Anxiety Disorders

Anxiety

• Anxiety is an unpleasant emotional state characterized by physical arousal and feelings of tension, apprehension, and worry
• Puts us on physical alert, preparing us to defensively “fight” or “flee” potential dangers,
• Also puts us on mental alert, making us focus our attention squarely on the threatening situation

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Anxiety Disorders

• In the anxiety disorders, the anxiety is maladaptive, disrupting everyday activities, moods, and thought processes
• Three features distinguish normal anxiety from pathological anxiety. Pathological anxiety is:
1. Irrational—it is provoked by perceived threats that are exaggerated or nonexistent, and the anxiety response is out of proportion to the actual importance of the situation.
2. Uncontrollable—the alarm reaction cannot be shut off even when the person knows it’s unrealistic.
3. Disruptive—it interferes with relationships, job or academic performance, or everyday activities

Generalized Anxiety Disorder�(GAD)

• Disruptive levels of persistent, unexplained feelings of apprehension and tenseness
• Lasting for 6 months or more
• Concentration switches from worry to worry making one jittery, agitated & sleep-deprived.

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GAD

Model of Development �of GAD

• GAD has some genetic component
• Related genetically to major depression
• Childhood trauma also related to GAD�

Are Your Worries Excessive?

• Add up your TOTAL Score
• 0-11 points = You are not the fretful type. Worry, which no doubt makes you uncomfortable, goads you to take necessary action in your life.
• 12-20 points = You’re a potentially unhealthy worrier.
• 21-30 points = Danger zone! Agonizing constantly about small matters isn’t good for you physically or emotionally.

Panic Disorder

• An anxiety disorder characterized by sudden bouts of intense, unexplained panic
• Panic attacks—sudden episode of helpless terror with high physiological arousal
• Very frightening—sufferers live in fear �of having them
• may happen several times a day
• Agoraphobia often develops as a result

Phobia

• Disruptive, irrational fears of specific objects or situations
• The fear must be both irrational and disruptive.
• Causes one to avoid the feared situation
• About 10 percent of the general population will experience a specific phobia at some point in their lives.

Phobias

• Generally, the objects or situations that produce specific phobias tend to fall into four categories
1. Natural environment—heights, water, lightning
2. Situation—flying, tunnels, crowds, social gathering
3. Injury—needles, blood, dentist, doctor
4. Animals or insects—insects, snakes, bats, dogs

Phobias

• It is not phobic to simply be anxious or afraid about something
• It needs to be irrational & debilitating

Some Unusual Phobias

• Watch this video of a girl with a phobia for pickles.
• Ailurophobia—fear of cats
• Algobphobia—fear of pain
• Anthropophobia—fear of men
• Monophobia—fear of being alone
• Pyrophobia—fear of fire

Social Anxiety Disorder

• Fear of failing or being embarrassed in public
• public speaking (stage fright)
• fear of crowds, strangers
• meeting new people
• eating in public
• Considered phobic if these fears interfere with normal behavior
• Equally found in males and females

Agoraphobia

• Fear of situations the person views as difficult to escape or help unavailable when panic strikes
• Fear of leaving one’s home or room in the house

Obsessive-Compulsive Disorder

• An anxiety disorder characterized by unwanted, repetitive thoughts and actions
• Obsessions – repetitive thoughts
• Compulsions – repetitive actions
• The obsessions/compulsions begin to take control of the person’s life.

Obsessive-Compulsive Disorder (OCD)

• Obsessions—irrational, disturbing thoughts that intrude into consciousness
• Compulsions—repetitive actions performed to alleviate obsessions
• Overt physical behaviors, such as repeatedly checking or washing your hands
• Covert mental behaviors, such as counting or reciting certain phrases to yourself
• Potential Biological Causes:
• The caudate nucleus is located in the basal ganglia and is associated with initiation of learned, habitual motor activities
• Drugs that increase Serotonin reduces the activity of the caudate nucleus and leads to a reduction in the obsessions and compulsions - people who recover from OCD using behavioral and cognitive therapies also show a reduction in activity in the caudate nucleus

Finding Your OCD Score

• Circle the following item numbers if you marked TRUE for them: 1, 2, 4, 6, 7, 8, 16, 17, 21
• Circle the following item numbers if you marked FALSE for them: 5, 9, 10, 11, 12, 13, 14, 19, 20, 22
• Now add up your total score. Highest score possible is a 20 (items 3 & 15 are validity checks)
• The mean (average) score is 11.15 for males and 11.24 for females.
• Remember, even if you scored high on this scale it doesn’t mean you have OCD. Always ask yourself, “Do these tendencies I have disrupt my daily life and relationships?” If the answer is NO you don’t have a problem.

Trichotillomannia: �The Disease of Hair Pulling

• Quick example (3 min)
• What it’s like to live with it – video
• Trich – An explanation – video

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Other Obsessions…

• Obsessive Texting - video

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Posttraumatic Stress Disorder�(PTSD)

• Reliving a severely upsetting event in unwanted recurring memories (flashbacks) and dreams
• Greater the emotional distress during a trauma, the higher the risk for PTSD

Posttraumatic Stress Disorder (PTSD)

• Follows events that produce intense horror or helplessness (traumatic episodes)
• Core symptoms include:
• Frequent recollection of traumatic event, often intrusive and interfering with normal thoughts
• Avoidance of situations that trigger recall of the event
• Increased physical arousal associated with stress
• There is a high correlation of suicide and drug abuse in PTSD – See news report on Military Suicides in Soldiers fighting in Iraq – 2 min.

• Survivor Resiliency – Even though 50% of adults will have a traumatic experience only 1 in 10 women & 1 in 20 men will develop PTSD
• Posttraumatic Growth – after struggling through a challenging crisis, people may report and increase in appreciation for life, more meaningful relationships, increased personal growth, increased personal strength, changed priorities & a richer spiritual life.

Potential Causes of PTSD

• Studies of the Hippocampus in PTSD patients find that on average, their hippocampus is 25% smaller.
• Some think this is a warning sign that someone is susceptible to PTSD.
• Others say it is due to overactive limbic system triggering excessive stress hormones whenever memories of traumatic experience come into consciousness
• Right Temporal Lobe over activated during a flashback.

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Causes of Anxiety Disorders

Development of Phobias

• Classical conditioning may be involved in the development of a specific phobia that can be traced back to some sort of traumatic event.
• People with phobias may have developed a conditioned response of fear to a conditioned stimulus then generalize that onto all similar stimuli

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• Problems with this theory:
• often no memory of a traumatic experience
• traumatic experience may not produce phobia

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Other Learning Factors

• Observational learning--watching another experiencing fearfulness--may result in developing fear.

• Operant Conditioning - Fear of an object may be negatively reinforced by avoiding the feared objects.

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Cognitive-Behavioral Theory of Panic Disorder

• Sufferers tend to misinterpret the physical signs of arousal as catastrophic and dangerous
• This interpretation leads to further physical arousal, tending toward a vicious cycle
• After their first panic attack, they become even more attuned to physical changes, increasing the likelihood of future panic attacks
• Therapy involves trying to get the person to rethink their phobia. Video (7 min)

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Biological Perspective�Natural Selection/Preparedness Theory

• We fear threats that were faced by our ancestors.
• Humans seem biologically prepared to acquire fears of certain animals and situations that were survival threats in human evolutionary history
• Compulsions typically exaggerate behaviors that contributed to our species’ survival
• Grooming, hand-washing, checking

Biological Factors

• Hereditary/Gene factors may result in a predisposition for developing anxiety disorders

• Brain functions appear to be different in an anxiety disorder patient
• The Caudate Nucleus is located in the Basal Ganglia and is associated with initiation of learned, habitual motor activities is overactive in OCD
• Anterior Cingulate Cortex – monitors our actions and checks for errors is hyperactive with OCD
• PTSD seems affected by an overactive Amygdala