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Anxiety-Related Disorders

Anxiety Disorders
Anxiety: Feelings of fear and apprehension.
Anxiety Disorders: A group of disorders
primarily characterized by extreme, unrealistic,
or debilitating anxiety with one of these criteria:
Anxiety is the major disturbance.
Anxiety is manifested only in particular
Anxiety results from an attempt to master
other symptoms.
Types of Anxiety Disorders
Anxiety is a part of everyones lives.
Anxiety is the price we pay for society
If it becomes intense and perseveres, then it may
be categorized as an anxiety disorder.
Types of anxiety disorders:
Panic Disorder
Generalized Anxiety Disorder (GAD)
Obsessive-Compulsive Disorders (OCD)
Understanding Disorders from Multipath
Biological Dimension:
Two main biological factors:
Brain structure
Genetic influences
Biological, psychological, and social factors
interact with one another
Interplay between genetic and environmental

Understanding Disorders from Multipath
Psychological Dimension:
Psychoanalytic theorists focus primarily on
parent-child relationship
Psychological variables such as ones sense
of control may also be involved
Early experiences can play a role in
determining vulnerability of children and need
to be considered
Understanding Disorders from Multipath
Social and Sociocultural Dimensions:
Daily environmental stress
Acculturation factors among minority groups
An anxiety disorder marked by a persistent,
irrational fear and avoidance of a specific object
or situation that disrupts normal functioning.
Phobias focus anxiety on a specific object,
activity, or situation.
Powerful imagination, can vividly anticipate
terrifying consequences
Recognize fear as excessive and irrational
Unable to control anxiety
Phobia: Strong, persistent, unwarranted fear of a
specific object or situation.
Agoraphobia: Intense fear of being in public places
where escape or help may not be available; in
extreme cases, fear of leaving home.
Social Phobia: Intense, excessive fear of being
scrutinized in one or more social situations.
Specific Phobia: Extreme fear of a specific object or
situation; a phobia not classified as agoraphobia or
social phobia.
Common Fears
Common and uncommon fears
Phobia Onset
Etiology of Phobias
Psychodynamic: Unconscious conflicts (expressions
of unacceptable wishes, fears and fantasies)
Classical conditioning
Baby Albert; generalization
Operant Conditioning
Object avoidance behavior reinforced with anxiety
Observational learning (modeling)
Cognitive-behavioral: Cognitive distortions and
catastrophic thoughts
Biological: Genetics or biological preparedness
Biological Preparedness
The brains shortcut for emotions
Treatment of Phobias
Neurobiological abnormalities can be normalized
with medication
Antidepressants, benzodiazepines, SSRIs
Exposure therapy (plus applied tension)
Systematic desensitization
Cognitive restructuring
Skills training
Virtual Reality
Panic Disorder and Generalized Anxiety Disorder
Panic Disorder: Characterized by intense fear
accompanied by bodily sensations.
Generalized Anxiety Disorder (GAD):
Characterized by milder anxiety-evoking
thoughts; chronic pathological worry.
Predominant characteristic: Free-floating (unfocused)

Panic Disorder
Somatic symptoms: Breathlessness, sweating, choking,
nausea, heart palpitations.
May lead to Agoraphobia: Anxiety about leaving ones home.
Lifetime prevalence: 3.5%; twice as common in women as in
An anxiety disorder marked by a minutes-long episode of
intense dread in which a person experiences terror and
accompanying chest pain, choking, or other frightening
A panic attack is anxiety to the extreme
1 in 75 suffers from this disorder with smokers having a
fourfold risk of a first attack.

Panic Attacks
Panic Attacks: Intense fear accompanied by pounding
heart, trembling, shortness of breath, fear of losing
control, fear of dying.
Panic attacks may be experienced in any of the
anxiety disorders.
Though panic attacks are relatively common, panic
disorder is quite rare.
Three types of panic attacks:
Situationally bound
Situationally predisposed
Unexpected or uncued
Generalized Anxiety Disorder (GAD)
Persistent high levels of anxiety and excessive
worry over major and minor life circumstances
(more persistent, less intense than Panic
DSM-IV-TR: Symptoms present at least six
Somatic symptoms: Heart palpitations, muscle
tension, restlessness, trembling, sleep
difficulties, poor concentration, persistent
Generalized Anxiety Disorder (GAD)
An anxiety disorder in which a person is continually
tense, apprehensive, and in a state of autonomic
nervous system arousal.
Characterized by free-floating anxiety
Person cannot identify, avoid, or deal with
source of anxiety.
Most have co-morbid disorders
World-wide: Most frequently diagnosed anxiety
Lifetime Prevalence: 5%; twice as common in women
as in men
Etiology of Panic Disorder and Generalized
Anxiety Disorder
Psychodynamic: Internal conflicts from unconscious
sexual and aggressive impulses.
When an unconsciously repressed memory seeks
conscious representation, we feel the anxiety.
Cognitive-behavioral: Interpretation of bodily
Anxiety-sensitivity theory of panic
Anxiety Sensitivity Index (ASI): Measures a
persons reactions to anxiety.
Positive Feedback Loop Between Cognitions and
Somatic Symptoms Leading to Panic Attacks
Etiology of Panic Disorder and Generalized
Anxiety Disorder
Biological: Changes and dysfunction of neural
structures and neurochemical responses to stressful
Valium and Librium can treat therefore might be
due to chemical imbalances.
Biological challenge tests
Give people w/ and w/o disorder certain chemicals which
raise internal processes (or ask to hyperventilate).
People w/ disorder much more likely to experience panic
Genetic studies indicate at least some heritability
A stronger role in panic disorder than in GAD
Treating Panic Disorder and Generalized Anxiety
Biochemical treatment:
Benzodiazepines for GAD, but problems of
tolerance and dependence
Antidepressants are medications of choice
SSRIs are most frequently prescribed
because they have fewest side effects.
High relapse rates after stopping medications
Treating Panic Disorder and Generalized Anxiety
Behavioral treatment (individual and/or group)
Cognitive-behavioral therapy:
Educate about disorder and symptoms
Muscle-relaxation training
Change unrealistic thoughts
Provide coping statements/use coping
Identify antecedents of panic
Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD):
Characterized by intrusive and repetitive
thoughts or images, or by the need to perform
acts or dwell on thoughts to reduce anxiety.
Ego-Dystonic Symptoms: The symptoms are
felt to be alien thoughts and actions, not under
voluntary control of patient.
Lifetime prevalence rate: 2.5% (possibly
underestimated); same for males and females
Obsessive-Compulsive Disorder
Obsession: Recurrent or persistent preoccupation
with something.
an idea; thought; image; impulse
Common obsessions include dirt, germs,
something terrible happening, symmetry, order or
Approximately 80% of normal population
experience obsessions (a song we cant get out
of our head!).
Patients with OCD: Obsessions last longer, are
more intense, produce more discomfort, and are
more difficult to dismiss.
Obsessive-Compulsive Disorder
Compulsion: An impulse experienced as irresistible
(The need to perform acts or to dwell on thoughts to
reduce anxiety).
Repetitive and seemingly purposeful behaviors performed
according to a rule or in a stereotyped fashion.
Common compulsions include: grooming, hand washing,
repeating rituals (e.g., in/out of door); checking locks,
appliances, car brakes, homework.
Children and adolescents with obsessive-compulsive
disorder, compulsions most commonly involve washing,
checking, and repeating acts.
Approximately 55% of normal population acknowledges
compulsive behaviors (dont step on a crack!).
Severe compulsive state: Stereotyped/rigid behaviors,
often with magical qualities.
Obsessive-Compulsive Disorder
Four Identified Types:
Harm-related, sexual, aggressive, and/or
religious obsession w/ checking compulsions
Symmetry obsessions w/ arranging and
repeating compulsions
Contamination obsessions w/ cleaning
Hoarding and saving compulsions
Etiology of Obsessive-Compulsive Disorder
Psychodynamic perspective: Attempts to fend
off anal sadistic, anal libidinous, and genital
Defense mechanisms used: substitution,
undoing, reaction formation, isolation
Behavioral and cognitive perspectives: Anxiety
Disconfirmatory bias-Search for evidence of
failure to perform an act rather than success
of an act.
Etiology of Obsessive-Compulsive Disorder
Biological perspective: Brain structure, genetic
factors, biochemical abnormalities.
Brain imaging procedures provide visual
Medications provide only partial relief
Treatment of Obsessive-Compulsive Disorder
Biological treatments: Partial relief with
fluoxetine and clomipramine, but side effects
and relapse after medication stops.
Behavioral treatments:
Exposure (similar to systematic desensitization),
plus response prevention.
Flooding: An exposure therapy that extinguishes
fear by placing client in continued in vivo or
imagined high anxiety-provoking situations.
Cognitive treatments: Identify and modify
irrational thoughts