1. Generalized Anxiety Disorder
Anxiety Disorders
Panic Disorder
Agoraphobia
Social Phobia
Specific Phobia
Generalized Anxiety Disorder

2. Panic Attack (not a diagnosis)
A. Discrete period of intense fear or discomfort, in which 4 or more of the following develop abruptly and reach a peak within 10 minutes
Palpitations
Sweating
Trembling/aching
Sensations of shortness of breath or smothering
Feeling of choking
Chest pain/discomfort
Nausea/abdominal distress
Feeling dizzy/unsteady/lightheaded/faint
Derealization/depersonalization
Fear of losing control/going crazy
Fear of dying
Paresthesias (numbness or tingling sensation)
Chills/hot flushes

3. Agoraphobia (not a diagnosis)
A. Anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms.
B. The situations are avoided or are endured with marked distress
C. Not better accounted for by another mental disorder

4. Panic Disorder without Agoraphobia
A. Both 1 and 2
1. Recurrent, unexpected panic attacks
2. At least one of the attacks has been followed by 1 or more months of 1 or more of the following
a. Persistent concern about having additional attacks
b. Worry about the implications of the attack or its consequences
c. Significant change in behavior related to the attacks
B. Absence of agoraphobia
C. Panic attacks are not due to a GMC or substance
D. Panic Attacks are not better accounted for by another mental disorder

5. Social Phobia
A. Marked, persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way that will be humiliating or embarrassing.
B. Exposure to the feared social situation almost invariably provokes an anxiety response
C. The person recognizes that the fear is excessive or unreasonable
D. The phobic stimulus is avoided or endured with intense anxiety or distress
E. There is significant distress or an impairment in functioning

6. Specific Phobia
A. Marked, persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation B. Exposure to the phobic stimulus almost always provokes an immediate anxiety response C. The person recognizes that the fear is excessive or unreasonable D. The phobic stimulus is avoided or endured with intense anxiety or distress E. There is significant distress or an impairment in functioning due to the phobia F. The phobia is not better accounted for by another mental disorder

7. Subtypes of Specific Phobia
Animal type
Natural environment type
Blood-Injection-Injury type
Situational type
Other type

8. Phobia
Marked by a persistent and irrational fear of an object or situation that disrupts behavior.
OBJECTIVE 7| Explain how a phobia differs from fears we all experience.

9. Kinds of Phobias Agoraphobia Phobia of open places. Acrophobia
Phobia of heights.
Claustrophobia
Phobia of closed spaces.
Hemophobia
Phobia of blood.

10. Examples of Phobias Acrophobia: Heights Aquaphobia: Water
Gephyrophobia: Bridges Ophidiophobia: Snakes
Aerophobia: Flying Arachnophobia: Spiders
Herpetophobia: Reptiles Ornithophobia: Birds
Agoraphobia: Open spaces Astraphobia: Lightning
Mikrophobia: Germs Phonophobia: Speaking aloud
Ailurophobia: Cats Brontophobia: Thunder
Murophobia: Mice Pyrophobia: Fire
Amaxophobia: Vehicles, driving Claustrophobia: Closed spaces
Numerophobia: Numbers Thanatophobia: Death
Anthophobia: Flowers Cynophobia: Dogs

11. Generalized Anxiety Disorder (GAD)
Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events
The person finds it difficult to control the worry
The anxiety and worry are associated with 3 or more of the following symptoms
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep Disturbance

12. Generalized Anxiety Disorder (GAD)
D. The focus of the anxiety and worry is not confined to features of another disorder and do not occur exclusively during PTSD E. There is clinically significant distress or impairment in functioning F. Not due to a GMC or substance

13. Trauma and Stress Related Disorders
PTSD

14. Post-Traumatic Stress Disorder
A. The person has been exposed to a traumatic event and have experienced four or more weeks of one or more of the following symptoms:
Haunting memories
2. Nightmares
3. Social withdrawal
Any type of trauma – rape victims ; accident survivors; veterans who have seen combat
4. Jumpy anxiety
5. Sleep problems

15. Resilience to PTSD
Only about 10% of women and 20% of men react to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience against traumatic situations.
All major religions of the world suggest that surviving a trauma leads to the growth of an individual.

16. Obsessive-Compulsive
OCD
Hoarding Disorder
Body dysmorphic Disorder

17. Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals/behaviors (compulsions) that cause distress.
People with OCD understands their behaviors are unreasonable. Their behaviors are directly related to reducing stress
OBJECTIVE 8| Describe the symptoms of obsessive-compulsive disorder.

18. Obsessive-Compulsive Disorder
A. Either obsessions or compulsions:
Obsessions as defined by 1, 2, 3, and 4
Recurrent, persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
The thoughts, impulses, or images are not simply excessive worries about real-life problems
The person attempts to ignore or suppress such thoughts, impulses, or images or tries to neutralize them with some other thought or action
The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind

19. Typical Obsessions
Doubts (e.g. Did I turn off the stove? Did I lock the door? Did I hurt someone?)
Fears that someone else has been hurt or killed
Fears that one has done something criminal
Fears that one may accidentally injure someone
Worry that one has become dirty or contaminated
Blasphemous or obscene thoughts
NOT just excessive worries about real-life problems

20. Obsessive-Compulsive Disorder
Compulsions as defined by 1 and 2
Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly
The compulsions are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

21. Typical Compulsions Checking Cleaning/washing
Doing things a certain number of times in a row
Doing and then undoing things
Doing things in a certain order, with symmetry
Mental acts such as praying, counting, etc.

22. Obsessive-Compulsive Disorder
B. The person has recognized that the obsessions or compulsions are excessive or unreasonable
C. There is significant distress or an impairment in functioning due to the obsessions or compulsions
D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to the other Axis I disorder
E. The disturbance is not due to a GMC or substance

23. Hoarding Disorder
Persistent difficulty discarding or parting with possessions, regardless of their actual value

24. Body Dysmorphic Disorder
Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
Causes significant distress and or social dysfunctions.
Check themselves often in the mirror

25. Explaining Anxiety Disorders
Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety.
OBJECTIVE 10| Discuss the contributions of the learning and biological perspectives to our understanding of the development of anxiety disorders.

26. The Learning Perspective
Learning theorists suggest that fear conditioning leads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced.
John Coletti/ Stock, Boston

27. The Learning Perspective
Investigators believe that fear responses are inculcated through observational learning. Young monkeys develop fear when they watch other monkeys who are afraid of snakes.

28. Anxiety Disorders - Overview
Most common mental disorders in the U.S.
At least 19% of the adult population suffer from at least one anxiety disorder in any given year
All are more common in women, except for OCD
Except for Panic Disorder, ages of onset are most likely going to be in childhood or adolescence (but do not have to be)
Anxiety Disorders cost $42 billion each year in health care, lost wages, and lost productivity

29. Anxiety Disorders Cultural Variations
Fear, Anxiety, and Anxiety Disorders exist in all cultures
Prevalence rates vary, but are generally the most common mental illness in all countries
Low rates: China (2.4%), Japan, Nigeria, and Spain
High rates: U.S. (19%), France, Colombia, and Lebanon
Fear stimulus and content of anxiety differ greatly between cultures

30. Dhat (India), Jiryan (India), Sukra Prameha (Sri Lanka), & Shen-k’uei (China)
Severe anxiety, panic symptoms, somatic complaints, hypochondriachal symptoms associated with the discharge of semen
Excessive semen loss is feared because of the belief that it represents the loss of one’s vital essence and can thereby be life threatening

31. Koro (South and Southeast Asia)
Sudden and intense anxiety that one’s genitalia will recede into the body and possibly cause death
Can occur in epidemics

32. Taijin Kyofusho (Japan)
An intense fear that one’s body, its parts, or its functions (sweating, body odor, facial expressions, etc.) displease, embarrass, or are offensive to other people
Similar to the DSM’s Social Phobia

33. The Biological Perspective
Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species.
Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias.

34. The Biological Perspective
Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex.
S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action
monitoring in obsessive-compulsive disorder. Psychological Science, 14,
Anterior Cingulate Cortex
of an OCD patient.

35. Panic Disorder What Causes Panic Disorder?
We don’t really know; many factors.
But: Strong evidence that norepinephrine is involved.
Norepinephrine: neurotransmitter especially active in Locus ceruleus part of the brain.

36. Biological model: Anatomy (structures)
Models of Abnormality
Biological model: Anatomy (structures)
Neo-Cortex
Corpus callosum
Amygdala
Locus ceruleus (Pons)

37. Panic Disorder
Anti-depressant drugs that regulate norepinephrine successful in treating panic
When Locus ceruleus stimulated in monkeys  panic like behavior
Locus ceruleus rich in norepinephrine carrying neurons
Hypothesis: Norepinephrine dysregulation may well be implicated in Panic Disorder

38. Obsessive-Compulsive Disorder
Psychodynamic Perspective
Anxiety rooted in repressed ID impulses
Impulses = obsessive thoughts
Compulsions = ego defenses against them
E.g.: Lady Macbeth: Anxiety/guilt over her part in a murder  compulsive hand washing to get rid of the imagined blood.
How would you treat Lady Macbeth?

39. Obsessive-Compulsive Disorder
Behavioral Perspective
Focus on compulsions, not obsessions
Theory: association forms randomly between fear/anxiety reduction and the compulsive behavior
Compulsive behavior becomes reinforcing because it reduces anxiety
Therefore compulsion increases in frequency

40. Obsessive-Compulsive Disorder
Biological Perspective
Drugs that increase Serotonin activity are somewhat effective in treating OCD
Serotonin is also active in 2 brain areas that have been associated with OCD: the orbital region of the frontal cortex and caudate nucleus

41. Caudate nucleus
Orbital frontal cortex