability and trouble sleeping.
4. changes in thoughts, feelings

and beliefs, like:
• feeling sad, anxious, or afraid most of the

time
• becoming emotionally numb
• losing interest in activities and
relationships
• thinking of themselves as a bad or guilty
person
• believing that the world is a scary,
dangerous place and people can’t be trusted
The symptoms of post traumatic stress

disorder are often debilitating and interfere with
the person’s ability to work, go to s c h o o l ,
a n d h a v e m e a n i n g f u l relationships. If left
untreated, they can become so severe that the
person attempts suicide.
Neuroendocrinology
PTSD symptoms may result when a traumatic event causes an over-reactive

adrenaline response, which creates deep neurological patterns 0in the brain. These patterns can
persist long after the event that triggered the fear, making an individual hyper-responsive to future
fearful situations. During traumatic experiences, the high levels of stress hormones secreted
suppress hypothalamic activity that may be a major factor toward the development of PTSD.
PTSD causes biochemical changes in the brain and body, that differ from other psychiatric
disorders such as major depression. Individuals diagnosed with PTSD respond more strongly to a
dexamethasone suppression test than individuals diagnosed with clinical depression. Most people
with PTSD show a low secretion of cortisol and high secretion of catecholamines in urine, with a
norepinephrine/cortisol ratio consequently higher than comparable non-diagnosed individuals.
This is in contrast to the normative fight-or-flight response, in which both catecholamine and
cortisol levels are elevated after exposure to a stressor.
Neuroanatomy
Regions of the brain associated with stress and post-traumatic stress disorder. A meta-
analysis of structural MRI studies found an association with reduced total brain volume,
intracranial volume, and volumes of the hippocampus, insula cortex, and anterior cingulate. People
with PTSD have decreased brain activity in the dorsal and rostral anterior cingulate cortices and
the ventromedial prefrontal cortex, areas linked to the experience and regulation of emotion.
Treatments
Eye movement desensitization and reprocessing (EMDR) is a form of

psychotherapy developed and studied by Francine Shapiro to treat PTSD. She had noticed
that, when she was thinking about disturbing memories herself, her eyes were moving rapidly.
When she brought her eye movements under control while thinking, the thoughts were less
distressing.
In 2002, Shapiro and Maxfield published a theory of why this might work, called
adaptive information processing. This theory proposes that eye movement can be used
to facilitate emotional processing of
memories, changing the person's
memory to attend to more adaptive
information. The therapist initiates
voluntary rapid eye movements while the
person focuses on memories, feelings or
thoughts about a particular trauma. The
therapists uses hand movements to get the
person to move their eyes backward and
forward, but hand-tapping or tones can also
be used. EMDR closely resembles
cognitive behavior therapy as it combines
exposure (re-visiting the traumatic event),
working on cognitive processes and
relaxation/self-monitoring. However,
exposure by way of being asked to think
about the experience
rather than talk about it has been
highlighted as one of the more important distinguishing elements of EMDR.
Acute Stress Disorder is the

development of specific fear behaviors that
2. Acute Stress Disorder last from 3 days to 1 month after a
traumatic event. These symptoms always
occur after the patient has experienced or
witnessed death or
threat of death, serious injury or sexual assault. Examples of traumatic events from the DSM-5
include physical attack, physical abuse, mugging, active combat, sexual violence, natural disaster
and serious accidents. Acute stress disorder can also result from hearing
about the violent or accidental trauma of a loved one, or repeated exposure to traumatic events
Symptoms and Causes
Individuals with acute stress disorder experience

intrusive thoughts or memories of the traumatic event.
Distressing dreams about the trauma and general sleep
disturbances are also common. The patient may also
experience flashbacks or distress when exposed to
triggers of the traumatic event. Conversely, the patient
may “block out” or be unable to remember parts or the
entire traumatic event. Many patients avoid external
reminders, such as places or people related to the
traumatic event. In addition to these
intrusive symptoms, patients experience a negative mood. They may feel depressed, anxious,
angry or guilty and unable to feel happy. Additionally, the patient may have unrealistic feelings or
beliefs about the event.
Acute Stress Disorder in Children
The DSM-5 explains that in children, symptoms of acute stress disorder may manifest
through play, where themes related to the trauma may emerge. Additionally, children may
experience nightmares, often with no memory of the content. Children also tend to experience
physical symptoms such as nausea, vomiting, headaches and vague pain. Emotional symptoms
include nervousness, fear, clinging to caregivers, irritability and withdrawn mood. They may
also be poorly behaved, whiny or demand more attention than usual.
Treatments
The primary treatment goal of acute stress disorder is to prevent the disorder from
developing into PSTD, which is chronic and involves long-term social and occupational
impairment. Debriefing or crisis therapy is one method of quickly treating acute stress disorder.
The goals of crisis therapy are to promote a sense of safety after a trauma, calm the victim,
promote a sense of self-efficacy, encourage community or victim connectedness, and instill a
sense of hope. Debriefing can be done in a variety of ways. When an entire community is affected
by a catastrophe, such as a school shooting or natural disaster, group therapy is helpful. During
individual therapy, victims of trauma can share their personal narrative related to the traumatic
event and quickly develop coping skills.
Adjustment disorders (AD)

3. Adjustment Disorder are stress-related conditions. You
experience more stress than would normally
be expected in response to a stressful or
unexpected event, and the
stress causes significant problems in your relationships, at work or at school.
Work problems, going away to school, an illness, death of a close family member or any
number of life changes can cause stress. Most of the time, people adjust to such changes within a
few months. But if you have an adjustment disorder, you continue to have emotional or behavioral
reactions that can contribute to feeling anxious or depressed.
Symptoms
Signs and symptoms depend on

the type of AD and can vary from person
to person. You experience more stress
than would normally be expected in
response to a stressful event, and the
stress causes significant problems in
your life. AD affect how you feel and
think about yourself and the world and
may also affect your actions or behavior.
Some examples include:
• Feeling sad, hopeless or not

enjoying things you used to enjoy
• Frequent crying
• Worrying or feeling anxious,
nervous, jittery or stressed out
• Trouble sleeping
• Lack of appetite
• Difficulty concentrating
• Feeling overwhelmed
• Difficulty functioning in daily
activities
• Withdrawing from
s o c i a l supports
• Avoiding important things such
as going to work or paying bills
• Suicidal thoughts or behavior
Symptoms of an adjustment disorder start within three months of a stressful event and last
no longer than 6 months after the end of the stressful event. However, persistent or chronic
adjustment disorders can continue for more than 6 months, especially if the stressor is ongoing,
such as unemployment.
Causes
Adjustment disorders are caused by significant changes or stressors in your life. Genetics,
your life experiences, and your temperament may increase your likelihood of developing an
adjustment disorder.
Treatment
Many people with adjustment disorders find treatment helpful, and they often need only
brief treatment. Others, including those with persistent adjustment disorders or ongoing stressors,
may benefit from longer treatment. Treatments for adjustment disorders include psychotherapy,
medications or both.
Psychotherapy
Psychotherapy, also called talk therapy, is the main treatment for adjustment disorders.
This can be provided as individual, group or family therapy. Therapy can:
• Provide emotional support
• Help you get back to your normal routine
• Help you learn why the stressful event affected you so much
• Help you learn stress-management and coping skills to deal with stressful events
Medications
Medications such as antidepressants and anti-anxiety drugs may be added to help with
symptoms of depression and anxiety. As with therapy, you may need medications only for a few
months, but don't stop taking any medication without talking with your doctor first. If stopped
suddenly, some medications, such as certain antidepressants, may cause withdrawal-like
symptoms.
Attachment disorders are the psychological result of

significant social neglect, that is, the absence of adequate social and
emotional caregiving during childhood, disrupting the normative bond
between children and their caregivers. These disorders, formerly
considered a single diagnosis, are now,
according to DSM-5, divided into reactive attachment disorder (RAD) and disinhibited
social engagement disorder (DSED).
Reactive attachment disorder (RAD) is

4. Reactive Attachment Disorder a condition in which an infant or young child
does not form a secure, healthy emotional bond
with his or her primary caretakers (parental
figures). Children with RAD often
have trouble managing their emotions. They struggle to form meaningful connections with other
people. Children with RAD rarely seek or show signs of comfort and may seem almost fearful of
their caretakers, even in situations where the current parent figures seem quite loving and
caring. These children are often irritable or sad, and may report feeling unsafe and/or alone.
Symptoms and Causes
Although there is no exact cause, researchers believe that lack of an appropriate level of
loving and consistent caretaking contributes to development of RAD. Inadequate caregiving can
make a child feel abandoned, alone and uncared for – all of which can prevent that child from
developing a healthy and secure emotional bond with his or her primary caretakers. Young
children form healthy relationships when their basic needs are consistently attended to – this
builds a sense of trust between the young child and caretakers. Examples of inappropriate, ongoing
caretaking situations that place a child at greater risk of developing RAD include:
• A baby whose diaper is soiled and not changed for many hours.
• A baby who is hungry and not fed for many hours.
• A baby who is crying and not attended to and who is not comforted when they are in
distress.
• A baby who is not held, touched, talked to, or interacted with for many hours at a time.
• An infant whose needs are met only some of the time (the caregiving is not consistent).
• A young child who only gains the attention of caretakers by acting up/or being
disruptive.
• A baby or young child who has had multiple primary caretakers (especially if the care
provided is inconsistent and/or from unfamiliar people).
• Any situation in which the child has been physically or emotionally neglected or
abused by primary caretakers or other adults.
Symptoms of reactive attachment

disorder vary from child to child. Infants
and young children who may have RAD
show common signs such as:
• Failure to show an expected range of

emotions when interacting with others; f a
ilure to show “emotions of
conscience” such as remorse, guilt, or
regret
• Avoiding eye contact and physical touch,
especially with caregivers
• Expressing anger; having tantrums; being irritable, unhappy and sad; disobedience and
arguing (beyond what would be “usual” for the child’s age and situation)
• Displaying inappropriate affection toward strangers while demonstrating a lack of affection
for and/or fear of their primary caretakers.
When children with RAD grow older, their symptoms usually fall into one of two general
patterns:
• Inhibited RAD symptoms. Children are aware of what happens around them, but they do
not respond typically to outside stimuli. Children showing inhibited RAD symptoms are
withdrawn and emotionally unresponsive. They may not show or seek affection from
caregivers or others, keeping largely to themselves.
• Disinhibited RAD symptoms. Children may be overly friendly toward strangers.

Children with disinhibited RAD symptoms do not prefer their primary caretakers over other
people. In most cases, these children act younger than their age and may seek out
affection from others in an unsafe way.
Treatments
Treatment for reactive attachment disorder focuses on repairing and/or creating

emotionally healthy family bonds. It aims to strengthen relationships between children and
their caretakers in a way that can later help the child to develop other healthy relationships. Both
children and parents benefit from tailored treatment plans. Treatment may incorporate:
• Psychotherapy/Counseling. A mental health provider works with the child and parents
in a variety of ways, sometimes one-on-one with the child, sometimes with just caretakers,
and sometimes in combination, to build skills and reduce problematic patterns of behavior.
• Family therapy. This therapy involves working together with the primary caretakers and
child to develop ways to interact in healthy ways.
• Social Skills Intervention. This therapy teaches the child how to interact more
appropriately with other similar–aged children in typical social settings. Parents are usually
also involved to help the child to use the skills they learn.
• Special education. If a child qualifies, these are school-based programs that help children
learn skills to succeed both academically and socially.
• Parenting skills classes. In these sessions parents may learn more effective ways of
managing their child’s challenges. This can be particularly beneficial as managing discipline
for children with RAD can be more difficult.
•
Disinhibited
4. Disinhibited Social Engagement Disorder social engagement
disorder (DSED) is an
attachment disorder. It may
make it difficult for
children to form deep, meaningful connections to others. Both DSED and RAD are seen in
children with a history of trauma or neglect. DSED requires treatment and won’t go away on its
own.
Symptoms and Causes
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), children
must have at least two of the following symptoms to be diagnosed with DSED:
• intense excitement or a lack of inhibition over

meeting or interacting with strangers or unfamiliar
adults
• behaviors with strangers that are overly friendly,
talkative, or physical and not age- appropriate
or culturally acceptable
• willingness or desire to leave a safe place or
situation with a stranger
• lack of desire or interest in checking in with a
trusted adult prior to leaving a safe place, or in a
situation that seems foreign, strange, or
threatening.
Children with DSED are at an increased risk of harm from others because of their
willingness to connect with strangers. They have trouble forming loving connections with other
children and adults.
Treatments
Treatments for DSED usually includes the child’s entire family unit. Talk therapy may
occur individually and in groups. Psychotherapeutic treatments meant to put the child at ease
may include play therapy and art therapy.
Name: Year & Section:
1.3.3 SELF-TEST # 11
I. DIAGNOSTICS: Label the disorder that the client had experience
1. "A lot of things scare me. I was afraid that if someone became sick, I would have another bad case, It
was a long process with many setbacks, Every bad news is an occasion for mental breakdown."
2. "I remember one specific incident that I will never forget. I was a bit apprehensive but desperate to
see the doctor so off I went. I got half way there and I suddenly had an overwhelming sense of fear. I was literally
frozen on the spot and I was a shaking wreck. Heart beating fast and felt like dying."
3. "I have a fear of injections. Whenever I will be told, I'll start shaking half an hour before having one,
then I'll have to be pinned down and I'll start screaming and I won't be able to breath, but the second the needle
goes into me I faint."
4. “When I approach someone, the first thing I do is subconsciously make excuses why I shouldn’t talk
to them. If I do talk to people, I stutter. And after failing at every conversation I try to have, I begin to feel that it’s
easier not to talk at all."
5. "For my little son, the start of school has always been a struggle. This year his distress escalated with
the added demand of starting in a new school due to a family move, and by November he missed twenty-six days
of school often complaining of headaches or stomachaches. His academic work has suffered, and his teachers have
sent his assignments home. He insists that he can't complete them without my presence. He worries that something
bad may happen to me while he is in school."
6. "I tried everything I could think of to get my 14–year–old daughter to join an after–school club or
accept invitations to parties. She insisted that she would rather stay home and read; she said she was afraid she
didn’t fit in with her classmates and didn't know what to say to them. Her grades have suffered because of lack of
class participation. Whenever she was in a group social situation, as in class or at a party, she suddenly became
frightened and her heart pounded."
7. “I got to a point where my stomach dropped as soon as I woke up. It’s like a feeling of grief and
despair. You’re shaking, tired and you don’t really feel there. It’s like you’re watching yourself. I tried to get
through it but I reached a stage when even the thought of going into my own garden made me panic. It was like
coming up against an invisible wall."
8. “I have witnessed a horrific tornado level on the farm 3 weeks ago. Since then, I had many
flashbacks of the incident, trouble sleeping, and a fear of going outside in storms.”
9. “I was involved in a car accident 6 weeks ago in which the driver of the other car was killed. Since
then, I had been unable to get into a car because it brings back the horrible scene I witnessed. Nightmares of the
incident haunt me and interfere with my sleep. I am irritable and had lost interest in my work and hobbies.”
10. “I withdrew from school because of incapacitating ritualistic behavior. I abandoned personal hygiene
because the compulsive rituals that I had to carry out during washing or cleaning were so time consuming that I
could do nothing else. I do these things after experiencing intrusive and persistent thoughts and impulses about sex,
aggression, and religion.”
1.4 LEARNING INSIGHTS

Anxiety disorders according to this provided algorithm can be diagnosed:
Anxiety Related Disorders

Presenting symptoms: fear, worry, repetitive, intrusive,
inappropriate thoughts or actions, reexperiencing of traumatic events.
1. If the presenting symptoms include fear of separation. Separation Anxiety
Disorder
2. If a child is unable to speak in some settings and to some

people. Selective Mutism
3. If the presenting symptom is fear, avoidance, or anxious Specific Phobia

anticipation about one or more specific situations. Social Anxiety Disorder
4. If the presenting symptom is recurrent panic attacks. Panic Disorder
5. If an intense fear of being in public places feel that escape

might be difficult, tends to avoid public places, and may not Agoraphobia
even venture out from home.
6. If pervasive symptoms of anxiety and worry are associated Generalized Anxiety

with a variety of events or situations and have persisted for Disorder
at least 6 months.thoughts or actions, reexperiencing of traumatic events.
inappropriate
7. If the presenting worry or anxiety is related to Obsessive Compulsive
Related Disorders
recurrent and persistent thoughts and/or ritualistic
behaviors or recurrent mental acts. 1. OCD
2. Body Dysmorphic
Disorder
3. Hoarding Disorder
4. Trichotillomania
5. Excoriation
Trauma-and Stressor
Related Disorders
1. Reactive
Disorder Attachment
2. Disinhibited
Engagement Social
8. If the presenting symptoms are related to
3. PTSD
reexperiencing highly traumatic events.
4. Acute Stress Disorder
1.5 CHAPTER QUESTIONS
1) Describe anxiety disorders.
2) Define the categories of anxiety disorders.
3) Explain the common signs and symptoms of anxiety disorders. With examples.
4) Describe the causes of anxiety disorders.
5) How common are anxiety disorders.
1.6 SUGGESTED READINGS
Barlow.H.David(2008) Abnormal Psychology :An Integrative Approach, Canada, Wadsworth

Cenanage Learning(Pub).
Barlow &Durand(2005) Essentials of Abnormal Psychology,New York, Thomson

Wadsworth(Pub).
Davison C .Gerald (2005) Abnormal Psychology, John Wiley&Sons(Pub).

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Modules in Abnormal Psychology First Semester S.Y.

UNIT THREE: Mild Mental Disorders

“The brighter the light, the darker the shadow.”

CHAPTER 1 Neurosis is a class of clinical

After reading this chapter, you will be able to:

1.3 LESSON 1: Anxiety Disorders

The term anxiety is mainly

1.3.1 Common Symptoms of Anxiety Disorders

• Palpitation almost pounding of

• Hot flashes or chills

• Nausea or stomach cramps etc.

1.3.2 Categories of Anxiety Disorders

1.3.2.1 Anxiety Related Disorders

1. Separation Anxiety Disorder Separation anxiety is a normal

Symptoms and Causes

2. Selective Mutism Selective mutism (SM) is an

Symptoms and Causes

The most evidence-based recommended treatment for selective mutism is behavioral

A specific phobia is any kind of

The fear or anxiety may be triggered both by

Symptoms and Causes

Phobias can be classified under the

1. Animal type – Fear of dogs, cats, rats and/or

The following are two therapies normally

• Cognitive behavioral therapy

Medications to aid CBT have not been

4. Social Anxiety Disorder

A person with social phobia m

Panic disorder occurs when you experience

Symptoms and Causes

Common symptoms associated

• racing heartbeat or palpitations

The symptoms of a panic attack

Treatment for panic disorder focuses on reducing or

Agoraphobia is a type of anxiety

Symptoms and Causes

Typical agoraphobia symptoms include fear of:

• Leaving home alone

• Fear or anxiety almost always results from exposure to the situation

Biology — including health conditions and

Agoraphobia treatment usually includes both psychotherapy and medication. It may

effective forms of psychotherapy for anxiety disorders, including agoraphobia. Generally a

You can learn:

• What factors may trigger a panic

• Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors

• Anti-anxiety medication. Anti-anxiety drugs called benzodiazepines are sedatives that,

Symptoms and Causes

Worries, doubts, and fears are a normal part of life. It’s

Physical symptoms of generalized anxiety disorder

• Feeling tense; having muscle tightness or body aches

Emotional symptoms of generalized anxiety disorder

• Constant worries running through your head

In children, excessive worrying centers on

• “What if” fears about situations far in the future

Cognitive Theories. The core feature of GAD, worry, is regarded as maladaptive

To Cope with Anxiety, Remember A-W-A-R-E

1.3.2.2 Obsessive-Compulsive and Related Disorders

Types and Symptoms

Obsessive thoughts can include:

• Worries about yourself or other people getting hurt

Compulsive habits can include:

• Doing tasks in a specific order every time or a certain “good”

According to the Diagnostic and