Anxiety Disorders

Anxiety – Characterized by ↑ heart rate, ↑ blood pressure, sweating, rapid breathing, dry mouth, sense of dread, uneasiness, trembling, nervousness Some anxiety is normal – when so intense & long-lasting that it impairs functioning, becomes a disorder Most common disorders in North America ~29% will experience ~2/3 are women

Generalized Anxiety Disorder (GAD) Excessive & long-lasting (~6 mo.) anxiety, not focused on any particular object or situation (“free-floating anxiety”) – Feel disaster is about to happen, jumpy, irritable, can’t sleep 3.1% of pop. in any given year 5% of pop. In lifetime Onset ~30 y.o. Somewhat more common in women Rarely treated

Today’s Goals and HW Goals: 1. To understand the symptoms and causes of anxiety disorders. 2. To understand the biomedical and psychological treatments for anxiety disorders. HW: 1. Read pages AND Take notes on material. 2. Complete somatoform, dissociative, and mood disorder sections of psychological disorders chart (my website).

Phobias An intense, irrational fear of an object or situation that does not objectively justify such a reaction – Usually realize fear is groundless, but anxiety persists – May greatly interfere with daily life – DSM subgroups: specific (9% of pop.), social, agoraphobia Onset: early teens

Classes of Phobias Specific phobias are unwarranted fears caused by the presence of a specific object or situation – Blood, injuries, or injections - early childhood onset – Situations (planes, elevators) – early 20s onset – Animals – early childhood onset – Natural environment (water, heights) – early childhood onset – Other (contracting illnesses, choking) Social phobia (Social Anxiety Disorder) involves a persistent fear linked to the presence of other people (adolescence onset) Agoraphobia or “Fear of the Marketplace”, avoidance of “unsafe” places where panic attack may recur

Top 10 fears (men and women combined) were the following: 1. Fear of snakes 2. Fear of being buried alive 3. Fear of heights 4. Fear of being bound or tied up 5. Fear of drowning 6. Fear of public speaking 7. Fear of hell 8. Fear of cancer 9. Fear of tornadoes and hurricanes 10. Fear of fire Discovery Health Channel; Penn, Schoen, & Berland Associates (2000)

Gender Comparison Top 5 fears of men: 1. Fear of being buried alive 2. Fear of heights 3. Fear of snakes 4. Fear of drowning 5. Fear of public speaking Top 5 fears of women: 1. Fear of snakes 2. Fear of being bound or tied up 3. Fear of being buried alive 4. Fear of heights 5. Fear of public speaking

Greatest difference between men and women: fear of being bound or tied up (women =27% vs. men 2%). We fear – giving a speech (36%) more than meeting new people (12%) – embarrassing ourselves in a sport (44%) more than asking someone for a date (35%) – being stranded in the ocean (62%) more than being stranded in the desert (24%) – the IRS (57%) more than God (30%)

Things we fear equally: – rats and dentists (58%) – elevators and flying (52%) – public speaking and being alone in the woods (40%) Level of fear in US = high BUT few seek treatment. – Among those who say they have a phobia or extreme fear, only 11 percent indicated that they sought professional help.

 Marked and Persistent Fear of One or More... Social or Performance Situations  Most Common Type of Social Fear? Public Speaking  Interferes With Life Functioning  Marked and Persistent Fear of One or More... Social or Performance Situations  Most Common Type of Social Fear? Public Speaking  Interferes With Life Functioning  Clinical Description

 Facts and Statistics  Occurs in 13.3% of Population  Most Prevalent Disorder  Males > Females  Begins in Adolescence  Presents Differently in Some Cultures (e.g., Japan)  Occurs in 13.3% of Population  Most Prevalent Disorder  Males > Females  Begins in Adolescence  Presents Differently in Some Cultures (e.g., Japan)

Etiology of Anxiety Disorders Psychoanalytic theory: phobias result from anxiety produced by repressed id impulses Biological/Genetic theory: Heritability of panic disorder, and evolutionary basis of phobias Behavioral theories: focus on learning as the etiological basis of phobias – Phobias are learned avoidance responses – Phobias may be acquired through modeling – We are biologically prepared to learn certain fears (e.g. taste with nausea) Cognitive theory: Thought processes result in high levels of anxiety

Treating Phobias Psychoanalytic therapy attempts to uncover repressed conflicts using free association Behavioral approaches use systematic desensitization and in vivo exposures to reduce anxiety responses to phobic stimuli and situations – Flooding: exposure to a phobic stimulus at full intensity (now graded exposure is used more) Cognitive approaches focus on altering irrational beliefs (using socratic dialogue to disconfirm and reconstruct automatic thoughts, images) systematic desensitzation

Treating Phobias Biological approach uses drugs to eliminate anxiety symptoms – Anxiolytic drugs such as the benzodiazepines (Valium) can reduce anxiety but are also addictive and give rise to withdrawal symptoms upon termination – MAO inhibitors such as phenelzine reduce the degradation of norepinephrine and serotonin MAO inhibitors can have adverse side effects – Selective serotonin reuptake inhibitors (SSRI’s) (fluoxetine) increase brain serotonin

Panic Disorder Recurring, terrifying panic attacks w/o warning or obvious cause Intense heart palpitations, pressure or pain in chest, dizziness or unsteadiness, sweating, feeling faint (may last minutes or hours) Often mistaken for heart attack – Can last for years w/ improvement and recurrence – Strong association w/ agoraphobia – 30% of pop. had panic attack w/in last year – Only 2-3 % developed full-blown panic disorder

Post-Traumatic Stress Disorder (PTSD) Pattern of adverse and disruptive reactions following a traumatic and threatening event i.e., war, natural disasters, assaults, abuse, accidents, etc. – Characteristic reactions: Anxiety, depression, irritability, jumpiness, inability to concentrate, sexual dysfunction, difficulty getting along w/ others, sleep disturbances, intense startle responses, suppressed immune system, nightmares, flashbacks – Disturbance lasts more than 1 month (1 mo. or less = acute stress disorder) – May last months, years, decades

Acute Stress Disorder: Psychological disturbance lasting up to one month following stresses from a traumatic event

Obsessive-Compulsive Disorder (OCD) Obsessions – plagued by persistent, upsetting, unwanted thoughts i.e., infection, contamination, causing harm to self/others Compulsions – ritualistic, repetitive behaviors i.e., washing, counting, checking, arranging, etc. – Interferes w/ daily life (>1 hr/day) – Derive no pleasure – recognize as irrational Onset: adolescence 2-3% of pop. during lifetime (1 in 40)

Common Compulsions Pursuing cleanliness Avoiding particular objects (e.g. cracks in a sidewalk) Performing repetitive, magical, protective practices Checking (e.g. “is the gas off?”) Performing a particular act (e.g. chewing slowly)

Etiology of OCD The psychoanalytic view is that OCD reflects arrest of personality development at the anal stage Behavioral accounts of OCD point to learned behaviors reinforced by fear reduction The biological view of OCD has focused on activation of the frontal lobes and basal ganglia

OCD Therapy Psychoanalytic procedures are not effective ERP: Exposure and Response Prevention involves exposing the OCD client to situations that elicit a compulsion and then restraining the client from performing the compulsion Biological treatment involves drugs that increase brain serotonin activity (Prozac)

Case Studies In small groups, consider the cases provided. Determine the likely diagnosis as well as a recommended course of treatment.

Anxiety Screening Test tests.shtmlhttp:// tests.shtml (Several anxiety tests, including social anxiety)