PSY 348

Anxiety Disorders I
Introduction

• Discussion question: what is anxiety?

What distinguishes fear from anxiety?
Introduction continued

• Fear: the emotional response to real or perceived imminent threat

• Anxiety: the anticipation of future threat

• Anxiety disorders are different from developmentally normal fear or anxiety in that
they’re excessive, or persist beyond developmentally appropriate periods
• Since individuals with anxiety disorders typically overestimate the danger in situations they
fear or avoid, the primary determination of whether the anxiety is excessive is made by the
clinician
Overview

• Anxiety disorders are the most common mental illness in the U.S., and affect up to 33.7% of the population at some point in their lives
(Bandelow & Michaelis, 2015)

• We will examine:
• Separation anxiety
• Selective mutism
• Specific phobia
• Social anxiety disorder
• Panic disorder
• Agoraphobia
• Generalized anxiety disorder
 This disorder is characterized by a developmentally
inappropriate fear of being separated from important
individuals (e.g., a parent or a spouse)

Usually this fear relates to concern that farm will befall the
attachment figure, or that they will not return

Estimated 12-month prevalence in the U.S. is 1.2% (Kessler

et al. 2012)

Separation More common in children than adults, but 57% of adults

report that it began during childhood (Silove et al., 2015)

Anxiety Occurs more frequently in women than men (Silove et al.,

Disorder 2015)
 Individuals with this diagnosis fail to speak in certain
situations when they are expected to do so, despite having
adequate knowledge and comfort with the language and the
ability to speak fluidly in other circumstances

Point prevalence is estimated to be less than 1% across

countries, although this varies based on ages of children and
setting (Muris & Ollendick, 2015)

Age of onset is usually between 2-5 years old, often when

children first begin schools

Selective Occurs more frequently in females than males

Mutism
 Individuals with this disorder fear a specific situation or
object (e.g., spiders, storms, heights)

The feared stimuli must almost always cause fear, and be

avoided or endured with high anxiety
• The fear must be out of proportion to the actual danger of the situation

12-month prevalence in the U.S. is 12.1% (Kesller et al.,

2012)

Most common specific phobias include animals and

heights

Tends to begin at a young age (mean = 7 years old)

Specific
Phobia Occurs more frequently in women than men
 Defining feature is fear and avoidance of social situations,
specifically because the individual fears negative
evaluation or social humiliation (Clark & Wells, 1995)

These individuals either avoid social situations or endure

them with high anxiety

12-month prevalence rate of 7.4% in the U.S., with higher

rates in women (Kessler et al., 2003; Kessler et al., 2012)
Social
Anxiety Often begins in childhood or adolescence, with a mean
age of onset between ages 11 and 13 (Kessler, 2003)

Disorder
 A panic attack is a rush of physiological symptoms (e.g.,
rapid heartbeat, shortness of breath, derealization, fear of
dying, etc.) that peaks within minutes

Approximately 28% of individuals report experiencing

one or more panic attacks in their lifetime; however, most
of these individuals do not meet diagnostic criteria for
panic disorder (Kessler et al., 2006)

A diagnosis of PD is warranted if panic attacks are

Panic recurrent and followed by at least one month of

significant fear or future attacks, fear of consequences of
attacks, and/or change of behavior related to the attacks
Disorder (PD) (e.g. avoiding places where attacks have occurred)
 The estimated 12-month prevalence of
panic disorder for adults in the U.S. is
2.4% (Kessler et al., 2012)

More common among women than among

men (de Jonge et al., 2016)

Panic More commonly diagnosed among adults

Disorder than among children, with average age of
onset of 23 (Kessler et al., 2006)
continued
 Defining feature of agoraphobia is a fear of situations in
which a person may not be able to escape or get help if
they experience embarrassing (e.g., vomiting) or panic-
like (e.g., shortness of breath) physiological symptoms

Situations often feared by these individuals include

crowds, lines, enclosed places (e.g., movie theaters), open
places (e.g., parking lots), public transportation, or being
alone while outside

Estimated 12-month prevalence in the U.S. is 1.7%, with

typical onset occurring in young adults (e.g., early 20s)

Agoraphobia
 Characterized by excessive worry and anxiety about multiple topics (e.g.,
relationships, work, health)

Individual must experience uncontrollable and excessive worry about multiple

topics for more days than not over a period of 6 months, as well as at least 3
physical symptoms (muscle tension, difficulty concentrating, being easily fatigued)

Lifetime prevalence is 3.7% worldwide, with higher rates in high-income countries

Generalized Typically begins in adulthood

Anxiety
Disorder More common among women than men

(GAD)
Obsessive Compulsive Disorder (OCD)

• Characterized by obsession and compulsions

• Obsessions are repetitive, intrusive thoughts that cause significant anxiety or distress
• Common obsessions involve violence, sex, religion, contamination, or germs
• Compulsions are repetitive and ritualistic behaviors (including mental acts) that reduce the anxiety caused by the
obsessions
• Examples include checking the stove, praying, handwashing, or repeating a phrase in one’s head
• Estimated 12-month prevalence in the U.S. is 1.2% (Kessler et al., 2012)
• Average age of onset is slightly earlier in men (21 years old) than women (22-24 years old)
• Slightly more prevalent among adult women than adult men
Body Individuals with this disorder are preoccupied with perceived physical

Dysmorphic flaws that are minor or not visible to others

Disorder Must be associated with repetitive behaviors (e.g., checking mirrors)

and cannot be better explained by an eating disorder

Point prevalence in the U.S. is 1.7-2.4%

Mean age of onset is 16

Body areas of concern tend to vary by gender, with women more

concerned about skin, breasts, thighs, and body hair, while men are
more likely to be concerned about genitals, balding, and muscular
build
Hoarding Characterized by difficult discarding items, resulting in
significant accumulation of clutter

Disorder Difficulty discarding must be due to a need to save the items,

or to avoid distress associated with discarding; resulting
clutter must impair the use of living areas

Point prevalence is estimated to be 2-6%

More common among older adults than younger adults

Preliminary studies suggest no difference in prevalence

between men and women
Body-focused This category includes both excoriation (skin-picking)
disorder and trichotillomania

repetitive Behavior must result in visible problems (e.g., hair loss, skin

behavior lesions), and individual must make repeated attempts to stop

or reduce the behavior

Lifetime prevalence in the U.S. is 0.6% for trichotillomania

and 1.4% for excoriation (Grant & Chamberlain, 2016; Grant
et al., 2012)

Typical age of onset for trichotillomania is between 10 and

13. years of age

Wide variation in age of onset for excoriation