Anxiety DisordersAnxiety Disorders

WEBWEB

Anxiety as a Normal and an Abnormal Response

• Some amount of anxiety is “normal” and is associated with optimal levels of functioning.

• Only when anxiety begins to interfere with social or occupational functioning is it considered “abnormal.”

The Fear and Anxiety Response Patterns

• Fear

• Panic

• Anxiety

• Anxiety Disorder

The Bell Curve

An Important Law- The Yerkes Dodson Law

Another Bell Curve- Courtesy of Our Good Buddies Yerkes-Dodsen

Phobic Disorders

• Phobias

1. Specific phobias

2. Social phobia

3. Agoraphobia

Specific Phobias

Specific Phobias

• Psychosocial causal factors

• Genetic and temperamental causal factors

• Preparedness and the nonrandom distribution of fears and phobias

• Treating specific phobias

Social Phobia

• General characteristics

Fear of being in social situations in which one will be embarrassed or humiliated

Social Phobia

• Interaction of psychosocial and biological causal factors– Social phobias as learned behavior– Social fears and phobias in an evolutionary

context– Preparedness and social phobia

Social Phobia

• Interaction of psychosocial and biological causal factors– Genetic and temperamental factors– Perceptions of uncontrollability– Cognitive variables

Panic Disorder With and Without Agoraphobia

• Panic disorder

• Panic versus anxiety

• Agoraphobia

• Agoraphobia without panic

Panic Disorder

• Prevalence and age of onset

• Comorbidity with other disorders

• Biological causal factors

• The role of Norepinephrine and Serotonin

Panic and the Brain

Panic Disorder

• Genetic factors

• Cognitive and behavioral causal factors

• Interoceptive fears

Panic Disorder: The Cognitive Theory of Panic

Panic Disorder: The Cognitive Theory of Panic

• Perceived control and safety• Anxiety sensitivity as a vulnerability factor

for panic• Safety behaviors and the persistence of

panic• Cognitive biases and the maintenance of

panic

Treating Panic Disorder and Agoraphobia

• Medications

• Behavioral and cognitive-behavioral treatments

Generalized Anxiety Disorder

• General characteristics

• Prevalence and age of onset

• Comorbidity with other disorders

Generalized Anxiety Disorder:Psychosocial Causal Factors

• The psychoanalytic viewpoint• Classical conditioning to many stimuli• The role of unpredictable and uncontrollable

events• A sense of mastery: immunizing against

anxiety

Generalized Anxiety Disorder:Biological Causal Factors

• Genetic factors

• A functional deficiency of GABA

• Neurobiological differences between anxiety and panic

Obsessive-Compulsive Disorder

• Obsessions- repetitive unwanted ideas that the person recognizes are irrational

• Compulsions- repetitive, often ritualized behavior whose behavior serves to diminish anxiety caused by obsessions

Obsessive-Compulsive Disorder

• Prevalence and age of onset

• Characteristics of OCD

• Types of compulsions

• Comorbidity with other disorders

Obsessive-Compulsive Disorder:Psychosocial Causal Factors

• Psychoanalytic viewpoint

• Behavioral viewpoint

• The role of memory

• Attempting to suppress obsessive thoughts

Obsessive-Compulsive Disorder:Biological Causal Factors

• Genetic influences

• Abnormalities in brain function

• The role of serotonin

Post-Traumatic Stress Disorder

• Critical Component – Symptoms occurs AFTER a traumatic stressor

Symptoms Categories

• Intrusive– distressing recollections– dreams– flashbacks– psychological trigger reactions– physiological trigger reactions

Symptoms Categories

• Avoidance– avoid thoughts, feelings or discussions– avoid activities, places– memory blocks– anhedonia (without pleasure)– numb– alexithymia (emotions unknown)– feeling of doom

Symptom Categories

• Hyperarousal Symptoms– sleep disturbance– anger problems– concentration– startle response– “on guard” hypervigilence

Diagnoses

• Acute Stress Disorder– new to DSM-IV (1994)– symptoms 2 days to 4 weeks following

traumatic event

• PTSD– new to DSM-III (1980)– symptoms beyond 4 weeks– delayed onset

Who Is Vulnerable?

• All ages

• Both genders

• Across Cultures and ethnic groups

Some StatsAndrews, Wahlberg, Montgomery (1993)

0

10

20

30

40

50

60

70

Black Hispanic NativeAmerican

White

Frequency

Employment

0

10

20

30

40

50

60

Employed Umemployed

Frequency

Depression

0

5

10

15

20

25

30

35

Total Group Severe PTSD Moderate PTSD

EnterExit

Types of Traumas

• Natural– earthquakes– floods– fires

• Human induces– war– crimes of violence

Co-Morbid Diagnoses

• Alcoholism– 75% for Vietnam Veterans with PTSD

• Depression– 77% of firefighters with PTSD also have

depression

• Generalized Anxiety

• Panic Attacks