The DSM-IV Anxiety Disorders

The DSM-IV Anxiety Disorders Panic Disorder with/without Agoraphobia Specific Phobia Social Phobia Obsessive Compulsive Disorder (OCD) Generalized Anxiety Disorder (GAD) Post Traumatic Stress Disorder (PTSD)

Criteria for a Panic Attack Discrete period of intense fear/discomfort in which at least 4 symptoms developed abruptly and reached a peak within 10 minutes • palpitations, pounding/racing heart • sweating • trembling/shaking • shortness of breath/smothering sensations • feeling of choking • chest pain/discomfort • nausea or abdominal distress • feeling dizzy, unsteady, faint or lightheaded • derealization or depersonalization • fear of losing control or going crazy • fear of dying • paresthesias (numbness or tingling sensations) • chills or hot flushes

Panic Disorder • recurrent, unexpected panic attacks • AND one month of concern about additional attacks • OR... worry about the implications of the attack or its consequences • OR... a significant change in behaviour related to the attacks

Agoraphobia • anxiety about being in places/situations from which escape might be difficult or embarrassing in the event of a panic attack • situations are avoided or endured with marked distress or anxiety about having a panic attack OR require the presence of a companion

Specific Phobia • marked and persistent fear that is excessive or unreasonable, cued by a specific object or situation • exposure to the phobic stimulus almost invariably provokes an immediate anxiety response (e.g., a panic attack) • phobic situation/object is avoided or endured with intense anxiety and distress

Specific Phobia - Types 1. Animal 2. Natural Environment (e.g., heights, water) 3. Blood-Injection-Injury Type 4. Situational (e.g., planes, elevators, driving) 5. Other (e.g., choking, vomiting)

Social Phobia • marked and persistent fear of social or performance situations • situations involve exposure to unfamiliar people or to possible evaluation by others • individual fears that he/she may do something humiliating or embarrassing.

Obsessive-Compulsive Disorder • recurrent and persistent obsessions and/or compulsions • symptoms cause marked distress • time consuming (more than 1 hour/day) • interfere significantly with person’s normal routine

OBSESSIONS • persistent and intrusive thoughts, impulses, images • inappropriate, cause marked anxiety or distress • person usually attempts to ignore or suppress them • ...OR neutralize them with some other thought or action • COMPULSIONS • repetitive behaviors or mental acts • performed to prevent or reduce anxiety/distress, not to provide pleasure or gratification

Mood Disorders Lifetime prevalence rates of depressive disorders: 13% men 25% women Lifetime prevalence rates of bipolar disorders: less than 1% for men and women 15% complete suicide

DSM-IV Mood Disorders

Mood Episodes • Major Depressive Episode • Manic Episode • Hypomanic Episode • Mixed Episode

1. Major Depressive Episode • Depressed mood • Loss of interest (anhedonia) • Significant weight loss or gain • Insomnia or hypersomnia • Psychomotor agitation or retardation • Fatigue or loss of energy • Worthlessness or guilt • Diminished ability to concentrate, indecisiveness

2. Manic Episode - Abnormally and persistently elevated, expansive, or irritable mood • Inflated self-esteem and grandiosity • Requiring very little sleep • Talkativeness • Flight of ideas • Distractibiltiy • Psychomotor agitation • Buying sprees, sexual indiscretions, foolish business investments

3. Hypomanic Episode Symptoms are milder than a Manic Episode • Less intense and last at least four days 4. Mixed Episode Both a Major Depressive Episode and a Manic Episode nearly everyday for at least a one week period

Major Depressive Disorder • One or more Major Depressive Episodes • No history of Manic, Hypomanic or Mixed Episodes Dysthymic Disorder • Less severe but more chronic than Major Depressive Disorder • Symptoms are milder but remain unchanged over long periods of time

Bipolar I Disorder • One or more Manic or Mixed Episodes • Often individuals have also had one or more Major Depressive Episodes Bipolar II Disorder • Presence (or history) of one or more Major Depressive Episodes • Presence (or history) of at least one Hypomanic Episode • There has never been a Manic Episode or a Mixed Episode

Cyclothymic Disorder • Less severe but more chronic than Bipolar Disorder • Symptoms of hypomania and depression are milder but remain unchanged over long periods of time

DSM-IV Specifiers • Chronic • Psychotic • Melancholic • Atypical • Catatonic • Postpartum Onset • Seasonal Pattern • Rapid Cycling Pattern

Eating Disorders • Females 10 x more likely to develop an eating disorder • Around 5% of young women will develop an eating disorder • Course and outcome of eating disorders is highly variable • Eating disorders are associated with serious complications, and have the highest mortality rate

DSM-IV Diagnostic criteria for Anorexia Nervosa • Low body weight • Fear of gaining weight or becoming fat • Weight-related self-evaluation, or denial of the seriousness of the low body weight • Amenorrhea RESTRICTING TYPE BINGE EATING/PURGING TYPE

DSM-IV: Diagnostic criteria for Bulimia Nervosa • Binge eating • Inappropriate compensatory behavior • Both occur, at least 2/ week for 3 months • Weight-related self-evaluation PURGING TYPE NON PURGING TYPE

Menstrual Dysfunction Hypothermia Hypotension Tiredness, Lethargy Headaches Hair Loss Dental Problems Electrolyte Abnormalities Parathesias Acute Gastric Dilation Delayed Gastric Emptying Constipation Swollen salivary gland Kidney Dysfunction Physical Complications

Depression Anxiety Mood swings Food Preoccupation Social Isolation Sleep Disturbances Self-Esteem Deficits Impulsive Behaviors Psychological Complications

Schizophrenia • Delusions and Irrational thought • Deterioration of Adaptive Behaviors • Hallucinations • Disturbed Emotion • Paranoid, Catatonic, Disorganized, Undifferentiated • Positive vs. Negative symptoms • Chronic, resistant to treatment

The DSM-IV Anxiety Disorders