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Anxiety, Obsessive-Compulsive, and

Related Disorders

Chapter 5

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Slides & Handots by !aren Clay "hines, Ph#D#American Pblic Uni$ersity System

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Anxiety

%hat distingishes ear rom an'iety(

)ear is a state o immediate alarm in

response to a serios, *no+n threat toones +ell-being

An'iety is a state o alarm in response to a$age sense o being in danger

oth ha$e the same physiological eatres. increase in respiration, perspiration,mscle tension, etc#

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Anxiety

Althogh npleasant, e'periences oear and an'iety oten are sel

/hey prepare s or action . or 01ght or2ight3 . +hen danger threatens

Ho+e$er, or some people, thediscomort is too se$ere or too re4ent,

lasts too long, or is triggered too easily /hese people are said to ha$e an an'iety or

related disorder

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Anxiety Disorders

Most common mental disorders in the U#S# n any gi$en year, 687 o the adlt poplation

in the U#S# e'periences one o the DSM-5

an'iety disorders Close to 97 de$elop one o the disorders at some

point in their li$es

:nly one-1th o these indi$idals see* treatment

Most indi$idals +ith one an'iety disorderalso s;er rom a second disorder n addition, many indi$idals +ith an an'iety

disorder also e'perience depression

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Anxiety Disorders

)i$e disordersed an'iety disorder ?=AD@

Phobias Agoraphobia

Social an'iety disorder

Panic disorders

Separately< :bsessi$e-Complsi$eDisorder and "elated Disorders

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Generalized AnxietyDisorder (GAD)

Characteri>ed by e'cessi$e an'iety ndermost circmstances and +orry abotpractically anything

Sometimes called 0ree-2oating3 an'iety

Symptoms inclde< eeling restless, *eyedp, or on edge atige diBclty

concentrating mscle tension, andorsleep problems

Symptoms mst last at least three months

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Generalized AnxietyDisorder (GAD)

/he disorder is common in %estern society As many as 7 o the US poplation ha$e

symptoms in any gi$en year and EF7 at some timedring their li$es

Usally 1rst appears in childhood or adolescence

%omen are diagnosed more oten than men by a

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GAD: Te !o"io"ultural#erspe"tive

According to this theory, =AD is most li*ely tode$elop in people aced +ith social conditionsthat trly are dangeros "esearch spports this theory ?e'ample< /hree Mile

sland in 699, Hrricane !atrina in II5, Haitianearth4a*e in I6I@

:ne o the most po+erl orms o societal stressis po$erty

%hy( "n-do+n commnities, higher crime rates,e+er edcational and Job opportnities, and greaterris* or health problems

As +old be predicted by the model, there arehigher rates o =AD in lo+er SKS grops

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GAD: Te !o"io"ultural#erspe"tive

Since race is closely tied to stress in theU#S#, it is not srprising that it is also tiedto the pre$alence o =AD

n any gi$en year, Arican Americans are LI7

more li*ely than +hite Americans to s;er

rom =AD

Mlticltral researchers ha$e not consistentlyond a heightened rate o =AD amongHispanics in the U#S#, althogh they do note

the pre$alence o nerviosin that poplation

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GAD: Te !o"io"ultural#erspe"tive

Althogh po$erty and other socialpressres may create a climate or=AD, other actors are clearly at +or*

Ho+ do +e *no+ this(

Most people li$ing in 0dangeros3en$ironments do not de$elop =AD

:ther models attempt to e'plain +hysome people de$elop the disorder andothers do notG

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GAD: Te #sy"odynami"#erspe"tive

)red belie$ed that all children e'periencean'iety

Realistic anxiety +hen they ace actal danger

Neurotic anxiety +hen they are pre$ented rome'pressing id implses

Moral anxiety +hen they are pnished ore'pressing id implses

Some children e'perience particlarly highle$els o an'iety, or their deense mechanismsare particlarly inade4ate, and they mayde$elop =AD

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GAD: Te #sy"odynami"#erspe"tive

/odays psychodynamic theorists oten disagree +ithspeci1c aspects o )reds e'planation

"esearchers ha$e ond some spport or thepsychodynamic perspecti$eygotic ?M, or identical@

t+ins, the rate is as high as L67

Among di>ygotic ?D, or raternal@ t+ins,the rate is only 667

sse is still open to debate

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#ani" Disorder:Te &iolo%i"al #erspe"tive

Drg therapies

Antidepressants are e;ecti$e at pre$entingor redcing panic attac*s

)nction at norepinephrine receptors in the panicbrain circit

ring at least some impro$ement to 8I7 opatients +ith panic disorder

mpro$ements re4ire maintenance o drgtherapy

Some ben>odia>epines ?especially ana'Talpra>olam@ ha$e also pro$ed helpl

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#ani" Disorder:Te Co%nitive #erspe"tive

Cogniti$e theorists recogni>e thatbiological actors are only part o thecase o panic attac*s

n their $ie+, ll panic reactions aree'perienced only by people +homisinterpret bodily e$ents

Cogniti$e treatment is aimed atcorrecting sch misinterpretations

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#ani" Disorder:Te Co%nitive #erspe"tive

Misinterpreting bodily sensations

Panic-prone people may be $ery sensiti$e tocertain bodily sensations and may

misinterpret them as signs o a medicalcatastrophe this leads to panic

%hy might some people be prone to schmisinterpretations(

K'perience more re4ent or intense bodilysensations

Ha$e e'perienced more trama-1lled e$ents o$erthe corse o their li$es

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#ani" Disorder:Te Co%nitive #erspe"tive

Misinterpreting bodily sensations

%hate$er the precise case, panic-prone people generally ha$e a highdegree o 0an'iety sensiti$ity3

/hey ocs on bodily sensations mch o thetime, are nable to assess the sensations

logically, and interpret them as potentiallyharml

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#ani" Disorder:Te Co%nitive #erspe"tive

Cogniti$e therapy /ries to correct peoples misinterpretations o

their bodily sensations

Step 6< Kdcate clients Abot panic in general

Abot the cases o bodily sensations

Abot their tendency to misinterpret the sensations

Step < /each clients to apply more accrate

interpretations ?especially +hen stressed@ Step L< /each clients s*ills or coping +ith an'iety

K'amples< rela'ation, breathing

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#ani" Disorder:Te Co%nitive #erspe"tive

Cogniti$e therapy

May also se 0biological challenge3procedres to indce panic sensations

ndce physical sensations, +hich caseeelings o panicac@,

2$o'amine ?$o'@ ring impro$ement to 5I.8I7 o those +ith

:CD

"elapse occrs i medication is stopped

"esearch sggests that combinationtherapy ?medication Q cogniti$e beha$ioraltherapy approaches@ may be most e;ecti$e

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Obsessive-Compulsive-Related

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Disorders

n recent years, a gro+ing nmber oclinical researchers ha$e lin*ed somee'cessi$e beha$ior patterns ?e#g#,hoarding, hair plling, shopping, se'@ to

:bsessi$e Complsi$e Disorder DSM-5 has created the grop name

0:bsessi$e-Complsi$e-"elatedDisorders3 and assigned or patterns to

that grop< hoarding disorder, hair-pulling disorder, excoriation (skin-picking)disorder, and body dysmorphic disorder

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Disorders

/heorists typically accont or obsessi$e-complsi$e-related disorders by sing thesame *inds o e'planations that ha$e beenapplied to obsessi$e-complsi$e disorder

Similarly, clinicians typically treat clients+ith these disorders by applying the *indso treatment sed +ith :CD, particlarly

antidepressant drgs, e'posre andresponse pre$ention, and cogniti$etherapy

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Disorders

%ith their addition to the DSM, it ishoped that they +ill be betterresearched, nderstood, and treated