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anxiety disorders


anxiety disorders the experience of anxiety generalized anxiety disorder panic disorder phobias obsessive-compulsive disorder posttraumatic stress disorder – PowerPoint PPT presentation

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Title: anxiety disorders

anxiety disorders
  • the experience of anxiety
  • generalized anxiety disorder
  • panic disorder
  • phobias
  • obsessive-compulsive disorder
  • posttraumatic stress disorder
  • treating anxiety disorders

the experience of anxiety
  • anxiety involves worry, fear, apprehension,
    intrusive thoughts, physical symptoms, and
    feelings of tension.
  • It often seems to have an automatic quality that
    comes more from within the individual than from
    situational factors.
  • It is normal for people to experience anxiety
    when faced with stressful, threatening
    situations, but it is abnormal to feel strong,
    chronic anxiety in the absence of an obvious
    cause. (However normal may vary with level of

common anxiety symptoms and self-descriptions
indicative of high anxiety symptoms
  • Nervousness, jitteriness
  • Tension
  • Feeling tired
  • Dizziness
  • Frequency of urination
  • Heart palpitations
  • Feeling faint
  • Breathlessness
  • Sweating
  • Trembling
  • Sleeplessness
  • Difficulty in concentrating
  • hypervigilance

pathological anxiety epidemiology
  • Anxiety disorders make up one of the most common
    groups of psychiatric disorders.
  • the national co morbidity study reported that one
    in four persons met the diagnostic criteria for
    at least one anxiety d/o
  • Women (30.5 percent lifetime prevalence) are more
    likely to have an anxiety d/o than are men (19.2
    percent lifetime prevalence).
  • Finally. The prevalence of anxiety d/o decreases
    with higher socioeconomic status.
  • Prevalence of anxiety d/o
  • Disorder percent(1yr-
  • prevalence)
  • Any anxiety d/o 13.3
  • Generalized anxiety
  • d/o 2.8
  • Panic d/o 1.7
  • Phobic d/o 8.0
  • Obsessive-compulsive
  • d/o 2.3
  • Posttraumatic stress
  • d/o 3.6
  • Source National Institute of Mental Health

self- descriptions
  • I am often bothered by the thumping of my
  • little annoyances get on my nerves and irritate
  • I often suddenly become scared for no good
  • I worry continuously, and that gets me down.
  • I frequently get spells of complete exhaustion
    and fatigue
  • it is always hard for me to make up my mind.
  • I always seem to be dreading something.
  • I feel nervous and high-strung all the time.
  • I often feel I cant overcome my difficulties.
  • I feel constantly under strain.

Psychological sciences
biological sciences
  • A range of biologically based sensitivities may
    exist among persons with the symptoms of anxiety
  • Autonomic nervous system(functional division of
    the nervous system concerned with visceral
    activities) stimulation of the ANS may cause
    peripheral manifestations of anxiety-
    cardiovascular and/or gastrointestinal.
  • Neurotransmitters (chemical product of the NS
    that makes possible the movement of the nerve
    impulse across the synapse)norepinephrine,
    serotonin,and y-aminobutyric acid (GABA) are the
    three major neurotransmitters associated with
  • Brain- imaging studies CT, MRI, PET, SPECT, EEG.
  • Genetic studies
  • Neuroanatomical considerations limbic system,
    and cerebral cortex.

generalized anxiety disorder 300.02
  • A person with GAD experiences vague but intense
    concerns and fearfulness that persist over a long
    period- at least 6-months.
  • The symptoms include motor tension, autonomic
    reactivity, apprehension about the future, and
  • durations as long as 20 years.
  • prolonged use of drugs can have significant side
  • The distinction between GAD and normal anxiety is
    emphasized by the use of the words excessive and
    difficult to control in the criteria and by the
    specification the symptoms cause significant
    impairment or distress.

clinical features of GAD
  • Excessive anxiety and worry occurring for at
    least 6 months and affecting many areas of a
    persons life.
  • Inability to control worry
  • The presence of 3 or more of the following
    symptoms( only one type of symptom is required
    for DSM-IV in the diagnosis of children)
  • a. restlessness feeling on edge
  • b. being easily fatigue
  • c. difficulty concentrating mind goes blank
  • d. irritability
  • e. muscle tension
  • f. sleep disturbance( difficulty falling or
    staying asleep unsatisfying sleep)
  • 4. Considerable distress or impairment in social,
    occupational, or other important areas of life.

treatment for GAD
  • Psychotherapy
  • Cognitive-behavioralcognitive address patients
    hypothesized cognitive distortions directly, and
    behavioral approaches address somatic symptoms
    directly. (relaxation and biofeedback).
  • supportive offers patients reassurance and
    comfort, although its long-term efficacy is
  • Insight-oriented focuses on uncovering
    conflicts and identifying ego strengths.

substance-induced anxiety disorder 293.84
  • The disorder is the direct result of a toxic
    substance. Including drugs of abuse, medication,
    poison, and alcohol, among others.
  • The DSM-IV diagnostic criteria for
    substance-induce anxiety disorder require the
    presence of prominent anxiety, panic attacks,
    obsessions, or compulsions. The guidelines state
    that the symptoms should have develop during the
    use of of the substance or within a month of the
    cessation of substance use. The structure of the
    diagnosis includes specification of the substance
    (e.g. cocaine), specification of the appropriate
    state during the onset (e.g., intoxication), and
    mention of the specific symptom pattern (e.g.,
    panic attacks).

Panic disorder
  • Panic Disorder is an illness in which a person
    experiences sudden, sometimes unexpected rushes
    of intense fear or discomfort accompanied by a
    number of distressing physical sensations.
  • The panic attack, the core feature of panic
    disorder, strikes suddenly, often in familiar
    places where there is seemingly nothing to be
    afraid of.
  • But when the attack comes, it comes as if there
    were a real threat, and the body reacts
    accordingly.  Panic disorder is often accompanied
    by agoraphobia, the fear of being alone in public
    places (such as supermarkets), particularly
    places from which a rapid exit would be difficult
    in the course of a panic attack.
  • In addition to agoraphobia, other phobias and
    obsessive-compulsive disorder can coexist with
    panic disorder.
  • .

Panic d/o Panic attacks
  • The term panic attack denotes an abrupt surge of
    intense anxiety rising to a peak that either is
    cued by the presence, or thoughts, of particular
    stimuli or that occurs without obvious cues and
    is spontaneous and unpredictable. During these
    episodes, the person experiences the urge to
    flee, or the feeling that they need to escape.
    The symptoms may be misdiagnose as a serious
    medical condition (M.I.).
  • It is known that the d/o typically begins when
    its victims are in their 20s. Often a serious
    event, will trigger the first attack. Women are
    two to three times more likely to be affected
    than men. 3 million Americans will experience
    panic disorders sometime in their lives.

Criteria for panic attack
  • A discrete period of intense fear or discomfort,
    in which four (or more) of the following symptoms
    developed abruptly and reached a peak within 10
    minutes is not codable disorder.
  • Palpitations, pounding heart, or accelerated
    heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Cheat pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Derealization (feelings or unreality) or
    depersonalization (being detached from oneself)
  • Fear of losing control or going crazy
  • Fear of dying
  • Paresthesias
  • Chills or hot flashes

treatment for panic disorder
  • Can consist of taking a medication to adjust the
    chemicals in your body-just as you might take
    medicine to correct a thyroid imbalance or any
    other hormonal imbalance. two major categories of
    medication that have been shown to be safe and
    effective in the treatment of panic disorder are
    antidepressants and benzodiazepines. Another
    treatment is cognitive behavior therapy (CBT),
    which focuses on reducing the persons fears of
    panic symptoms and assisting the person to resume
    avoided activities. The combination of medication
    and psychotherapy appears to be more effective
    than either treatment alone.

  • DSM-IV-TR includes diagnoses for panic disorder
    with and without agoraphobia and also for
    agoraphobia without history of panic disorder.
  • patients with agoraphobia avoid situations in
    which it would be difficult to obtain help. They
    prefer to be accompanied by someone in crowded
    stores, closed-in spaces (tunnels, bridges, and
    elevators) and closed-in vehicles (subways,
    buses, and airplanes) severely affected patients
    may refuse to leave the house. Agoraphobic
    individuals are often clinging and dependent.

Diagnostic criteria for
  • Panic disorder with agoraphobia 300.21
  • Both (1) and (2)
  • The presence of agoraphobia
  • Agoraphobia without history of panic disorder
  • The presence of agoraphobia related to fear of
    developing panic-like symptoms
  • Criteria have never been met for panic disorder
  • The disturbance is not due to the direct
    physiological effects of a substance or a general
    medical condition
  • If an associated general medical condition is
    present, the fear described in criterion A is
    clearly in excess of that usually associated with
    the condition.

  • People who have phobias have fears related to
    specific objects, people, or situations.
  • Phobias often develop gradually or begin with a
    generalized anxiety attack.
  • Phobias are common disorders that affect women
    about twice as frequently as men. Phobias often
    begin before adulthood and are likely to become
  • Phobias can be grouped into three main types
    specific phobias, social phobias, and agoraphobia.

examples for five categories of phobias
  • Separation fear social fears
  • Crowds eating with strangers
  • Traveling alone being watched while writing
  • Being alone at home being watched while working
  • Animal fears
  • Mice
  • Rats mutilation fears
  • Insects open wounds
  • Nature fears surgical operations
  • Mountains blood
  • The ocean
  • Cliffs, heights

Specific phobias 300.29
  • Most commonly occurring type of phobia. This
    group includes miscellaneous irrational fears
    such as intense fear of a certain type of animal
    or of being in an enclosed place. Specific
    phobias may arise from an earlier frightening or
    anxiety-producing situation that involved the
    type of person or situation that later became
    associated with the phobia. Procedures that use
    the classical conditioning approach of pairing
    the phobic stimulus with nonanxiety response are
    often used successfully to treat specify phobias.
  • Criteria A (excessive fear) and B (stimulus
  • In specific phobia the panic attack is
    situationally bound to the specific phobic
    stimulus. Specify type.
  • Treatment exposure therapy(therapist desensitize
    pt. by using a series of gradual, self-paced
    exposures to the phobic stimuli, and they teach
    pt.s various techniques to deal with anxiety,
    including relaxation, breathing control, and
    cognitive approaches. Pharmacotherapy may also

Social phobias (social anxiety disorder) 300.23
  • Intense and incapacitating fear and embarrassment
    when dealing with others characterize social
    phobias. Fear of blushing when in a social
    situation and fear of eating when others are
    present are two social phobias that are
    especially difficult to treat successfully.
  • Treatment
  • Psychotherapy for the generalized type of social
    phobia usually involves a combination of
    behavioral and cognitive methods, including
    retraining, desensitization, rehearsal during
    sessions, and a range of homework assignments.

Obsessive-compulsive disorder 300.3
  • People affected by an obsessive-compulsive d/o
    are unable to control their preoccupation with
    specific ideas or are unable to prevent
    themselves from repeatedly carrying out a
    particular act or series of acts that affect
    their ability to carry out normal activities.
  • Obsessive behavior is the inability to stop
    thinking about a particular idea or topic. The
    topic of these thoughts is often felt by the
    person involved to be unpleasant and shameful.
  • Compulsive behavior is the need to perform
    certain behaviors over and over. Many compulsions
    deal with counting, ordering, checking, touching
    and washing.

  • Criteria for obsessive-compulsive disorder
    include having recurrent and persistent thoughts,
    impulses, or images that are not simply general
    worries and real-life problems.
  • Patients recognize that the unwanted thoughts and
    rituals are the products of their minds, but
    distress persist and personal routines are
    seriously disrupted.

OCD symptoms patterns
  • The presentation of obsessions and compulsions is
    heterogeneous in adults and in children and
    adolescents. The symptoms of an individual
    patient may overlap with time, but OCD has four
    major symptoms patterns.
  • 1. Contamination- the fear object is often hard
    to avoid (e.g. feces, urine, dust, or
    germs)accompanied by compulsive avoidance.
    patients usually believe that the contamination
    is spread from object to object or person to
  • 2. pathological doubt-often implies some danger
    of violence (e.g. forgetting to turn off the
    stove or not locking the door)followed by a
    compulsion of checking. The pt.s always feel
    guilty about having forgotten or committed
  • 3. Intrusive thoughts- repetitious thoughts of a
    sexual or aggressive act that is reprehensible to
    the pt. without compulsions.

OCD-symptoms patterns
  • 4. Symmetry- the fourth most common patterns is
    the need for symmetry or precision, which can
    lead to a compulsion of slowness.
  • 5. Other symptom patterns- religious obsessions
    and compulsive hoarding are common in patients
    with OCD. Trichotilomania (compulsive hair
    pulling) and nail niting may be compulsions
    related to OCD.
  • Cognitive therapist seek to help patients become
    aware of their excessive sense of responsibility
    as a step toward overcoming obsessions and

Posttraumatic stress disorder 309.81 (PTSD)
  • PTSD may occur after an extreme stress such as a
    natural disaster, a serious accident, or
    participation in a battle or other war-related
  • PTSD symptoms vary widely but may include
    recurrent dreams, flashbacks, impaired
    concentration, and emotional numbing. T
  • hose experience PTSD after a stressful experience
    are likely to have had previous histories of
    psychological disorder.

  • The emotional disorder that often arises after a
    trauma such as war, assault, natural disaster, or
    death of a loved one is posttraumatic stress
    disorder(PTSD). According to the DSM-IV-TR, a
    person with
  • PTSD must have been exposed to some event during
    which he/she feels fear, helplessness, or horror.
  • Then, the person continues to reexperience the
    event through memories, reenactments, nightmares,
    or flashbacks. Cues that remind the person of
    the event are avoided and emotional
    responsiveness is numbed.
  • Often such individuals are chronically
    overaroused, easily startled, and quick to anger.
    With PTSD, the alarm response is a true alarm,
    meaning that it occurs in response to real threat
    or danger.