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Anxiety%20Disorders

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Anxiety Disorders Panic Disorder Agoraphobia Social Phobia Specific Phobia Obsessive Compulsive Disorder Generalized Anxiety Disorder (PTSD & Acute Stress Disorder) – PowerPoint PPT presentation

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Title: Anxiety%20Disorders


1
Anxiety Disorders
  • Panic Disorder
  • Agoraphobia
  • Social Phobia
  • Specific Phobia
  • Obsessive Compulsive Disorder
  • Generalized Anxiety Disorder
  • (PTSD Acute Stress Disorder)

2
Panic Attack (not a diagnosis)
  • A. Discrete period of intense fear or discomfort,
    in which 4 or more of the following Six develop
    abruptly and reach a peak within 10 minutes
  • Palpitations
  • Sweating
  • Trembling/aching
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain/discomfort
  • Nausea/abdominal distress
  • Feeling dizzy/unsteady/lightheaded/faint
  • Derealization/depersonalization
  • Fear of losing control/going crazy
  • Fear of dying
  • Paresthesias (numbness or tingling sensation)
  • Chills/hot flushes

3
Agoraphobia (not a diagnosis)
  • A. Anxiety about being in places or situations
    from which escape might be difficult or in which
    help may not be available in the event of having
    an unexpected or situationally predisposed panic
    attack or panic-like symptoms.
  • B. The situations are avoided or are endured with
    marked distress
  • C. Not better accounted for by another mental
    disorder

4
Some help
Panic Attacks
NO
YES
NO
Agoraphobia
YES
5
Panic Disorder without Agoraphobia
  • A. Both 1 and 2
  • 1. Recurrent, unexpected panic attacks
  • 2. At least one of the attacks has been followed
    by 1 or more months of 1 or more of the following
  • a. Persistent concern about having additional
    attacks
  • b. Worry about the implications of the attack or
    its consequences
  • c. Significant change in behavior related to the
    attacks
  • B. Absence of agoraphobia
  • C. Panic attacks are not due to a GMC or
    substance
  • D. Panic Attacks are not better accounted for by
    another mental disorder

6
Panic Disorder with Agoraphobia
  • A. Both 1 and 2
  • 1. Recurrent, unexpected panic attacks
  • 2. At least one of the attacks has been followed
    by 1 or more months of 1 or more of the following
  • a. Persistent concern about having additional
    attacks
  • b. Worry about the implications of the attack or
    its consequences
  • c. Significant change in behavior related to the
    attacks
  • B. Presence of agoraphobia
  • C. Panic attacks are not due to a GMC or
    substance
  • D. Panic Attacks are not better accounted for by
    another mental disorder

7
Agoraphobia without History of Panic Disorder
  • A. Presence of Agoraphobia related to fear of
    developing panic-like symptoms
  • B. Criteria have never been met for Panic
    Disorder
  • C. Disturbance is not due to a GMC or substance
  • D. If an associated GMC is present, the
    agoraphobia is in excess of that usually
    associated with the condition

8
Social Phobia
  • A. Marked, persistent fear of one or more social
    or performance situations in which the person is
    exposed to unfamiliar people or to possible
    scrutiny by others. The individual fears that he
    or she will act in a way that will be humiliating
    or embarrassing.
  • B. Exposure to the feared social situation almost
    invariably provokes an anxiety response
  • C. The person recognizes that the fear is
    excessive or unreasonable
  • D. The phobic stimulus is avoided or endured with
    intense anxiety or distress
  • E. There is significant distress or an impairment
    in functioning

9
Specific Phobia
  • A. Marked, persistent fear that is excessive or
    unreasonable, cued by the presence or
    anticipation of a specific object or situation
  • B. Exposure to the phobic stimulus almost always
    provokes an immediate anxiety response
  • C. The person recognizes that the fear is
    excessive or unreasonable
  • D. The phobic stimulus is avoided or endured with
    intense anxiety or distress
  • E. There is significant distress or an impairment
    in functioning due to the phobia
  • F. The phobia is not better accounted for by
    another mental disorder

10
Subtypes of Specific Phobia
  • Animal type
  • Natural environment type
  • Blood-Injection-Injury type
  • Situational type
  • Other type

11
Phobia
  • Marked by a persistent and irrational fear of an
    object or situation that disrupts behavior.

12
Kinds of Phobias
Phobia of open places.
Agoraphobia
Phobia of heights.
Acrophobia
Phobia of closed spaces.
Claustrophobia
Phobia of blood.
Hemophobia
13
Dont concept map this
  • Acrophobia Heights Aquaphobia Water
  • Gephyrophobia Bridges Ophidiophobia Snakes
  • Aerophobia Flying Arachnophobia Spiders
  • Herpetophobia Reptiles Ornithophobia Birds
  • Agoraphobia Open spaces Astraphobia Lightning
  • Mikrophobia Germs Phonophobia Speaking aloud
  • Ailurophobia Cats Brontophobia Thunder
  • Murophobia Mice Pyrophobia Fire
  • Amaxophobia Vehicles, driving Claustrophobia
    Closed spaces
  • Numerophobia Numbers Thanatophobia Death
  • Anthophobia Flowers Cynophobia Dogs

14
Good Question
  • If phobias are learned behaviors,
  • why dont they extinguish on their own???

15
Answer to the Good Question
  • Avoidance works!
  • Fear is never tested

16
Obsessive-Compulsive Disorder
  • Persistence of unwanted thoughts (obsessions) and
    urges to engage in senseless rituals
    (compulsions) that cause distress.

17
Obsessive-Compulsive Disorder
  • A. Either obsessions or compulsions
  • Obsessions as defined by 1, 2, 3, and 4
  • Recurrent, persistent thoughts, impulses, or
    images that are experienced at some time during
    the disturbance, as intrusive and inappropriate
    and that cause marked anxiety or distress
  • The thoughts, impulses, or images are not simply
    excessive worries about real-life problems
  • The person attempts to ignore or suppress such
    thoughts, impulses, or images or tries to
    neutralize them with some other thought or action
  • The person recognizes that the obsessional
    thoughts, impulses, or images are a product of
    his or her own mind

18
Typical Obsessions
  • Doubts (e.g. Did I turn off the stove? Did I
    lock the door? Did I hurt someone?)
  • Fears that someone else has been hurt or killed
  • Fears that one has done something criminal
  • Fears that one may accidentally injure someone
  • Worry that one has become dirty or contaminated
  • Blasphemous or obscene thoughts
  • NOT just excessive worries about real-life
    problems

19
Obsessive-Compulsive Disorder
  • Compulsions as defined by 1 and 2
  • Repetitive behaviors or mental acts that the
    person feels driven to perform in response to an
    obsession or according to rules that must be
    applied rigidly
  • The compulsions are aimed at preventing or
    reducing distress or preventing some dreaded
    event or situation however, these behaviors or
    mental acts are not connected in a realistic way
    with what they are designed to neutralize or
    prevent or are clearly excessive

20
Typical Compulsions
  • Checking
  • Cleaning/washing
  • Doing things a certain number of times in a row
  • Doing and then undoing things
  • Doing things in a certain order, with symmetry
  • Mental acts such as praying, counting, etc.

21
Obsessive-Compulsive Disorder
  • B. The person has recognized that the obsessions
    or compulsions are excessive or unreasonable
  • C. There is significant distress or an impairment
    in functioning due to the obsessions or
    compulsions
  • D. If another Axis I disorder is present, the
    content of the obsessions or compulsions is not
    restricted to the other Axis I disorder
  • E. The disturbance is not due to a GMC or
    substance

22
OCD in Children
  • Children have an average of 4 obsessions and 4
    compulsions at any given time
  • Often comorbid with Tourettes syndrome and/or
    ADHD

23
Generalized Anxiety Disorder (GAD)
  • Excessive anxiety and worry occurring more days
    than not for at least 6 months, about a number of
    events
  • The person finds it difficult to control the
    worry
  • The anxiety and worry are associated with 3 or
    more of the following symptoms
  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep Disturbance

24
Generalized Anxiety Disorder (GAD)
  • D. The focus of the anxiety and worry is not
    confined to features of another disorder and do
    not occur exclusively during PTSD
  • E. There is clinically significant distress or
    impairment in functioning
  • F. Not due to a GMC or substance

25
Post-Traumatic Stress Disorder
  • A. The person has been exposed to a traumatic
    event and have experienced four or more weeks of
    one or more of the following symptoms
  1. Haunting memories

2. Nightmares
3. Social withdrawal
4. Jumpy anxiety
5. Sleep problems
Bettmann/ Corbis
26
Resilience to PTSD
  • Only about 10 of women and 20 of men react to
    traumatic situations and develop PTSD.

Holocaust survivors show remarkable resilience
against traumatic situations.
All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
27
Resilience to PTSD
  • Only about 10 of women and 20 of men react to
    traumatic situations and develop PTSD.

Holocaust survivors show remarkable resilience
against traumatic situations.
All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
28
Anxiety Disorders - Overview
  • Most common mental disorders in the U.S.
  • At least 19 of the adult population suffer from
    at least one anxiety disorder in any given year
  • All are more common in women, except for OCD
  • Except for Panic Disorder, ages of onset are most
    likely going to be in childhood or adolescence
    (but do not have to be)
  • Anxiety Disorders cost 42 billion each year in
    health care, lost wages, and lost productivity

29
Anxiety DisordersCultural Variations
  • Fear, Anxiety, and Anxiety Disorders exist in all
    cultures
  • Prevalence rates vary, but are generally the most
    common mental illness in all countries
  • Low rates China (2.4), Japan, Nigeria, and
    Spain
  • High rates U.S. (19), France, Colombia, and
    Lebanon
  • Fear stimulus and content of anxiety differ
    greatly between cultures

30
Dhat (India), Jiryan (India), Sukra Prameha (Sri
Lanka), Shen-kuei (China)
  • Severe anxiety, panic symptoms, somatic
    complaints, hypochondriachal symptoms associated
    with the discharge of semen
  • Excessive semen loss is feared because of the
    belief that it represents the loss of ones vital
    essence and can thereby be life threatening

31
Koro (South and Southeast Asia)
  • Sudden and intense anxiety that ones genitalia
    will recede into the body and possibly cause
    death
  • Can occur in epidemics

32
Taijin Kyofusho (Japan)
  • An intense fear that ones body, its parts, or
    its functions (sweating, body odor, facial
    expressions, etc.) displease, embarrass, or are
    offensive to other people
  • Similar to the DSMs Social Phobia

33
Explaining Anxiety Disorders
Freud suggested that we repress our painful and
intolerable ideas, feelings, and thoughts,
resulting in anxiety.
34
The Learning Perspective
Learning theorists suggest that fear conditioning
leads to anxiety. This anxiety then becomes
associated with other objects or events (stimulus
generalization) and is reinforced.
John Coletti/ Stock, Boston
35
The Learning Perspective
Investigators believe that fear responses are
inculcated through observational learning. Young
monkeys develop fear when they watch other
monkeys who are afraid of snakes.
36
The Biological Perspective
Natural Selection has led our ancestors to learn
to fear snakes, spiders, and other animals.
Therefore, fear preserves the species.
Twin studies suggest that our genes may be partly
responsible for developing fears and anxiety.
Twins are more likely to share phobias.
37
The Biological Perspective
Generalized anxiety, panic attacks, and even OCD
are linked with brain circuits like the anterior
cingulate cortex.
S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones,
C.S. Carter (2003). Overactive action monitoring
in obsessive-compulsive disorder. Psychological
Science, 14, 347-353.
Anterior Cingulate Cortex of an OCD patient.
38
Panic Disorder
  • What Causes Panic Disorder?
  • We dont really know many factors.
  • But Strong evidence that norepinephrine is
    involved.
  • Norepinephrine neurotransmitter especially
    active in Locus ceruleus part of the brain.

39
Models of Abnormality
  • Biological model Anatomy (structures)

Neo-Cortex
Corpus callosum
Amygdala
Locus ceruleus (Pons)
40
Panic Disorder
  • Anti-depressant drugs that regulate
    norepinephrine successful in treating panic
  • When Locus ceruleus stimulated in monkeys ? panic
    like behavior
  • Locus ceruleus rich in norepinephrine carrying
    neurons
  • Hypothesis Norepinephrine dysregulation may well
    be implicated in Panic Disorder

41
Obsessive-Compulsive Disorder
Psychodynamic Perspective
  • Anxiety rooted in repressed ID impulses
  • Impulses obsessive thoughts
  • Compulsions ego defenses against them
  • E.g. Lady Macbeth Anxiety/guilt over her part
    in a murder ? compulsive hand washing to get rid
    of the imagined blood.
  • How would you treat Lady Macbeth?

42
Obsessive-Compulsive Disorder
Behavioral Perspective
  • Focus on compulsions, not obsessions
  • Theory association forms randomly between
    fear/anxiety reduction and the compulsive
    behavior
  • Compulsive behavior becomes reinforcing because
    it reduces anxiety
  • Therefore compulsion increases in frequency

43
Obsessive-Compulsive Disorder
Biological Perspective
  • Drugs that increase Serotonin activity are
    somewhat effective in treating OCD
  • Serotonin is also active in 2 brain areas that
    have been associated with OCD the orbital region
    of the frontal cortex and caudate nucleus

44
Caudate nucleus
Orbital frontal cortex
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