PSYABNP Module 4a:

Trauma/Stressor Disorders
Anxiety Disorders
Obsessive-Compulsive Related Disorders
Somatic Symptom Related Disorders
Trauma- and Stressor-
Related Disorders
■ Posttraumatic Stress Disorder
■ Acute Stress Disorder
■ Adjustment Disorder
Anxiety Disorders

■ Separation Anxiety Disorder

■ Selective Mutism
■ Specific Phobia
■ Social Anxiety Disorder (Social Phobia)
■ Panic Disorder
■ Agoraphobia
■ Generalized Anxiety Disorder
 Obsessive-Compulsive and
Related Disorders
■ Obsessive Compulsive Disorder
■ Body Dysmorphic Disorder
■ Hoarding Disorder
■ Trichotillomania (hair-pulling)
■ Excoriation (Skin-Picking) Disorder
 Somatic Symptom and
Related Disorders (SSRD)
■ Somatic Symptom Disorder
■ Illness Anxiety Disorder
■ Conversion Disorder
■ Psychological Factors Affecting Other Medical
Conditions
■ Factitious Disorder
Trauma- and Stressor-
Related Disorders
■ Exposure to a traumatic or stressful event
Adjustment Disorder APA, 2013)

presence of emotional or behavioral symptoms in response to

identifiable stressor

■ Response to identifiable stressor within 3 months of onset of

stressor.
■ Marked distress, out of proportion to severity or intensity of
stressor (consider external context and cultural factors )
■ Significant impairment in areas of functioning
■ Once stressor or its consequences have ended, symptoms do not
persist for more than an additional 6 months.
■ Specify if with:
– Depressed mood
– Anxiety
– Mixed anxiety and depressed mood
– Disturbance of conduct
Anxiety Disorders

■ excessive fear and anxiety; persistent

SEPARATION ANXIETY
DISORDER
■ Fear or anxious about :
– separation from attachment figures that is developmentally
inappropriate.
– harm coming to attachment figures leading to loss or
separation, reluctance to be away from them
■ Nightmares and physical symptoms of distress
■ Develops in childhood and may continue to adulthood
 PANIC ATTACK
■ abrupt surge of intense fear or intense discomfort that peaks
within minutes, accompanied by physical and/or cognitive
symptoms: (4 or more)
1. palpitations, pounding heart, or accelerated heart rate
2. sweating
3. trembling or shaking
4. sensations of shortness of breath or smothering
5. feeling of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, lightheaded or faint;
9. derealization or depersonalization
10. fear of losing control or going crazy
11. fear of dying
12. paresthesias (numbness or tingling sensation)
13. chills or hot flushes
PANIC DISORDER

■ Recurrent unexpected panic attacks

■ Persistent concern or worry about having more
panic attacks
■ Changes in behavior because of panic attacks
 SPECIFIC PHOBIA
■ Irrational fear of a specific object or situation that
markedly interferes with the person’s capacity to
function
■ Fears are excessive and unreasonable
■ Attempts to avoid situations in which phobic
response might occur.
■ Specify if:
– Animal
– Natural Environment
– Blood-Injection-Injury
– Situational
– Other
Identify the type of phobia
TERM FEAR OF
Coulrophobia Clowns
Agyiophobia Crossing the street
Arachnophobia Spiders
Trypanophobia Needles
Triskaidekaphobia Number 13
Astraphobia Thunder and lightning
 SPECIFIC PHOBIA
■ Psychodynamic
– Ego defense against a repressed wish
■ Behavioral
– Experiencing a traumatic event
– Episode of panic attack
■ Cognitive
– Vicarious: Seeing someone experience a traumatic event;
– Being warned repeatedly about a fearful object, event, person
– Prepared learning – people become highly prepared for
learning about certain types of objects or situations over the
course of evolution for the survival of the species (e.g., fear of
snakes)
SOCIAL ANXIETY DISORDER
(Social Phobia)
■ Fearful of anxious or avoidant of social interactions
and situations involving possible scrutiny (e.g.,
meeting unfamiliar people, performing in front of
others, observed eating or drinking)
■ Cognitive ideation: Negatively evaluated by others, by
being embarrassed, humiliated, or rejected, or
offending others.
 AGORAPHOBIA
■ Fearful about the following situations:
– Using public transportation
– Being in open spaces
– Being in enclosed places
– Standing in line or being in a crowd
– Being outside of home alone
■ Escape might be difficult or help not available in
case of panic attack or embarrassing symptoms
■ Situations often avoided or require a companion
Obsessive-Compulsive and
Related Disorders
 OBSESSIVE-COMPLUSIVE
DISORDER (OCD)
Obsessions
■ Recurrent and persistent thoughts, urges or images
that are intrusive and unwanted
■ Preoccupations
Compulsions
■ Repetitive behaviors or mental acts performed in
relation to obsession or rigid application of rules
■ Rituals
 OCD Diagnostic Criteria (APA, 2013)
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
■ Recurrent and persistent thoughts,
urges, or images that are
experienced, at some time during
the disturbance, as intrusive and
unwanted, and that in most
individuals cause marked anxiety or
distress.
■ The individual attempts to ignore or
suppress such thoughts, urges, or
images, or to neutralize them with
some other thought or action (i.e.,
by performing a compulsion).
Compulsions are defined by (1) and (2):
■ Repetitive behaviors (e.g., hand
washing, ordering, checking) or mental
acts (e.g., praying, counting, repeating
words silently) that the individual feels
driven to perform in response to an
obsession or according to rules that
must be applied rigidly.
■ The behaviors or mental acts are
aimed at preventing or reducing
anxiety or distress, or preventing
some dreaded event or situation;
however, these behaviors or mental
acts are not connected in a realistic
way with what they are designed to
neutralize or prevent, or are clearly
excessive.
OCD Diagnostic Criteria (APA, 2013)

B. The obsessions or compulsions are time-consuming (e.g., take

more than 1 hour per day) or cause clinically significant distress
or impairment in social, occupational, or other important areas of
functioning.
OCD
Common themes or dimension in the content of
obsessions and compulsions (APA, 2013)

Obsession
1. Cleaning: contamination
2. Symmetry: symmetry
3. Forbidden or taboo
thoughts: aggressive, sexual
or religious
4. Harm: fears of harm to self
or others
Compulsion
1. Cleaning: cleaning
2. Symmetry: repeating,
ordering, counting
3. Forbidden or taboo thoughts:
rituals countering the thoughts
4. Harm: checking or rituals
countering the fear
 Theories
Biological
■ Dysfunction in brain circuitry (striatum connecting to thalamus
and frontal cortex) – inability to control primitive urges or
stereotyped behaviors.
Cognitive-Behavioral
■ Inability to turn off negative, intrusive thoughts
Psychodynamic
■ Compulsive behavior is a defense against unacceptable wish
OCD vs. OCPD (APA, 2013)
These conditions are different but can be comorbid if symptoms
of both OCD and OCPD are manifested by an individual

OBSESSIVE-COMPLUSIVE OBSESSIVE-COMPLUSIVE
DISORDER (OCD) PERSONALITY DISORDER (OCPD)

■ Characterized by intrusive ■ Characterized by

thoughts, images, urges
(obsessions) or repetitive
behaviors (compulsions)
performed to dispel the
obsessions.
■ OCD does not involve
maladaptive personality
patterns.
maladaptive personality
patterns (enduring and
pervasive) of excessive
perfectionism and rigid
control.
■ OCPD does not involve
intrusive, unwanted
obsessions and compulsive
behaviors.
 Body Dysmorphic Disorder
■ Formerly known as dysmorphophobia
■ Preoccupation with perceived defects or flaws in
physical appearance not observable or appear slight
to others
■ Range: Unattractive to Look like a monster
■ Repetitive behaviors or mental acts in response to
appearance concerns (mirror checking, excessive
grooming, comparing with others)
Hoarding Disorder

■ Persistent difficulty discarding or parting with

possessions, regardless of actual value
■ Due to a perceived need to save possessions and
distress with discarding them
■ Leads to clutter in active living areas
■ Specify if:
With excessive acquisition
Somatic Symptom and
Related Disorders (SSRD)
Etiology for SSRD

■ Genetic and biological vulnerability (e.g., increased

sensitivity to pain)
■ Early traumatic experiences
■ Learning
– Reinforcement for physical illness but not for
nonsomatic illness
■ Social/cultural norms
– Stigmatizing psychological suffering
Somatic Symptom Disorder

■ Multiple, current somatic symptoms that are distressing and

disruptive of daily living
■ Specific symptoms (localized pain) or nonspecific (fatigue)
■ Symptoms may be medically unexplained or accompany
diagnosed medical disorders
■ Characterized not by the somatic symptoms per se but the
way the individual presents and interprets the symptoms.
■ Excessive worry about the illness, negative appraisal of the
symptoms as threatening and harmful.
 Illness Anxiety Disorder
■ Formerly hypochondriasis
■ Preoccupation with having or acquiring a serious
illness
■ No somatic symptoms or mild
■ High level of anxiety about health or health status
■ Excessive health-related behaviors or maladaptive
avoidance

■ Specify if:
Care-seeking type
Care-avoidant type
Conversion Disorder
(Functional Neurological
Symptom Disorder)
■ Altered voluntary motor or sensory function
■ Symptom not based on or explained by medical
condition
■ Specifiers:
– With weakness or paralysis
– With abnormal movement
– With swallowing symptoms
– With speech symptoms
– With attacks or seizures
– With anesthesia or sensory loss
– With special sensory symptom
– With mixed symptom
 Psychological Factors Affecting
Other Medical Conditions
■ Psychological or behavioral factors adversely affect an
existing medical condition in one of the following ways:
– Course is exacerbated or delayed recovery
– Poor adherence to treatment
– Health risks
– Influence underlying pathophysiology
■ Factors:
– psychological distress
– interpersonal interaction
– coping styles
– maladaptive health behaviors (denial)
Factitious Disorder
Imposed on Self
■ Falsifying physical or psychological symptoms, or
inducing injury or disease, associated with
identified deception
■ Presents self as ill, impaired, or injured
■ Deceptive behavior evident even without obvious
external rewards
■ Munchausen syndrome
■ Not malingering
Factitious Disorder
Imposed on Another
■ Formerly known as FD by Proxy
■ The diagnosis is given to the perpetrator, not the
victim (given abuse diagnosis)