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Understanding Anxiety Disorders: GAD, Panic Disorder, Phobias, OCD, and PTSD

Gain insights into different anxiety disorders including Generalized Anxiety Disorder, Panic Disorder, Phobias, Obsessive-Compulsive Disorder, and Post-Traumatic Stress Disorder, and learn about their symptoms, causes, and available treatments.

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Understanding Anxiety Disorders: GAD, Panic Disorder, Phobias, OCD, and PTSD

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  1. Unit XII Module 66

  2. Anxiety Disorders

  3. GAD: Generalized Anxiety Disorder • Emotional-cognitive symptoms include worrying, having anxious feelings and thoughts about many subjects, and sometimes “free-floating” anxiety with no attachment to any subject. Anxious anticipation interferes with concentration. • It can be harder because the victim does not know what causes the anxiety and therefore cannot avoid it or deal with it. • Physical symptoms include autonomic arousal, trembling, sweating, fidgeting, agitation, and sleep disruption and irritability

  4. Panic Disorder: “I’m Dying” Apanic attack isnot just an “anxiety attack.” It may include: • many minutes of intense dread or terror. • chest pains, choking, numbness, or other frightening physical sensations. Patients may feel certain that it’s a heart attack. Last from 30 min to an hour • a feeling of a need to escape. • Death is near Panic disorder refers to repeated and unexpected panic attacks, as well as a fear of the next attack, and a change in behavior to avoid panic attacks.

  5. Specific Phobia A specific phobia is more than just a strong fear or dislike. A specific phobia is diagnosed when there is an uncontrollable, irrational, intense desire to avoid the some object or situation. Even an image of the object can trigger a reaction--“GET IT AWAY FROM ME!!!”--the uncontrollable, irrational, intense desire to avoid the object of the phobia. Mysophobia: fear of germs Claustrophobia Hemophobia: fear of blood

  6. Some Fears and Phobias What trends are evident here? Which varies more, fear or phobias? What does this imply? Some Other Phobias Social anxiety disorder refers to an intense fear of being watched and judged by others. Extreme shyness. It is visible as a fear of public appearances in which embarrassment or humiliation is possible, such as public speaking, eating, or performing. Agoraphobiais the avoidance of situations in which one will fear having a panic attack, especially a situation in which it is difficult to get help, and from which it difficult to escape.

  7. Obsessive-Compulsive Disorder and related disorder[OCD] • Obsessions are intense, unwanted worries, ideas, and images that repeatedly pop up in the mind. (thoughts) • A compulsion even though they know it doesn’t make sense. is a repeatedly strong feeling of “needing” to carry out an action, (behaviors) • Why is it tied to anxiety? • Behavior worsens through a cycle of negative reinforcement. • It lessens anxiety. • When is it a “disorder”? • Distress: when you are deeply frustrated with not being able to control the behaviors or • Dysfunction: when the time and mental energy spent on these thoughts and behaviors interfere with everyday life

  8. Common OCD Behaviors Percentage of children and adolescents with OCD reporting these obsessions or compulsions: Common pattern: RECHECKING Although you know that you’ve already made sure the door is locked, you feel you must check again. And again. The anxiety is too much to not recheck.

  9. Other related disorders… • Body Dysmorphic Disorder.. is a distressing, handicapping, and/or impairing preoccupation with an imagined or slight defect in body appearance that the sufferer perceives to be ugly, unattractive, and/or deformed. • They may actually have an abnormality but the preoccupation with it is excessive. Some sort of repetitive behavior like mirror checking. • Hoarding…Without exception, hoarding is always accompanied by varying levels of anxiety and sometime develops alongside other mental illnesses such as dementia and schizophrenia.  • Trichotillomania…hair pulling. It seems to soothe anxiety • Excoriation…skin picking disorder. Mostly found in people with OCD

  10. Post-Traumatic Stress Disorder [PTSD] About 10 to 35 percent of people who experience trauma not only have burned-in memories, but also four weeks to a lifetime of: • repeated intrusive recall of those memories. • nightmares and other re-experiencing. • social withdrawal or phobic avoidance. • jumpy anxiety or hypervigilance. • insomnia or sleep problems.

  11. PTSD • Accidents, disasters, violence and sexual assaults • 8.5 % of Manhattan residents reported PTSD after 9/11 • People inside the WTC suffered PTSD doubled compared to those outside the towers. • 1 in 6 combat infantry reported PTSD, depression, or anxiety

  12. Resilience and Post-Traumatic Growth • Resilience/recovery after trauma may include: • some lingering, but not overwhelming, stress. • finding strengths in yourself. • finding connection with others. • finding hope. • seeing the trauma as a challenge that can be overcome. • seeing yourself as a survivor. Which People get PTSD? • Those with less control in the situation (inside WTC) • Those traumatized more frequently • Those with brain differences (sensitive limbic system) • Those who have less resiliency • Those who get re-traumatized

  13. Is PTSD over diagnosed? • There is a broadened definition of trauma • 9 in 10 New Yorkers although grief stricken did not have a pathological response to the attacks • In 71 studies, most Holocaust survivors do not show signs of PTSD. Why is this? • Resilience and post traumatic growth can also occur. • Make 6 boxes on a clean sheet of paper…about 5 lines deep

  14. Understanding Anxiety Disorders: Explanations from Different Perspectives Cognitive appraisals: uncertainty is danger Learning perspective: overgeneralizing a conditioned response Observational learning: worrying like mom Biology: Genes Biology: Brain Evolutionary: surviving by avoiding danger

  15. Understanding Anxiety Disorders: Freudian/Psychodynamic Perspective • Sigmund Freud felt that anxiety stems from repressed childhood impulses, socially inappropriate desires, and emotional conflicts. • We repress/bury these issues in the unconscious mind, but they still come up, as anxiety.

  16. Classical Conditioning and Anxiety Operant Conditioning and Anxiety • Stimulus generalization. • If a person is attacked by a fierce do then they learn to fear all dogs. • Some assault victims will feel anxiety when returning to the scene of the crime. • This explains why certain cues or situations can create anxiety or panic attacks • The result is a phobia or generalized anxiety. • Reinforcement maintains our phobias and compulsions after they arise. • We may feel anxious in a situation and make a decision to leave. When we leave, our anxiety is reduced and the behavior is reinforced. • If we know we have locked a door but feel anxious and compelled to re-check, rechecking will help us temporarily feel better. • The result is an increase in anxious thoughts and behaviors.

  17. Observational Learning and Anxiety • Experiments with humans and monkeys show that anxiety can be acquired through observational learning. If you see someone else avoiding or fearing some object or creature, you might pick up that fear and adopt iteven after the original scared person is not around. • In this way, fears get passed down in families.

  18. Cognition and Anxiety • Cognition-interpretations and irrational beliefs can cause anxiety. How do you interpret the creaky noise in the house? • Cognition includes mental habits such as hypervigilance (persistently watching out for danger). Finding a spider in the bed makes you believe in an infestation. • An argument means the end of a relationship.

  19. Biology and Anxiety: An Evolutionary Perspective 1. Human phobic objects: Snakes Heights Closed spaces Darkness 2. Similar but non-phobic objects: Fish Low places Open spaces Bright light Modern fears may have an evolutionary reason. Fear of flying is our fear of heights and confinement. However, in WWII people did not fear the planes flying and dropping bombs. They became desensitized to them. • Evolutionary psychologists believe that ancestors prone to fear the items on list #1 were less likely to die before reproducing.

  20. Biology and Anxiety: Genes Genes and Neurotransmitters • Genes regulate levels of neurotransmitters. • People with anxiety have problems with a gene associated with levels of serotonin, a neurotransmitter involved in regulating sleep and mood. • People with anxiety also have a gene that triggers high levels of glutamate, an excitatory neurotransmitter involved in the brain’s alarm centers. Too much glutamate sets off alarms in the brain. • Studies show that identical twins, even raised separately, develop similar phobias (more similar than two unrelated people). • Some people seem to have an inborn high-strung temperament, while others are more easygoing. • Temperament may be encoded in our genes.

  21. Biology and Anxiety: The Brain • Traumatic experiences can burn fear circuits into the amygdala; these circuits are later triggered and activated. • Anxiety disorders include over arousal of brain areas involved in impulse control and habitual behaviors. • Drugs can limit the emotions felt when remembering the experience. The OCD brain shows extra activity in the ACC, which monitors our actions and checks for errors. ACC = anterior cingulate gyrus

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