Anxiety DisordersAnxiety Disorders

Distressing, persistent anxiety or Distressing, persistent anxiety or maladaptive behaviors that maladaptive behaviors that

reduce anxietyreduce anxiety

Manifestations of AnxietyManifestations of Anxiety• CognitiveCognitive

– Thought process range from Thought process range from generalized worry to generalized worry to overwhelming fear (focus on overwhelming fear (focus on impending doom)impending doom)

• BehavioralBehavioral– The avoidance of anxiety-The avoidance of anxiety-

provoking situation provoking situation

• SomaticSomatic– Physiological complaints due Physiological complaints due

to activation of sympathetic to activation of sympathetic nervous system (stomach nervous system (stomach aches, headaches, shakiness, aches, headaches, shakiness, etc.)etc.)

Specific PhobiasSpecific Phobias• Specific phobias = irrational, Specific phobias = irrational,

persistent fear of specific persistent fear of specific objects or situationsobjects or situations

• Simple phobias:Simple phobias:– Claustrophobia = enclosed Claustrophobia = enclosed

spacesspaces– Agoraphobia = open spacesAgoraphobia = open spaces– Arachnophobia = spidersArachnophobia = spiders– Acrophobia = heightsAcrophobia = heights

• Social phobia = fear of social Social phobia = fear of social situations & embarrassmentsituations & embarrassment

Phobias - irrational fears Phobias - irrational fears http://phobialist.com/http://phobialist.com/

• Hematophobia: Hematophobia: BloodBlood

• Gephyrophobia: Gephyrophobia: Crossing a bridgeCrossing a bridge

• Kenophobia: Kenophobia: Empty Empty roomsrooms

• Cynophobia: Cynophobia: DogsDogs• Coulrophobia: Coulrophobia: clownsclowns

• Aerophobia: Aerophobia: FlyingFlying• Entomophobia: Entomophobia:

InsectsInsects• Gamophobia: Gamophobia:

MarriageMarriage• Ophdophobia: Ophdophobia:

SnakesSnakes• Xenophobia: Xenophobia:

StrangersStrangers• Melissophobia: Melissophobia: BeesBees

Anxiety DisordersAnxiety Disorders• Common and uncommon fearsCommon and uncommon fears

Afraid of it Bothers slightly Not at all afraid of it

Beingclosed in,

in a smallplace

Being alone

In a house

at night

Percentageof peoplesurveyed

100

90

80

70

60

50

40

30

20

10

0Snakes Being

in high,exposedplaces

Mice Flyingon an

airplane

Spidersand

insects

Thunderand

lightning

Dogs Drivinga car

Being In a

crowdof people

Cats

Generalized Anxiety Disorder Generalized Anxiety Disorder (GAD)(GAD)

• Persistent high levels of anxiety and Persistent high levels of anxiety and excessive worry excessive worry with symptoms for with symptoms for at least 6 monthsat least 6 months

• Restlessness, Restlessness, difficulty sleeping, difficulty sleeping, lack of concentration, lack of concentration, muscle tension, muscle tension, irritabilityirritability

Panic DisorderPanic Disorder• Recurrent, unexpected panic Recurrent, unexpected panic

attacks attacks – Feelings of terrorFeelings of terror– Pounding heart, difficulty Pounding heart, difficulty

breathingbreathing– Fearful of future attacksFearful of future attacks

• Often accompanied by Often accompanied by secondary conditions, such as secondary conditions, such as agoraphobiaagoraphobia

Posttraumatic Stress DisorderPosttraumatic Stress Disorder• Flashbacks or nightmares Flashbacks or nightmares

following extremely following extremely troubling eventtroubling event

• http://www.youtube.com/http://www.youtube.com/watch?watch?v=6VsVA5p7heQ&feature=rv=6VsVA5p7heQ&feature=related elated

Posttraumatic Stress Disorder in a Community Sample..., Brian Engdahl et al, American Journal of

Psychiatry, 1997, pp. 1576-81.

Obsessive-Compulsive Disorder Obsessive-Compulsive Disorder (OCD)(OCD)

Persistent, unwanted thoughts (obsessions) Persistent, unwanted thoughts (obsessions) cause someone to feel the need (compulsion) cause someone to feel the need (compulsion) to engage in an actionto engage in an action

(did I already do this slide?… I better do it (did I already do this slide?… I better do it againagain

(did I already do this slide?… I better do it (did I already do this slide?… I better do it again) again)

• http://www.youtube.com/watch?v=44DCWslbsNM&feature=related http://www.youtube.com/watch?v=44DCWslbsNM&feature=related • http://www.youtube.com/watch?v=tPFQMRx2l3Y http://www.youtube.com/watch?v=tPFQMRx2l3Y

Common Examples of OCDCommon Examples of OCDCommon Obsessions:Common Obsessions: Common Common

Compulsions:Compulsions:

Contamination fears of germs, Contamination fears of germs, dirt, etc.dirt, etc. WashingWashing

Imagining having harmed self or Imagining having harmed self or othersothers RepeatingRepeating

Imagining losing control of Imagining losing control of aggressive urgesaggressive urges CheckingChecking

Intrusive sexual thoughts or Intrusive sexual thoughts or urgesurges TouchingTouching

Excessive religious or moral Excessive religious or moral doubtdoubt CountingCounting

Forbidden thoughtsForbidden thoughts Ordering/arrangingOrdering/arranging

A need to have things A need to have things "just so""just so" Hoarding or savingHoarding or saving

A need to tell, ask, confessA need to tell, ask, confess PrayingPraying

Anxiety DisordersAnxiety Disorders• Fear of embarrassing oneself in public to the extent Fear of embarrassing oneself in public to the extent

that one is isolated completely.that one is isolated completely.

Social phobiaSocial phobia• Recurrent thoughts that lead to ritual behaviors.Recurrent thoughts that lead to ritual behaviors.

OCDOCD• Constant anxiety and worry for no particular cause.Constant anxiety and worry for no particular cause.

Generalized Anxiety DisorderGeneralized Anxiety Disorder• Fear of being in wide, open, public spaces like a Fear of being in wide, open, public spaces like a

stadium or shopping mall.stadium or shopping mall.

AgoraphobiaAgoraphobia• Re-occurring flashbacks or nightmares of a prior Re-occurring flashbacks or nightmares of a prior

traumatic event.traumatic event.

PTSDPTSD

Anxiety DisordersAnxiety Disorders

• PET Scan of brain of PET Scan of brain of person with person with Obsessive/ Obsessive/ Compulsive disorderCompulsive disorder

• High metabolic High metabolic activity (red) in activity (red) in frontal lobe areas frontal lobe areas involved with involved with directing attentiondirecting attention

Prevalence of Anxiety Disorders in the Prevalence of Anxiety Disorders in the U.S.U.S.

Specific Phobia

19.2 Million

Social Phobia

15 Million

GAD6.8 Million

Panic Disorder6 Million

OCD2.2 Million

Explaining Anxiety DisordersExplaining Anxiety Disorders• BiologicalBiological

– Fears may have an evolutionary basis (contribute Fears may have an evolutionary basis (contribute to survival)to survival)

– Genetic predisposition Genetic predisposition to fears and anxiety to fears and anxiety (tend to run in families)(tend to run in families)

– Lack of GABA Lack of GABA neurotransmitterneurotransmitter

• CognitiveCognitive– Irrational beliefs regarding Irrational beliefs regarding

feared stimulus feared stimulus (exaggeration)(exaggeration)

Explaining Anxiety DisordersExplaining Anxiety Disorders• Behavioral (learning)Behavioral (learning)

– Classical conditioning Classical conditioning of fearof fear

– Avoidance relieves Avoidance relieves fear (negative fear (negative reinforcement)reinforcement)

• Biopsychosocial Biopsychosocial modelmodel– Anxiety has a Anxiety has a

biological involvement biological involvement and learning and learning component, both of component, both of which are influenced which are influenced by cultureby culture

Somatoform DisordersSomatoform Disorders

Complaints of physical symptoms with Complaints of physical symptoms with no physiological explanation (they are no physiological explanation (they are

psychologically based)psychologically based)

• Somatization disorderSomatization disorder = multiple = multiple physical complaints with no physical physical complaints with no physical explanation, onset before age 30explanation, onset before age 30

• Conversion disorderConversion disorder = specific severe = specific severe physical complaint (paralysis, physical complaint (paralysis, blindness) with no physical causeblindness) with no physical cause– La belle indifferenceLa belle indifference

Glove Anesthesia

A conversion disorder in which a person can’t feel their hand (B). Neurologically this is impossible because the sensory nerves of the hand and arm are organized as shown in (A) rather than (B).

Body Dysmorphic DisorderBody Dysmorphic Disorder

• Excessive Excessive preoccupation preoccupation w/minor or w/minor or imagined flaw in imagined flaw in physical physical appearanceappearance

HypochondriasisHypochondriasis• Persistent Persistent

preoccupation with preoccupation with one’s health despite one’s health despite the fact that the fact that genuine symptoms genuine symptoms of the disorder are of the disorder are lackinglacking

Hypochondriasis

Occurs equally in men and women.

Typical age of onset is 20-30.

Prevalence rate 1%–5%.

$20 billion a year spent on unnecessary medical procedures.

Explaining Somatoform Explaining Somatoform DisordersDisorders

• Psychoanalytic – unresolved childhood conflicts, experiences

• Behavioral– Reinforcement

(anxiety is reduced)– Interpersonal gains in

terms of sympathy & support

• Sociocultural factors

Dissociative DisordersDissociative Disorders

Disruption or disturbances in memory, consciousness, or identity due to

psychological factors

Psychogenic (dissociative) Amnesia• Person loses memory due to stress or

psychological trauma (no physical cause)

Psychogenic (Dissociative) Fugue

• Confusion over personal identity & assumes new identity (usually travel away from home & start new life)

Case Study: Dissociative Fugue

• Jennifer Wilbanks developed a fear of her upcoming wedding. Over several weeks she bought bus tickets, cut her hair and took the bus to Las Vegas and finally ended up in New Mexico. She confabulated an abduction story but finally admitted to her bus ride. (Neither Wilbanks nor Mason will answer mail or emails for an interview). She was a worker in a doctor's office.

Depersonalization Disorder

• Most common dissociative disorder• Feelings of unreality about self• “This is not my body…I am trapped in

someone else’s body”

Dissociative Identity Disorder• Person has several personalities rather than

one integrated personality (a.k.a. Multiple Personality)

• http://www.youtube.com/watch?v=NDUw-yCRBUM&feature=related

• http://www.youtube.com/watch?v=xRY7Oj-dl3o

Theoretical Causes of Dissociative Disorders

• Psychodynamic extremely traumatic event is repressed so that a split in consciousness results

• Behaviorists people who have experienced a trauma simply find not thinking about it to be rewarding (negative reinforcement)