Generalized Anxiety Disorder,

Obsessive Compulsive &

Related Disorders
Generalized Anxiety Disorder
 CASE STUDY Irene was a 20-year-old college student - Ref. Pg. 134

She carried a 3.7 grade point average, she was convinced she would flunk every test she took. Irene
worried until she dropped out of the first college she attended after 1 month. She felt depressed for a
while and then decided to take a couple of courses at a local junior college, believing she could handle
the work there better. After achieving straight A’s at the junior college for 2 years, she enrolled once
again in a 4-year college as a junior.

She was also concerned about relationships with her friends. Whenever she was with her new
boyfriend, she feared making a fool of herself and losing his interest.

She was also very worried about eating the wrong types or amounts of food. She became reluctant to
have her blood pressure checked for fear it would be high or to
weigh herself for fear she was not losing weight.
Key points to be noted from Case Study -
Academic life

Romantic life

Personal Health

Physiological distress

People around her -- Mother was also affected

 Generalized Anxiety Disorder
Description -
Generalized anxiety disorder is a mental health disorder that produces fear,
worry, and a constant feeling of being overwhelmed. It is characterized by
excessive, persistent, and unrealistic worry about everyday things.
Symptoms -
• Persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the
events
• Overthinking plans and solutions to all possible worst-case outcomes
• Perceiving situations and events as threatening, even when they aren't
• Difficulty handling uncertainty
• Indecisiveness and fear of making the wrong decision
• Inability to set aside or let go of a worry
• Inability to relax, feeling restless, and feeling keyed up or on edge
• Difficulty concentrating, or the feeling that your mind "goes blank"
Diagnostic Criteria for GAD (DSM 5) -
1. Excessive anxiety and worry, occurring more days than not for at least 6 months about
a number of events or activities.
2. The individual finds it difficult to control the worry.
3. The anxiety and worry are associated with at least three (or more) of the following six
symptoms (with at least some symptoms present for more days than not for the past 6
months) [Note: Only one item is required in children]:
• Restlessness or feeling keyed up or on edge
• Being easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbance
4. The anxiety, worry or physical symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
5. The disturbance is not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general medical condition (e.g.,
hyperthyroidism).
6. The disturbance is not better explained by another mental disorder (e.g.,
anxiety or worry about having panic attacks in panic disorder, negative evaluation
in social anxiety disorder).
Causes -
The exact cause of GAD is not fully understood, although it's likely that a combination
of several factors plays a role.

Research has suggested that these may include:

• the genes you inherit from your parents
• having a history of stressful or traumatic experiences, such as domestic violence,
child abuse or bullying

Treatment -
CBT is widely used for GAD.
Medication -
• Antidepressants : Escitalopram (Lexapro)
• Anti-anxiety medications: Benzodiazepines, Buspirone
An Integrative Model
of GAD -
Obsessive Compulsive &
Related Disorders
 Obsessive Compulsive Disorder
Description -
Obsessive-compulsive disorder (OCD) is a disorder in which people have
recurring, unwanted thoughts, ideas or sensations (obsessions). To get rid of the
thoughts, they feel driven to do something repetitively (compulsions).
Symptoms -
The main symptoms of OCD are obsessions and compulsions that interfere with
normal activities. For example, symptoms may often prevent you from getting to
work on time.
• obsessions are unwanted, intrusive thoughts or mental images that
cause intense anxiety.
• compulsions are repetitive actions that you feel like you have to do to
ease or get rid of the obsessions. They are time-consuming and get
in the way of important activities that one value.
Types of Obsessions and AssociatedCompulsions
Diagnostic Criteria for OCD (DSM 5) -
Presence of obsessions, compulsions or both:
Obsessions are defined by 1 and 2:
1. Recurrent and persistent thoughts, urges, or images that in most individuals cause marked
anxiety or distress
2. The individual attempts to ignore or suppress such thoughts, impulses, or images, or to
neutralize them with some other thought or action

Compulsions are defined by 1 and 2:

1. Repetitive behaviors
2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some
dreaded event or situation; however, these behaviors or mental acts either are not connected in a
realistic way with what they are designed to neutralize or prevent or are clearly excessive
2. 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.
3. The disturbance is not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition.
4. The disturbance is not better explained by the symptoms of another mental
disorder (e.g., excessive worries, as in generalized anxiety disorder, or
preoccupation with appearance, as in body dysmorphic disorder).
Causes -
Experts do not know what causes OCD, but there are various theories. Genetic,
neurological, behavioral, cognitive, and environmental factors may all contribute.

Treatment -
CBT is widely used for OCD.
ERP - Exposure and Response Prevention approach
Medication -
• Antidepressants :
Escitalopram (Lexapro)
Fluoxetine (Prozac)
An Integrative Model
of OCD -
Obsessive Compulsive & Related Disorders

• Body Dysmorphic Disorder (BDD)

• Hoarding Disorder

• Trichotillomania (Hair Pulling

Disorder)

• Excoriation (Skin Picking Disorder)

Body Dysmorphic Disorder (BDD)
A mental illness involving obsessive focus
on a perceived flaw in appearance.

The flaw may be minor or imagined. But the

person may spend hours a day trying to fix
it. The person may try many cosmetic
procedures or exercise to excess.
People with this disorder may frequently
examine their appearance in a mirror,
constantly compare their appearance with
that of others and avoid social situations or
photos.
 Hoarding Disorder
Hoarding disorder is the difficulty
throwing away or parting with
possessions because one believes
that they need to save them.
Individuals may experience distress at
the thought of getting rid of the items.
So they gradually keep or gather a
huge number of items, regardless of
their actual value.
Trichotillomania (Hair Pulling Disorder)
A disorder that involves recurrent, irresistible
urges to pull out body hair.

The urges involve pulling out hair from the

scalp, eyebrows and other areas of the body.
Symptoms include compulsive hair pulling and
hair loss, such as bald patches on the scalp.
Social and work functioning may be affected.
Excoriation (Skin Picking Disorder)
Excoriation (skin picking disorder) is
characterized, as the label implies, by
repetitive and compulsive picking of the
skin, leading to tissue damage.