Units 12/13: Mental Illness and Therapies

1. CHS AP Psychology Units 12/13: Mental Illness and Therapies Essential Task 12/13.3:Discuss the major diagnostic category of anxiety disorders with specific attention to the diagnoses of panic disorder, agoraphobia, social phobia, specific phobias, OCD, GAD and PTSD, detail the defining symptoms of each and identify the best approach(es) for explaining the cause(es) of each.

2. Anxiety Disorders involve fears that are uncontrollable, disproportionate to the actual danger the person might be in, and disruptive of ordinary life. The DSM-5 recognizes 12 types of anxiety disorders. Anxiety Disorders

3. Generalized Anxiety Disorder (GAD) • Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events • Unable to Identify the reasons • 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

4. 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 *Could be due to a deficiency in the neurotransmitter GABA, the brain’s brake pedal

5. Panic Attack Discrete period of intense fear or discomfort, in which 4 or more of the following 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

6. 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 (Pons).

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

8. Phobias: Based on Fear • How does a fear become a phobia? • When a situation is so dreaded that the individual goes to almost any length to avoid it. • Where do phobias come from? • Experiences, memories, or learned associations • Monkeys vs snakes

9. 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

10. Subtypes of Specific Phobia • Animal type • Natural environment type • Blood-Injection-Injury type • Situational type • Other type

11. Kinds of 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

12. Good Question… If phobias are learned behaviors, why don’t they extinguish on their own?

13. Answer to the “Good Question”… • Avoidance works! • Fear is never tested

14. Social Anxiety Disorder(formerly Social Phobia) 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

15. Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress. Obsessive-Compulsive Disorder https://www.youtube.com/watch?v=KOami82xKec

16. Obsessive-Compulsive Disorder Obsessions as defined by 1, 2, 3, and 4 • Recurrent, persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress • The thoughts, impulses, or images are not simply excessive worries about real-life problems • The person attempts to ignore or suppress such thoughts, impulses, or images or tries to neutralize them with some other thought or action • The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind

17. 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

18. Obsessive-Compulsive Disorder Compulsions as defined by 1 and 2 • Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly • The compulsions are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

19. 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.

20. Obsessive-Compulsive Disorder • The person has recognized that the obsessions or compulsions are excessive or unreasonable • There is significant distress or an impairment in functioning due to the obsessions or compulsions • If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to the other Axis I disorder • The disturbance is not due to a GMC or substance

21. DSM-5 Expanded OCD-Related Disorders • Hoarding Disorder- collecting, poor organizational skills, and difficulty discarding, but also deficits in decision-making and procrastination • Excoriation Disorder (skin picking)- picking one’s skin to the point of injury. • Trichotillomania (hair pulling)- person compulsively pulls at his ore her hair, from the scalp, eyebrows, and other areas of the body. • Body Dysmorphic Disorder- involves a distressing preoccupation with imagined or slight flaws in one’s physical appearance.

22. 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

23. 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: Post-Traumatic Stress Disorder • Haunting memories 2. Nightmares 3. Social withdrawal 4. Jumpy anxiety 5. Sleep problems Can occur immediately after the trauma or months and even years after.

24. 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