Anxiety Disorders

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Anxiety Disorders

• 6.26.2007

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Anxiety Disoders

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

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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

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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

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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

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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

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Some help
Panic Attacks
NO
YES
NO
Agoraphobia
YES
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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

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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

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Facts about Panic Disorder

• Prevalence
• Gender
• Age of onset
• Course
• Treatment

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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

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Facts about Agoraphobia

• Prevalence
• Gender
• Age of Onset
• Course

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Panic DisorderCognitive Model
Affect
Cognitions
PANIC SYMPTOMS
Behavior
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Panic Disorder - Treatment

• Relaxation/Breathing techniques Behavioral Cog
• Cognitive Restructuring Cognition Cog

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Panic Disorder - Treatment

• Medications
• Benzodiazepines/Anxiolytics
• Antidepressants
• Cognitive-Behavioral Therapies Medication

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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

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Subtypes of Specific Phobia

• Animal type
• Natural environment type
• Blood-Injection-Injury type
• Situational type
• Other type

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Facts about Specific Phobia

• Prevalence
• Gender
• Age of Onset
• Course
• Culture

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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

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Facts about Social Phobia

• Prevalence
• Gender
• Age of Onset
• Course
• Associated w/

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Phobias in Children

• Symptoms in Children
• Social Phobia
• Specific Phobia

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Phobias - Potential Causes

• Psychodynamic Perspective Defense Against
  Anxiety
• Behavioral Perspective Learned Behavior
• Classical Conditioning and Generalization
• Direct traumatic conditioning
• Vicarious conditioning

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Phobias Potential Causes

• Genetic Perspective Heritability of
  Predisposing Factors
• Evolutionary Perspective

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Good Question

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

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Answer to the Good Question

• Avoidance works!
• Fear is never tested

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Phobias - Treatment

• Relaxation/Breathing techniques
• Cognitive Restructuring
• Exposure Therapy

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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

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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

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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

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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.

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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

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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
• Diagnostic issues

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Obsessions and Compulsions Two Possibilities

• No relationship
• Relationship

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Facts about OCD

• Prevalence
• Gender
• Age of Onset
• Course
• Associated w/

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OCD Potential Causes

• Behavioral Perspective
• Compulsions
• Cognitive Perspective
• Obsessions

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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

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OCD - Treatment

• Cognitive Behavioral Therapies
• Exposure and Response Prevention (ERP)
• Medications

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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

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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

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Facts about GAD

• Prevalence
• Gender
• Age of Onset
• Course
• Associated w/

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GAD Potential Causes

• Psychodynamic Perspective
• Behavioral Perspective Learned Behavior
• Genetic/Biological Perspective
• Cognitive Perspective

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GAD - Treatment

• Benzodiazepines
• Antidepressants
• Cognitive Therapy
• Relaxation/Breathing Techniques

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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

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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

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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

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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

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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

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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

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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