Anxiety Disorders, OCD, and PTSD Module 41 Anxiety Disorders, OCD, and PTSD Josef F. Steufer/Getty Images

Anxiety Disorders, OCD, and PTSD Anxiety is a part of life for all of us. Some of us are more prone to notice and remember information perceived as threatening, and the brain’s danger-detection system becomes hyperactive. When this occurs, we are at greater risk for an anxiety disorder, or for two other disorders that involve anxiety: Obsessive-compulsive disorder (OCD) Posttraumatic stress disorder (PTSD) OCD and PTSD were formerly classified as anxiety disorders, but the DSM-5 now classifies them separately.

Anxiety Disorders, OCD, and PTSD Anxiety Disorders 41-1: HOW DO GENERALIZED ANXIETY DISORDER, PANIC DISORDER, AND PHOBIAS DIFFER? Anxiety disorders are marked by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety; include: Generalized anxiety disorder: Person is unexplainably and continually tense and uneasy. Panic disorder: Person experiences panic attacks, sudden episodes of intense dread, and fears the next episode’s unpredictable onset. Phobia: Person is intensely and irrationally afraid of a specific object, activity, or situation.

Anxiety Disorders Generalized Anxiety Disorder Generalized anxiety disorder: Person is continually tense, apprehensive, and in a state of autonomic nervous system arousal. Worry continually, often jittery, on edge, and sleep deprived Lack of concentration on a task Two-thirds women Anxiety is free-floating (not linked to a specific stressor or threat) Often seen with depression, but usually debilitating even on its own May lead to physical problems (high blood pressure)

Anxiety Disorders Panic Disorder Panic disorder: An anxiety disorder marked by unpredictable, minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Often followed by worry over a possible next attack. Panic attacks: Sudden episodes of intense dread Physical symptoms accompany the attack: Irregular heartbeat, chest pains, shortness of breath, choking, trembling, dizziness Agoraphobia: Fear or avoidance of public situations from which escape may be difficult (should a panic attack occur).

Anxiety Disorders Phobias Phobia: Anxiety disorder marked by a persistent and irrational fear of a specific object, activity, or situation. Specific phobias include a fear of particular animals, insects, heights, blood, or closed spaces. Social anxiety disorder (formerly called “ social phobia”) is an intense fear of other people’s negative judgments. People with this disorder avoid social situations (speaking up in a group, eating out, going to parties), and if unable to avoid them, may experience strong symptoms of their anxiety. See Figure 14.3 for some common and uncommon specific fears.

Anxiety Disorders, OCD, and PTSD Obsessive-Compulsive Disorder (OCD) 41-2: WHAT IS OCD? Obsessive-compulsive disorder (OCD) Characterized by persistent and repetitive thoughts (obsessions), actions (compulsions), or both Occurs when obsessive thoughts and compulsive behaviors persistently interfere with everyday life and cause distress Is more common among teens and young adults than older people Twin studies reveal that OCD has a strong genetic basis

COMMON OBSESSIONS AND COMPULSIONS AMONG CHILDREN AND ADOLESCENTS WITH OBSESSIVE-COMPULSIVE DISORDER

Anxiety Disorders, OCD, and PTSD Posttraumatic Stress Disorder (PTSD) 41-3: WHAT IS PTSD? Post traumatic stress disorder (PTSD) Is characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia lingering for four weeks or more after a traumatic experience. Often involves military veterans (7.6 percent of combatants; 1.4 of noncombatants among American military personnel in Afghanistan) and survivors of accidents, disasters, and violent and sexual assaults (including an estimated two-thirds of prostitutes). Women at higher risk (1 in 10) than men (1 in 20) of developing this disorder, following a traumatic event. Most men and women display impressive survivor resiliency. Symptoms of posttraumatic stress disorder (PTSD) include four or more weeks of haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or sleep problems following some traumatic experience.

Understanding Anxiety Disorders, OCD, and PTSD Conditioning 41-4: HOW DO CONDITIONING, COGNITION, AND BIOLOGY CONTRIBUTE TO THE FEELINGS AND THOUGHTS THAT MARK ANXIETY DISORDERS, OCD, AND PTSD? Conditioning research helps explain how panic-prone people associate anxiety with certain cues. Learning may magnify a single painful and frightening event into a full-blown phobia through two conditioning processes: Stimulus generalization: Research demonstrates how a fearful event can later become a fear of similar events. Reinforcement can help maintain a developed and generalized phobia.

Understanding Anxiety Disorders, OCD, and PTSD Cognition Conditioning influences our feelings of anxiety, but so does cognition—our thoughts, memories, interpretations, and expectations. Observing others can contribute to development of some fears. Olsson and colleagues: Wild monkey research findings Our interpretations and expectations also shape our reactions. Hypervigilance

Understanding Anxiety Disorders, OCD, and PTSD Biology Genes Genetic predisposition to anxiety, OCD, and PTSD Researchers have identifies 17 gene variations associated with typical anxiety disorder symptoms Genes influence levels of neurotransmitters: Serotonin: Influences sleep, mood, attending to threat Glutamate: Heightens activity in the brain’s alarm centers Experience affects gene expression. Epigenetic marks are often organic molecules that attach to chromosomes and turn certain genes on or off

Understanding Anxiety Disorders, OCD, and PTSD Biology The Brain Traumatic fear-learning experiences can leave tracks in the brain Fear circuits created within the amygdala result in easy inroads for more fear experiences Brain scans show higher-than-normal activity in the amygdala of brain scans of people with PTSD when they view traumatic images Anterior cingulate cortex, a brain region that monitors our actions and checks for errors, is especially likely to be hyperactive in people with OCD

Understanding Anxiety Disorders, OCD, and PTSD Biology Natural Selection We seem biologically prepared to fear certain threats—these are easily conditioned and difficult to extinguish. Some modern fears may have an evolutionary explanation Fear of flying may be rooted in our biological predisposition to fear heights and confinement Our phobias focus on dangers our ancestors faced. Our compulsive acts typically exaggerate behaviors that helped them survive.