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Anxiety, Somatoform, Dissociative and Stress Disorders.

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Anxiety, Anxiety, Somatoform, Somatoform, Dissociative Dissociative and Stress and Stress Disorders Disorders
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Page 1: Anxiety, Somatoform, Dissociative and Stress Disorders.

Anxiety, Anxiety, Somatoform, Somatoform,

Dissociative and Dissociative and Stress DisordersStress Disorders

Page 2: Anxiety, Somatoform, Dissociative and Stress Disorders.

Anxiety Anxiety DisordersDisorders

Page 3: Anxiety, Somatoform, Dissociative and Stress Disorders.

Anxiety DisordersAnxiety Disorders AnxietyAnxiety is a general feeling of is a general feeling of

apprehension characterized by a apprehension characterized by a behavioral, cognitive, or behavioral, cognitive, or psychological symptom.psychological symptom. Most people find anxiety to be an Most people find anxiety to be an

uncomfortable state uncomfortable state People will attempt to relieve or People will attempt to relieve or

lessen anxietylessen anxiety Due to operant conditioning’s Due to operant conditioning’s

effects, people associate strange effects, people associate strange behaviors with lowering their behaviors with lowering their anxietyanxiety

Page 4: Anxiety, Somatoform, Dissociative and Stress Disorders.

PhobiasPhobias.. AA Phobia Phobia is an intense, excessive is an intense, excessive

fear of an activity, object or situationfear of an activity, object or situation– Some phobias have an obvious Some phobias have an obvious

connection to a traumatic experienceconnection to a traumatic experience– Other phobias are generalized from Other phobias are generalized from

a traumatic experience like a fear of a traumatic experience like a fear of cotton balls after an attack by white cotton balls after an attack by white chickenschickens

– Most phobias do not have a specific Most phobias do not have a specific triggering event and most likely triggering event and most likely result from an operant conditioning result from an operant conditioning reinforcement of an anxiety reinforcement of an anxiety producing or reducing eventproducing or reducing event

Page 5: Anxiety, Somatoform, Dissociative and Stress Disorders.

PhobiasPhobias AgoraphobiaAgoraphobia is avoidance of public places is avoidance of public places

where the individual may develop symptoms of where the individual may develop symptoms of panic panic – People can end up confining themselves in their People can end up confining themselves in their

houses or even a single roomhouses or even a single room Social PhobiaSocial Phobia is a fear of being seen or is a fear of being seen or

observed, and perhaps judged, by othersobserved, and perhaps judged, by others– Social AnxietySocial Anxiety is an increase in anxiety when in a is an increase in anxiety when in a

social situationsocial situation Specific phobia Specific phobia is any phobia other than is any phobia other than

Agoraphobia or social phobia.Agoraphobia or social phobia.

Page 6: Anxiety, Somatoform, Dissociative and Stress Disorders.

Panic DisorderPanic Disorder Panic DisorderPanic Disorder is a disorder in is a disorder in

which one may experience racing which one may experience racing pulse or difficulty breathing. Heart pulse or difficulty breathing. Heart rate can accelerate up to 180 rate can accelerate up to 180 beats per minute and can last from beats per minute and can last from a few minutes to an hour. Victims a few minutes to an hour. Victims may believe they are going crazy may believe they are going crazy or having a heart attack.or having a heart attack.– This collection of symptoms is This collection of symptoms is

called a Panic Attackcalled a Panic Attack

Page 7: Anxiety, Somatoform, Dissociative and Stress Disorders.

Panic AttacksPanic Attacks Panic attacks are not unusual. 15 Panic attacks are not unusual. 15

to 30% of individuals report to 30% of individuals report experiencing at least one attack experiencing at least one attack in their lifetime. in their lifetime. – Frequent attacks are diagnosed Frequent attacks are diagnosed

as panic disorderas panic disorder– People can associate a panic People can associate a panic

attack with specific activities or attack with specific activities or places causing them to places causing them to associate the attack and the associate the attack and the event or activity leading to a event or activity leading to a phobia or avoidance behaviorphobia or avoidance behavior

Page 8: Anxiety, Somatoform, Dissociative and Stress Disorders.

Generalized Anxiety Generalized Anxiety DisorderDisorder

Generalized Anxiety DisorderGeneralized Anxiety Disorder is a chronically is a chronically high level of anxiety that is not attached to a high level of anxiety that is not attached to a specific stimulation.specific stimulation.– Can be progressiveCan be progressive– Can be triggered by steroid useCan be triggered by steroid use– Can be triggered by Marijuana useCan be triggered by Marijuana use– Found in both men and women often with Found in both men and women often with

different resultsdifferent results Men often use violent out bursts to decrease Men often use violent out bursts to decrease

anxiety to a comfortable or socially anxiety to a comfortable or socially acceptable levelacceptable level

Women often resort to substance abuse to Women often resort to substance abuse to return to a socially acceptable level of anxietyreturn to a socially acceptable level of anxiety

Page 9: Anxiety, Somatoform, Dissociative and Stress Disorders.

Abuse/Cycle of ViolenceAbuse/Cycle of Violence

Men often use violent outbursts to Men often use violent outbursts to increase their feelings of control over increase their feelings of control over anxiety by blaming or attempting to anxiety by blaming or attempting to control their partner.control their partner.

This is a dangerous cycle and usually This is a dangerous cycle and usually continues to get worse until continues to get worse until intervention jail or deathintervention jail or death

Page 10: Anxiety, Somatoform, Dissociative and Stress Disorders.

. . Obsessive Compulsive Obsessive Compulsive DisorderDisorder

Obsessive Compulsive DisorderObsessive Compulsive Disorder is is an anxiety disorder characterized by an anxiety disorder characterized by repetitive, irrational thoughts and repetitive, irrational thoughts and irresistible impulses such as washing irresistible impulses such as washing hands. hands. – The lifetime prevalence of OCD is about The lifetime prevalence of OCD is about

2.5 percent and the rate is higher 2.5 percent and the rate is higher among women.among women.

Page 11: Anxiety, Somatoform, Dissociative and Stress Disorders.

. . Obsessive Compulsive DisorderObsessive Compulsive Disorder

Obsessive compulsive disorder is not a Obsessive compulsive disorder is not a personality trait. It is a coping mechanism personality trait. It is a coping mechanism for dealing with the obsessive thoughts for dealing with the obsessive thoughts people experience that has been reinforced people experience that has been reinforced over time because it decreases or avoids over time because it decreases or avoids the feelings of anxiety and panic people the feelings of anxiety and panic people feel. During the movie you will be trying to feel. During the movie you will be trying to identify what behaviors Mr. Udall identify what behaviors Mr. Udall shows that are part of his obsessive shows that are part of his obsessive compulsive disorder and which compulsive disorder and which behaviors are part of his personality behaviors are part of his personality and if there are any other behaviors and if there are any other behaviors which might indicate another disorder.which might indicate another disorder.

As Good As It Gets

Page 12: Anxiety, Somatoform, Dissociative and Stress Disorders.

Put Mr. Udall’s behaviors on a T ChartPut Mr. Udall’s behaviors on a T Chart

OCD BehaviorsOCD Behaviors PersonalityPersonality

As Good As It Gets

Page 13: Anxiety, Somatoform, Dissociative and Stress Disorders.

Blind Man TagBlind Man Tag

A great warm up activity low key A great warm up activity low key tag gametag game– Safety concerns Safety concerns

Leaders must maintain contact w/ blind Leaders must maintain contact w/ blind at all timesat all times

Walk onlyWalk only Must have a consistent, flat field of Must have a consistent, flat field of

play. Make it small grass if possibleplay. Make it small grass if possible

RulesRules

Played just like tagPlayed just like tag

Page 14: Anxiety, Somatoform, Dissociative and Stress Disorders.

Somatoform DisordersSomatoform Disorders

Somatoform Disorders Somatoform Disorders involves involves complaints of bodily symptoms that complaints of bodily symptoms that do not have a medical causedo not have a medical cause

Notice that it does not say “Identifiable medical cause.” This is because Many physical symptoms have a medical cause that Doctors just haven’t figured out yet

Page 15: Anxiety, Somatoform, Dissociative and Stress Disorders.

HypochondriasHypochondrias

HypochondriasHypochondrias is a preoccupation is a preoccupation with physical symptoms that are with physical symptoms that are believed to indicate a serious illness.believed to indicate a serious illness.

Usually the physical symptoms are common, and benignlike heart burn or headache, but the diagnosisThey come up with for themselves is uncommon and disastrous

Page 16: Anxiety, Somatoform, Dissociative and Stress Disorders.

Somatization DisorderSomatization Disorder

SomatoformSomatoform disorderdisorder involving involving multiple symptoms that are vague multiple symptoms that are vague and unrelated, have no medical and unrelated, have no medical cause and are interfering with an cause and are interfering with an individuals ability to functionindividuals ability to function

A person will have physical complaints that help them have a legitimate excuse for altering their behavior or help them deal with anxiety

Page 17: Anxiety, Somatoform, Dissociative and Stress Disorders.

Conversion DisorderConversion Disorder

Conversion Disorder Conversion Disorder is when an is when an individual presents sensory or motor individual presents sensory or motor symptoms that do not have a symptoms that do not have a medical reason.medical reason.

Anxiety, fear, guilt and stress are expressedas physical symptoms

Page 18: Anxiety, Somatoform, Dissociative and Stress Disorders.

Journal EntryJournal Entry What is your earliest childhood What is your earliest childhood

memory? How old were you?memory? How old were you? How much of your childhood (ages How much of your childhood (ages

1-10) do you recall? 1-10) do you recall? Of the things you recall about your Of the things you recall about your

childhood, what percent are childhood, what percent are positive memories and what % are positive memories and what % are negative?negative?

DO you have any memories that are DO you have any memories that are missing or incomplete because they missing or incomplete because they are scary or sad?are scary or sad?

Page 19: Anxiety, Somatoform, Dissociative and Stress Disorders.
Page 20: Anxiety, Somatoform, Dissociative and Stress Disorders.

Dissociative DisordersDissociative Disorders

Dissociative Disorders Dissociative Disorders affect the affect the function of the mind, such as function of the mind, such as memory for events, knowledge of memory for events, knowledge of one’s identityone’s identity

Page 21: Anxiety, Somatoform, Dissociative and Stress Disorders.

Dissociative DisordersDissociative Disorders

Dissociative disorders develop as Dissociative disorders develop as a coping mechanism for dealing a coping mechanism for dealing with stressful situations. with stressful situations. – People who are more sensitive to People who are more sensitive to

dissociation will use it initially to dissociation will use it initially to cope with very serious situations cope with very serious situations and it can easily become a way of and it can easily become a way of life.life.

Page 22: Anxiety, Somatoform, Dissociative and Stress Disorders.

Dissociative AmnesiaDissociative Amnesia

Dissociative Amnesia Dissociative Amnesia involves a involves a sudden inability to recall important sudden inability to recall important personal information and other facts personal information and other facts often occurs after emotional trauma. often occurs after emotional trauma.

Page 23: Anxiety, Somatoform, Dissociative and Stress Disorders.

Journal EntryJournal Entry :A week has :A week has passedpassed

How would you feel if you How would you feel if you woke up far away from home woke up far away from home with no recollection of how with no recollection of how you got there, only to find you got there, only to find out that a week has passed out that a week has passed and you have no idea what and you have no idea what has happened? What would has happened? What would your concerns be?your concerns be?

Page 24: Anxiety, Somatoform, Dissociative and Stress Disorders.

Dissociative FugueDissociative Fugue

DissociativeDissociative Fugue Fugue involving involving amnesia and flight from the amnesia and flight from the workplace or home; may involve workplace or home; may involve establishing a new identity in a new establishing a new identity in a new location. location.

Page 25: Anxiety, Somatoform, Dissociative and Stress Disorders.

Dissociative Identity Dissociative Identity DisorderDisorder

Dissociative Identity Disorder Dissociative Identity Disorder (multiple personality) is the most (multiple personality) is the most dramatic dissociative disorder. dramatic dissociative disorder. Although once thought rare, many Although once thought rare, many suggest that it is not rare but under-suggest that it is not rare but under-diagnosed. diagnosed.

http://www.youtube.com/watch?v=d73YSNtdT3o

Page 26: Anxiety, Somatoform, Dissociative and Stress Disorders.

Stress Disorders Stress Disorders

Stress Disorders result from the Stress Disorders result from the brain’s attempt to cope with a brain’s attempt to cope with a stressful situation. The process of stressful situation. The process of coping, forces changes in the coping, forces changes in the brain’s chemistry that create long brain’s chemistry that create long term effects.term effects.– Stress disorders can be very Stress disorders can be very

debilitatingdebilitating– The effects can cause permanent The effects can cause permanent

damage to physical and emotional damage to physical and emotional systemssystems

Page 27: Anxiety, Somatoform, Dissociative and Stress Disorders.

Acute Stress Disorder Acute Stress Disorder (ASD)(ASD)

Acute Stress Disorder (ASD) Acute Stress Disorder (ASD) Develops in the first few days after a Develops in the first few days after a traumatic incident.traumatic incident.Involves dissociative symptoms such Involves dissociative symptoms such as “zoning out”, feeling numb or as “zoning out”, feeling numb or dazed, detached or emotionally dazed, detached or emotionally unresponsive, recurrent images, unresponsive, recurrent images, thoughts and dreams; “flashbacks”thoughts and dreams; “flashbacks”2 days to 4 week duration 2 days to 4 week duration

Page 28: Anxiety, Somatoform, Dissociative and Stress Disorders.

Post Traumatic Stress Disorder Post Traumatic Stress Disorder (PTSD)(PTSD)

Post Traumatic Stress Disorder (PTSD) Persists over Post Traumatic Stress Disorder (PTSD) Persists over a period of time or occurs at least six months after a period of time or occurs at least six months after event. event.

Triggers: Internal or external cues that cause Triggers: Internal or external cues that cause intense reactions or distress often taking the person intense reactions or distress often taking the person back to the original source of the stress and forcing back to the original source of the stress and forcing them to relive it (Flashbacks)them to relive it (Flashbacks)– Ironically the treatment is to talk about and revisit the Ironically the treatment is to talk about and revisit the

source of the stress over and over in one on one or group source of the stress over and over in one on one or group therapy until the triggers no longer lead to the intense therapy until the triggers no longer lead to the intense reactions and flashbacks. Support groups are an important reactions and flashbacks. Support groups are an important part of this type of therapy.part of this type of therapy.

– EMDR a promising new Therapy uses brain biology to EMDR a promising new Therapy uses brain biology to reprogram memoriesreprogram memories

http://www.youtube.com/watch?v=zBtqWrs2-K0&list=RDWFYeoPqjV28

Page 29: Anxiety, Somatoform, Dissociative and Stress Disorders.

PTSD in ChildrenPTSD in Children Distancing themselves from physical Distancing themselves from physical

contact and relationshipscontact and relationships Self-destructive behavior Self-destructive behavior amnesia or dissociationamnesia or dissociation Somatization panic=painSomatization panic=pain Vivid nightmares and/or flashbacksVivid nightmares and/or flashbacks Depression/lack of affectDepression/lack of affect Difficulty in school/ability to concentrateDifficulty in school/ability to concentrate

http://www.youtube.com/watch?v=WFYeoPqjV28&feature=related

Page 30: Anxiety, Somatoform, Dissociative and Stress Disorders.

PTSD in ChildrenPTSD in ChildrenNotes to CaregiversNotes to CaregiversLook for behavioral signs: Look for behavioral signs:

– Bed wetting Bed wetting – promiscuous behavior, promiscuous behavior, – precocious understanding of sex, precocious understanding of sex, – pain / preoccupation with genitals pain / preoccupation with genitals – Vivid nightmares and/or flashbacks Vivid nightmares and/or flashbacks – Depression or flat affect Depression or flat affect – Drop in grades, unable to focusDrop in grades, unable to focus

Listen! Support, don’t react. Assure them that it Listen! Support, don’t react. Assure them that it is not their fault and the adult was wrong. is not their fault and the adult was wrong. Report!Report!

Be patient w/ physical contact and relationshipsBe patient w/ physical contact and relationships Provide alternatives for self-destructive behavior Provide alternatives for self-destructive behavior http://www.youtube.com/watch?v=WFYeoPqjV28

Page 31: Anxiety, Somatoform, Dissociative and Stress Disorders.

Complex PTSD or Disorders of Complex PTSD or Disorders of Extreme Stress not Otherwise Extreme Stress not Otherwise

Specified (DESNOS)Specified (DESNOS)

Difficulty with regulation of affect Difficulty with regulation of affect (emotion)(emotion)

self destructive behavior self destructive behavior amnesia or dissociationamnesia or dissociation somatization –panic=painsomatization –panic=pain relationship issuesrelationship issues DepressionDepression

http://www.youtube.com/watch?v=zkqibQWCecc

http://www.youtube.com/watch?v=WFYeoPqjV28&feature=related

Page 32: Anxiety, Somatoform, Dissociative and Stress Disorders.

Sometimes disorders present with Sometimes disorders present with complex combinations of symptomscomplex combinations of symptoms– In this example a woman with PTSD is In this example a woman with PTSD is

experience a dissociative response and experience a dissociative response and heading toward a panic attack as she heading toward a panic attack as she tries to cope with a flashback. Her tries to cope with a flashback. Her therapist does an great job of therapist does an great job of attempting to ground her in the present attempting to ground her in the present and reintegrate her dissociation to bring and reintegrate her dissociation to bring her back to the presenther back to the present

http://www.youtube.com/watch?v=k_8SX2GJiyQ&feature=related


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