Abnormal Psychology

1. Abnormal Psychology Dr. David M. McCord Anxiety Disorders

2. DSM-IV Classification Categories • Disorders Usually First Evident in Infancy, Childhood, or Adolescence • Delirium, Dementia, and Amnestic and Other Cognitive Disorders • Substance-Related Disorders • Schizophrenia and Other Psychotic Disorders • Mood Disorders • Anxiety Disorders • Somatoform Disorders • Dissociative Disorders • Sexual and Gender Identity Disorders • Sleep Disorders • Eating Disorders • Factitious Disorders • Adjustment Disorders • Impulse Control Disorders • Personality Disorders

3. Anxiety Disorders • Phobias • Specific Phobia • Social Phobia • Panic Disorder • Without Agoraphobia • With Agoraphobia • Agoraphobia Without History of Panic Disorder • Generalized Anxiety Disorder • Obsessive-Compulsive Disorder • Posttraumatic Stress Disorder • Acute Stress Disorder

4. Specific Phobia (300.29) • Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). • Exposure to the phobic stimulus almost always provokes an immediate anxiety response, which may take the form of a situation-specific Panic Attack. • The person recognizes that the fear is excessive or unreasonable. • The phobic situation is (1) avoided or (2) endured with intense anxiety or distress • The avoidance, anxiety, or distress interferes significantly with the person’s normal routine, occupational or academic functioning, or social activities or relationships, or there is marked distress about having the phobia. • In individuals under 18, duration is at least 6 months. • Specific types to be specified in diagnosis are: • Animal Type • Natural Environment Type (e.g., heights, storms, water) • Blood-Injection-Injury Type • Situational Type (e.g., planes, elevators, enclosed places) • Other Type (e.g., phobic avoidance of situations that may lead to choking, vomiting, contracting an illness, loud sounds, costumed characters).

5. Social Phobia (300.23) • A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to the possible scrutiny of others. The individual fears they will act in a way that is embarrassing or show anxiety symptoms. • Exposure to the situation almost always provokes an anxiety reaction, which may be a situation-specific Panic Attack. • Person recognizes fear as excessive or unreasonable. • Social or performance situations are avoided or endured with intense anxiety or distress. • Avoidance or distress interferes significantly with occupational or academic functioning, normal routine, social activities or relationships, or there is marked distress about having the phobia. • If under 18, condition has existed for at least 6 months.

6. Panic Attack (definition) • A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes: • Palpitations, pounding heart, or accelerated heart rate • Sweating • Trembling or shaking • Sensations of shortness of breath or smothering • Feeling of choking • Chest pain or discomfort • Nausea or abdominal distress • Feeling dizzy, unsteady, or lightheaded, or faint • Derealization (feelings of unreality) or depersonalization (being detached from oneself) • Fear of losing control or going crazy • Fear of dying • Paraesthesias • Chills or hot flushes

7. Agoraphobia (definition) • Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile. • The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.

8. Panic Disorder Without Agoraphobia (300.01) • Recurrent and unexpected Panic Attacks • At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following: • Persistent concerns about having additional attacks • Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, going crazy) • A significant change in behavior related to the attacks • Absence of agoraphobia Panic Disorder With Agoraphobia (300.21) • (same as above) • (same as above) • Presence of agoraphobia Agoraphobia Without History of Panic Disorder (300.22) • Presence of agoraphobia • Criteria for Panic Disorder have never been met

9. Obsessive-Compulsive Disorder • Either obsessions or compulsions: Obsessions as defined by: • recurrent and 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 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 (not imposed from without as in thought insertion)

10. Compulsions as defined by: • repetitive behaviors (e.g., handwashing, ordering, checking, ) or mental acts (praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly • the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. The obsessions or compulsions cause marked distress, are time consuming (taking more than 1 hour per day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships

11. Posttraumatic Stress Disorder • The person has been exposed to a traumatic event in which both of the following were present: • the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others • the person’s response involved intense fear, helplessness, or horror • The traumatic event is persistently reexperienced in one (or more) of the following ways: • recurrent and intrusive recollections of the event, including images, thoughts, or perceptions • recurrent distressing dreams of the event • acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated • intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event • physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

12. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: • efforts to avoid thoughts, feelings, or conversations associated with the trauma • efforts to avoid activities, places, or people that arouse recollections of the trauma • inability to recall an important aspect of the trauma • markedly diminished interest or participation in significant activities • feeling of detachment or estrangement from others • restricted range of affect (e.g., unable to experience feelings of love) • sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) • Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: • difficulty falling or staying asleep • irritability or outbursts of anger • difficulty concentrating • hypervigilance • exaggerated startle response