1. Anxiety Disorders Module 48

2. What is anxiety? Anxiety is the CNS’s physiological and emotional response to a vague sense of threat or danger. Fear is the CNS’s physiological and emotional response to a serious threat to one’s well being. Anxiety is a natural reaction to danger or new situations. When does it become maladaptive?

3. Psychological Disorders Anxiety Disorders  Generalized Anxiety Disorder and Panic Disorder  Phobias  Obsessive-Compulsive Disorders  Post-Traumatic Stress Disorders  Explaining Anxiety Disorders

4. General Anxiety Disorder DSM Checklist Excessive or ongoing anxiety and worry, for at least six months, about numerous events or activities. Difficulty controlling worry Significant distress or impairment. At least three of the following symptoms: restlessness, easily fatigued, irritability, muscle tension, sleep disturbance.

5. Demographics Women outnumber men 2 to 1 About 3.1% of the population suffers it in any given year. It may emerge at any time but usually appears in childhood or adolescence Consistent across western societies Close to 6% of the population will develop it across they lifetimes Higher mortality rates

6. Panic Disorders DSM Checklist Recurrent unexpected panic attacks A month or more of one of the following after at least one of the attacks: –Persistent concern about having additional attacks –Worry about implications or consequences of the attack. –Significant change in behavior related to the attacks

7. Secondary Disorders Panic attacks can lead to secondary disorders, such as agoraphobia. Not everyone with panic disorder develops agoraphobia but many do. DSM distinguishes between panic disorder without agoraphobia and with agoraphobia.

8. What is Panic Attack? Intense period in which at least four of the following symptoms develop suddenly and reach a peak within 10 minutes. Sweating Trembling or shaking Palpitations, pounding heart, or accelerated heart rate A feeling of choking Chest pain or discomfort Nausea Feeling dizzy, unsteady, lightheaded Numbness Chills, hot flashes Fear of dying

9. Phobias Phobias are an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object or situation.

10. Phobias Specific phobias Social phobias: a fear of social or performance situations in which embarrassment may occur. Agoraphobia falls into this category.

11. Specific Phobias DSM Checklist Marked and persistent fear of a specific object or situation that is excessive or unreasonable, lasting at least six months. Immediate anxiety usually produced by exposure to the object. Recognition that the fear is excessive or unreasonable. Avoidance of the feared situation. Significant distress or impairment. Social phobia: add fear of embarrassment to the above symptoms

12. Demographics Specific phobias: female to male ratio 2:1 Social phobia: female to male 3:2

13. Obsessive Compulsive Disorder Obsessions are persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness Compulsions: are repetitive and rigid behaviors or mental acts that people feel they must perform in order to prevent or reduce axxiety.

14. Obsessive Compulsive Disorder DSM Checklist Recurrent obsessions or compulsions Past or present recognition that the obsessions or compulsions are excessive or unreasonable. Significant distress or impairment, or disruption by symptoms for more than one hour per day

15. Obsessions Wishes Impulses Images Ideas doubts

16. Compulsions Cleaning compulsions Checking compulsions Seek order and balance Touching, verbal, and counting compulsions. Compulsive acts are usually a response to obsessive thoughts 14,075.50/28,851

17. Common Examples of OCD Common Obsessions: Common Compulsions: Contamination fears of germs, dirt, etc. Washing Imagining having harmed self or others Repeating Imagining losing control of aggressive urges Checking Intrusive sexual thoughts or urgesTouching Excessive religious or moral doubtCounting Forbidden thoughtsOrdering/arranging A need to have things "just so"Hoarding or saving A need to tell, ask, confessPraying

18. Post Traumatic Stress Disorder The person has been exposed to a traumatic event in which both of the following were present: The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. The person’s response involved intense fear, helplessness or horror

19. DSM Checklist Recurrent and intrusive distressing recollections of the event, including images, thoughts and perceptions Recurrent distressing dreams of the events Acting or feeling as if the traumatic event was recurring. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

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

21. Explaining Anxiety Disorders Freud suggested that we repress our painful intolerable, ideas, feelings and thoughts resulting in anxiety.

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

23. The Learning Perspective Fear responses, investigators believe, are inculcated through observational learning. Young monkeys develop fear when they watch other monkeys fear snakes.

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

25. The Biological Perspective Generalized anxiety, panic attacks, and even OCD is linked with brain circuits like the anterior cingulate cortex. Anterior Cingulate Cortex of an OCD patient. 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, 347-353.