Anxiety and Somatoform Disorders Adapted from an outline

Anxiety and Somatoform Disorders Adapted from an outline © 2009 American Psychological Association

Anxiety Disorders �A. A diagnosis of anxiety disorder occurs when overwhelming anxiety disrupts social or occupational functioning or produces significant distress. �Taylor Manifest Anxiety Scale

Anxiety Disorders �B. Manifestations of anxiety � 1. Cognitive: Thought processes range from generalized worry to overwhelming fear and often focus on various possibilities of impending doom. � 2. Behavioral: The avoidance of an anxiety-provoking situation may be practiced. For example, persons may be unwilling to leave home. � 3. Somatic: Numerous physiological complaints are experienced due to activation of the sympathetic nervous system. Examples include stomach aches, headaches, shakiness, and so forth.

Specific anxiety disorders �A. Panic disorder � 1. Recurrent and unexpected panic attacks are severe and involve feelings of terror and physiological involvement, such as a pounding heart and difficulty breathing. � 2. These attacks lead to concern about future attacks or losing control, which may result in the individual being fearful of having a panic attack in public or of leaving home.

Specific anxiety disorders �B. Generalized anxiety disorder � 1. This is characterized by persistent high levels of anxiety and excessive worry with symptoms present for at least six months. � 2. The physiological responses are similar to, although not as severe as, those experienced in panic disorder, but they are more persistent.

Specific anxiety disorders �C. Phobia � 1. A persistent, irrational, unrealistic fear of specific objects or situations. � 2. Exposure to a feared stimulus produces intense fear or panic. The anxiety dissipates when the phobic situation is not being confronted. � 3. Three subcategories include: � a) Simple phobias, such as fear of closed spaces (claustrophobia) or spiders (arachnophobia). � b) Agoraphobia, which is the irrational fear of open spaces, leading to a fear of leaving home or other safe havens. � c) Social phobias involving social situations, such as public speaking.

Specific anxiety disorders �D. Obsessive-compulsive disorder (OCD) � 1. This involves both patterns of obsessions (thoughts, images, or impulses that recur or persist despite a person’s efforts to suppress them) and compulsions (repetitive, purposeful, but undesired acts performed in a ritualized manner in response to an obsession). � 2. Persons with the disorder acknowledge the senselessness of their behavior; however, when anxiety rises, the ritualized behavior to relieve the tension cannot be resisted.

Trauma and stressorrelated disorders Added in the DSM-V

Trauma and stressor-related disorders A. Posttraumatic stress disorder: �A maladaptive reaction to actual or threatened death, serious injury, or sexual violence characterized by problems such as recurrent intrusive memories of the event, flashbacks, fear of stimuli associated with the event, negative changes in mood and ability to concentrate, irritability, and feelings of detachment

Trauma and stressor-related disorders B. Adjustment disorder: �A person’s development of emotional or behavioral problems within 3 months after experiencing a stressful event

Causes of trauma and stress-related disorders A. Psychological: Negative appraisals, fatalistic beliefs, apprehension, early childhood traumas, lack of social support, poor coping skills, low efficacy, limited self-capacities B. Biological: Abnormal activity of cortisol and norepinephrine; abnormal activity in a circuit involving the hypothalamus and amygdala

Explaining anxiety disorders �A. The learning perspective � 1. Generalized anxiety has been linked with a classical conditioning of fear and the attendant stimulus. � 2. Avoidance relieves fear through negative reinforcement.

Explaining anxiety disorders �B. The cognitive perspective � 1. Observational learning can produce fear which results in anxiety. � 2. For example, if a parent fears dogs, the child may learn this fear through observation.

Explaining anxiety disorders �C. The biological perspective � 1. Fears that represent age-old threats, such as heights or spiders, may have contributed to our survival and have an evolutionary basis. � 2. Some people are genetically predisposed to fears and high anxiety. These disorders tend to run in families.

Explaining anxiety disorders �D. The biopsychosocial perspective views anxiety as having a biological involvement and learning component, both of which are influenced by culture.

Somatoform Disorders �A. These disorders are characterized by complaints of physical symptoms that have no organic or physiological explanation-they are psychologically based. �The symptoms are not considered voluntary or under conscious control.

Specific somatoform disorders � 1. Somatization disorder is characterized by multiple physical complaints with no organic explanation and an onset before age 30. � 2. Conversion disorder is characterized by a specific physical complaint, such as paralysis of the legs, or blindness. Patients strongly believe there is impairment, but may show less distress than with a real loss. � 3. Hypochondriasis is characterized by persistent preoccupation with one's health and physical condition, despite the fact that genuine symptoms of a disorder are lacking.

Explaining somatoform disorders �A. These disorders now constitute only 5% of all disorders treated. Decreasing incidence seems linked to our growing understanding of physiological and psychological disorders. �B. The behavioral perspective suggests that avoidance behavior (becoming ill to avoid or reduce anxiety-arousing stress) is reinforced in two ways: � 1. Anxiety is reduced. � 2. There are interpersonal gains in terms of sympathy and support.