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Anxiety Disorders. Phobias Panic Disorders Generalized Anxiety Disorder Obsessive-Compulsive Disorder Post-trauma disorders Other anxiety disorders. Symptoms of anxiety. Gastrointestinal Genitourinary Cardiovascular Skin Ocular Musculoskeletal Mental/cognitive.

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Anxiety Disorders

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anxiety disorders

Anxiety Disorders


Panic Disorders

Generalized Anxiety Disorder

Obsessive-Compulsive Disorder

Post-trauma disorders

Other anxiety disorders

symptoms of anxiety
Symptoms of anxiety
  • Gastrointestinal
  • Genitourinary
  • Cardiovascular
  • Skin
  • Ocular
  • Musculoskeletal
  • Mental/cognitive

Fear is a response to a perceived danger or threat. Anxiety is the anticipation of a possible threat.

1 phobias
1. Phobias
  • General characteristics of phobias
    • Fear sensations
    • Avoidance behavior
    • Cognitive recognition that the fear is out of proportion to the stimulus
1a specific phobia objects or situations
1A. Specific Phobia: Objects or situations
  • Lifetime prevalence:
    • 7% men, 16% women
  • Types of specific phobias
    • Animal Type
    • Natural Environment Type
    • Blood-Injection-Injury Type
      • Predictive validity: Treat with muscle tension, not relaxation
    • Situational Type
    • Other Type
specific phobias in other cultures
Specific phobias in other cultures
  • Pa-feng and pa-leng
  • Jin-kyofu-sho or taijin-kyofu-sho
1b social phobia social anxiety disorder people s scrutiny
1B. Social Phobia (Social Anxiety Disorder): People’s scrutiny
  • Lifetime prevalence: 11% M; 15% F
  • Fear of scrutiny
  • Fear of evaluation
  • Fear of doing or saying something humiliating or embarrassing
    • In USA, fear of personal embarrassment
    • In Japan, fear of embarrassing others
  • Adolescent onset
2 panic disorder
2. Panic Disorder
  • With Agoraphobia
  • Without Agoraphobia
  • Recurrent, unexpected (uncued) panic attacks followed by persistent worry
    • situationally cued phobias vs. situationally predisposed Panic Disorder
  • (DSM-IV also lists Agoraphobia without History of Panic Disorder)
panic attack at least 4 symptoms within 10 minutes
Panic attack: At least 4 symptoms within 10 minutes
  • Heart: racing, palpitations, pounding
    • Dizzy, lightheaded, faint, unsteady
  • Skin: sweating
    • paresthesias
    • chills or hot flashes
  • Muscles: Trembling, shaking
  • Respiratory: shortness of breath, smothering
    • choking feeling
    • Chest pain or discomfort
  • Gastrointestinal: nausea or distress
  • Cognitive/mental:derealization/depersonalization
    • fear of losing control/going crazy
    • fear of dying
3 generalized anxiety disorder overanxious disorder of childhood
3. Generalized Anxiety Disorder/ Overanxious Disorder of Childhood
  • Excessive anxiety and worry
    • More than half of the time
    • Lasting at least 6 months
    • Focussing on several topics
    • Hard to control
    • At least three symptoms (one in children) out of: restlessness, rapid fatigue, mind wandering or blanking, irritability, tense muscles, sleep problems
4 obsessive compulsive disorder
4. Obsessive-Compulsive Disorder
  • Repeated, distressing obsessions (thoughts, impulses, images, doubts) or compulsions (rituals; yielding or controlling)
  • Take up at least 1 hour per day
  • Are done to relieve or prevent anxiety
  • Adults recognize the symptoms as extreme; children may not.
  • Resistance is futile.
  • Seen in religious people as scrupulosity.
ocd distribution
OCD Distribution
  • 80% of normal people report obsessions; 54% report compulsions
  • Lifetime prevalence 2 - 3%
  • No gender difference
  • Begins either before age 10 or 18-30
  • Less common among African Americans and Mexican Americans
  • More common in divorced, separated, or unemployed people
ocd ramifications
OCD ramifications
  • Is there a connection to self-injury?
  • Are so-called sexual addictions examples of OCD?
  • Are obsessions ever the re-experiencing events of post-trauma disorders? (Freeman & Leonard, 2000)
  • Are eating disorders like OCD?
  • Is there a connection to tic disorders?
5 post trauma disorders
5. Post-trauma disorders
  • Acute Stress Disorder: Within 1 month
  • Posttraumatic Stress Disorder: > 1 mo.
    • Acute, chronic, and delayed specifiers
  • Extreme trauma
    • Threat of death or serious injury
    • Witnessing trauma to others
    • Learning about violent death, harm, or threat to a loved one or close friend
    • Worse if caused by human design
  • Reexperiencing, arousal, and avoidance
post trauma disorders
Post-trauma disorders…
  • Lifetime incidence between 1 and 14% in the general population, but between 3 and 58% in those exposed to trauma
  • PTSD is third only to Depression and Substance Abuse disorders among young adults (Breslau, Davis, Andreski, & Peterson, 1991), and is more common among young people than older folks (Norris, 1992)
post trauma disorders15
Post-trauma disorders…
  • Comorbid with Substance-Related Disorders, Panic Disorders, Obsessive-Compulsive Disorder, Phobias, Depression, and Somatization Disorder
  • Often experience survivor guilt, broken relationships
  • Especially common in war-torn areas and in migrants from such nations
6 other anxiety disorders
6. Other anxiety disorders
  • Anxiety Disorder Due to a General Medical Condition
    • Examples: Hyperthyroidism, hypoglycemia, congestive heart failure, pneumonia, B12 deficiency, encephalitis
  • Substance-Induced Anxiety Disorder
    • May be during intoxication or withdrawal
    • Examples: Alcohol, amphetamines, caffeine, cocaine, marijuana, many medications, heavy metals, CO, CO2
  • Anxiety Disorder NOS
etiologies of anxiety disorders
Etiologies of anxiety disorders
  • Psychoanalysis: Phobias
    • Freud: Defense against id-triggered anxiety
    • Arieti: Specific placement of general mistrust
    • Phobic object is symbolic
  • Behavioral theories: All anxiety disorders
    • Classical conditioning and operant avoidance
      • About half of people recall appropriate trauma experiences; half do not (Kendler, Myers, & Prescott, 2002)
      • But Loftus (1993) found that 25% of 1500 people who had been hospitalized in the last year had no recall memory of it.
      • Recall of painful childhood events is particularly poor.
    • Role of extinction, contingency, and preparedness
    • Focus on UCR, not UCS
more etiologies
More etiologies
  • Gender and culture
    • All anxiety disorders but OCD are more often diagnosed in women, usually twice as often. Gender may be a marker variable.
  • Modeling and imitation: All anxiety disorders
    • Vicarious conditioning and consequences to the model
    • Mineka’s monkeys (1984, 1989)
    • Limited generality: Most people with phobias report no such modeling
cognition all anxiety disorders
Cognition: All anxiety disorders
  • Rumination and self-awareness
  • Attendance to threat and perceived control
  • Negativity and pessimism in self-evaluation
  • Unconscious processes: Subliminal stimulation provokes fear in people with phobias (Ohman & Soares, 1994)
  • Social skills and social phobia
biological theories
Biological theories
  • ANS reactivity or lability
  • Genetic factors
    • Familiality:
      • 64% concordance vs 3% of population for blood and injection type of Specific Phobia
      • 20 – 40% heritability for phobias, GAD, and PTSD
      • 48% heritability for panic disorder
    • Temperament
    • Correlational data
neurological factors
Neurological factors
  • Elevated responsiveness in the amygdala, part of the fear circuit of the limbic system
  • Poor functioning of serotonin (5-HT) and GABA, and elevated levels of norepinephrine (NE), perhaps caused by a surge in the fear circuit, which includes the locus ceruleus.
personality factors
Personality factors
  • Behavioral inhibition
    • Highly reactive infants (14 months old) were more likely (45%) to show anxiety symptoms at age 7.5 than those with low infant reactions (15%)
  • High neuroticism doubles the risk of anxiety disorders
  • About half of adults with anxiety disorders had evidence of psychiatric disorders in childhood, usually anxiety disorders (33%) or depression (Gregory et al., 2007)
  • Psychoanalysis
    • Uncover the repression
    • Confront the fear
behavioral approaches
Behavioral approaches
  • Confront with relaxation: Systematic desensitization
  • Confront with tension: Blood and injection phobias
    • Counter parasympathetic overshoot
  • Flooding, in vivo, vicarious, and imaginal
  • Social skills training
cognitive approaches
Cognitive approaches
  • Cognitive restructuring not effective with specific phobias
  • Some effectiveness for social phobia, if combined with social skills training
biological treatments
Biological treatments
  • Anxiolytic drugs: Benzodiazepines
  • Antidepressants may be useful for social phobia.
    • Riddle (2001) found fluvoxamine (Luvox) effective in children with social phobia and OCD
  • Confronting the feared stimulus is essential for all of the treatment approaches, but anxiolytic drugs may lessen the effectiveness of exposure therapies.