Anxiety Disorders & Obsessive-Compulsive and Related Disorders

1. Anxiety Disorders
&
Obsessive-Compulsive and
Related Disorders
MAP106 – Advanced Abnormal Psychology

2. Anxiety Disorders

3. Definition of Terms
Anxiety
• A negative mood state characterized by mostly symptoms of physical tension and apprehension about the
future
• Subjective sense of unease, a set of behaviors, or a physiological response originating in the brain and
reflected in elevated heart rate and muscle tension
Fear
• An immediate alarm reaction to danger.
Panic
• It is a sudden experience of an overwhelming reaction when there is nothing to be afraid of.
Panic Attack
• Abrupt experience of intense fear or acute discomfort accompanied by physical symptoms such as heart
palpitations, chest pain, shortness of breath, and possible dizziness.
• It can be cued or uncued

4. Causes of Anxiety Disorders
Biological
• Low levels of gamma-
aminobutyric acid
(GABA)
• Behavioral Inhibition
System: activated by
signals from the brain
stem that may help
signal danger.
• Fight/Flight System
Psychological
• Psychic reaction to
danger surrounding the
reactivation of infantile
fearful situation
• An early product of
classical conditioning,
modeling, or other
forms of learning
• Lack of sense of control
Social
• Stressful life events
may trigger our
vulnerabilities

5. Generalized Anxiety Disorder
• At least 6 months of excessive
anxiety and worry (apprehensive
expectation) that is ongoing
more days than not
• Characterized by the following:
• Muscle tension
• Mental Agitation
• Susceptibility to fatigue
• Some irritability
• Difficulty sleeping
STATISTICS:
• 3.1% of the population
• 5.7% at some point during course of
lifetime
• 1.1% of adolescents
• During early adulthood, it is
thought of as a response to a life
stressor.
• Prevalent in older adults.
• More common among females

6. Generalized Anxiety Disorder
CAUSES:
• Low cardiac vagal tone
• The vagus nerve innervates the heart
and decreases its activity
• People with GAD are also known as
“autonomic restrictors”
• High sensitivity to threat
• Allocate attention more readily to
sources of threat
• Learning that the world is dangerous
and out of control that they might not
be able to cope.
• Evidence of an intense cognitive
processing on the frontal lobes in the
left hemisphere as indicated by EEG
waves.
TREATMENT:
• Benzodiazepines
• Impairments in motor and cognitive
functioning
• Psychological Dependence
• Some research suggests
antidepressants like Paxil and Effexor
• Cognitive-Behavioral Therapy
• Patients evoke worry and confront
threatening images and thoughts head
on.
• To counteract and control worry
• Meditation and mindfulness
• Teaches the clients to be tolerant of
feelings of anxiety
• CBT + Zoloft was found to be better

7. Panic Disorder with or without
Agoraphobia
• Experiencing severe, unexpected
panic attacks that they may think
they’re dying or losing control.
• Must also develop anxiety over the
possibility of having another panic
attack or about its implications or
consequences.
• Must persist for at least 1 month
• AGORAPHOBIA: fear/avoidance of
situations where escape is impossible.
• Must persist for at least 6 months
• INTROCEPTIVE AVOIDANCE:
avoidance of internal physical
sensations
STATISTICS:
• Can be found in 2.7% of the population
for a year.
• May occur at some point during lifetime
at 4.7%
• Two-thirds are women
• The onset is between midteens through
40s.
• Asian and African countries have lowest
rates
• White Americans have a higher
prevalence.

8. Panic Disorder with or without
Agoraphobia
CAUSES:
• Learned Alarms
• Interpretation of normal physical
sensations in a catastrophic way
• Early object loss and/or separation
anxiety
• TREATMENT:
• SSRIs
• Sexual dysfunctions
• Xanax
• Physical and psychological dependence
• Exposure-based Treatment
• Patient can gradually face feared
situations and learn that there is
nothing to fear.
• Therapist help structure exercises that
the clients will be provided with
psychological coping mechanisms in
completing the exercises.
• May be combined with relaxation or
breathing retraining
• Panic Control Treatment
• Cognitive Therapy

9. Specific Phobia
• Irrational fear of a specific
object or situation that can
interfere individual functioning
that persists for at least 6
months.
• Blood-injection-injury
• Situational
• Natural Environment
• Animal
• Others
STATISTICS:
• Occurs in majority of people.
• Most cases tend to be among
females.
• The median age of onset is 7 years
old.
• Hispanics are more likely to report.

10. Specific Phobia
CAUSES:
• Direct experience
• Experiencing false alarms
• Vicarious experience
• Being told about the danger
TREATMENT:
• Structured and consistent
exposure-based exercises

11. Separation Anxiety Disorder
• Developmentally inappropriate
and excessive fear or anxiety
associated with separation from
home or primary caregivers
• CHILDREN: at least 4 weeks
• ADULTS: at least 6 months
TREATMENT:
• CBT
• Incorporation of parents

12. Social Anxiety Disorder
(Social Phobia)
• Marked fear or anxiety focused
on one or more
social/performance situations
lasting for at least 6 months.
• People suffering from this tends
to focus on the possibility of
embarrassing themselves
STATISTICS:
• 12.1% of the population
• In a given 1-year period, the
prevalence is 6.8%
• 50:50 sex ratio
• Common among White Americans
compared with the minorities

13. Social Anxiety Disorder
(Social Phobia)
CAUSES:
• Biological predisposition to being
socially inhibited
• Experience of an unexpected
panic attack in social situation
(becoming conditioned)
• Real experience of social trauma
(i. e., bullying).
TREATMENT:
• Cognitive Therapy
• Emphasize real-life experiences to
disprove automatic perceptions of
danger
• Interpersonal Psychotherapy
• D-cycloserine (DCS) + CBT
• The drug may facilitate the extinction
of anxiety by modifying the
neurotransmitter flow in the
glutamate system.

14. Selective Mutism
• Lack of speech in one or more
settings in which speaking is
socially expected that must
occur for more than one month
and cannot be limited to the
first month of school
TREATMENT:
• Play socializing games that
encourages verbal participation
• Modeling
• Stimulus Fading
• Shaping

15. Obsessive-Compulsive
and Related Disorders
Obsessions
• Intrusive, nonsensical
thoughts, images, or urges
that an individual tries to
resist or eliminate.
Compulsions
• Thoughts or actions that
are used to suppress the
obsessions and provide
relief

16. Obsessive-Compulsive
Disorder
• Recurrent obsessions or
compulsions that causes
significant distress
• WITH GOOD INSIGHT: if the client
is able to recognize that obsessive-
compulsive beliefs are not true
• Subtypes:
• Symmetry
• Forbidden thoughts
• Cleaning/Contamination
• Hoarding
STATISTICS:
• Lifetime prevalence of 1.6 to 2.3%
• The range of onset is from childhood
to 30s (median is 19 years of age).
• Men develops earlier compared to
women.
• Has a chronic course
• Cultural implication in Arab countries

17. Obsessive-Compulsive
Disorder
CAUSES:
• Thought-Action Fusion
• Equating thoughts with the specific
actions or activity represented by the
thoughts.
• Leads to an attitude of excessive
responsibility that may result to guilt
TREATMENT:
• Clomipramine/SSRIs
• Exposure and Ritual Prevention
• Rituals are actively prevented and
the client is systematically and
gradually exposed to feared
thought/situation
• Cingulotomy
• Deep Brain Stimulation

18. Body Dysmorphic Disorder
• Preoccupation with imagined or
minor physical defect in
appearance.
• Their compulsive behavior may
involve looking in mirrors to check
physical features.
• WITH MUSCLE DYSMORPHIA:
preoccupation with the thought of
one’s physique being too small or
insufficiently muscular.
• Most may seek plastic surgeons or
dermatologists
STATISTICS:
• Difficult to be estimated due to its
tendency to be kept as a secret.
• Onset is from adolescence through
the 20s

19. Body Dysmorphic Disorder
CAUSES:
• Displacement as a defense
mechanism
• Unconscious conflict becomes
anxiety provoking to be admitted
into consciousness that a person
displaces into another body part
TREATMENT:
• Clomipramine
• Fluvoxamine
• Exposure and Response
Prevention
• CBT

20. Hoarding Disorder
• Excessive acquisition of things
• Difficulty to discard
• Living with excessive clutter
under conditions best
characterized by gross
disorganization
STATISTICS:
• The average age for seeking
treatment is approximately 50.

21. Hoarding Disorder
CAUSES:
• Strong emotional attachment to
possessions
• Marked deficits in deciding
whether a possession is worth
keeping or not.
TREATMENT:
• CBT
• Teach the clients to assign any
value to reduce anxiety about
throwing away items that are
valued

22. Trichotillomania & Excoriation
• TRICHOTILLOMANIA: urge to
pull hair from everywhere
• EXCORIATION: repetitive and
compulsive picking of the skin
resulting to tissue damage
TREATMENT:
• Habit Reversal Training
• Clients are carefully taught of being
aware with their behavior and make
them substitute a different behavior
that are reasonably pleasurable, but
harmless