Anxiety, Trauma- and Stressor-Related, and Obsessive

Compulsive and Related Disorders

ABNORMAL PSYCHOLOGY

TOPIC OUTLINE
I. ANXIETY
II. ANXIETY DISORDERS
III. TRAUMA AND STRESSOR
RELATED DISORDERS
IV. OBSESSIVE COMPULSIVE AND
RELATED DISORDERS

I. ANXIETY
II.
ANXIETY
→ A negative mood state characterized by bodily 2 TYPES OF PANIC ATTACK
symptoms of physical tension and by → Unexpected Attacks - important in panic disorder
apprehension about the future. → Expected Attacks- more common in specific
→ In humans, it can be a subjective sense of phobias or social phobia
unease, a set of behaviors looking worried and
anxious or fidgeting, or a physiological response CAUSES OF ANXIETY AND RELATED DISORDERS
originating in the brain and reflected in elevated
heart rate and muscle tension. BIOLOGICAL CONTRIBUTION
→ No single genes’ contributions from collections
of genes in several areas on chromosomes
FEAR makes us vulnerable.
→ Immediate emotional reaction to current danger → In several years, the role of corticotropin-
characterized by strong escapist action releasing factor (crf) system as a central to
tendencies and surge in sympathetic branch of expression of anxiety and depression. This is
autonomic nervous system because CRF activated the hypothalamic-
→ Alarm reaction to danger or life-threatening pituitary-adrenocortical (hpa) axis (part of the crf
emergencies. system)

PSYCHOLOGICAL CONTRIBUTION
PANIC ATTACK → Psychoanalytic Theorist – Freud explained
→ An abrupt experience of intense fear or acute that anxiety is a psychic reaction to danger by
discomfort accompanied by physical symptoms reactivation of an infantile fearful situation.
that usually include heart palpitations, chest → Behavioral Theorist – anxiety is a product of
pain, shortness of breath, and possibly, early classical conditioning, modeling or other
dizziness. forms of learning.
→ Fear occurring at an inappropriate time → General Sense of Uncontrollability- develop
early as function of upbringing and other
disruptive or traumatic environmental factors.
“secure home base” provided by the parents
enable their children to develop a healthy sense
of control.

External cues – are places of situations similar to the

one where the initial panic attack occurred

Internal cues- are increases heart rate or respiration

that were associated with the initial panic attack, even
if they are now the result of normal circumstances.
Anxiety, Trauma- and Stressor-Related, and Obsessive
Compulsive and Related Disorders
ABNORMAL PSYCHOLOGY

SOCIAL CONTRIBUTION
→ Stressful life events
→ Panic attacks often co-occur with certain medical
conditions
→ 20% of patients with panic disorder had
attempted suicide.

III. ANXIETY DISORDERS

SEPARATION ANXIETY (SEPANX)

→ It is characterized by children’s unrealistic and
persistent worry that something will happen to
their parents or other people in their life or that
something will happen to the children
themselves that will separate them from their
parents.
→ 3 symptoms / 4weeks SPECIFIC PHOBIA
→ Children often refuse to go to school or even to → An irrational fear of a specific object or situation
leave home (not because they are afraid; but that markedly interfers with an individual’s ability
focus in losing or separating from loved ones); to function.
fear decreases as they grow. → Examples: flying, heights, animals, receiving an
injection, seeing blood.

SELECTIVE MUTISM
→ Rare childhood disorder characterized by a lack
of speech in one or more settings in which
speaking is socially expected.
→ It seems clearly driven b social anxiety, since the
failure to speak is not because of a lack of
knowledge of speech or any physical difficulties,
nor is it due to another disorder in which
speaking is rare or can be impaired such as
autism spectrum disorder.
Anxiety, Trauma- and Stressor-Related, and Obsessive
Compulsive and Related Disorders
ABNORMAL PSYCHOLOGY

FOUR MAJOR SUBTYPES OF SPECIFIC

PHOBIA: Note: terrifying experiences alone do not create
phobias. True phobia also requires anxiety over the
→ Blood-injection-injury type possibility of another extremely traumatic event or
→ Situational Type false alarm and we are likely to avoid situations in
→ Natural Environment Type which that terrible thing might occur.
→ Animal Type

BLOOD-INJECTION-INJURY PHOBIA SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)

→ Runs in families more strongly than any phobic → Marked fear or anxiety about one or more social
disorder we know. situations in which the person is exposed to
→ People with this phobia inherit a strong possible scrutiny by others.
vasovagal response to blood, injury, or the → Examples: social interactions like having
possibility of an injection, all of which cause a conversation, meeting unfamiliar people. Being
drop in blood pressure and tendency to faint. observed like eating, drinking. Performing in
front of others like giving a speech.
SITUATIONAL PHOBIA
→ Fear of public transportation or enclosed places.
→ Claustrophobia- a fear of small enclosed places.
→ Note: the main difference between situational
phobia and panic disorder is that people with
situational phobia never experience panic
attacks outside the context of their phobic
objection or situation.

NATURAL ENVIRONMENT PHOBIA

→ Fears of situations or events occurring in nature
→ Example: heights, storms, water
→ These fears also seem to cluster together like if
you fear one situation or event, such as deep
water, you are likely to fear another, such as
storms.

Note: they are not phobias if they are only passing

fears. They have to be persistent (lasting at least six
months) and to interfere substantially with the
person’s functioning, leading to avoidance of boat
trips or summer vacations in the mountains where
they might be a storm.

ANIMAL PHOBIA
→ Fear of animals and insects
→ Pa-leng – a variant of phobia in Chinese culture,
sometimes frigo phobia or fear of the cold.

PHOBIAS ARE ACQUIRED BY:

Direct experience – where real danger or pain results

in an alarm response (a true alarm)

False Alarm- (panic attack) in a specific situation,

observing someone else experience severe fear
(vicarious experience), or, under the right conditions,
being told about danger.
Anxiety, Trauma- and Stressor-Related, and Obsessive
Compulsive and Related Disorders
ABNORMAL PSYCHOLOGY

PANIC DISORDER
→ Individuals experience severe, unexpected panic
attacks; they may think they’re dying or INTEROCETIVE AVOIDANCE
otherwise losing control. → Avoidance of internal physical sensations.
→ Associated with autonomic arousal, presumably → Most patients with panic disorder and
as a result of sympathetic nervous system surge agoraphobic avoidance also display this.
(for instance, increased heart rate, palpitations, → These behaviors involve removing oneself from
perspiration, and trembling) situations or activities that might produce the
→ To meet criteria for panic disorder, a person must physiological arousal that somehow resembles
experience unexpected panic attack and develop the beginnings of a panic attack.
substantial anxiety over the possibility of having
another attack or about the implications of the
attack or its consequences. In other words, the
person must think that each attack is a sign of
impending death or incapacitation.

→ Onset of panic disorder usually occurs in

early adult life from mid-teens
through about 40 yrs of age

Note: people experienced panic disorder

without developing agoraphobia and some
people develop agoraphobia in the absence of
panic disorder.

AGORAPHOBIA
→ Refers to the fear of marketplace
→ Agora – the Greek marketplace, was a busy,
bustling area. One of the most stressful places
for individuals with agoraphobia today is the
shopping mall.
→ When they do venture outside their homes,
people with agoraphobia always plan for rapid
escape.
→ Some individuals do not avoid agoraphobic
situations but endure them with “intense dread”
→ May be characterized either by avoiding the
situations or by enduring them with intense fear
and anxiety.
Anxiety, Trauma- and Stressor-Related, and Obsessive
Compulsive and Related Disorders
ABNORMAL PSYCHOLOGY

SUSTO
→ A disorder that is characterized by sweating, GENERALIZED ANXIETY DISORDER
increased heart rate, and insomnia, but not by → You can’t stop worrying, even if you know it is
reports of anxiety or fear, even though a severe doing you no good and probably making
fright is the cause. everyone else around you miserable.
→ Must be at least six months of excessive anxiety
NOCTURNAL PANIC and worry.
→ Panic attacks that occur more often between → Characterized by muscle tension, mental
1:30am and 3:30 am agitation, susceptibility to fatigue.
→ Occur during delta wave or slow wave sleep → For children, only one physical symptom is
which typically occurs several hours after we fall required for a diagnosis of GAD
asleep and is the deepest stage of sleep. → People with GAD mostly worry about minor,
→ Caused by change in stages of sleep to slow everyday life events, a characteristic that
wave sleep produces physical sensations of distinguishes GAD from other anxiety disorders.
“letting go” that are frightening to an individual → More common in males
with panic disorders → People with GAD have been called “autonomic
→ Individuals who experience this do wake up and restrictors”
later remember the event clearly → Chronic worriers, with accompanying autonomic
inflexibility and quite severe muscle tension.
→ Benzodiazepines- are most often prescribed for
SLEEP TERROR generalized anxiety, and the evidence indicates
→ Often children awake imagining that something that the give some relief, at least in short term.
is chasing them around the room. It is common
for them to scream and get out of bed as if
something were after them.

ISOLATED SLEEP PARALYSIS

→ Occurs during the transitional state between
sleep and waking, when a person is either falling
asleep or waking up, but mostly when waking
up.
→ The individual is unable to move and
experiences a surge of terror that resembles a
panic attack; occasionally, there are also vivid
hallucinations.

Note: the cognitive process is most important in panic

disorder.

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

(SSRI)
→ Indicated drug for panic disorder
→ Examples: Prozac and Paxil
→ Alprazolam (Xanax): commonly used for panic
disorder, work quickly but are hard to stop taking
because of psychological and physical
dependence and addiction.

PANIC CONTROL TREATMENT (PCT)

→ Concentrates on exposing patients with panic
disorder to the cluster of interoceptive (physical)
sensations that remind them of their panic
attacks.
Anxiety, Trauma- and Stressor-Related, and Obsessive
Compulsive and Related Disorders
ABNORMAL PSYCHOLOGY

III. TRAUMA AND STRESSOR RELATED

DISORDERS

POSTTRAUMATIC STRESS DISORDER (PTSD) ATTACHMENT DISORDERS

→ Exposure to a traumatic event during which an → refers to disturbed and developmentally
individual experiences or witnesses death or inappropriate behaviors in children, emerging
threatened death, actual or threatened serious before five years of age, in which the child is
injury, or actual or threatened sexual violation. unable or unwilling to form normal attachment
→ When memories occur suddenly, accompanied relationships with caregiving adults.
by strong emotion, and the victims find
themselves reliving the event or flashback.
→ Victims most often avoid anything that reminds REACTIVE ATTACHMENT DISORDER
them of the trauma. They often display a → the child will very seldom seek out a caregiver
characteristic restriction or numbing of emotional for protection, support, and nurturance and will
responsiveness, which may be disruptive to seldom respond to offers from caregivers to
interpersonal relationships. They are sometimes provide this kind of care.
unable to remember certain aspects of the
event. It is possible that victims unconsciously DISINHIBITED SOCIAL ENGAGEMENT DISORDER
attempt to avoid the experience of emotion itself, → similar set of child rearing circumstances-
like people with panic disorder, because intense perhaps including early persistent harsh
emotions could bring back memories of the punishment-would result in a of behavior in
trauma. which the child shows no inhibitions whatsoever
→ PTSD cannot be made until at least one month to approaching adults.
after the occurrence of the traumatic event. In
PTSD with delayed onset, individuals show few
or no symptoms immediately or for months after
a trauma, but at least 6 months later, and
perhaps years afterward develop full-blown
PTSD.
→ Acute Stress Disorder- occurring within the first
month after the trauma, but the different name
emphasizes the severe reaction that some
people have immediately.
→ Someone personally experiences trauma and
develops this disorder.

CATHARSIS
→ Reliving emotional trauma to relieve emotional
suffering
→ This trick is in arranging the re-exposure so that
it will be therapeutic rather than traumatic

IMAGINAL EXPOSURE
→ The content of the trauma and the emotions
associated with it are worked through
systematically, has been used for decades
under a variety of names.

ADJUSTMENT DISORDERS
→ describe anxious or depressive reactions to life
stress that are generally milder than one would
see in acute stress disorder or PTSD but are
nevertheless impairing in terms of interfering
with work or school performance, interpersonal
relationships, or other areas of living.
Anxiety, Trauma- and Stressor-Related, and Obsessive
Compulsive and Related Disorders
ABNORMAL PSYCHOLOGY
Anxiety, Trauma- and Stressor-Related, and Obsessive
Compulsive and Related Disorders
ABNORMAL PSYCHOLOGY

IV. OBSESSIVE-COMPULSIVE DISORDERS

OBSESSIVE-COMPULSIVE DISORDER
→ the devastating culmination of the anxiety
disorders. It is not uncommon for someone with
OCD to experience severe generalized anxiety,
recurrent panic attacks, debilitating avoidance,
and major depression, all occurring
simultaneously with obsessive-compulsive
symptoms.
→ Victims resort to magic and rituals

OBSESSIONS
→ Are intrusive and mostly nonsensical thoughts,
images, or urges that the individual tries to resist
or eliminate.

COMPULSIONS
→ Are the thoughts or actions used to suppress the
obsessions and provide relief.
Anxiety, Trauma- and Stressor-Related, and Obsessive
Compulsive and Related Disorders
ABNORMAL PSYCHOLOGY

TIC DISORDER THOUGHT-ACTION FUSION

→ involuntary movement (sudden jerking of limbs, → When clients with OCD equate thoughts with
for example), to co-occur in patients with OCD specific actions or activity represented by the
(particularly or in their families.) thoughts with the specific actions or activity
→ More complex tics with invol-untary vocalizations represented by the thoughts.
are referred to as Tourette's disorder

EXPOSURE AND RITUAL PREVENTION (ERP)

→ A process whereby the rituals are actively
prevented and the patient is systematically and
gradually exposed to the feared thoughts or
situations.

BODY DYSMORPHIC DISORDER

→ Most people fantasize about improving
something, but some relatively normal-looking
people think they are so ugly they refuse to
interact with others or otherwise function
normally for fear that people will laugh at their
ugliness.
→ The disorder has been referred to as “imagined
ugliness”
→ Considered as somatoform disorder because its
central feature is a psychological preoccupation
with somatic (physical) issues.
→ Dysmorphobia- (literally, fear of ugliness), was
thought to represent a psychotic delusional state
because the affected individuals were unable to
realize, even for a fleeting moment, that their
ideas were irrational.
→ Taijin kyofusho- Japanese variant of social
anxiety disorder which individual may believe
they have horrendous bad breath or body odor
and thus avoid social interaction.
Anxiety, Trauma- and Stressor-Related, and Obsessive
Compulsive and Related Disorders
ABNORMAL PSYCHOLOGY

HOARDING DISORDER
→ The three major characteristics of this problem
are excessive acquisition of things, difficulty
discarding anything, and living with excessive
clutter under conditions best characterized as
gross disorganization.
→ these individuals usually begin acquiring things
during their years and often experience great
pleasure, even euphoria, from shopping or
otherwise collecting various items. Shopping or
collecting things may be a response to feeling
down or depressed and is sometimes called,
facetiously, "retail therapy" But unlike most
people who like to shop or collect, these
individuals then experience strong anxiety and
distress about throwing anything away, because
everything has either some potential use or
sentimental value in their minds, or simply
becomes an extension of their own identity.
→ Animal Hoarders – are characterized by the
failure or inability to care for the animals or
provide suitable living quarters.

TRICHOTILLOMANIA (HAIR PULLING DISORDER)

→ The urge to pull out one's own hair from
anywhere on the body, including the scalp,
eyebrows, and arms, is referred to as
trichotillomania. This behavior results in
noticeable hair loss, distress, and significant
social impairments. This disorder can often have
severe social consequences, and, as a result,
those affected can go to great lengths to conceal
their behavior.

EXCORIATION (SKIN PICKING DISORDER)

→ Repetitive and compulsive picking of the skin,
leading to tissue damage.
→ Largely a female disorder

Note: Habit reversal training – the most evidence for

success with these two disorders. In this treatment,
are carefully taught to be more aware of their
repetitive behavior, particularly as it is just about to
begin, and to then substitute a different behavior,
such as chewing gum, applying a soothing lotion to
the skin, or some other reasonably pleasurable but
harmless behavior.