1. Anxiety Disorders Panic Disorder Agoraphobia Social Phobia
Specific Phobia
Obsessive Compulsive Disorder
Generalized Anxiety Disorder
(PTSD & Acute Stress Disorder)

2. Panic Attack
A. Discrete period of intense fear or discomfort, in which 4 or more of the following Six develop abruptly and reach a peak within 10 minutes
Palpitations
Sweating
Trembling/aching
Sensations of shortness of breath or smothering
Feeling of choking
Chest pain/discomfort
Nausea/abdominal distress
Feeling dizzy/unsteady/lightheaded/faint
Derealization/depersonalization
Fear of losing control/going crazy
Fear of dying
Paresthesias (numbness or tingling sensation)
Chills/hot flushes

3. Agoraphobia
Anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms.
2 or moreExperiences required
B. The situations are avoided or are endured with marked distress
C. Not better accounted for by another mental disorder

4. Social Phobia (LINK)
A. Marked, persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way that will be humiliating or embarrassing.
B. Exposure to the feared social situation almost invariably provokes an anxiety response
C. The person recognizes that the fear is excessive or unreasonable
D. The phobic stimulus is avoided or endured with intense anxiety or distress
E. There is significant distress or an impairment in functioning

5. Specific Phobia
A. Marked, persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation
B. Exposure to the phobic stimulus almost always provokes an immediate anxiety response
C. The person recognizes that the fear is excessive or unreasonable
D. The phobic stimulus is avoided or endured with intense anxiety or distress
E. There is significant distress or an impairment in functioning due to the phobia
F. The phobia is not better accounted for by another mental disorder

6. Subtypes of Specific Phobia (LINK)
Animal type
Natural environment type
Blood-Injection-Injury type
Situational type
Other type

7. Phobia
Marked by a persistent and irrational fear of an object or situation that disrupts behavior.
OBJECTIVE 7| Explain how a phobia differs from fears we all experience.

8. Common Phobias Acrophobia: Heights Aquaphobia: Water
Gephyrophobia: Bridges Ophidiophobia: Snakes
Aerophobia: Flying Arachnophobia: Spiders
Herpetophobia: Reptiles Ornithophobia: Birds
Agoraphobia: Open spaces Astraphobia: Lightning
Mikrophobia: Germs Phonophobia: Speaking aloud
Ailurophobia: Cats Brontophobia: Thunder
Murophobia: Mice Pyrophobia: Fire
Amaxophobia: Vehicles, driving Claustrophobia: Closed spaces
Numerophobia: Numbers Thanatophobia: Death
Anthophobia: Flowers Cynophobia: Dogs

9. Good Question… If phobias are learned behaviors,
why don’t they extinguish on their own???
Avoidance works!
Fear is never tested

10. Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress.
Realize the obsession is unreasonable
OBJECTIVE 8| Describe the symptoms of obsessive-compulsive disorder.

11. Typical Obsessions
Doubts (e.g. Did I turn off the stove? Did I lock the door? Did I hurt someone?)
Fears that someone else has been hurt or killed
Fears that one has done something criminal
Fears that one may accidentally injure someone
Worry that one has become dirty or contaminated
Blasphemous or obscene thoughts
NOT just excessive worries about real-life problems

12. Typical Compulsions Checking Cleaning/washing
Doing things a certain number of times in a row
Doing and then undoing things
Doing things in a certain order, with symmetry
Mental acts such as praying, counting, etc.

13. OCD in Children
Children have an average of 4 obsessions and 4 compulsions at any given time
Often comorbid with Tourette’s syndrome and/or ADHD

14. Generalized Anxiety Disorder (GAD)
Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events
The person finds it difficult to control the worry
The anxiety and worry are associated with 3 or more of the following symptoms
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep Disturbance

15. Generalized Anxiety Disorder (GAD)
D. The focus of the anxiety and worry is not confined to features of another disorder and do not occur exclusively during PTSD
E. There is clinically significant distress or impairment in functioning
F. Not due to a GMC or substance

16. Post-Traumatic Stress Disorder
A. The person has been exposed to a traumatic event and have experienced four or more weeks of one or more of the following symptoms:
Haunting memories
2. Nightmares
3. Social withdrawal
OBJECTIVE 9| Describe the symptoms of post-traumatic stress disorder, and discuss survivor resiliency.
4. Jumpy anxiety
5. Sleep problems
Bettmann/ Corbis

17. Resilience to PTSD
Only about 10% of women and 20% of men react to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience against traumatic situations.
All major religions of the world suggest that surviving a trauma leads to the growth of an individual.

18. Anxiety Disorders - Overview
Most common mental disorders in the U.S.
At least 19% of the adult population suffer from at least one anxiety disorder in any given year
All are more common in women, except for OCD
Except for Panic Disorder, ages of onset are most likely going to be in childhood or adolescence (but do not have to be)
Anxiety Disorders cost $42 billion each year in health care, lost wages, and lost productivity

19. Anxiety Disorders Cultural Variations
Fear, Anxiety, and Anxiety Disorders exist in all cultures
Prevalence rates vary, but are generally the most common mental illness in all countries
Low rates: China (2.4%), Japan, Nigeria, and Spain
High rates: U.S. (19%), France, Colombia, and Lebanon
Fear stimulus and content of anxiety differ greatly between cultures

20. Dhat (India), Jiryan (India), Sukra Prameha (Sri Lanka), & Shen-k’uei (China)
Severe anxiety, panic symptoms, somatic complaints, hypochondriachal symptoms associated with the discharge of semen
Excessive semen loss is feared because of the belief that it represents the loss of one’s vital essence and can thereby be life threatening

21. Koro (South and Southeast Asia)
Sudden and intense anxiety that one’s genitalia will recede into the body and possibly cause death
Can occur in epidemics

22. Taijin Kyofusho (Japan)
An intense fear that one’s body, its parts, or its functions (sweating, body odor, facial expressions, etc.) displease, embarrass, or are offensive to other people
Similar to the DSM’s Social Phobia

23. Explaining Anxiety Disorders
Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety.
OCD = Anxiety rooted in repressed ID impulses
Impulses = obsessive thoughts
Compulsions = ego defenses against them
E.g.: Lady Macbeth: Anxiety/guilt over her part in a murder  compulsive hand washing to get rid of the imagined blood.
How would you treat Lady Macbeth?
OBJECTIVE 10| Discuss the contributions of the learning and biological perspectives to our understanding of the development of anxiety disorders.

24. The Learning Perspective
Learning theorists suggest that fear conditioning leads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced.
John Coletti/ Stock, Boston

25. The Learning Perspective
Investigators believe that fear responses are inculcated through observational learning. Young monkeys develop fear when they watch other monkeys who are afraid of snakes.

26. The Biological Perspective
Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species.
Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias.

27. The Biological Perspective
Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex.
S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action
monitoring in obsessive-compulsive disorder. Psychological Science, 14,
Anterior Cingulate Cortex
of an OCD patient.

28. Panic Disorder What Causes Panic Disorder?
We don’t really know; many factors.
But: Strong evidence that norepinephrine is involved.
Norepinephrine: neurotransmitter especially active in Locus ceruleus part of the brain.

29. Biological model: Anatomy (structures)
Models of Abnormality
Biological model: Anatomy (structures)
Neo-Cortex
Corpus callosum
Amygdala
Locus ceruleus (Pons)

30. Panic Disorder
Anti-depressant drugs that regulate norepinephrine successful in treating panic
When Locus ceruleus stimulated in monkeys  panic like behavior
Locus ceruleus rich in norepinephrine carrying neurons
Hypothesis: Norepinephrine dysregulation may well be implicated in Panic Disorder

31. Obsessive-Compulsive Disorder
Behavioral Perspective
Focus on compulsions, not obsessions
Theory: association forms randomly between fear/anxiety reduction and the compulsive behavior
Compulsive behavior becomes reinforcing because it reduces anxiety
Therefore compulsion increases in frequency

32. Obsessive-Compulsive Disorder
Biological Perspective
Drugs that increase Serotonin activity are somewhat effective in treating OCD
Serotonin is also active in 2 brain areas that have been associated with OCD: the orbital region of the frontal cortex and caudate nucleus

33. Caudate nucleus
Orbital frontal cortex