Anxiety Disorders

Definition of Anxiety Anxiety is a feeling of apprehension or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel. Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety.

Anxiety disorders… Highly treatable yet also resistant to extinction Often begins early in life Reported more by women than men Reported more in Western countries Often comorbid both with other anxiety diagnoses and with other disorder groups (e.g. Mood disorders, psychoses)

Anxiety Disorders Phobias Panic disorder GAD: Generalized Anxiety Disorder PTSD: Post-traumatic stress disorder OCD: Obsessive Compulsive Disorder

Anxiety Facts Anxiety disorders affect 12% of the population, causing mild to severe impairment. Measured for the first time in 2013, 2.6% of Canadians had generalized anxiety disorder One in four Canadians (25%) will have at least one anxiety disorder in their lifetime Anxiety is the most common mental illness in Canada. Hospitalization rates for anxiety disorders in general hospitals are twice as high among women as men. Anxiety disorders can be effectively treated in the community setting. Most common mental illness in the U.S. with 19 million of the adult (ages 18-54) U.S. population affected. Anxiety disorders cost more than $42 billion a year. More than $22 billion are associated with the repeated use of healthcare services, as those with anxiety disorders seek relief for symptoms that mimic physical illnesses. Anxiety is highly treatable (up to 90% of cases), but only one-third of those who suffer from it receive treatment Depression often accompanies anxiety disorders 2003 Anxiety Disorders Association of America

Anxiety Statistics Anxiety Disorders One-Year Prevalence (Adults) PercentPopulation Estimate* (Millions) Any Anxiety Disorder Panic Disorder Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Any Phobia Generalized Anxiety Disorder * Based on 7/1/98 U.S. Census resident population estimate of million, age 18-54

How common are psychological disorders? Countries vary greatly in the percentage of people reporting mental health issues in the past year.

Sensory Input 2. Amygdala registers danger 3. Amygdala triggers fast response 4. More considered response based on cortical processing 1. Thalamus receives stimulus and sends to both amygdala and cortex Parts of the brain involved in fear response = thalamus, amygdala, hypothalamus, which then instruct the endocrine glands and autonomic nerv.sys. Evolved fear module (pink) versus considered response (red) = “fight or flight” versus “feel the fear and do it anyway (or do it differently)”!

Panic Disorder: “I’m Dying” The abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes Anyone can experience a panic attack, but some people have panic attacks repeatedly, unexpectedly, and without apparent reason The fear of having a panic attack becomes a problem of itself, possibly leading to agoraphobia

Comer, Fundamentals of Abnormal Psychology, 3e 10

Comer, Fundamentals of Abnormal Psychology, 3e 11

Generalized Anxiety Disorder  Symptoms must occur for at least 6 months and include chronic anxiety not associated with any specific situation or object  The individual frequently experiences:  Sleep problems  Difficulty concentrating  Irritability  Tenseness  Being hypervigilant  om/watch?v=KbY4HG 4Uod4 om/watch?v=KbY4HG 4Uod4 Similar to Panic disorder however,

Comer, Fundamentals of Abnormal Psychology, 3e 13

Post-Traumatic Stress Disorder [PTSD] About 10 to 35 percent of people who experience trauma not only have burned-in memories, but also four weeks to a lifetime of:  repeated intrusive recall of those memories.  nightmares and other re- experiencing.  social withdrawal or phobic avoidance.  jumpy anxiety or hypervigilance.  insomnia or sleep problems.

Prevalence of PTSD prevalence among general population is 7.8% prevalence among survivors of trauma is 17.9% –victims of rape = 33% –male Vietnam combat veterans = 31% –victims of serious car accidents = 25%

PTSD – Dr. Amen be.com/watch?v= LM_nw5N3n-I be.com/watch?v= LM_nw5N3n-I 6 minutes

Common Causes There is no one cause for anxiety disorders. Several factors can play a role –Genetics –Brain biochemistry –Overactive "fight or flight" response Can be caused by too much stress –Life circumstances –Personality People who have low self-esteem and poor coping skills may be more prone Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug. In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may be the cause of anxiety.

Behavioral and Cognitive Therapy Teaches patient to react differently to situations and bodily sensations that trigger anxiety Teaches patient to understand how thinking patterns that contribute to symptoms Patients learn that by changing how they perceive feelings of anxiety, the less likely they are to have them Examples: Hyperventilating, writing down list of top fears and doing one of them once a week, spinning in a chair until dizzy; after awhile patients learned to cope with the negative feelings associated with them and replace them with positive ones

Medical Treatment antidepressants are first drug choice SSRIs: increase levels of serotonin Tricyclics: increase levels of serotonin and norepinephrine –imipramine (Tofranil) –clomipramine (Anafranil) take about 4 weeks to work, but are generally safe and not addicting SSRIs are currently drug of choice