Anxiety Disorders

1. Anxiety Disorders A Closer Look at Psychological Disorders

2. First, a warning… • Don’t overreact if you begin to discover in yourself some of the symptoms we will discuss. That’s typical. • We all have some of these symptoms some of the time. • Just remember, they do not suggest a disorder unless they meet all four of the criteria we talked about before – the symptoms must be maladaptive, unjustifiable, disturbing, and atypical.

3. Anxiety Disorders • Anxiety is a general state of dread or uneasiness that a person feels in response to a real or imagined danger. • People suffering from anxiety disorders feel anxiety but not just normal anxiety. They suffer anxiety that is out of proportion to the situation provoking it. • Anxiety disorders are the most common type of mental illness in the United States, affecting 40 million Americans annually.

4. Portion of population meeting criteria for disorder (%) 0 5 10 15 20 25 30 35 40 45 50 Any Disorder Substance Use Disorders (Including Alcoholism) Category Anxiety Disorders Mood Disorders SchizophrenicDisorders Abnormal Behavior: Myths and Realities Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenic Disorders Eating Disorders

5. There are several different kinds of anxiety disorders: Anxiety Disorders (cont.)

6. Generalized Anxiety Disorder • An anxiety disorder in which a person is continuously tense, apprehensive and in a state of autonomic nervous system arousal (“free-floating” anxiety). • While we all may experience the symptoms of G.A.D • For true sufferers, the symptoms are more lasting and are often not attached to any specific event. • Individuals with generalized anxiety disorder must experience at least 3 of the following symptoms: • Restlessness • Feeling on edge • Difficulty concentrating or mind going blank • Irritability • Muscle tension • Sleep disturbance

7. Panic Disorder • Panic is a feeling of sudden, helpless terror, such as the overwhelming fright one might experience when cornered by a predator. • Sufferers of a panic disorder have anxiety accompanied by panic attacks – episodes of unexplained terror and fear that something bad is going to happen. • Panic attacks can last for a few minutes or for an hour or more. • Symptoms: may include a sense of smothering, choking, or difficulty breathing; faintness or dizziness; nausea; and chest pains. • Panic disorder may be inherited. • The panic victim usually experiences the first attack shortly after a stressful event, but future attacks usually appear out of nowhere. • Can cause secondary disorders, such as agoraphobia. • After a number of panic attacks, victims may become so concerned about exhibiting panic in public that they may be afraid to leave home, developing agoraphobia, or a fear of going out in public

8. Examples of People Suffering from Panic Disorder Jonathan and Jordanhttp://www.youtube.com/watch?v=277Q8dsArhI Panic Disorderhttp://www.youtube.com/watch?v=2gNGUartUEI NKOTB - Jon and Jordan Knight talk Panic disorderhttp://www.youtube.com/watch?v=gR4AOEOjp4s&feature=related

9. Phobic Disorder • The word “phobia” is the Greek word for “morbid fear.” • It refers to Phobos, the Greek god of terror. The names of most phobias begin with the Greek word for the feared object or situation. • A phobia is a fear that is both irrational and disruptive (impairs the ability to lead a normal life). • People can have • Specific phobias – fear of a particular object, thing, or situation (heights, dogs, spiders, enclosed spaces, etc.) • Social phobias – fear you will embarrass yourself in a social setting (fear of speaking in public, eating in public, meeting strangers, etc.) • Agoraphobia – fear of being away from a safe place (like home); of being away from a familiar person (like a spouse); or of being in crowds or in other situations that are difficult to leave.

10. Simple Phobias Social Phobias Agoraphobias Type of Phobias 25 20 15 Portion of population reporting each phobia (%) 10 5 0 Bugs, mice, snakes, bats Going out by oneself Closed places Heights Water Storms Animals Speaking to new acquaintances Crowds Being alone Tunnels or bridges Speaking in public Public transport Eating in public Abnormal Behavior: Myths and Realities Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenic Disorders Eating Disorders

11. Obesophobia- Fear of gaining weight. Ochlophobia- Fear of crowds or mobs. Ochophobia- Fear of vehicles. Octophobia - Fear of the figure 8. Odontophobia- Fear of teeth or dental surgery. Odynophobia or Odynephobia- Fear of pain. Oenophobia- Fear of wines. Oikophobia- Fear of home surroundings, house. Olfactophobia- Fear of smells. Ombrophobia- Fear of rain or of being rained on. Ommetaphobia or Ommatophobia- Fear of eyes. Oneirophobia- Fear of dreams. Onomatophobia- Fear of hearing a certain word or of names. Ophidiophobia- Fear of snakes. (Snakephobia) Ophthalmophobia- Fear of being stared at. Opiophobia- Fear medical doctors experience of prescribing needed pain medications for patients. Optophobia- Fear of opening one's eyes. Ornithophobia- Fear of birds. Orthophobia- Fear of property. Osmophobia or Osphresiophobia- Fear of smells or odors. Ostraconophobia- Fear of shellfish. Ouranophobia or Uranophobia- Fear of heaven. Phobias beginning with “o”: The Phobia List Link

12. Obsessive-Compulsive Disorder • Two major components: • Obsessions – repetitive __________ • Compulsions– repetitive ____________ • Obsessions and compulsions are not always bad things… • You might become obsessed with the lyrics to your favorite song, which get stuck in your head all day • A good athlete might be obsessed with winning and compulsive about training. A good student might be obsessed with grades and compulsive about studying. These are not bad things.

13. Obsessive-Compulsive Disorder (cont.) • When are obsessions and compulsions harmful? • When they begin to take control with some people, what could have been helpful tendencies become obsessive-compulsive disorder. • If sufferers are prevented from engaging in their ritual behavior, ___________ and __________ rapidly build.

14. What Causes Obsessive-Compulsive Disorder? Possible causes: • Obsessions: may serve as diversions from a person’s real fears and their origins and thus may reduce anxiety. • Compulsions: provide a disturbed person with the evidence that he is at least doing something well.

15. Some possible symptoms of OCD Symptoms may include some, all, or perhaps none of the following: • Repeated hand washing or repeated clearing of the throat, although nothing may need to be cleared. • Specific counting systems — e.g., counting in groups of four, arranging objects in groups of three, grouping objects in odd/even numbered groups, "counting" steps — e.g., feeling the necessity to take 12 steps to the car in the morning. • Perfectly aligning objects at complete, absolute right angles, or aligning objects perfectly parallel etc. • Having to "cancel out" bad thoughts with good thoughts, like imagining harming a child and having to imagine a child playing happily to cancel it out.

16. Some possible symptoms of OCD Symptoms may include some, all, or perhaps none of the following: • A fear of contamination; some sufferers may fear the presence of human body secretions such as saliva, blood, sweat, tears, vomit, or mucus, or excretions such as urine or feces. Some OCD sufferers even fear that the soap they're using is contaminated. • A need for both sides of the body to feel even. If one hand gets wet, the sufferer may feel very uncomfortable if the other is not. If the sufferer is walking and bumps into something, he/she may hit the object or person back to feel a sense of evenness. These symptoms are also experienced in a reversed manner. Some sufferers would rather things to be uneven, favoring the preferred side of the body. • An obsession with numbers (be it in math class, watching TV, or in a room). Some people are obsessed with even numbers and loathe odd numbers (odd numbers cause them a great deal of anxiety and often make the person uncomfortable or even angry) or vice versa.

17. Examples of People with OCD Howie Mandel talks about living with OCD http://www.youtube.com/watch?v=dSZNnz9SM4g http://www.videobash.com/video_show/chad-s-ocd-from-obsessed-on-a-amp-e-655399

18. Examples of People with OCD As a young man (shown in the photo), Howard Hughes was a handsome, dashing daredevil pilot and movie producer who appeared to be reasonably well adjusted. However, as the years went by, his behavior gradually became more and more maladaptive, as obsessions and compulsions came to dominate his life. In his later years (shown in the drawing), he spent most of his time in darkened rooms, naked, unkempt, and dirty, following bizarre rituals to alleviate his anxieties. (The drawing was done by an NBC artist and was based on descriptions from men who had seen Hughes.)

19. Post-traumatic Stress Disorder • A condition in which a person who has experienced a traumatic event feels severe and long-lasting after-effects. • Intense stress is the trigger, and symptoms include nightmares, persistent fear, difficulty relating normally to others, and troubling memories or flashbacks of the traumatic event. • PTSD can be extremely long-lasting, lasting decades after the event. • People who are exposed repeatedly or over a long period of time to distressing conditions are more likely to develop the disorder • Example: military combat veterans, rape and assault victims, abused children, survivors of natural disasters, etc.

20. Resilience to PTSD • Only about 10% of women and 20% of men react to traumatic situations and develop PTSD. • Holocaust survivors show remarkable resilience against traumatic situations.

21. Can you think of examples of people/characters from literature, TV, or movies who suffered from the following disorders? • Phobic disorder • Panic disorder • Obsessive-compulsive disorder • Post-traumatic stress disorder

22. Etiology of Anxiety Disorders What causes an anxiety disorder?

23. What Causes Anxiety Disorders? • Predictions: • . • . • . • . • .

24. What Causes Anxiety Disorders? • As always seems to be the case, one has to consider both nature and nurture for possible explanations as to the cause of anxiety disorders.

25. What Causes Anxiety Disorders? (cont.) • Nature (biological): • Heredity– a likelihood for developing anxiety disorders. The specific fear may not be inherited, but the predisposition to be fearful is. • Twin studies suggest a moderate genetic predisposition to anxiety disorders. They may be more likely in people who are especially sensitive to the physiological symptoms of anxiety. Figure 14.6: Twin studies of anxiety disorders. The concordance rate for anxiety disorders in identical twins is higher than that for fraternal twins, who share less genetic overlap. These results suggest that there is a genetic predisposition to anxiety disorders. (Data based on Noyes et al., 1987; Slater & Shields, 1969; Torgersen, 1979, 1983)

26. What Causes Anxiety Disorders? (cont.) • Nature (biological): • Brain function – Brain scans show that people with anxiety disorders have brains that literally function differently from those who don’t (like in the amygdala, the emotion center). This is why such disorders often respond to medication. • Abnormalities in neurotransmitter activity at GABA synapses have been implicated in some types of anxiety disorders, and abnormalities in serotonin synapses have been implicated in panic and obsessive-compulsive disorders. Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex. A PET scan of the brain of a person with Obsessive-Compulsive Disorder (OCD). High metabolic activity (red) in the frontal lobe areas are involved with directing attention. Anterior Cingulate Cortex of an OCD patient. Brain image of an OCD patient

27. What Causes Anxiety Disorders? (cont.) • Nature (biological): • Evolution – We are likely to fear situations that posed danger to the earliest humans. People who didn’t have a healthy dose of fear were less likely to survive. Those who did survive passed on their tendency to fear these dangers to us. • Note: We don’t have a similar inherited tendency to fear threats that have developed more recently. Cars, for example, kill more people in the modern world than snake bites do, yet more people fear snakes than fear cars.

28. What Causes Anxiety Disorders? (cont.) • Nurture (learning): • Conditioning – We associate fear with certain places or things (like Little Albert). Many anxiety responses, especially phobias, may be caused by classical conditioning and maintained by operant conditioning (we are rewarded when our anxiety is reduced because we avoid the object, for example). • Observationallearning – We can also learn fears from our parents our older siblings. If we see them experience fear during a thunderstorm, we may learn to fear thunderstorms as well (remember the caged monkeys who became afraid of snakes). • Reinforcement – We also learn to associate emotions with actions, depending on the results that follow those actions. If it will reduce our anxiety or fear, we will continue the behavior. (If we are afraid of heights, we learn to avoid heights. Someone with OCD might learn that his compulsive hand-washing reduces his anxiety, so he repeats the behavior.

29. Figure 14.7: Conditioning as an explanation for phobias. (a) Many phobias appear to be acquired through classical conditioning when a neutral stimulus is paired with an anxiety-arousing stimulus. (b) Once acquired, a phobia may be maintained through operant conditioning. Avoidance of the phobic stimulus reduces anxiety, resulting in negative reinforcement.

30. What Causes Anxiety Disorders? (cont.) • Other Explanations for Anxiety Disorders: • Our Unconscious – Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety. • CognitiveTheories – Cognitive theories hold that certain styles of thinking, over-interpreting harmless situations as threatening, for example, make some people more vulnerable to anxiety disorders. • Personality – The personality trait of neuroticism has been linked to anxiety disorders, and stress appears to precipitate the onset of anxiety disorders. Figure 14.8: Cognitive factors in anxiety disorders. Eysenck and his colleagues (1991) compared how subjects with anxiety problems and nonanxious subjects tended to interpret sentences that could be viewed as threatening or nonthreatening. Consistent with cognitive models of anxiety disorders, anxious subjects were more likely to interpret the sentences in a threatening light.