Anxiety Disorders

WEB
 Anxiety as a Normal
and an Abnormal Response
• Some amount of anxiety is “normal” and is
associated with optimal levels of
functioning.

• Only when anxiety begins to interfere with

social or occupational functioning is it
considered “abnormal.”
The Fear and Anxiety Response
Patterns
• Fear
• Panic
• Anxiety
• Anxiety Disorder
The Bell Curve
An Important Law- The Yerkes Dodson Law
 Another Bell Curve-
Courtesy of Our Good Buddies Yerkes-Dodsen
 Phobic Disorders

• Phobias
1. Specific phobias
2. Social phobia
3. Agoraphobia
Specific Phobias
 Specific Phobias

• Psychosocial causal factors

• Genetic and temperamental causal factors
• Preparedness and the nonrandom
distribution of fears and phobias
• Treating specific phobias
 Social Phobia
• General characteristics
Fear of being in social situations in
which one will be
embarrassed or humiliated
 Social Phobia

• Interaction of psychosocial and biological

causal factors
– Social phobias as learned behavior
– Social fears and phobias in an evolutionary
context
– Preparedness and social phobia
 Social Phobia

• Interaction of psychosocial and biological

causal factors
– Genetic and temperamental factors
– Perceptions of uncontrollability
– Cognitive variables
 Panic Disorder With and
Without Agoraphobia
• Panic disorder
• Panic versus anxiety
• Agoraphobia
• Agoraphobia without panic
 Panic Disorder

• Prevalence and age of onset

• Comorbidity with other disorders
• Biological causal factors
• The role of Norepinephrine and
Serotonin
Panic and the Brain
 Panic Disorder
• Genetic factors
• Cognitive and behavioral causal factors
• Interoceptive fears
Panic Disorder: The Cognitive
Theory of Panic
Panic Disorder: The Cognitive
Theory of Panic

• Perceived control and safety

• Anxiety sensitivity as a vulnerability factor
for panic
• Safety behaviors and the persistence of
panic
• Cognitive biases and the maintenance of
panic
 Treating Panic Disorder and
Agoraphobia

• Medications
• Behavioral and
cognitive-behavioral
treatments
 Generalized Anxiety Disorder

• General characteristics
• Prevalence and age of onset
• Comorbidity with other disorders
 Generalized Anxiety Disorder:
Psychosocial Causal Factors

• The psychoanalytic viewpoint

• Classical conditioning to many stimuli
• The role of unpredictable and uncontrollable
events
• A sense of mastery: immunizing against
anxiety
 Generalized Anxiety Disorder:
Biological Causal Factors
• Genetic factors
• A functional deficiency of GABA
• Neurobiological differences between
anxiety and panic
Obsessive-Compulsive Disorder
• Obsessions- repetitive unwanted ideas that
the person recognizes are irrational
• Compulsions- repetitive, often ritualized
behavior whose behavior serves to
diminish anxiety caused by obsessions
Obsessive-Compulsive Disorder

• Prevalence and age of onset

• Characteristics of OCD
• Types of compulsions
• Comorbidity with other disorders
Obsessive-Compulsive Disorder:
Psychosocial Causal Factors

• Psychoanalytic viewpoint
• Behavioral viewpoint
• The role of memory
• Attempting to suppress obsessive thoughts
Obsessive-Compulsive Disorder:
Biological Causal Factors

• Genetic influences
• Abnormalities in brain
function
• The role of serotonin
 Post-Traumatic Stress Disorder
• Critical Component
– Symptoms occurs AFTER a traumatic stressor
 Symptoms Categories
• Intrusive
– distressing recollections
– dreams
– flashbacks
– psychological trigger reactions
– physiological trigger reactions
 Symptoms Categories
• Avoidance
– avoid thoughts, feelings or discussions
– avoid activities, places
– memory blocks
– anhedonia (without pleasure)
– numb
– alexithymia (emotions unknown)
– feeling of doom
 Symptom Categories
• Hyperarousal Symptoms
– sleep disturbance
– anger problems
– concentration
– startle response
– “on guard” hypervigilence
 Diagnoses
• Acute Stress Disorder
– new to DSM-IV (1994)
– symptoms 2 days to 4 weeks following
traumatic event
• PTSD
– new to DSM-III (1980)
– symptoms beyond 4 weeks
– delayed onset
 Who Is Vulnerable?
• All ages
• Both genders
• Across Cultures and ethnic groups
 Some Stats
Andrews, Wahlberg,
Montgomery (1993)
70
60
50
40
30 Frequency
20
10
0
Black Hispanic Native White
American
 Employment
60

50

40

30
Frequency
20

10

0
Employed Umemployed
 Depression
35

30

25

20
Enter
15 Exit
10
5
0
Total Group Severe PTSD Moderate PTSD
 Types of Traumas
• Natural
– earthquakes
– floods
– fires
• Human induces
– war
– crimes of violence
 Co-Morbid Diagnoses
• Alcoholism
– 75% for Vietnam Veterans with PTSD
• Depression
– 77% of firefighters with PTSD also have
depression
• Generalized Anxiety
• Panic Attacks