Anxiety Disorders Chapter 3

Outline The Complexity of Anxiety Disorders Generalized anxiety disorder Panic disorder with and without Agoraphobia Specific Phobia Social Phobia Posttraumatic Stress Disorder Obsessive-Compulsive Disorder

The complexity of Anxiety Disorders Negative mood state characterized by bodily symptoms of physical tension, and apprehension about the future Fear Immediate alarm reaction to present danger activating a massive response from the autonomic nervous system (flight or fight) Panic attack Abrupt experience of intense fear or discomfort in the absence of danger accompanied by physical symptoms (dizziness, heart palpitations, chest, pain, shortness of breath)

Anxiety and its causes Causes of Anxiety Biological contributions Inherited tendency to be tense, behavioral inhibition system (anxiety), flight or fright system (panic) Psychological contributions Early childhood (overprotective and overintrusive parents, psychological vulnerability Social contributions Social pressures (family, job, school) Comorbidity of anxiety disorders Co-occurrence of two or more disorders in a single individual (high (50%) in anxiety disorders)

Generalized anxiety disorder Intense, uncontrollable, unfocused, chronic, and continuous worry and mental agitation that is distressing and unproductive accompanied by physical symptoms of tenseness, irritability and restlessness (generalized to everyday life) 4% of population (two thirds are women), onset in early adulthood Psychological treatments (CBT, meditation) have approx. the same benefit as drugs (benzodiazepines) but are better in the long term Cognitive-Behavioral Therapy (CBT) systematic exposure to anxiety-provoking situations or thoughts learning to substitute positive behaviors and thoughts for negative ones learning new coping skills; relaxation, meditation, breathing exercises

Generalized anxiety disorder

Panic disorder with and without agoraphobia Individuals experience severe unexpected panic attacks, they may think they’re dying Y Agoraphobia is fear and avoidance of situations in which they would feel unsafe in the event of a panic attack (e.g. public places, “fear of market place”) 3.5% of population (two thirds are women), onset in early adulthood Treatment usually involves medication (antidepressants) but it has high levels of relapse (20-50%), psychological treatments involve gradual exposure combined with coping exercises (panic control treatment)

Specific phobia Irrational fear of a specific object or situation that markedly interferes with an individual’s ability to function Y-Snake Phobia There are four major subtypes of specific phobia Animal type Natural environment type (heights, storms, water) Blood-injection-injury phobia (runs in families) Situational phobia (planes, elevators, claustrophobia) Other (e.g. choking, contracting an illness) 11% of population with different onsets Treatment consists of exposure-based therapy

Social phobia Extreme, enduring, irrational fear and avoidance of social or performance situations Y-Virtual Reality Social phobia generalized type vs. performance anxiety 13.3.% of population at some point in their lives (favors females only somewhat); onset 15 years of age The most effective treatment is cognitive behavioral group therapy; medication in severe cases (antidepressants)

Social phobia

Posttraumatic stress disorder Enduring, distressing emotional disorder that follows exposure to a severe helplessness or fear-inducing threat Y - PTSD It is characterized by reexperiencing the trauma, avoiding stimuli associated with it, increased vigilance and arousal, sometimes suicidal thoughts and attempts, and sometimes memory impairments Acute PTSD (1-3 months after event) or chronic PTSD (more than 3 months) Combat and sexual assault are the most common traumas Treatments – catharsis, gradual imaginal exposure, possibly antidepressants

Obsessive-compulsive disorder Anxiety disorder involving unwanted, persistent, intrusive thoughts and impulses as well as repetitive actions intended to suppress them Most frequent obsessions (contamination, sexual content, aggressive impulses, need for symmetry) and compulsions (checking, ordering, arranging, washing, cleaning) 2.6% of population (majority female) Exposure and ritual prevention and CBT treatments Y-OCD patient