ANXIETY DISORDERS
TYPES OF ANXIETY DISORDER
• Panic disorder
Panic disorder with agoraphobia or without agoraphobia
• Phobic disorder
Specific Phobias
Social Phobias
• Generalized Anxiety Disorder (GAD)
• Obsessive Compulsive Disorder (OCD)
• Post-traumatic Stress Disorder (PTSD)
• Acute Stress Disorder (ASD)
ANXIETY DISORDERS
As Anxiety disorders, as the term suggests, has an
unrealistic, irrational fear or anxiety of disabling
intensity at its core and its principal and most
obvious manifestation.
AGORAPHOBIA/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 panic
attacks or panic-like symptoms.
PANIC ATTACKS: A discrete period of intense fear or
discomfort which developed abruptly and reached a
peak within 10 minutes.
PANIC ATTACKS SYMPTOMS
PANIC DISORDERS
PANIC DISORDER
Panic disorder defined as the occurrence
of unexpected panic attacks.
Panic disorder with agoraphobia
characterized by both recurrent
unexpected panic attacks and
agoraphobia.
Panic disorder without agoraphobia
characterized by recurrent unexpected
panic attacks.
Symptoms: 1. persistent concern of having attack.
2. Worry about the implications of attack.
3. A significant change in behavior related
to attack.
• COURSE AND PREVALENCE:
• Age at onset for panic disorder varies but
lay between late adolescence and mid-30s.
• Lifetime prevalence of panic disorder
reported to be high as 3.5% and one year
prevalence rate are between 0.5% and
1.5%.
• Duration: at least one month
• Differential Diagnosis: Panic disorder is not
diagnosed , if panic attacks are judged to be direct physiological
consequence general medical condition or substance. In panic
disorder avoidance is associated with anxiety of having a panic
attack but in other disorders it is associated with concern about
harmful consequence of feared object or situation. In Panic disorder
with agoraphobia fear of having unexpected panic attack with
avoidance of multiple situations and in specific phobia or social
phobia it to specific situations.
PHOBIC DISORDER
PHOBIC DISORDER
A persistent and disproportionate fear of some specific
object or situation that presents little or no actual danger
to person.
Specific phobias: is characterized by clinically significant
anxiety provoked by exposure of specific feared object or
situation, often leading to avoidance.
Specific types:
Animal type: feared cued by animal or insect
Natural Environment type: feared cued by object in natural environment like
storm, water or height.
Blood Injection type: fear cued by receiving injection or seeing blood.
Situational type: fear cued by situation such as tunnels bridges, elevator.
Other type: fear of choking, vomiting, contracting illness.
Course and Prevalence
• Age onset for specific phobia lay between childhood
to mid-20s.
• In community samples current prevalence rate
ranges from 4% to 8.8% and lifetime prevalence rates
ranges from 7.2% to 11.3%.
• Duration: at least 6 months.
• Differential Diagnosis:
Social phobia.
Post-traumatic stress disorder
Obsessive Compulsive disorder
Hypochondrias
Anorexia Nervosa and Bulimia Nervosa
SOCIAL PHOBIA
Is characterized by clinically significant
anxiety provoking by exposure to certain
types of social or performance situation,
which people exposed to unfamiliar people
or to scrutiny by others.
The individual fears that he or she will act
in a way that will be humiliating or
embarrassing.
Duration: at least 6 months.
Course and Prevalence:
It has an onset in the mid-teens.
Studies have reported a lifetime prevalence of
social phobia ranging from 3% to 13%.
DIFFERENTIAL DIAGNOSIS
Separation Anxiety disorder
Generalized Anxiety disorder
Schizoid Personality disorder
performance anxiety, stage fright and shyness
OBSESSIVE COMPULSIVE
DISORDER
OBSESSIVE COMPULSIVE DISORDER
Obsessive Compulsive Disorder characterized by
obsessions(which cause marked anxiety) and by
compulsions( which serve to neutralize anxiety)
Obsession: are persistent thoughts, ideas, impulses, or
images that seem to invade a person’s consciousness.
Compulsions: are repetitive and rigid behavior or mental
act that a person feels compelled to perform to reduce
distress or anxiety. :
Types
Verbal compulsion: compel them to repeat expressions, phrases.
Touching rituals: must touch or avoid touching certain items
Counting compulsion: driven to count the things they see around them.
Course and Prevalence
Community studies have estimated a lifetime prevalence
of 2.5% and 1 year prevalence of 0.5%-2.1% in adults. OCD
prevalence is similar in many different cultures.
Age onset is earlier in males than females: between age 6
and 15 for males and between age 20 and 29 years for
females.
Differential diagnosis:
• OCD is not diagnosed if the content of thoughts or activities related to another mental
disorder like Body Dysmorphic disorder or Specific phobia.
• Major depressive disorder.
• Generalized Anxiety disorder.
• Hypochondrias.
• Additional diagnosis of delusional disorder or psychotic disorder not otherwise specified
GENERALIZED ANXIETY DISORDER
GENERALIZED ANXIETY DISORDER (GAD)
People with Generalized Anxiety Disorder (GAD) go through
the day filled with excessive and uncontrollable WORRY
and TENSION even though there is little or nothing to
provoke it.
GENERALIZED ANXIETY
DISORDER
Excessive anxiety and worry occurring
more days than not for at least 6 months
about number of events and activities.
Symptoms:
• Restlessness or feeling keyed up or on edge
• Being easily fatigue
• Irritability & muscle tension
• Sleep disturbance
• Difficulty concentrating or mind going blank
Course and prevalence:
• Onset occurring after age 20 years.
• 1 year prevalence rate for GAD was 3%
and lifetime rate was 5%.
So what does
GAD look like?
People with GAD often:
• Have trouble falling asleep
• Startle easily
• Have trouble staying asleep
• Can’t relax
• Have difficulty concentrating
• Experience Muscle Pains
• Feel irritable
• Get easily upset
• Snap at people for minor reasons
How do People with GAD act in
Daily Life (other than worrying)?
• Excessive reassurance-seeking
• Checking
• Information Seeking or List Making
• Refusal to delegate to others
• Avoidance / Procrastination
• Having others make decisions for you
WHAT IS NORMAL ANXIETY?
WHAT IS ABNORMAL ANXIETY?
Differential Diagnosis
GAD should be made only when the focus
of the anxiety and worry is unrelated to
other disorder like
• Panic disorder
• Obsessive Compulsive disorder
• Hypochondrias
• Separation Anxiety disorder
• Post-traumatic Stress disorder.
Posttraumatic Stress Disorder
PTSD is characterized by the re-experiencing of an
extremely traumatic event accompanied by the
symptoms of increased arousal and by avoidance of
stimuli associated with trauma.
Symptoms:
• Nightmares
• Sleep disturbances
• Startle responses
• Anger outburst
• Regressive behavior
• Detachment
• Avoidance of trauma recollections
• Avoidance of talk of trauma
• Distress at exposure to similar stimuli
Course and Prevalence
PTSD can occur at any age, including childhood.
Community based studies reveal a lifetime prevalence
for PTSD approximately 8% of adult population in United
States.
Duration:
Acute: duration of symptoms less than 3 months.
Chronic: duration of symptoms last 3 months or longer.
With Delayed onset: 6 months have passed between the traumatic
event and the onset of symptoms.
Differential Diagnosis
Acute Stress disorder
Adjustment disorder
Flash backs in PTSD should also be
distinguished from hallucinations, illusions
and other perceptual disturbances.
ACUTE STRESS DISORDER
Acute Stress Disorder (ASD) is
characterized by symptoms similar to those
PSTD that occur immediately in the
aftermath of an extremely traumatic event.
Symptoms:
• Depersonalization.
• Dissociative amnesia (inability to recall traumatic events).
• Subjective sense of numbing, detachment or emotional
responsiveness.
• De realization.
Traumatic event is persistently re-experienced
• Thoughts.
• Recurrent images.
• Flashback episode.
• Sense of reliving the experience.
• Distress on exposure to reminders of traumatic events.
Marked symptoms of anxiety or increased arousal
• difficulty in sleeping.
• irritability
• poor concentration
• hyper vigilance
• motor restlessness
• exaggerated startle response
Course and Prevalence
• Symptoms experienced during or immediately after the
trauma, last for at least 2 days, and maximum 4 weeks
and occur within 4 weeks of the traumatic event.
• ASD in few available studies, rates ranging from 14% to
33% have been reported in individuals exposed to severe
trauma.
Differential Diagnosis
Distinguish from mental disorder due to general
medical condition( e.g. head injury) and from
Substance Induced disorder (e.g. related alcohol
intoxication.
Major depressive disorder in diagnosed in addition
to the diagnosis of Acute stress disorder.
PTSD
Adjustment Disorder
CAUSES OF ANXIETY DISORDERS
• Genetic
• Biological
• Developmental
• Socio Economic
• Workplace Stress
The first is experiential:
• Behaviourists believe that
many people may learn their
fear or Phobia from an initial
experience, such as an
embarrassing situation,
physical or sexual abuse, or the
witnessing of a violent act.
Similar subsequent
experiences serve to reinforce
the fear.
THEORIES ON ANXIETY
DISORDER
The Psychodynamic Theory
The Humanistic- Existential Theory
The Behavioral Theory
The Neuroscience Theory
The Cognitive Theory
The Socio-cultural Theory
THE PSYCHODYNAMIC THEORY
The fundamental concept is that anxiety is at the
root of neurosis.
Anxiety stemmed in the form of unacceptable ID
impulses attempting to break through into
consciousness and behavior.
In all neurosis the relief of anxiety is sought through
various defense mechanism.
For example, in panic attack, the cause that is id impulse moves
closer to the boundaries of conscious mind, resulting in rapid building up
of anxiety. The ego responds with desperate effort to repression, once the
ego regain upper hand the impulse once again safely repressed.
THE HUMANISTIC-EXISTENTIAL
THEORY
Humanistic- existential theorists describe anxiety as
the outcome of the conflict between the individual
and society.
According to humanists the source of neurosis is the
discrepancy between the self concept and the ideal
self.
If the way we perceive ourselves is very different
from the way we would like to be, we feel incapable
of meeting life’s challenges, and anxiety results.
THE BEHAVIORAL THEORY
According to behaviorists avoidance is a
response learned to relieve anxiety.
For example, Agoraphobia is a strategy to
avoid panic attacks in public.
Avoidance learning is a major source of
anxiety and is two-stage process:
1) Through respondent conditioning, a neutral
stimulus becomes anxiety arousing.
2) The avoidance response relieves anxiety through
negative reinforcement and becomes habitual.
Another way of acquiring fear reactions is
through modeling.
THE NEUROSCIENCE THEORY
Anxiety disorders appear to have genetic
basis.
In Norwegian study, the concordance rate
for panic disorder in MZ twins was 31
percent, as opposed to 0 percent for D
twins (Torgersen, 1983).
Abnormalities in the neurotransmitters
gamma-amino butyric acid (GABA) and
serotonin may have a particular role in
susceptibility to generalized anxiety
disorder.
Serotonin is a major player in OCD and
social phobia.
THE COGNITIVE THEORY
According to the cognitive theory, people with
anxiety disorders misperceive or misinterpret
internal and external stimuli.
Events that are not really threatening, and anxiety
results.
In the case of panic disorder, if a person upon
experiencing unusual bodily sensations
catastrophically, as a signal that he or she is about to
pass out or have a heart attack, then panic could
result.
THE SOCIO-CULTURAL THEORY
According to socio-cultural theorists, phobic and
GAD are more likely to develop in people who are
confronted with societal pressure.
Stressful changes have occurred in the society have
also increased the prevalence of anxiety disorders.
TREATMENT OF ANXIETY
DISORDER
TREATMENT FOR GAD
• THERAPY
• Cognitive Therapy
• Behavioural Therapy
• MEDICATIONS
• The Medications used for GAD include:
• Anti – Depressants
• Anti – Anxiety Drugs
• Beta Blockers
MEDICATIONS FOR ANXIETY DISORDERS
• Medications will NOT CURE anxiety disorders, but can
keep them under control while the patient receives
therapy.
•
• With proper treatment, many people with anxiety
disorders can lead normal, fulfilling lives!
PSYCHOLOGICAL TREATMENT
FOR ANXIETY DISORDER
• Systematic Desensitization
• Flooding and Implosive Therapy
• Modeling
• Exposure Treatment
• Group Therapy
• Rational-emotive behavior therapy
• Self-instruction training
• Relaxation training
• Biofeedback training
• Crisis intervention therapy
• Do you become anxious when you face anything that reminds
you of that traumatic event?
• Are you afraid that you will be in a situation where you will
not be able to escape?
• Do you feel that you worry excessively about many things?
• What is the differential diagnosis of panic disorder with
agoraphobia with specific phobias?
• How can anxiety disorder can be treated through systematic
desensitization?
• What is psychodynamic view regarding anxiety disorders?
REFERENCES
Barlow. D. H & Durand. V. M., (2002). Abnormal Psychology An Integrative Approach. (3 rd Ed). Published by Wadsworth Group
, Belmont, USA.
Bootzin. R. R., Accocella. J. R & Alloy. L. B., (1972). Abnormal Psychology Current Perspectives. (6 th Ed). Published by
McGraw-Hill-Inc, New York.
Carson. R.C., Butcher J. N & Mineka. S., (2001). Abnormal Psychology and Modern Life. ( 11 th Ed). Published by Pearson
education, Inc. and Dorling Kindersley Publishing Inc.
Comer. R. J., (1995). Abnormal Psychology. (2 nd Ed). Published by W. H. Freeman and Company, USA.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM–IV). Washington,
DC: APA.
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