1. Chapter 13 Anxiety and Related Disorders Cause clinically significant distress and impairment

2. The Complexity of Anxiety Disorders Anxiety – future-oriented mood state – Apprehension about future danger or misfortune; especially inability to control – Somatic and behavior symptoms of tension – Characterized by negative affect Anxiety and fear are normal emotional states

3. The Complexity of Anxiety Disorders Fear – the present-oriented mood state – Immediate fight or flight response to danger or threat – Involves sympathetic nervous system – Strong avoidance/escapist tendencies – Marked negative affect

4. Biological Contributions to Anxiety and Panic Genetic vulnerability Anxiety and brain circuits – Depleted levels of GABA

5. Psychological Contributions to Anxiety Integrated model – Early childhood - Experiences with uncontrollability and unpredictability – Especially how parents respond to child’s needs – “secure base” vs. overprotective parents

6. Psychological Contributions to Fear Behavioral and cognitive views – Invokes conditioning and cognitive explanations – Anxiety and fear are learned responses – Catastrophic thinking and appraisals play a role Social contributions – Stressful life events trigger vulnerabilities

8. An Integrated Model – Comorbidity is common across the anxiety disorders (about 50%) – Major depression is the most common secondary diagnosis

9. The Anxiety Disorders: An Overview Generalized anxiety disorder (GAD) Panic disorder with and without agoraphobia (PDA) Specific phobias Social phobia (SAD) Posttraumatic stress disorder (PTSD) Obsessive-compulsive disorder (OCD)

10. Specific Phobias: An Overview Overview and defining features – Extreme irrational fear of a specific object or situation – Persons will go to great lengths to avoid phobic objects – Most recognize that the fear and avoidance are unreasonable – Markedly interferes with one’s ability to function

11. Some phobias (from phobialist.com) Iatrophobia- Fear of going to the doctor or of doctors. Ichthyophobia- Fear of fish. Ideophobia- Fear of ideas. Illyngophobia- Fear of vertigo or feeling dizzy when looking down. Iophobia- Fear of poison. Insectophobia - Fear of insects. Isolophobia- Fear of solitude, being alone. Isopterophobia- Fear of termites, insects that eat wood. Ithyphallophobia- Fear of seeing, thinking about or having an erect penis. Japanophobia- Fear of Japanese. Judeophobia- Fear of Jews. Radiophobia- Fear of radiation, x-rays. Ranidaphobia- Fear of frogs. Rectophobia- Fear of rectum or rectal diseases. Rhabdophobia- Fear of being severely punished or beaten by a rod, or of being severely criticized. Also fear of magic.(wand) Rhypophobia- Fear of defecation. Rhytiphobia- Fear of getting wrinkles. Rupophobia- Fear of dirt. Russophobia- Fear of Russians.

12. Specific Phobias: Associated Features and Treatment Subtypes of specific phobia 1) Blood-injury-injection phobia – unusual vasovagal response 2) Situational phobia – trains, planes, automobiles, closed spaces 3) Natural environment phobia – natural events (e.g., heights, storms) 4) Animal phobia – animals and insects – Other – Separation anxiety – seen in children

13. Specific Phobias: An Overview Facts and statistics – Females are again over-represented (4:1) – Affects about 12.5% of the general population – Phobias tend to last a lifetime

14. Specific Phobias: Associated Features and Treatment Causes of phobias – Direct experience or traumatic conditioning, prepared tendency, event will happen again Psychological treatments of specific phobias – Cognitive-behavior therapies are highly effective – exposure therapy

16. Posttraumatic Stress Disorder (PTSD): An Overview Overview and defining features – Main etiologic characteristics – trauma exposure and response (intense fear, helplessness, or horror) – Re-experiencing (e.g., memories, nightmares, flashbacks) – Avoidance – Emotional numbing and interpersonal problems – Markedly interferes with one's ability to function – PTSD diagnosis – only after one month post-trauma

17. Posttraumatic Stress Disorder (PTSD): An Overview Statistics – Combat and sexual assault are the most common traumas – Lower than expected prevalence rates in trauma victims

18. PTSD: Causes and Associated Features Subtypes and associated features of PTSD – Acute – Chronic – Delayed onset – onset six months or more post trauma – Acute stress disorder – PTSD immediately post- trauma (up to one month)

19. PTSD: Causes and Associated Features Causes of PTSD – Intensity of the trauma and one's reaction to it (i.e., true alarm) – Learned alarms – direct conditioning and observational learning – Biological vulnerability – Uncontrollability and unpredictability – Extent of social support, or lack thereof, post- trauma

22. PTSD: Treatment Psychological treatments – Cognitive-behavioral therapies (CBT) are highly effective – CBT may include graduated or massed (e.g., flooding) imaginal exposure – SSRIs

23. Obsessive-Compulsive Disorder (OCD): An Overview Obsessions – intrusive and nonsensical thoughts, images, or urges Symmetry 26.7%, forbidden thoughts 21%, cleaning and contamination 15.9% and hoarding 15.4% – Compulsions – thoughts or actions to neutralize thoughts – Cleaning and washing or checking rituals are common

24. Obsessive-Compulsive Disorder (OCD): An Overview Overview and defining features – Tic disorder and OCD – Hoarding

25. OCD: Causes and Associated Features Statistics – Affects about 1.6% of the general population – Mostly female (60% in adults) – In children, more males than females – Onset usually in early adolescence or young adulthood – chronic

26. 13% of “normal” people have unwanted thoughts Aggressive thoughts Causing harm to elderly people Imagining or wishing harm upon someone close to oneself Impulses to violently attack, hit, harm or kill a person, small child, or animal Impulses to shout at or abuse someone, or attack and violently punish someone, or say something rude, inappropriate, nasty or violent to someone. Sexual thoughts Sexual obsessions involve intrusive thoughts or images of "kissing, touching, fondling, sexual relations with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", involving “heterosexual or homosexual content" with others. Blasphemous religious thoughts sexual thoughts about God, saints, and religious figures bad thoughts or images during prayer or meditation thoughts of being possessed

27. OCD: Causes and Associated Features Causes of OCD – Parallels the other anxiety disorders – Early life experiences – Learning that some thoughts are dangerous/unacceptable – Thought-action fusion – the thought is similar to the action

29. OCD: Treatment Medication treatment – Clomipramine and other SSRIs – benefit 35-60% of patients (moderate at best) – Relapse is common with medication discontinuation – Psychosurgery (cingulotomy) is used in extreme cases

30. OCD: Treatment Psychological treatment – CBT involves exposure and response prevention (ERP) – most effective (86%) – Combining CBT with medication – no better than CBT alone

31. Stereotyped Movement Disorders Tourette’s Syndrome Onset before 18 Multiple motor tics and 1 or more vocal tics Occurring nearly every day for > year Comorbid with ADHD and OCD

32. Social Phobia or Social Anxiety Disorder (SAD) – Extreme and irrational fear in social and/or performance situations – Markedly interferes with one’s ability to function – Often avoid social situations or endure them with great distress – Generalized subtype – affects many social situations

33. Social Phobia: An Overview Facts and statistics – Affects about 12.1% of the general population – Gender prevalence is about equal – Second only to specific phobia in the anxiety disorders – Peak age of onset at about 13 years

34. Social Phobia: Associated Features and Treatment Causes – Biological and evolutionary vulnerability – Similar learning pathways as specific phobias and panic disorder Psychological treatment – CBT highly effective – Cognitive-behavioral group treatment (CBGT)

35. Eating Disorders: An Overview Two major types of DSM-IV-TR eating disorders –A–Anorexia nervosa and bulimia nervosa –S–Severe disruptions in eating behavior –E–Extreme fear and apprehension about gaining weight Strong sociocultural origins – Westernized views Binge eating disorder Obesity – A growing epidemic

36. Bulimia Nervosa: Overview and Defining Features Binge eating – hallmark of bulimia – Binge Eating excess amounts of food – Eating is perceived as uncontrollable

37. Bulimia Nervosa: Compensatory behaviors – Purging Self-induced vomiting, diuretics, laxatives – Some exercise excessively, whereas others fast – Purging subtype – most common subtype – Nonpurging subtype – about one-third of bulimics

38. Associated medical features –M–Most are within 10% of target body weight –P–Purging methods can result in severe medical problems Erosion of dental enamel, electrolyte imbalance Kidney failure, cardiac arrhythmia, seizures, intestinal problems

39. Bulimia Nervosa: Associated Features Associated psychological features – Most are overly concerned with body shape – Fear of gaining weight – Most have comorbid psychological disorders

40. Anorexia Nervosa: Overview and Defining Features Successful weight loss – hallmark of anorexia – Defined as 15% below expected weight – Intense fear of obesity and losing control over eating – Anorexics show a relentless pursuit of thinness – Often begins with dieting – amenorrhea

41. DSM-IV-TR subtypes of anorexia – Restricting subtype – limit caloric intake via diet and fasting – Binge-eating-purging subtype

42. Anorexia Nervosa: Overview and Defining Features Associated features – Most show marked disturbance in body image – Most are comorbid for other psychological disorders

43. Anorexia Nervosa: Overview and Defining Features – Methods of weight loss have life threatening consequences