The DSM-IV Anxiety Disorders

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The DSM-IV Anxiety Disorders

• Panic Disorder with/without Agoraphobia
• Specific Phobia
• Social Phobia
• Obsessive Compulsive Disorder (OCD)
• Generalized Anxiety Disorder (GAD)
• Post Traumatic Stress Disorder (PTSD)

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Criteria for a Panic Attack
Discrete period of intense fear/discomfort in
which at least 4 symptoms developed abruptly and
reached a peak within 10 minutes

• palpitations, pounding/racing heart
• sweating
• trembling/shaking
• shortness of breath/smothering sensations
• feeling of choking
• chest pain/discomfort
• nausea or abdominal distress
• feeling dizzy, unsteady, faint or lightheaded
• derealization or depersonalization
• fear of losing control or going crazy
• fear of dying
• paresthesias (numbness or tingling sensations)
• chills or hot flushes

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Panic Disorder

• recurrent, unexpected panic attacks
• AND one month of concern about additional
  attacks
• OR... worry about the implications of the attack
  or its consequences
• OR... a significant change in behaviour related
  to the attacks

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Agoraphobia

• anxiety about being in places/situations from
  which escape might be difficult or embarrassing
  in the event of a panic attack
• situations are avoided or endured with marked
  distress or anxiety about having a panic attack
  OR require the presence of a companion

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Specific Phobia

• marked and persistent fear that is excessive or
  unreasonable, cued by a specific object or
  situation
• exposure to the phobic stimulus almost invariably
  provokes an immediate anxiety response (e.g., a
  panic attack)
• phobic situation/object is avoided or endured
  with intense anxiety and distress

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Specific Phobia - Types
1. Animal 2. Natural Environment (e.g., heights,
water) 3. Blood-Injection-Injury Type 4.
Situational (e.g., planes, elevators, driving) 5.
Other (e.g., choking, vomiting)
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Social Phobia

• marked and persistent fear of social or
  performance situations
• situations involve exposure to unfamiliar people
  or to possible evaluation by others
• individual fears that he/she may do something
  humiliating or embarrassing.

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Obsessive-Compulsive Disorder

• recurrent and persistent obsessions and/or
  compulsions
• symptoms cause marked distress
• time consuming (more than 1 hour/day)
• interfere significantly with persons normal
  routine

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• OBSESSIONS
• persistent and intrusive thoughts, impulses,
  images
• inappropriate, cause marked anxiety or distress
• person usually attempts to ignore or suppress
  them
• ...OR neutralize them with some other thought or
  action
• COMPULSIONS
• repetitive behaviors or mental acts
• performed to prevent or reduce anxiety/distress,
  not to provide pleasure or gratification

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Mood Disorders

• Lifetime prevalence rates of depressive
  disorders
• 13 men
• 25 women
• Lifetime prevalence rates of bipolar disorders
• less than 1 for men and women
• 15 complete suicide

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DSM-IV Mood Disorders
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Mood Episodes

• Major Depressive Episode
• Manic Episode
• Hypomanic Episode
• Mixed Episode

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1. Major Depressive Episode

• Depressed mood
• Loss of interest (anhedonia)
• Significant weight loss or gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Worthlessness or guilt
• Diminished ability to concentrate, indecisiveness

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2. Manic Episode

• - Abnormally and persistently elevated,
  expansive, or irritable mood
• Inflated self-esteem and grandiosity
• Requiring very little sleep
• Talkativeness
• Flight of ideas
• Distractibiltiy
• Psychomotor agitation
• Buying sprees, sexual indiscretions, foolish
  business investments

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3. Hypomanic Episode

• Symptoms are milder than a Manic Episode
• Less intense and last at least four days
• 4. Mixed Episode
• Both a Major Depressive Episode and a Manic
  Episode nearly everyday for at least a one week
  period

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Major Depressive Disorder

• One or more Major Depressive Episodes
• No history of Manic, Hypomanic or Mixed Episodes
• Dysthymic Disorder
• Less severe but more chronic than Major
  Depressive Disorder
• Symptoms are milder but remain unchanged over
  long periods of time

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Bipolar I Disorder

• One or more Manic or Mixed Episodes
• Often individuals have also had one or more Major
  Depressive Episodes
• Bipolar II Disorder
• Presence (or history) of one or more Major
  Depressive Episodes
• Presence (or history) of at least one Hypomanic
  Episode
• There has never been a Manic Episode or a Mixed
  Episode

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Cyclothymic Disorder

• Less severe but more chronic than Bipolar
  Disorder
• Symptoms of hypomania and depression are milder
  but remain unchanged over long periods of time

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DSM-IV Specifiers

1. Chronic
2. Psychotic
3. Melancholic
4. Atypical
5. Catatonic
6. Postpartum Onset
7. Seasonal Pattern
8. Rapid Cycling Pattern

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Eating Disorders

• Females 10 x more likely to develop an eating
  disorder
• Around 5 of young women will develop an eating
  disorder
• Course and outcome of eating disorders is highly
  variable
• Eating disorders are associated with serious
  complications, and have the highest mortality rate

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DSM-IV Diagnostic criteria for Anorexia Nervosa

• Low body weight
• Fear of gaining weight or becoming fat
• Weight-related self-evaluation, or denial of the
  seriousness of the low body weight
• Amenorrhea
• RESTRICTING TYPE
• BINGE EATING/PURGING TYPE

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DSM-IV Diagnostic criteria for Bulimia Nervosa

• Binge eating
• Inappropriate compensatory behavior
• Both occur, at least 2/ week for 3 months
• Weight-related self-evaluation
• PURGING TYPE
• NON PURGING TYPE

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Physical Complications

• Menstrual Dysfunction
• Hypothermia
• Hypotension
• Tiredness, Lethargy
• Headaches
• Hair Loss
• Dental Problems

• Electrolyte Abnormalities
• Parathesias
• Acute Gastric Dilation
• Delayed Gastric Emptying
• Constipation
• Swollen salivary gland
• Kidney Dysfunction

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Psychological Complications

• Depression
• Anxiety
• Mood swings
• Food Preoccupation

• Social Isolation
• Sleep Disturbances
• Self-Esteem Deficits
• Impulsive Behaviors

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Schizophrenia

• Delusions and Irrational thought
• Deterioration of Adaptive Behaviors
• Hallucinations
• Disturbed Emotion
• Paranoid, Catatonic, Disorganized,
  Undifferentiated
• Positive vs. Negative symptoms
• Chronic, resistant to treatment