OoOooo!!!

Booo!!!

Life is Scary!!!

• We are vulnerable creatures in a dangerous world

• Danger is a fact of life• Our responsibility is:

1. Protect

2. Prepare

3. Propel

4. Pray

Fear • Is normal

• Is contextual

• Is necessary

• Demands a response

Bi-Focal Perception

Can see Foreground Can see Background

But: In the presence of danger threat or fear . . .

The human being’s

Perceptions become:

Binary:

• Either/or• Yes/no• Live/die• Kill/be killed

Responses to Danger or Threats

• Fight

• Flight

• Freeze

• Faint

Each response to Danger, Threat or Fear

• Is driven physiologically

• Is at first automatic

• Tends to eventually become a Stereotyped response, and . . .

• Reified across time, which makes it . . .

• A predictable pattern to life’s stressors

Fight

Assumes it can defeat

the threat

Flight

It assumes it can outrun the threat

Freeze

It assumes it can buy

Time to survive the threat

Faint

It assumes that it has run out of time and hopes to become the smallest possible target to the threat

Hostility (Fight)

Avoidance (Flight)

Denial (Freeze)

Dissociation (Faint)

Question for you

When I am exposed to danger, threat or fear, which is my most likely stereotyped, reified, predictable response?

Anxiety Disorders

Anxiety Disorders• Acute Stress Disorder • Agoraphobia Without History of Panic Disorder • Anxiety Disorder Due to General Medical Condition • Generalized Anxiety Disorder • Obsessive-Compulsive Disorder • Panic Disorder With Agoraphobia • Panic Disorder Without Agoraphobia • Posttraumatic Stress Disorder • Specific Phobia | Social Phobia • Substance-Induced Anxiety Disorder • Anxiety Disorder NOS (300.00)

Building Blocks

Panic Attacks Agoraphobia

Criteria For Panic Attacks

• Note: A Panic Attack is not a codable disorder. Code the specific diagnosis in which the Panic Attack occurs (e.g., 300.21 Panic Disorder With Agoraphobia.

• A discrete period of intense fear or discomfort, in which four (or more) of the symptoms developed abruptly and reached a peak within 10 minutes

Panic Symptoms

(1) palpitations, pounding heart, or accelerated heart rate (2) sweating (3) trembling or shaking (4) sensations of shortness of breath or smothering (5) feeling of choking (6) chest pain or discomfort (7) nausea or abdominal distress (8) feeling dizzy, unsteady, lightheaded, or faint (9) derealization (feelings of unreality) or depersonalization (being

detached from oneself) (10) fear of losing control or going crazy (11) fear of dying (12) paresthesias (numbness or tingling sensations) (13) chills or hot flushes

Criteria For Agoraphobia

• Avoidance or anxiety related to open spaces or any place outside of one's home or a safe zone.

• Note: Agoraphobia is not a codable disorder. Code the specific disorder in which the Agoraphobia occurs (e.g., 300.21 Panic Disorder With Agoraphobia or 300.22 Agoraphobia Without History of Panic Disorder).

Criterion A

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.

Fears 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.

Criterion B

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.

Criterion C

Is not better accounted for by another mental disorder

Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment)

Specific Phobia (e.g., avoidance limited to a single situation like elevators)

Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination)

Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor)

Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).

TransferenceBut the concept of transference has significance far beyond its application in psychoanalytic therapy. Transference is probably one of the most common reasons for human error and conflict in sizing up reality. It makes us see the world through the glasses of our own wishes and fears and consequently makes us confuse illusion with reality. We do not see people as they really are but the way we want them to be or fear that they are. Those illusions about other people take place of reality. We do not perceive others as they are but as they appear to us to be, and when we react to them, we are reacting not to the real human being on their own right but to products of our imagination.