Anxiety disorders

ANXIETY DISORDERS
● In the DSM-IV, obsessive-compulsive disorder was included
in the anxiety disorders classification.
● In the DSM-5, anxiety disorders and obsessive-compulsive
and related disorders are now two separate classifications.
● Humans, as well as most mammalian species, are born with
the innate capacity to experience fear.
● A distinction is sometimes made between the responses of
fear and anxiety.
○ Fear is an adaptive state for dealing with a real
threat or danger.
○ Anxiety is the apprehensive anticipation of future
danger or misfortune.
● Fear is inferred indirectly from three kinds of data:
○ Subjective experiences of apprehension such as
dread, fright, tension, inability to concentrate, the
desire to flee a particular situation, and physical
sensations
○ Behavioral manifestations such as flight,
disorganization of speech, motor incoordination,
impairment of performance on complex
problem-solving tasks, or sometimes immobilization
○ Physiological responses such as rapid and irregular
heartbeat and breathing, palmar sweating, dry
mouth, dilated pupils, and muscular trembling
● Sympathetic nervous system: rapid and irregular heartbeat
and breathing, palmar sweating, dry mouth, dilated pupils,
and muscular trembling
● Parasympathetic nervous system: diarrhea, increased
frequency of urination, and fainting—The fainting response is
likely to occur only in strong, acute fear states.
● The fear response in humans, regardless of whatever
unlearned tendencies exist for certain stimuli to elicit fear, is
a highly learnable response that can become associated
with almost any situation or stimulus (external or internal)
that happens to be present when the fear occurs.
● It is also powerfully influenced by observational learning.
● The DSM-5 classifies the different anxiety disorders in part
based on the occurrence of certain components of the
anxiety symptom complex.
● Two such components are the following:
○ Panic attacks
○ Agoraphobia
● Many of the anxiety disorders in the DSM-5 involve one or
both of these components, but all involve intensely
uncomfortable fear or anxiety as the main presenting
symptom.
PANIC ATTACK
❖ A panic attack involves a rapidly developing sense of intense
fear and anxiety.
❖ People undergoing a panic attack feel intense discomfort;
some think during the first such experience that they are
dying.
❖ Panic attacks are relatively rare in children; they are much
more common in adults (1 in 9 adults in a 12-month period).
❖ Panic attacks are not, themselves, diagnosable disorders,
but they play a role in several anxiety disorders.
❖ Symptoms (at least 4 required):
➢ Heart palpitations or accelerated heart rate
➢ Trembling or shaking
➢ Sweating
➢ Chest pain
➢ Shortness of breath or sensation of suffocation
➢ Feelings of choking
➢ Dizziness
➢ Numbness or tingling sensations
➢ Chills or heat sensations
➢ Nausea
➢ Derealization or depersonalization
➢ Fear of losing control
➢ Fear of dying
REFERENCES:
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed). Author.
Barlow, D. H., Durand, V. M, & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Cengage.

REFERENCES:
DISORDERS KEY SYMPTOMS DURATION ETIOLOGY DIFFERENTIAL TREATMENT
Separation
Anxiety
Disorder
A person
experiences
developmentally
inappropriate and
excessive fear or
anxiety associated
with separation
from home or from
primary caregivers.
The
disturbance
must last at
least 4
weeks in
children,
and 6
months or
more in
adults.
Generalized Anxiety Disorder: if
separation from attachment figures
do not predominate clinical picture.
Agoraphobia: if they are anxious
about being trapped or incapacitated
in which escape is perceived to be
difficult
Conduct Disorder: if the anxiety about
separation is not responsible for
school absences
Social Anxiety Disorder: school
avoidance must be due to the fear of
being judged negatively
Posttraumatic Stress Disorder: the
central concern must be about
intrusions and avoidance of
memories associated with the
traumatic event
Illness Anxiety Disorder: must be
concerned about medical diagnosis
Bereavement: yearning and longing
for the deceased
Depressive and Bipolar Disorders:
low motivation for engaging with the
outside world
Oppositional Defiant Disorder: if
behavior is persistently oppositional
CBT appears to be effective for
separation anxiety disorder in
children.
Parents are often included to
help structure the exercises and
to address parental reaction to
childhood anxiety

REFERENCES:
and unrelated to the
anticipation/occurrence of separation
Psychotic Disorders: if there is a
misperception of an actual separation
Dependent Personality Disorder:
indiscriminate tendency to rely on
others
Borderline Personality Disorder: there
must be problems in identity,
self-direction, interpersonal
functioning, and impulsivity
Selective
Mutism
A persistent failure
to speak in
situations where
speaking is
expected, such as
social and school
settings.
The individual does
speak in other
situations,
however.
After the
first month
in a new
social
situation,
selective
mutism can
be
diagnosed if
the failure to
speak
persists one
month and
is not due to
lack of
knowledge
about the
language,
comfort with
the spoken
language,
embarrassm
ent about
speaking
Communication Disorders: the
speech disturbance is not restricted
to specific conditions
Neurodevelopmental Disorders &
Schizophrenia and Psychotic
Disorders: deficits in social
communication and inappropriately
speaking in social situations
Social Anxiety Disorder: the social
anxiety may be associated. Thus,
both diagnosis may be given
Behavioral interventions
including reinforcement,
shaping and stimulus control of
speech, perhaps combined with
modeling, appear to be the
treatments of choice for the
condition.
Antidepressants may be useful.

REFERENCES:
connected
to a
communicati
on disorder
such as
stuttering, or
a pervasive
developmen
tal disorder
or psychotic
disorder.
Specific
Phobia
This involves
intense and
persistent fear
triggered by
specific objects or
situations.
The fear reaction is
excessive.
Most individuals
with phobias
realize that their
reactions are
excessive or
unreasonable, but
this realization
does not reduce
the phobic
response.
The DSM-5
provides for
including subtype
indicators in the
diagnosis of
specific phobia:
It must last
for at least 6
months and
interferes
significantly
with a
person’s life
or is
associated
with marked
distress.
BIOLOGICAL:
Specific phobias are more
common in families in which
other members have
phobias.
Monozygotic twins show
higher concordance rates for
specific phobias than
dizygotic twins.
There seems to be an innate
preparedness to fear certain
stimuli evolutionarily
associated with real dangers
– animals, the dark, heights.
BEHAVIORAL:
Classical/operant
conditioning
Two-factor theory of phobia
● Pavlovian conditioning in
which object or situation
is paired with a traumatic
event or a strong
sensation of fear
● Operant conditioning in
which avoidance behavior
Agoraphobia: if two or more
agoraphobic situations are feared
Social Anxiety Disorder: if negative
evaluation is feared
Separation Anxiety Disorder: if
separation from a primary caregiver
or attachment figure is the main
manifestation
Panic Disorder: if there is an
experience of uncued panic attacks
Obsessive-compulsive Disorder: if
the primary fear/anxiety is an object
or situation as a result of obsessions
Trauma and Stressor Related
Disorders: if the phobia occurs
following a traumatic event
Eating Disorders: avoidance behavior
is limited to the avoidance of food
and food-related cues
In the case of specific phobia,
no pharmacological intervention
has been shown to be effective.
Nearly all empirically-supported
therapies for specific phobias
involve exposure to the feared
stimulus:
● Systematic desensitization
● Participant modeling
Exposure therapies involving
actual, rather than imagined,
contact appear to be the most
effective approaches.

REFERENCES:
● Animal type
● Natural
environment
type
● Blood-injectio
n-injury type
● Situational
type
● Other types
(fear of
choking,
clowns,
noises)
is negatively reinforced
by the reduction in fear
that avoidance produces
Observational learning
PSYCHOANALYTIC:
The psychoanalytic theory of
phobia formation
emphasizes some initial
repression of an
anxiety-arousing conflict, the
projection of the conflict onto
the external world, and then
displacement of the anxiety
onto some other target.
Social
Anxiety
Disorder
The symptoms are
connected to
situations in which
the person is
exposed to
unfamiliar people,
or to the scrutiny of
others, and fears
acting in a way that
might prove
embarrassing or
humiliating.
Exposure to these
situations almost
immediately
triggers distressing
fear symptoms,
which at times may
escalate into panic
attacks.
At least 6
months
Social anxiety disorder runs
in families; first degree
relatives of sufferers have
two to six times greater risk
of developing the condition.
The amygdala may respond
differently to novel faces
rather than to familiar faces
in people with social anxiety
disorder.
Learning models assume
social anxiety disorder
develops in similar ways as
other phobias, involving a
conditioned association
between social cues and
unpleasant or embarrassing
events or social defeats.
● There is no information
Agoraphobia: if escape might be
difficult or might not be available
Panic Disorder: concerned with the
panic attacks
Generalized Anxiety Disorder: social
worries is focused on the nature of
ongoing relationships
Separation Anxiety Disorder: may
avoid social settings due to the
concerns of being separated from
attachment figures, but it must be
deemed developmentally
inappropriate
Specific Phobia: if fear about
negative evaluations in other settings
is not generalized
Benzodiazepines appear to be
effective in short-term relief for
social anxiety. SNRIs have also
been used effectively.
Cognitive-behavioral therapies
are effective treatments.
● These techniques typically
involve systematic exposure
to feared social situations,
often combined with
relaxation training or
desensitization.
● Newer CBT applications,
including virtual reality
technologies that provide
computer-generated
scenarios of public speaking
situations, also appear
promising for treating social
anxiety.

REFERENCES:
It involves shyness
and social anxiety
that is severe
enough to interfere
with normal life in
terms of
occupational,
academic, or
interpersonal
functioning and
which has occurred
for at least six
months.
The diagnosis can
be sub-typed as
performance only if
the fear is limited to
performing or
speaking in public.
that establishes a
relationship between the
disorder and childhood
maltreatment or
adversity.
Psychodynamic models tend
to emphasize internal
conflicts that produce
anxiety (as in the other
phobias) as the probable
cause of social anxiety
disorder.
Selective Mutism: there must be no
fear of negative evaluations in social
situations where no speaking is
required
Major Depressive Disorder: feelings
of being bad or unworthy must be
present
Body Dysmorphic Disorder: if social
fears is due to beliefs about personal
appearance
Delusional Disorder: if beliefs are out
of proportion to the actual threat
posed by the social situation
Autism Spectrum Disorder: if the
client does not have an adequate
age-appropriate social relationship
and social communication capacity
Avoidant Personality Disorder: a
broader sense of avoidance must be
present
Oppositional Defiant Disorder: refusal
to speak must be due to opposition to
authority figures
Panic
Disorder
It is characterized
by recurrent,
spontaneous and
unexpected panic
attacks with anxiety
about future
attacks and their
Must be
followed by
one month
or more of
persistent
concern that
the attacks
BIOLOGICAL:
Panic disorder is known to
run in families, with
first-degree relatives of
panic disorder victims up to
8 times more likely to also
show the disorder.
Other specified/Unspecified Anxiety
Disorder: the client must experience
limited symptom unexpected panic
attack
Antidepressant medications,
especially the SSRIs, have
been used effectively in treating
panic disorder without the risk
of dependence of the
benzodiazepines.

REFERENCES:
consequences.
The panic attacks
are not due to
another medical
condition or the
effects of a
substance.
will recur or
lead to
significant
changes in
behavior
related to
avoiding
another
attack.
Potential oversensitivity of
the fear network in the brain;
for example, the amygdala.
Low levels of GABA activity
in some parts of the cortex
are detected.
Panic attacks can be
triggered in those who are
prone to them by several
stimuli:
● Sodium lactate
● Stimulants (such as
caffeine)
● Carbon dioxide
There is an increased risk
for panic disorder in those
who smoke and those with
respiratory disturbances
such as asthma.
COGNITIVE:
There is a tendency to make
catastrophic
misinterpretations of
physiological sensations.
These catastrophic thoughts
and expectations then
generate the full-blown panic
attack, which in turn justifies
the original catastrophic
interpretation.
BEHAVIORAL:
Early panic attacks are
preceded by internal
Behavioral and
cognitive-behavioral therapies
typically involve exposure to
feared interoceptive or
exteroceptive stimuli.
● These treatments have been
quite successful, and they
appear to be more effective
and less subject to relapse
than pharmacological
methods.

REFERENCES:
physiological (interoceptive)
cues, as well as
exteroceptive cues in the
environment.
The anxiety associated with
the attack becomes
conditioned to those early
cues, especially in people
with an associative history of
uncontrollable or
unpredictable negative
events.
Anxiety then becomes a
conditioned stimulus
predicting of the next panic
attack, which further
increases anxiety, spiraling
into panic disorder
PSYCHODYNAMIC:
Psychodynamic models of
panic disorder emphasize
internal conflicts.
Freud’s original focus was
on the sexual and
aggressive impulses that
produced anxiety in the ego.
Ego defenses normally
contain the anxiety through
defense mechanisms, but
these are overwhelmed if
the unconscious conflict is
too threatening.

REFERENCES:
Agoraphobia It involves anxiety
about being in
places or situations
from which escape
would be difficult,
embarrassing, or
impossible in the
event of having a
panic attack or
panic-like
symptoms.
NOTE: Panic
attacks can occur
with or without
accompanying
agoraphobia.
Agoraphobia can
also occur without
a history of panic
attacks, thus in the
DSM-5 it was
elevated to a
stand-alone
diagnosis.
● Both
diagnoses
(agoraphobia
and panic
disorder) are
given for
those who
have both
sets of
symptoms.
At least 6
months
Stressful events may be
associated with the onset of
agoraphobia, but there is
also a relatively strong
genetic link to phobias
Specific Phobia, Situational Type: If
the fear, anxiety, or avoidance is not
limited to an agoraphobic situation
Separation Anxiety Disorder: the
thoughts are about detachment from
significant others and the home
environment
Social Anxiety Disorder: the focus is
on fear of being negatively evaluated
Panic Disorder: if the avoidance does
not extend to two or more
agoraphobic situations
Acute Stress Disorder and
Posttraumatic Stress Disorder: if the
fear, anxiety, or avoidance reminds
the client of a traumatic event
Major Depressive Disorder: may
leave due to apathy, loss of energy,
low self-esteem, and anhedonia
Behavioral and
cognitive-behavioral
interventions
● Exposure-based CBT
● Virtual-reality exposure
therapy
Pharmacological treatment
SSRI anti-depressants
Generalized
Anxiety
It is characterized
by a nearly
At least 6
months
BIOLOGICAL:
Several brain pathways also
Social Anxiety Disorder: a
preoccupation of social situations
Both medical and psychological
treatments can be helpful for

REFERENCES:
Disorder constant state of
worry and
apprehension
about a wide
variety of events or
activities, on most
days over a
6-month period.
Several symptoms
of autonomic
arousal are
present, including
disturbed sleep
and concentration,
muscle tension,
irritability, and
fatigue, to the
extent that they
interfere with daily
life.
People with GAD
find their worries
difficult to control,
distressing, and
physically
troublesome.
However, they do
not progress into
panic attacks.
active in other anxiety
disorders, including the
amygdala and the limbic
system and the prefrontal
cortex, are implicated in
GAD.
Inhibition of these pathways,
mediated by the
neurotransmitter GABA, is
assumed to be deficient in
GAD sufferers.
Genetic evidence is mixed;
its modest heritability may
be somewhat smaller than
that for other anxiety
disorders.
COGNITIVE-BEHAVIORAL:
Similar to that for panic
disorder, interoceptive and
exteroceptive stimuli
become predictive of worry
and apprehension to the
point that widespread
anxiety occurs as a
conditioned response.
This would be most likely to
occur in people who have a
history of uncontrollable and
unpredictable events, and
who would also be less likely
to identify periods of safety
from threat, resulting in
hypervigilance.
This results in a cognitive
where they will be performing and be
evaluated by others
Obsessive-Compulsive Disorder:
must be intrusive and unwanted
thoughts, urges, or images
Adjustment Disorder: the anxiety
occurs in response to an identified
stressor within 3 months at its onset
Depressive, Bipolar, and Psychotic
Disorder: separate diagnosis if the
excessive worry has occurred under
such episode
GAD but rarely result in total
symptom remission.
Effective medications include
GABA stimulants such as the
benzodiazapines and buspirone
for short-term treatments.
Antidepressants, especially the
SSRIs, may be more helpful
both in the longer term and with
concomitant depression.
Psychotherapy for GAD can be
helpful as well, and appears to
be at least as effective as
pharmacological treatment.
There is some disagreement
about the effectiveness of CBT
in controlled clinical trials.
● Some literature reviews found
CBT to be helpful in the
short-term for GAD, but
lacked evidence of sustained
improvement.
● Others indicate CBT is
consistently clinically effective
for both anxiety and
depression.

REFERENCES:
tendency to over-appraise
and attend to threatening
interoceptive and
exteroceptive cues, and
such an interpretive bias can
increase vulnerability to
anxiety disorders
PSYCHOANALYTIC:
Anxiety is created by
unconscious conflict, which
overwhelms the ego
defenses with unacceptable
impulses and produces a
widespread overt anxiety
reaction.

Anxiety disorders

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Anxiety disorders

Similar to Anxiety disorders (20)

More from Martin Vince Cruz, RPm

More from Martin Vince Cruz, RPm (20)

Recently uploaded

Recently uploaded (20)

Anxiety disorders