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Page 1: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Anxiety Disorders, Anxiety Disorders, Obsessive Compulsive Obsessive Compulsive Disorders & Trauma - & Disorders & Trauma - & Stress-Related DisordersStress-Related Disorders

Page 2: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Neurotic Beh

-Anxiety-based-No distortions in reality-Recognizes problem-No great personality disorganization

Psychotic

-Gross distortions in reality (e.g., perception)-Some personality disorganization-Does not recognize problem

Bo r d e r l i n e

Page 3: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Neurotic BehaviourNeurotic Behaviour

““Doing the same thing over and over Doing the same thing over and over expecting a different outcome” expecting a different outcome”

““You yourself produce the thing you fear You yourself produce the thing you fear thethe

most”most” Deals with anxiety-based disorders Deals with anxiety-based disorders

including:including:– Generalized AnxietyGeneralized Anxiety– PanicPanic– Obsessive ComplusiveObsessive Complusive– PhobiasPhobias– Others that have anxiety as a basisOthers that have anxiety as a basis

Page 4: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Neurotic BehaviourNeurotic Behaviour

Maladaptive behaviour pattern Maladaptive behaviour pattern that that does notdoes not involve gross involve gross distortions in reality or marked distortions in reality or marked personality disorganizationpersonality disorganization

Person recognizes that behaviour Person recognizes that behaviour is unacceptable or irrational (ego is unacceptable or irrational (ego dystonic dystonic apart from the ego) apart from the ego)

Page 5: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Neurotic AnxietyNeurotic Anxiety

Central component of anxiety disorders Central component of anxiety disorders and anxiety-based disordersand anxiety-based disorders

No obvious danger or threatNo obvious danger or threat Event or stimulus is, objectively, minor Event or stimulus is, objectively, minor

or insignificant (e.g., mouse, thunder, or insignificant (e.g., mouse, thunder, shopping mall, etc.)shopping mall, etc.)

Page 6: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Neurotic Paradox INeurotic Paradox I

Neurotic evaluates innocuous Neurotic evaluates innocuous events as anxiety provoking events as anxiety provoking inordinate anxiety responseinordinate anxiety response

Deals with anxiety in defensive Deals with anxiety in defensive fashion, usually avoidance fashion, usually avoidance reduces anxiety in short termreduces anxiety in short term

Page 7: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Neurotic Paradox IINeurotic Paradox II

This defensive behaviour results in This defensive behaviour results in self-defeating behaviour:self-defeating behaviour:– Does exactly opposite of what is Does exactly opposite of what is

healthy or adaptivehealthy or adaptive

Page 8: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Neurotic Paradox Neurotic Paradox OutcomesOutcomes

Blocks personal growthBlocks personal growth Relationship problems (especially Relationship problems (especially

intimacy)intimacy) Anxiety focus of lifeAnxiety focus of life Lack of energy and enthusiasmLack of energy and enthusiasm Egocentric concernsEgocentric concerns

Page 9: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Neurotic Paradox ProcessNeurotic Paradox Process

Maximize pleasureMaximize pleasure Minimize painMinimize pain Immediate Effect: Reduce AnxietyImmediate Effect: Reduce Anxiety Long Term: Don’t resolve the Long Term: Don’t resolve the

actual problemactual problem E.G. Doug, the Graduate StudentE.G. Doug, the Graduate Student

Page 10: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Neurotic Styles: Neurotic Styles: CharacteristicsCharacteristics

Deficit in behavioural repertoire Deficit in behavioural repertoire (Inhibition)(Inhibition)

Behaves in an inflexible and Behaves in an inflexible and exaggerated manner exaggerated manner oppositeopposite to to the deficient behaviourthe deficient behaviour

Behaviour does not fully contain Behaviour does not fully contain the anxietythe anxiety

Page 11: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Neurotic StylesNeurotic Styles

Aggression/Assertion InhibitionAggression/Assertion Inhibition Responsibility/Independence Responsibility/Independence

InhibitionInhibition Compliance/Submission InhibitionCompliance/Submission Inhibition Intimacy/Trust InhibitionIntimacy/Trust Inhibition

Page 12: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Aggression/Assertion Aggression/Assertion InhibitionInhibition

Person uncomfortable with aggression Person uncomfortable with aggression and/or assertion and avoids situations and/or assertion and avoids situations where need to engage in this behaviourwhere need to engage in this behaviour

Irrationally clings to cooperative stanceIrrationally clings to cooperative stance Thought to result in problems such as Thought to result in problems such as

hypertension,ulcers, migraines, other hypertension,ulcers, migraines, other stress-related disordersstress-related disorders

Potential sudden aggressive outburstsPotential sudden aggressive outbursts

Page 13: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Responsibility/Independence Responsibility/Independence InhibitionInhibition

Person has aversion to autonomyPerson has aversion to autonomy Avoids situations where they are in Avoids situations where they are in

charge or in control other others or charge or in control other others or themselvesthemselves

Appear incompetent in simple Appear incompetent in simple tasks to “pull” direction by otherstasks to “pull” direction by others

Poor relationships, helplessness, Poor relationships, helplessness, depressiondepression

Page 14: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Compliance/Submission Compliance/Submission InhibitionInhibition

Neurotic is often the “rebel” and Neurotic is often the “rebel” and avoids submission to authorityavoids submission to authority

Need to be non-compliant (i.e., Need to be non-compliant (i.e., self-reliant, independent, free-self-reliant, independent, free-thinking, to a fault)thinking, to a fault)

Page 15: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Intimacy/Trust InhibitionIntimacy/Trust Inhibition

Retreats from closeness and Retreats from closeness and withdraws from people who want withdraws from people who want deeper relationshipsdeeper relationships

All relationships short-term to All relationships short-term to avoid intimacyavoid intimacy

End relationships at crucial points End relationships at crucial points in the establishment of intimacy in the establishment of intimacy (not just romantic relationships, (not just romantic relationships, friendships too)friendships too)

Page 16: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Interpersonal Interpersonal ConsequencesConsequences

Some will result in depending too Some will result in depending too much on others that results in much on others that results in others feeling “used and others feeling “used and manipulated”manipulated”

Unpredictable demands on others Unpredictable demands on others that results in others feeling angry, that results in others feeling angry, frustrated, guilty, etc.frustrated, guilty, etc.

Page 17: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Interpersonal Aspects of Interpersonal Aspects of Neurotic Styles INeurotic Styles I

Extremely sensitive to acts, Extremely sensitive to acts, opinions, feelings of othersopinions, feelings of others

Lack of spontaneity (stilted, Lack of spontaneity (stilted, controlled, mechanical)controlled, mechanical)

Superficial relationships if anySuperficial relationships if any Relationships often stormyRelationships often stormy Private life is one of turmoil and Private life is one of turmoil and

inner tormentinner torment

Page 18: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Interpersonal Aspects of Interpersonal Aspects of Neurotic Styles IINeurotic Styles II

Don’t have large networks of Don’t have large networks of enduring relationshipsenduring relationships

Speculation that some Speculation that some complementary “hooking up” is complementary “hooking up” is match made in hellmatch made in hell– Two people with aggression/assertion Two people with aggression/assertion

inhibitioninhibition– One with responsibility/independence One with responsibility/independence

style and one with style and one with compliance/submsission stylecompliance/submsission style

Page 19: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Anxiety Disorders - Anxiety Disorders - SymptomsSymptoms

Mood SxMood Sx: Anxiety, tension, panic, : Anxiety, tension, panic, apprehensionapprehension

Cognitive SxCognitive Sx: Reflects the : Reflects the apprehension and concern about apprehension and concern about the “doom”the “doom”

Somatic SxSomatic Sx: : – ImmediateImmediate– DelayedDelayed

Motor SxMotor Sx: Reactivity: Reactivity

Page 20: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Anxiety Disorders: DSM-VAnxiety Disorders: DSM-V

Specific PhobiasSpecific Phobias Panic DisorderPanic Disorder Social Anxiety DisorderSocial Anxiety Disorder AgoraphobiaAgoraphobia Generalized Anxiety DisorderGeneralized Anxiety Disorder Selective MutismSelective Mutism

Page 21: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

PhobiasPhobias

Persistent, excessive, irrational fear of a specific object, activity, or situation

Fears have no justification in reality or are out of proportion

Aware of the irrational nature of the fear

Avoidance is common response

Page 22: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Phobias EffectsPhobias Effects

1.1. Avoidance can result in Avoidance can result in unfortunate consequencesunfortunate consequences

2.2. If feared object cannot be If feared object cannot be avoided, person may experience avoided, person may experience overwhelming and uncontrollable overwhelming and uncontrollable fear and panicfear and panic

E.G. Student in class exampleE.G. Student in class example

Page 23: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Types of PhobiasTypes of Phobias

Agoraphobia: Anxiety in open Agoraphobia: Anxiety in open spacesspaces

Social Phobia: Anxiety regarding Social Phobia: Anxiety regarding being criticizedbeing criticized

Specific Phobia: Anxiety regarding Specific Phobia: Anxiety regarding object or situation other than open object or situation other than open spaces or personal criticism spaces or personal criticism (heights, pain, storms, blood, etc.)(heights, pain, storms, blood, etc.)Steve Social Phobia

Page 24: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Clinical ExamplesClinical Examples

Woman in GananoqueWoman in Gananoque

Page 25: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Panic DisorderPanic Disorder

Brief periods of exceptionally Brief periods of exceptionally intense spontaneous anxietyintense spontaneous anxiety

Steven Panic 1, 2, 3

Page 26: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Panic DisorderPanic Disorder

Recurrent unexpected panic Recurrent unexpected panic attacksattacks

Persistent concern about Persistent concern about additional attacks for one additional attacks for one monthmonth

See Text & Student Guide See Text & Student Guide

Page 27: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder

Involves recurrent obsessions Involves recurrent obsessions and/or compulsionsand/or compulsions

OCD Chuck 1,2,3

Page 28: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

ObsessionsObsessions

ObsessionsObsessions: persistent idea, : persistent idea, thought, image, impulse that thought, image, impulse that person cannot get out of his/her person cannot get out of his/her mind and that tend to be mind and that tend to be repugnantrepugnant

ExamplesExamples: Thoughts of violence, : Thoughts of violence, contamination, doubting one’s contamination, doubting one’s actionsactions

Page 29: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

CompulsionsCompulsions

Behaviours performed in Behaviours performed in stereotypic fashion that reduce stereotypic fashion that reduce anxiety related to the obsessionsanxiety related to the obsessions

Examples: handwashing, counting, Examples: handwashing, counting, checking, touchingchecking, touching

Page 30: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder

Involves recurrent obsessions Involves recurrent obsessions and/or compulsionsand/or compulsions

OCD2

Page 31: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Obsessive Compulsive Obsessive Compulsive Disorder:Disorder:CasesCases Shoemaker (Handwashing)Shoemaker (Handwashing) Seventeen year old religious boySeventeen year old religious boy Police Officer/Lawyer Police Officer/Lawyer Classical Concert audience Classical Concert audience

membermember

Page 32: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Post Traumatic Stress Post Traumatic Stress DisorderDisorder Existed throughout historyExisted throughout history Major feature: Re-experiencing of a Major feature: Re-experiencing of a

traumatic and disturbing eventtraumatic and disturbing event Differ from other disorders in that Differ from other disorders in that

source of anxiety is externalsource of anxiety is external Extremely debilitating: May re-Extremely debilitating: May re-

experience event for months, years, experience event for months, years, decadesdecades

Page 33: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Shell Shock, Battle Fatigue, Shell Shock, Battle Fatigue, PTSDPTSD

Page 34: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Noncombat CasualtiesNoncombat Casualties

Page 35: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Post Traumatic Stress Post Traumatic Stress DisorderDisorder Severe psychological reaction to Severe psychological reaction to

experience of a traumaexperience of a trauma Often events involve actual or Often events involve actual or

threatened death, or serious injurythreatened death, or serious injury These events can include natural These events can include natural

disasters (floods) or human made disasters (floods) or human made disasters (war, rape, assault)disasters (war, rape, assault)

Can involve actual involvement with Can involve actual involvement with event, witnessing or being indirectly event, witnessing or being indirectly involvedinvolved

Page 36: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

CharacteristicsCharacteristics

May take form of recurrent painful May take form of recurrent painful memories, dreams, nightmaresmemories, dreams, nightmares

FlashbacksFlashbacks General numbing of General numbing of

responsiveness and decreased responsiveness and decreased involvement with external worldinvolvement with external world

Page 37: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Post Traumatic Stress Post Traumatic Stress DisorderDisorder Trauma persistently re-experienced by Trauma persistently re-experienced by

personperson Person persistently avoids stimuli Person persistently avoids stimuli

associated with the traumaassociated with the trauma Persistent symptoms of increased Persistent symptoms of increased

arousalarousal Impaired concentration and memoryImpaired concentration and memory Depression, social withdrawal, Depression, social withdrawal,

decreased sexual interest, numbnessdecreased sexual interest, numbness

Page 38: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Post Traumatic Stress Post Traumatic Stress DisorderDisorder Differ from other disorders in that Differ from other disorders in that

source of anxiety is externalsource of anxiety is external Extremely dibilitating: May re-Extremely dibilitating: May re-

experience event for months, years, experience event for months, years, decadesdecades

Symptoms appear usually quickly Symptoms appear usually quickly after the eventafter the event

May be incubation periodMay be incubation period

Page 39: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

Post Traumatic Stress Post Traumatic Stress Disorder: CasesDisorder: Cases

Five year old & DaughterFive year old & Daughter Jessica Russell CaseJessica Russell Case Heather Thomas CaseHeather Thomas Case Marine CaseMarine Case RCMP (Airline, vehicle deaths)RCMP (Airline, vehicle deaths)

Page 40: Anxiety Disorders, Obsessive Compulsive Disorders & Trauma - & Stress-Related Disorders.

PDM ApproachPDM Approach

Include Anxiety Personality DisordersInclude Anxiety Personality Disorders– Characterological anxiety:Characterological anxiety:

Phobic Personality DisorderPhobic Personality Disorder Anxious Personality DisorderAnxious Personality Disorder Obsessive-Compulsive Personality DisorderObsessive-Compulsive Personality Disorder

Describes the internal experience of anxiety Describes the internal experience of anxiety disorders (conscious & unconscious)disorders (conscious & unconscious)– Some similar to Sx in DSM but also include relationship Some similar to Sx in DSM but also include relationship

problems that arise from themproblems that arise from them– Fears of rejection, guilt, blaming, dependency, Fears of rejection, guilt, blaming, dependency,

smotheredsmothered Great Importance on Trauma and PTSD SpectrumGreat Importance on Trauma and PTSD Spectrum


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