anxiety disorders

1. Anxiety Disorders 6.26.2007

3. Anxiety Is there anything good about anxiety? Future-oriented mood state characterized by strong negative affect Apprehension about future danger or misfortune Involves prolonged/chronic activation of stress response system Somatic symptoms of tension Dread Generalized Anxiety Disorder, OCD, Panic Disorder

4. Fear Is there anything good about fear? Present-oriented mood state characterized by strong negative affect Immediate, temporary activation of stress response system Strong avoidance/escape tendencies Panic Disorder, Agoraphobia, Social Phobia, Specific Phobia, OCD

5. Panic Attack (not a diagnosis) A. Discrete period of intense fear or discomfort, in which 4 or more of the following Sx 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

6. 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

7. Some help�

8. 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

9. 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

10. Facts about Panic Disorder Prevalence: Gender: Age of onset: Course: Treatment:

11. 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

12. Facts about Agoraphobia Prevalence: Gender: Age of Onset: Course:

13. Panic DisorderCognitive Model

14. Panic Disorder - Treatment Relaxation/Breathing techniques � Behavioral Cog Cognitive Restructuring � Cognition Cog

15. Panic Disorder - Treatment Medications Benzodiazepines/Anxiolytics Antidepressants Cognitive-Behavioral Therapies + Medication

16. 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

17. Subtypes of Specific Phobia Animal type Natural environment type Blood-Injection-Injury type Situational type Other type

18. Facts about Specific Phobia Prevalence: Gender: Age of Onset: Course: Culture:

19. 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

20. Facts about Social Phobia Prevalence: Gender: Age of Onset: Course: Associated w/:

21. Phobias in Children Symptoms in Children Social Phobia Specific Phobia

22. Phobias - Potential Causes Psychodynamic Perspective � Defense Against Anxiety Behavioral Perspective � Learned Behavior Classical Conditioning and Generalization Direct traumatic conditioning Vicarious conditioning

23. Phobias � Potential Causes Genetic Perspective � Heritability of Predisposing Factors Evolutionary Perspective

24. Good Question� If phobias are learned behaviors, why don�t they extinguish on their own???

25. Answer to the Good Question� Avoidance works! Fear is never tested

26. Phobias - Treatment Relaxation/Breathing techniques Cognitive Restructuring Exposure Therapy

27. 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

28. 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

29. 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

30. 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.

31. 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

32. OCD in Children Children have an average of 4 obsessions and 4 compulsions at any given time Often comorbid with Tourette�s syndrome and/or ADHD Diagnostic issues:

33. Obsessions and Compulsions Two Possibilities No relationship Relationship

34. Facts about OCD Prevalence: Gender: Age of Onset: Course: Associated w/:

35. OCD � Potential Causes Behavioral Perspective Compulsions Cognitive Perspective Obsessions

36. OCD � Potential Causes Genetic Perspective Biological Perspective Serotonin dysfunction Abnormal brain functioning Evolutionary Perspective Obsessions about dirt and contamination occur at nonrandom rate �Wired� to obsess about dangerous or threatening stimuli

37. OCD - Treatment Cognitive Behavioral Therapies �Exposure and Response Prevention� (ERP) Medications

38. 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

39. 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

40. Facts about GAD Prevalence: Gender: Age of Onset: Course: Associated w/:

41. GAD � Potential Causes Psychodynamic Perspective Behavioral Perspective � Learned Behavior Genetic/Biological Perspective Cognitive Perspective

42. GAD - Treatment Benzodiazepines Antidepressants Cognitive Therapy Relaxation/Breathing Techniques

43. 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

44. 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

45. Nervios (Latin America) General state of vulnerability to life stressors and/or a syndrome brought on by difficult life circumstances Chronic, but severity varies among sufferers Wide range of symptoms including: Emotional distress, headaches (�brain aches�), irritability, stomach disturbances, sleep difficulties, nervousness, easy tearfulness, inability to concentrate, trembling, tingling sensations, and dizziness Similar to Adjustment, Anxiety, Depressive, Dissociative, Somatoform, and Psychotic disorders

46. Ataque de nervios Direct result of a stressful event relating to the family Sense of being out of control Common symptoms: Uncontrollable shouting, attacks of crying, trembling, heat in the chest rising into the head, verbal or physical aggression Infrequent symptoms: Dissociative experiences, seizure-like or fainting episodes, and suicidal gestures Brief episode, return to normal functioning rapidly Similar to Panic Disorder, but is not associated with fear or apprehension of additional attacks and is related to a specific event

47. Dhat (India), Jiryan (India), Sukra Prameha (Sri Lanka), & Shen-k�uei (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 one�s vital essence and can thereby be life threatening

48. Koro (South and Southeast Asia) Sudden and intense anxiety that one�s genitalia will recede into the body and possibly cause death Can occur in epidemics

49. Taijin Kyofusho (Japan) An intense fear that one�s body, its parts, or its functions (sweating, body odor, facial expressions, etc.) displease, embarrass, or are offensive to other people Similar to the DSM�s Social Phobia