Anxiety Disorders

Anxiety-Related Disorders

Anxiety Disorders

Anxiety: Feelings of fear and apprehension.Anxiety Disorders: A group of disorders

primarily characterized by extreme, unrealistic, or debilitating anxiety with one of these criteria:Anxiety is the major disturbance.Anxiety is manifested only in particular

situations.Anxiety results from an attempt to master

other symptoms.

Types of Anxiety Disorders

Anxiety is a part of everyone’s lives.“Anxiety is the price we pay for society”

If it becomes intense and perseveres, then it may be categorized as an anxiety disorder.

Types of anxiety disorders:Panic DisorderGeneralized Anxiety Disorder (GAD)PhobiasObsessive-Compulsive Disorders (OCD)

Understanding Disorders from Multipath Perspective

Biological Dimension: Two main biological factors:

Brain structureGenetic influences

Biological, psychological, and social factors interact with one another Interplay between genetic and environmental

influences

Understanding Disorders from Multipath Perspective

Psychological Dimension:Psychoanalytic theorists focus primarily on

parent-child relationshipPsychological variables such as one’s sense

of control may also be involved Early experiences can play a role in

determining vulnerability of children and need to be considered

Understanding Disorders from Multipath Perspective

Social and Sociocultural Dimensions:Daily environmental stressGenderAcculturation factors among minority groups

Phobias

An anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object or situation that disrupts normal functioning.

Phobias focus anxiety on a specific object, activity, or situation.

Powerful imagination, can vividly anticipate terrifying consequences

Recognize fear as excessive and irrationalUnable to control anxiety

Phobias

Phobia: Strong, persistent, unwarranted fear of a specific object or situation.Agoraphobia: Intense fear of being in public places

where escape or help may not be available; in extreme cases, fear of leaving home.

Social Phobia: Intense, excessive fear of being scrutinized in one or more social situations.

Specific Phobia: Extreme fear of a specific object or situation; a phobia not classified as agoraphobia or social phobia.

PhobiasCommon Fears

Common and uncommon fears

PhobiasPhobia Onset

Etiology of Phobias

Psychodynamic: Unconscious conflicts (expressions of unacceptable wishes, fears and fantasies)

Behavioral: Classical conditioning

Baby Albert; generalizationOperant Conditioning

Object avoidance behavior reinforced with anxiety reduction

Observational learning (modeling)Cognitive-behavioral: Cognitive distortions and

catastrophic thoughtsBiological: Genetics or biological preparedness

PhobiasBiological Preparedness

The brain’s shortcut for emotions

Treatment of Phobias

Biochemical:Neurobiological abnormalities can be normalized

with medicationAntidepressants, benzodiazepines, SSRIs

Behavioral:Exposure therapy (plus applied tension)Systematic desensitizationModelingCognitive restructuringSkills trainingVirtual Reality

Panic Disorder and Generalized Anxiety Disorder

Panic Disorder: Characterized by intense fear accompanied by bodily sensations.

Generalized Anxiety Disorder (GAD): Characterized by milder anxiety-evoking thoughts; “chronic pathological worry”.Predominant characteristic: Free-floating (unfocused)

anxiety

Panic Disorder

Somatic symptoms: Breathlessness, sweating, choking, nausea, heart palpitations.

May lead to Agoraphobia: Anxiety about leaving one’s home.Lifetime prevalence: 3.5%; twice as common in women as in

men.An anxiety disorder marked by a minutes-long episode of

intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations.A panic attack is anxiety to the extreme1 in 75 suffers from this disorder with smokers having a

fourfold risk of a first attack.

Panic Attacks

Panic Attacks: Intense fear accompanied by pounding heart, trembling, shortness of breath, fear of losing control, fear of dying.

Panic attacks may be experienced in any of the anxiety disorders.

Though panic attacks are relatively common, panic disorder is quite rare.

Three types of panic attacks:Situationally boundSituationally predisposedUnexpected or uncued

Generalized Anxiety Disorder (GAD)

Persistent high levels of anxiety and excessive worry over major and minor life circumstances (more persistent, less intense than Panic Disorder).

DSM-IV-TR: Symptoms present at least six months

Somatic symptoms: Heart palpitations, muscle tension, restlessness, trembling, sleep difficulties, poor concentration, persistent apprehension/nervousness.

Generalized Anxiety Disorder (GAD)

An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.

Characterized by “free-floating anxiety”Person cannot identify, avoid, or deal with

source of anxiety.Most have co-morbid disordersWorld-wide: Most frequently diagnosed anxiety

disorderLifetime Prevalence: 5%; twice as common in women

as in men

Etiology of Panic Disorder and Generalized Anxiety Disorder

Psychodynamic: Internal conflicts from unconscious sexual and aggressive impulses.When an unconsciously repressed memory seeks

conscious representation, we feel the anxiety.Cognitive-behavioral: Interpretation of bodily

sensations Anxiety-sensitivity theory of panic

Anxiety Sensitivity Index (ASI): Measures a person’s reactions to anxiety.

Positive Feedback Loop Between Cognitions and Somatic Symptoms Leading to Panic Attacks

Etiology of Panic Disorder and Generalized Anxiety Disorder

Biological: Changes and dysfunction of neural structures and neurochemical responses to stressful stimuli.Valium and Librium can treat therefore might be

due to chemical imbalances.Biological challenge tests

Give people w/ and w/o disorder certain chemicals which raise internal processes (or ask to hyperventilate).

People w/ disorder much more likely to experience panic attack.

Genetic studies indicate at least some heritabilityA stronger role in panic disorder than in GAD

Treating Panic Disorder and Generalized Anxiety Disorder

Biochemical treatment:Benzodiazepines for GAD, but problems of

tolerance and dependenceAntidepressants are medications of choiceSSRIs are most frequently prescribed

because they have fewest side effects.High relapse rates after stopping

medications

Treating Panic Disorder and Generalized Anxiety Disorder

Behavioral treatment (individual and/or group)Cognitive-behavioral therapy:

Educate about disorder and symptomsMuscle-relaxation trainingSymptom-inductionChange unrealistic thoughtsProvide coping statements/use coping

strategiesIdentify antecedents of panic

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD): Characterized by intrusive and repetitive thoughts or images, or by the need to perform acts or dwell on thoughts to reduce anxiety.

Ego-Dystonic Symptoms: The symptoms are felt to be alien thoughts and actions, not under voluntary control of patient.

Lifetime prevalence rate: 2.5% (possibly underestimated); same for males and females

Obsessive-Compulsive Disorder

Obsession: Recurrent or persistent preoccupation with something.an idea; thought; image; impulseCommon obsessions include – dirt, germs,

something terrible happening, symmetry, order or exactnessApproximately 80% of “normal” population

experience obsessions (a song we can’t get out of our head!).

Patients with OCD: Obsessions last longer, are more intense, produce more discomfort, and are more difficult to dismiss.

Obsessive-Compulsive Disorder

Compulsion: An impulse experienced as irresistible (The need to perform acts or to dwell on thoughts to reduce anxiety).Repetitive and seemingly purposeful behaviors performed

according to a rule or in a stereotyped fashion. Common compulsions include: grooming, hand washing,

repeating rituals (e.g., in/out of door); checking locks, appliances, car brakes, homework.Children and adolescents with obsessive-compulsive

disorder, compulsions most commonly involve washing, checking, and repeating acts.

Approximately 55% of “normal” population acknowledges compulsive behaviors (don’t step on a crack!).

Severe compulsive state: Stereotyped/rigid behaviors, often with magical qualities.

Obsessive-Compulsive Disorder

Four Identified Types: Harm-related, sexual, aggressive, and/or

religious obsession w/ checking compulsionsSymmetry obsessions w/ arranging and

repeating compulsionsContamination obsessions w/ cleaning

compulsionsHoarding and saving compulsions

Etiology of Obsessive-Compulsive Disorder

Psychodynamic perspective: Attempts to fend off anal sadistic, anal libidinous, and genital impulses.Defense mechanisms used: substitution,

undoing, reaction formation, isolationBehavioral and cognitive perspectives: Anxiety

reductionDisconfirmatory bias-Search for evidence of

failure to perform an act rather than success of an act.

Etiology of Obsessive-Compulsive Disorder

Biological perspective: Brain structure, genetic factors, biochemical abnormalities.Brain imaging procedures provide visual

insightMedications provide only partial relief

Treatment of Obsessive-Compulsive Disorder

Biological treatments: Partial relief with fluoxetine and clomipramine, but side effects and relapse after medication stops.

Behavioral treatments:Exposure (similar to systematic desensitization),

plus response prevention.Flooding: An exposure therapy that extinguishes

fear by placing client in continued in vivo or imagined high anxiety-provoking situations.

Cognitive treatments: Identify and modify irrational thoughts