Anxiety Disorders

Anxiety is a negative mood state characterized by bodily symptoms of physical

tension and by apprehension about the future.

Anxiety Fear
 anxious apprehension and worry  experienced when a person is
that is a more general reaction faced with a real and immediate
that is out of proportion to threats danger
in the environment  present-oriented
 future-oriented  can be adaptive
 can be adaptive if not excessive

A Panic Attack is defined as an abrupt experience of intense fear or acute discomfort,

accompanied by physical symptoms that usually include heart palpitations, chest pain,
shortness of breath, and, possibly, dizziness.

Two Basic Types of Panic Attacks

 Expected (cued) panic attack
 Unexpected (uncued) panic attack
Comorbidity with Physical Disorders

 An important study indicated that the presence of any anxiety disorder was
uniquely and significantly associated with thyroid disease, respiratory disease,
gastrointestinal disease, arthritis, migraine headaches, and allergic conditions
 Anxiety and depression are both defined in terms of negative emotional
experiences and both are triggered by stressful experiences.

Figure 1 Clark and Watson Model

 Suicide - Based on epidemiological data, Weissman and colleagues found that

20% of patients with panic disorder had attempted suicide. They concluded that
such attempts were associated with panic disorder.

 People with generalized anxiety disorder and social anxiety disorder who
engaged in deliberate self-harm were especially more likely to engage in this
behavior multiple times, and at least one of those times was a suicide attempt.
Generalized Anxiety Disorder (GAD)

GAD is characterized by muscle

tension, mental agitation
susceptibility to fatigue (probably
the result of chronic excessive
muscle tension), some irritability,
and difficulty sleeping.
Focusing one’s attention is
difficult, as the mind quickly
switches from crisis to crisis.
People with GAD mostly worry about
minor, everyday life events, a
characteristic that distinguishes GAD
from other anxiety disorders.
For children, only one physical symptom
is required for a diagnosis
of GAD.
Children with GAD most often worry
about competence in academics, athletic,
or social performance, as well as family
issues.
Statistics
 Approximately 3.1% of the population
meets the criteria for GAD during a
given 1-year period and 5.7% at some
point during their lifetime.
 For adolescents only (ages 13–17), the
one-year prevalence is somewhat lower
at 1.1%
 About twice as many individuals with
GAD are female than male in
epidemiological studies (where
individuals with GAD are identified from
population surveys), which include
people who do not necessarily seek
treatment.
 GAD is prevalent among older adults.
Causes
 As with most anxiety disorders, there
seems to be a generalized biological
vulnerability.
 Anxiety Sensitivity is the tendency to
become distressed in response to
arousal-related sensations, arising from
beliefs that these anxiety-related
sensations have harmful consequences
Treatment
 GAD is quite common, and available treatments, both drug and psychological, are
reasonably effective. Benzodiazepines are most often prescribed for generalized
anxiety, and the evidence indicates that they give some relief, at least in the short term.
 Cognitive-Behavioral Treatment (CBT)

Panic Disorder and Agoraphobia

Panic Disorder - individuals experience

severe, unexpected panic attacks; they
may think they are dying or otherwise
losing control.

Agoraphobia is fear and avoidance of

situations in which a person feels unsafe
or unable to escape to get home or to a
hospital in the event of a developing
panic, panic-like symptoms, or other
physical symptoms, such as loss of

bladder control.

The term agoraphobia was coined in 1871

by Karl Westphal, a German physician,
and, in the original Greek, refers to fear of
the marketplace. This is an appropriate term
because the agora, the Greek marketplace,
was a busy, bustling area. One of the most
stressful places for individuals with
agoraphobia today is the shopping mall, the
modern-day agora.
Statistics
 Approximately 2.7% of the population meet the criteria for PD during a given 1-year
period and 4.7% met them at some point during their lives, two-thirds of them women.
 Onset of panic disorder usually occurs in early adult life – from midteens through about
40 years of age. The median age of onset is between 20 and 24.

Causes
 Strong evidence indicates that agoraphobia often develops after a person has
unexpected panic attacks (or panic-like sensations), but whether agoraphobia develops
and how severe it becomes seems to be socially and culturally determined.
 Some people are also
more likely than others to
have an emergency alarm
reaction (unexpected panic
attack) when confronted
with stress-producing
events.
 Learned alarms - cues
become associated with a
number of different internal
and external stimuli
through a learning process.

Treatment
 Medication - A large number of drugs affecting the noradrenergic, serotonergic, or
GABA–benzodiazepine neurotransmitter systems, or some combination, seem effective
in treating panic disorder.
 Psychological Intervention - treatments concentrated on reducing agoraphobic
avoidance, using strategies based on exposure to feared situations.
 Gradual exposure exercises, sometimes combined with anxiety-reducing coping
mechanisms such as relaxation or breathing retraining, have proved effective in helping
patients overcome agoraphobic behavior whether associated with panic disorder or not.
 Panic Control Treatment - concentrates on exposing patients with panic disorder to
the cluster of interoceptive (physical) sensations that remind them of their panic
attacks. The therapist attempts to create “mini” panic attacks in the office by having the
patients exercise to elevate their heart rates or perhaps by spinning them in a chair to
make them dizzy.
 Combined Psychological and Drug Treatments - General conclusions from studies
suggest no advantage to combining drugs and CBT initially for panic disorder and
agoraphobia. Furthermore, the psychological treatments seemed to perform better in
the long run (6 months after treatment had stopped). This suggests that psychological
treatment should be offered initially, followed by drug treatment for those patients who
do not respond adequately or for whom psychological treatment is not available.
Specific Phobia

A specific phobia is an irrational fear of a specific object or situation that markedly

interferes with an individual’s ability to function.

Blood-Injection-Injury
Phobia
People with this phobia inherit
a strong vasovagal response
to blood, injury, or the
possibility of injection, all of
which cause a drop in blood
pressure and a tendency to
faint. The phobia develops
over the possibility of having
this response. The average
age of onset for this phobia is
approximately 9 years.
Situational Phobia
Phobias characterized by fear
of public transportation or
enclosed places are called
situational phobias.
Claustrophobia, a fear of small
enclosed places, is situational.

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
object or situation.
Natural Environment
Phobia
People develop fears of
situations or events occurring
in nature. The major examples are heights, storms, and water.
Animal Phobia
Fears of animals and insects. These fears are common but become phobic only if severe
interference with functioning occurs.

Statistics
 The median age of onset for specific phobia is 7 years of age, the youngest of any
anxiety disorder except separation anxiety disorder. Once a phobia develops, it tends
to last a lifetime (run a chronic course).

Causes
  Direct Experience, where real danger or pain results in an alarm response (a true
alarm). This is one way of developing a phobia, and there are at least three others:

experiencing a false alarm (panic attack) in a specific situation, observing someone

else experiencing severe fear (vicarious experience), or, under the right conditions,
being told about danger

Treatment
 Exposure exercises with the phobia object or situation.

Separation Anxiety Disorder

Separation anxiety disorder is characterized by children’s unrealistic and persistent worry that
something will happen to their parents or other important people in their life or that something
will happen to the children themselves that will separate them from their parents (for example,
they will be lost, kidnapped, killed, or hurt in an accident).

Children often refuse to go to school or even to leave home, not because they are afraid of
school but because they are afraid of separating from loved ones. These fears can result in
refusing
to sleep alone and may be characterized by nightmares involving possible separation and by
physical symptoms, distress, and anxiety.
Social Anxiety Disorder (Social Phobia)

Statistics
- As many as 12.1% of the general population
suffer from SAD at some point in their lives.
- Unlike other anxiety disorders for
which females predominate the sex
ratio for SAD is nearly 50:50
- SAD usually begins during
adolescence, with
a peak age of onset around 13 years.

Causes

Treatments
 Cognitive therapy program (emphasized real-life experiences during therapy to
disprove automatic perceptions of danger); substantially benefited 84% of
individuals receiving treatment.
 Pharmacological intervention – beta-blockers (drug that lower heart rate and blood
pressure); SSRIs
 cognitive-behavioral treatment and an SSRI were comparable in efficacy but that
the combination was no better than the two individual treatments.

Selective Mutism
A rare childhood disorder characterized by a lack of speech in one or more settings in which
speaking is socially expected. In order to meet diagnostic criteria for SM, the lack of speech
must occur for more than one month and cannot be limited to the first month of school. Further
evidence that this disorder is strongly related to social anxiety is found in the high rates of
comorbidity of SM and anxiety disorders, particularly SAD.
Trauma and Stressor-Related Disorders

Posttraumatic Stress Disorder (PTSD)

DSM-5 describes the setting event for PTSD as exposure to a traumatic event during which an
individual experiences or witnesses death or threatened death, actual or threatened serious
injury, or actual or threatened sexual violation.

Victims typically are chronically over-aroused, easily startled, and quick to anger. New to DSM-
5 is the addition of “reckless or self-destructive behavior” under the PTSD E criteria as one sign
of increased arousal and reactivity.

Clinical Description
 The diagnosis of PTSD cannot be made until at Acute Stress Disorder (ASD)
least one month after the occurrence of the is similar to PTSD, occurring
traumatic event. within the first month after the
 In PTSD with delayed onset, individuals show trauma, but the different name
few or no symptoms immediately or for months emphasizes the severe
after a trauma, but at least 6 months later, and reaction that some people
perhaps years afterward, develop full-blown
have immediately.
PTSD.

Causes
 PTSD is the one disorder for which we know the cause at least in terms of the
precipitating event: Someone personally experiences a trauma and develops a
disorder. Whether or not a person develops PTSD, however, is a surprisingly complex
issue involving biological, psychological, and social factors. We know that the intensity
of exposure to assaultive violence contributes to the etiology of PTSD
