Anxiety, Trauma and Stressor Related and Obsessive

– Compulsive and Related Disorder

Anxiety Disorders
Anxiety Disorders
• Anxiety disorder include disorders that share features of excessive fear
and anxiety and related behavioral disturbance
• Fear is the emotional response to real or perceived imminent threat.
• Anxiety is anticipation of future threat (reflex assessment and
readiness if danger occurs)
• Panic attacks feature prominently within anxiety disorders as a particular
type of fear response
• Fear is a basic emotion “fight and flight” response of the autonomic
nervous system (instant reaction to any possible threat)
Anxiety Disorders
• Anxiety in normal amount is beneficial (mild to moderate) helps us
to prepare in advance
• Its maladaptive when it becomes chronic and severe
• Biological factors, genetic vulnerability is manifested at a
psychological level, apart of personality trait “neuroticism”
• Limbic system “emotional brain”
• Gamma Aminobutyric Acid (GABA) norepinephrine and Serotonin
• Classical Conditioning, repeated exposure to abuse
Anxiety Disorders
• Parenting styles perceptions of uncontrollability
• Panic, Greek God Pan “Blood curling screams”
• Panic attack is a abrupt experience of intense fear or acute
discomfort with physical symptoms (within minutes)
• Two types, expected (cued) and unexpected (uncued) with or without
triggers
• Unexpected are important in panic disorder, expected are common in
specific phobias or social phobia.
Anxiety Disorders
• Panic attack as a specifier, it is not a mental disorder it can occur in
any anxiety disorder as well as other mental disorders (Post traumatic
disorders or depressive disorders with panic disorder, medical
conditions
• Panic attacks could be possibly experienced once or twice in a
lifetime, goes away after stressful event
• Physical symptoms four or more, panic attacks meet all the criteria
but fewer than four physical and cognitive symptoms (limited
symptoms attack)
Anxiety Disorders
• Biological basis
• Anxiety is associated with the limbic system. Behavioral
Inhibition System (BIS) receives stimulation from the amygdala.
• Panic attack is linked with the fight and flight system.
• Inherit, tense, upright and anxious ) genetic vulnerability does not
cause anxiety disorder, but stress or other environmental factors
(diathesis – stress model) can turn “on” genes
Anxiety Disorders
• Psychological basis
• Classical conditioning, modeling or other forms of learning
• Bulldozer type of parenting, would develop a sense of
uncontrollability over their environment
• Comorbidity, co occurrence of two or more disorders in a single
individual
• Suicide is associated with panic disorder.
Anxiety Disorders
• Generalized Anxiety Disorders
• Worry indiscriminately about everything, 6 months of excessive
anxiety and worry (apprehensive expectation) more days than not
• Out of proportion to actual likelihood or impact of the anticipated
event.
• Worry everyday about competence or performance
• Should be interfering with life compared to non pathological anxiety
• Worry may shift from one problem to another, greater range of life
circumstances about which a person worries.
Anxiety Disorders
• Accompanied by physical symptoms (pag ka balisa)
• Panic Disorder and Agoraphobia
• Presence of panic attack is contained within the criteria for the
disorder
• Individuals experience severe, unexpected panic attacks, with or
without agoraphobia
• Experience an unexpected panic attack and develop substantial
anxiety over the possibility of having another one.
Anxiety Disorders
• Agoraphobia avoidance is a way of coping with unexpected panic
attacks. Other methods to cope such as drugs and alcohol
• Recurrent unexpected panic attacks “more than one unexpected
panic attacks”
• Occur “out of the blue” relaxing or emerging from sleep (nocturnal
panic attack)
• One per week, for months, daily, two per month over many years.
• More than one unexpected full symptom (less than four) for diagnosis
of panic disorder.
Anxiety Disorders
• Persistent worries related to physical concerns.
• panic attack, reflects presence of life threatening illness, social
concerns, embarrassment, feelings of being judge because of visible
panic symptoms.
• Mental functioning, going crazy or loosing control.
• Avoiding physical exertion, reorganizing daily life to ensure help.
Restricting daily activities
• Avoiding activities that might provoke panic attack.
Anxiety Disorders
• Agoraphobia
• Intense fear or anxiety triggers by the real or anticipated exposure to
a wide range of situations at least two of the following 5 situations.
• Burdened by the thought that something terrible might happen,
escape might be difficult.
• Active avoidance, behaving in ways that are intentionally designed to
prevent contact with agoraphobic situations (Jobs, and buying
outside)
Anxiety Disorders
• Out of proportion to actual danger posed by the agoraphobic
situations.
• Completely homebound and dependent on others for basic needs.
• Accompanied by depressive symptoms, abuse of alcohol and sedative
medication.
• Neurobiologically overreactive, stress producing events.
• Conditioning and other forms of learning (learned alarms)
Anxiety Disorders
• Specific Phobia
• Irrational fear of a specific object or situation that interferes with
an individual’s ability to function.
• Phobic stimulus, fear or anxiety must be intense or severe, may be full
or limited symptom panic attack (immediately rather than delayed)
• Active avoidance, life and behavior adjustments
• Physiological Arousal
• In severe cases even innocent representations of it can elicit fear
(television or photographs)
Anxiety Disorders
• Separation Anxiety Disorder
• Excessive fear or anxiety concerning separation from home or
attachment figures (parents, important people or themselves)
• Clinging behavior or shadowing behavior
• Refusal to go to sleep if not accompanied by an attachment figure
• Physical symptoms (head aches and vomiting)
• Disturbance lasts for a period of at least 4 weeks children and
adolescent, younger than 18 years old. 6 months or longer in adults.
Anxiety Disorders
• Reports unusual perceptual experiences (frightening creatures trying
to reach them, eyes staring at them
• Described as demanding, need constant attention, adults
overly dependent and over protective.
• Develops after life stress or loss
Anxiety Disorders
• Social Anxiety Disorder (Social Phobia)
• Intense fear or anxiety of social situations in which the individual may
be scrutinized by others.
• Fear of being ( negatively evaluated, act or appear in a certain way or
show anxiety symptoms, blushing, sweating and trembling. Offending
others or rejected (shy bladder syndrome)
• Situations almost always provoke fear or anxiety.
Anxiety Disorders
• At least 6 months to differentiate with transient social fears
• Rigid body posture, inadequate eye contact, overly soft voice, shy and
withdrawn
• Seek jobs that do not require social interaction.
• Performance anxiety, no difficulty with social interaction unless they
must do something “specific” in front of people. (evaluated
negatively)
Trauma and Stressor Related Disorders
• Disorders in which exposure to a traumatic or stressful event.
• Post traumatic stress disorder
• Exposure to a traumatic event
• Flash backs, reliving the vent
• Strong reactions to stressful events typically disappears within a
month.
• At least one month after, delayed onset few or no immediate
symptoms or for months after trauma at 6 months later.
Trauma and Stressor Related Disorders
• Acute Stress Disorder
• Occurring within the first month after the trauma, lasting 3 days to 1
month.
• Adjustment Disorder
• Anxious or depressive reactions to life stress that are generally
milder than one would see in acute stress disorder or PTSD but are
nevertheless impairing in terms of interfering with work or school
performance, interpersonal relationships, or other areas of living
• Life stress not traumatic (single to multiple events) like romantic
relationships and marital problems.
Attachment Disorders
• Disturbed and developmentally inappropriate behaviors in children,
emerging before five years of age, in which the child is unable or
unwilling to form normal attachment relationships with
caregiving adults
• Abusive child rearing practices
• Failure to meet the child’s basic emotional needs or basic needs
• Exposure to adverse childhood experiences.
Attachment Disorders
• Reactive Attachment Disorder
• The child will very seldom seek out a caregiver for protection,
support, and nurturance and will seldom respond to offers from
caregivers to provide this kind of care
• Disinhibited Social Engagement Disorder
• A pattern of behavior in which the child shows no inhibitions
whatsoever to approaching adults
Obsessive-Compulsive Disorder (OCD)
• Clinical description

• Obsessions
• Intrusive and nonsensical
• Thoughts, images, or urges
• Attempts to resist or eliminate
• Compulsions
• Thoughts or actions
• Suppress obsessions
• Provide relief
Obsessions
• 60% have multiple obsessions
• Need for symmetry
• Forbidden thoughts or actions
• Cleaning and contamination
• Hording
Compulsions
• Four major categories
• Checking
• Ordering
• Arranging
• Washing/cleaning

• Association with obsessions

Tic disorder
• Tic disorder is characterized by involuntary movement (sudden
jerking of limbs, for example), to co-occur in patients with OCD
Body Dysmorphic Disorder BDD)
• A preoccupation with some imagined defect in appearance by
someone who actually looks reasonably normal
• Comorbid with OCD 10%
• Course lifelong
• Onset – early adolescence through 20s
• Reaction to a horrible or grotesque feature
Hoarding Disorder
• Estimates of prevalence range between 2% and 5% of the population,
which is twice as high as the prevalence of OCD
• Men = women
• Individuals usually begin acquiring things during their teenage years and
often experience great pleasure, even euphoria, from shopping or otherwise
collecting various items
• OCD tends to wax and wane, whereas hoarding behavior can begin early in
life and get worse with each passing decade
Trichotillomania (Hair Pulling Disorder)
and Excoriation (Skin Picking Disorder)
• The urge to pull out one’s own hair from anywhere on the body,
including the scalp, eyebrows, and arms, is referred to as
trichotillomania

• Excoriation (skin picking disorder) is characterized by repetitive and

compulsive picking of the skin, leading to tissue damage