ANXIETY

DISORDERS

BPSY 80 – ABNORMAL
PSYCHOLOGY

S. HAYAG
DEFINITIONS

 ANXIETY- is a future-oriented mood state, characterized by

bodily symptoms of physical tension and by apprehension
about the future
 FEAR- is an immediate alarm reaction to current danger
characterized by strong escapist action tendencies and, often,
a surge in the sympathetic branch of the autonomic nervous
system
 PANIC- experiencing the alarm response of fear even if when
there is nothing to be afraid of; sudden overwhelming reaction
FROM NORMAL TO
DISORDERED ANXIETY AND
FEAR
 Psychological dysfunction- pervasive and
persistent symptoms of anxiety and fear
 Involve excessive avoidance and escapist
tendencies (atypical)
 Causes clinically significant distress and
impairment
Causes of Anxiety and
Related Disorders
Biological Contribution
Psychological Contribution
Social Contribution
Biological Contributions to Anxiety
and Panic

 Diathesis-Stress
• Inherit vulnerabilities for anxiety and panic, not disorders
• Stress and life circumstances activate vulnerability
 Biological Causes and Inherent Vulnerabilities
• Anxiety and brain circuit and neurotransmitter
• Corticotropin releasing factor (CRF)-HPA
• Behavioral Inhibition system (BIS)
• Fight/Flight system(FFS)-produces an immediate alarm-and-
escape response that looks very much like panic in human
Psychological Contributions

 Began with Freud

 Anxiety is a psychic reaction to danger
 Anxiety involves reactivation of an infantile fear situation
 Behavioristic View
 Anxiety was the product of early classical conditioning modeling, or
other forms of learning
 Psychological Views
 A sense of control(or lack of it) that developed from early
experiences makes us more or less vulnerable to anxiety in later life
Social Contributions to
Anxiety
 Stressful life events trigger our biological
and psychological vulnerabilities
 Many stressors are familial and
interpersonal
TRIPLE VULNERABILITY
THEORY
1. Generalized Biological Vulnerability (diathesis)-
tendency to be uptight or high strung might be
inherited
2. Generalized Psychological Vulnerability- grow up
believing the world is dangerous and out of control and
you might not be able to cope based on your early
experiences
3. Specific Psychological Vulnerability- learn from early
experience
ANXIETY DISORDERS

• Disorders traditionally grouped together as

anxiety disorders include:
• Generalized anxiety disorder(GAD)
• Panic disorder (PD) and Agoraphobia
• Specific phobia
• Social anxiety disorder and
• Selective Mutism
GAD
Generalized anxiety
disorder(GAD)
• a psychological disorder characterized by excessive or
disproportionate anxiety about several aspects of life,
such as work, social relationships, or financial matters that
occurs more days than not, for at least 6 months.
DIAGNOSTIC CRITERIA FOR
GENERALIZED ANXIETY DISORDER
(GAD)-DSM5
 Excessive anxiety and worry occurring more days than not for or at least 6 months about
a number of events or activities(such as work or school performance)
 The individual finds it difficult to control the worry
 The anxiety and worry are associated with at least three(or more) of the ff. 6 symptoms:

1. Restlessness or feeling keyed up or on edge

2. Being easily fatigue
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle Tension
6. Sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep)
DIAGNOSTIC CRITERIA FOR
GENERALIZED ANXIETY DISORDER
(GAD)-DSM 5
 The anxiety, worry or physical symptoms cause clinically
significant distress or impairment in social, occupational, or
other important areas of functioning.
 The disturbance is not due to direct physiological effects of
substance (drug abuse, medication or general medication
condition like hyperthyroidism)
 The disturbance is not better explained by another disorder
( anxiety or worry about having panic attacks in panic
disorder, negative evaluation in social anxiety disorder)
Facts/Prevalence

• For adolescents only(GAD affects 3.1% of the population meets criteria for GAD
during a given 1-year period and 5.7% at some points during their lifetime.
• 13-17), the one-year prevalence is somewhat lower at 1.1%
• Females outnumber male approximately two-thirds
• Onset is often insidious(gradually), beginning in early adulthood. Median age of
onset is 31
• Once develop, GAD is chronic course(tend to last a long time, sometimes a
lifetime), characterized by waxing and waning symptoms
• Prevalent among older adults (10%)
• Tendency to be anxious runs in families
PANIC DISORDER

 PANIC- experiencing the alarm response of fear when

there is nothing to be afraid of
 Panic attack- an abrupt experience of intense fear or
acute discomfort, accompanied by physical symptoms,
chest pain, shortness of breath, and, possibly, dizziness
2 Types of Panic Attack

• Expected Panic Attack (Cued)- you are

aware of what and when you might panic
• Unexpected Panic Attack (Uncued)- you
don’t have a clue when or where the next
attack will occur
Panic Disorder(PD)

individual experience
severe, unexpected
panic attack
SYMPTOMS

• Pounding or fast heartbeat

• Sweating
• Trembling or shaking
• Shortness of breath or a feeling of being smothered
• A choking feeling
• Chest pain
SYMPTOMS

• Nausea or stomach pains

• Feeling dizzy or faint
• Chills or hot flashes
• Numbness or tingling in the body
• Feeling unreal or detached
• A fear of losing control or going crazy
• A fear of dying
DSM5-Diagnostic Criteria for
Panic Disorder
A. Recurrent unexpected panic attacks are present
B. At least one of the attacks has been followed by 1 month or
more of one or both of the following:
(a.)Persistent concern of worry about additional panic attacks
of their consequences or (b.) A significant maladaptive change in
behavior related to the attack
C. The disturbance is not better explained by another mental disorder
D. The disturbance is not attributable to the physiological effects of a
substance or another medical condition
FACTS AND PREVALENCE

 2.7% of the population meet criteria for PD during a given 1-

year period
 4.7% met them at some points during their lives
 Two-thirds of them women
 Onset of PD usually occurs in early adult life- from midteen
through about 40 years of age
 20 and 24 is the median age of onset
 Most initial unexpected panic attacks begin at or after puberty
AGORAPHOBIA
Agoraphobia

fear and avoidance of situation

in which a person feels unsafe or
unable to escape
Agoraphobia

is a type of anxiety disorder in which

you fear and avoid places or
situations that might cause you to
panic and make you feel trapped,
helpless or embarrassed.
SYMPTOMS

 Afraid of leaving their home for extended periods of time

 Afraid of being alone in the social situation
 Afraid of losing control in a public place
 Afraid of being in places where it would be difficult to
escape, such as car or elevator
 Detached or estranged from others
 Anxious and agitated
FACTS AND PREVALENCE

Most (75% or more) of those who

suffer from agoraphobia are women
DSM5-Diagnostic Criteria for
Agoraphobia
A. Marked fear or anxiety about two or more of the ff.
situations: Public transportation, open spaces,
enclosed spaces, standing in line or being in a crowd,
being outside the home alone
B. The individual fears or avoids these situations due to
thoughts that escape might be difficult or help might
not be available in the event of developing panic-like
symptoms or other incapacitating or embarrassing
symptoms
DSM5-Diagnostic Criteria for
Agoraphobia
C. The agoraphobic situations almost always provoke fear or
anxiety
D. The agoraphobic situations are actively avoided, require the
presence of a companion, or an endured with intense fear or
anxiety
E. The fear or anxiety is out of proportion to the actual danger
posed by the agoraphobic situations, and to the sociocultural
context
F. The fear, anxiety or avoidance is persistent, typically lasting for 6
months or more
DSM5-Diagnostic Criteria for
Agoraphobia
G. The fear, anxiety or avoidance causes clinically significant
distress or impairment in social occupational or other
important areas of functioning
H. If another medical condition is present, the fear anxiety or
avoidance is clearly excessive
I. The fear, anxiety or avoidance is not better explained by
the symptoms of another mental disorder and are not related
to obsessions, perceived deficits of flaws in appearance,
reminders of traumatic events, or fear of separation
SPECIFIC PHOBIAS

is any kind of anxiety disorder that

amounts to an unreasonable or irrational
fear related to exposure to specific
objects or situations. The fear or anxiety
may be triggered both by the presence and
the anticipation of the specific object or
situation
SPECIFIC PHOBIA

 Overview and Defining Features

 Extreme and irritational fear of a specific object or
situation
 Markedly interferes with one’s ability to function
 Recognize fears are unreasonable
 Still go to lengths to avoid phobic objects
SYMPTOMS

• Physical Symptoms: racing heartbeat, difficulty in

breathing, trembling or shaking, sweating, nausea, dry
mouth, chest pain or tightness
• Emotional Symptoms: feeling overwhelming anxiety or
fear, knowing that your fear is irrational, but feeling
powerless to overcome it, fear of losing control, and
feeling an intense need to escape
Facts and Prevalence

• Sex Ratio-common among female with the ratio 4:1 except fear
of height
• During a given 1-year period, the prevalence is 8.7% overall
but 15.8% in adolescents
• Median Age onset- 7 years of age
• Follow a chronic course, once a phobia develops, it tends to
last a lifetime
• Prevalence of specific phobias varies from one culture to
another
Causes/Etiology
Specific Phobias:

 Associated Features and Subtypes of Specific Phobias

 Blood-Injury-Injection phobia- vasovagal response
 Situational phobia- public transportation or enclosed places (e.g.
planes)
 Natural Environment Phobia- Events occurring in nature ( e.g.
heights, storms)
 Animal phobia- Animal and insects
 Other phobias- Do not fit into other categories (e.g. fear of choking,
vomiting)
 Separation anxiety disorder- Children’s worry that something will
happen to parents
Diagnostic Criteria for
Specific Phobia- DSM5
A. Marked fear or anxiety about a specific object or
situation (e.g., fling, heights, animals, receiving an
injection, seeing blood).
B. The phobic object or situation almost always provokes
immediate fear or anxiety. Note: In children, the anxiety
may be expressed by crying, tantrums, freezing, or clinging.
C. The phobic object or situation is actively avoided or
endured with intense fear or anxiety.
Diagnostic Criteria for
Specific Phobia- DSM5
D. The fear or anxiety is out of proportion to the actual danger
posed by the specific object or situation, and to the
sociocultural context.
E. The fear, anxiety or avoidance is persistent, typically
lasting for
6 months or more.
F . The fear, anxiety, or avoidance causes clinically significant
distress or impairment in social, occupational or other
important areas of functioning.
Diagnostic Criteria for
Specific Phobia- DSM5
G. The disturbance is not better explained by the symptoms
of another mental disorder, including fear, anxiety and
avoidance of: situations associated with panic-like
symptoms or other incapacitating symptoms (as in
agoraphobia); objects or situations related to obsessions (as
in obsessive-compulsive disorder); reminders of traumatic
events (as in posttraumatic stress disorder); separation from
home or attachment figures (as in separation anxiety
disorder); or social situations (as in social anxiety disorder).
Specify types

• Animal
• Natural environment (e.g., heights, storms, and water)
• Blood–injection–injury
• Situational (e.g., planes, elevators, or enclosed places)
• Other (e.g., phobic avoidance of situations that may lead
to choking, vomiting, or contracting an illness; or in
children, avoidance of loud sounds or costumed
characters)