ANXIETY OBSESSIVECOMPULSIVE AND TRAUMA AND STRESSORRELATED DISORDERS CHAPTER

ANXIETY, OBSESSIVECOMPULSIVE, AND TRAUMA AND STRESSOR-RELATED DISORDERS CHAPTER 8 Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

THE NATURE OF ANXIETY DISORDERS • The essential feature of anxiety disorders is the experience of a chronic and intense feeling of anxiety. • A future-oriented response which involves a sense of dread about what might happen to you in the future. • Fear: Innate alarm response to a dangerous or lifethreatening situation. • Anxiety disorders are the most highly prevalent of all psychological disorders with the exception of substance use disorders. Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

PANIC DISORDER • Panic attacks on a recurrent basis • Has constant apprehension and worry about the possibility of recurring attacks • Panic attack: A period of intense fear and physical discomfort accompanied by the feeling that one is being overwhelmed and is about to lose control Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

DEMOGRAPHICS OF LIFETIME PREVALENCE FOR ANXIETY DISORDERS Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

SEPARATION ANXIETY DISORDER • A childhood disorder characterized by intense and inappropriate anxiety, lasting at least 4 weeks, concerning separation from home or caregivers. • Epidemiologists estimate that 4. 1 percent of children have diagnosable separation anxiety disorder and about one-third of these persist into adulthood. Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

THEORIES AND TREATMENT OF SEPARATION ANXIETY DISORDER • A bio-psychosocial model seems particularly appropriate for understanding separation anxiety disorder. • Results of twin studies suggest strong genetic support. • Important environmental contributions to the development of this disorder. Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

SELECTIVE MUTISM • A disorder originating in childhood in which the individual consciously refuses to talk. • Children with this disorder are capable of using normal language, but they become almost completely silent under certain circumstances. • Anxiety may be at the root of selective mutism given that children most typically show this behavior in school rather than at home. Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

SPECIFIC PHOBIAS • Phobia: An irrational fear associated with a particular object or situation • Specific Phobia: An irrational and unabating fear of a particular object, activity, or situation Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

SPECIFIC PHOBIAS • Categories • • • Animals Natural environment Blood-injection-injury Engaging in activities in particular situations Variety of miscellaneous stimuli Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

SPECIFIC PHOBIAS: THEORIES AND TREATMENT • • • Systematic desensitization Flooding Imaginal flooding Graduated exposure Thought stopping Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

SOCIAL ANXIETY DISORDER • Social Anxiety Disorder is characterized by intense, fear of anxiety of social situations in which the individual may be scrutinized by others. • The anxiety the person experiences is centered on a desire to avoid humiliation or embarrassment Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

SOCIAL ANXIETY DISORDER: THEORIES AND TREATMENT • Biological perspectives • SSRIs and SNRIs • Psychological perspectives • Motivational interviewing • Acceptance and commitment therapy • Mindfulness/meditation • http: //www. succeedsocially. com/cognitivedistortions Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

PANIC DISORDER • An anxiety disorder in which an individual has panic attacks on a recurrent basis or has constant worry about the possibility of recurring attacks. • Panic disorder is often associated with agoraphobia Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

AGORAPHOBIA • Intense anxiety about being trapped or stranded in a situation without help if a panic attack occurs. • Fear or anxiety about two of the following five: • • • Using public transportation Being in an enclosed space (such as a theater) Being in an open space (such as a parking lot) Being outside of the home alone Standing in line or being in a crowd • Their fear or anxiety is out of proportion to the actual danger involved in the situation Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

THEORIES AND TREATMENT OF PANIC DISORDER AND AGORAPHOBIA • Biological perspectives • Neurotransmitters • Anxiety Sensitivity • Psychological perspectives • Conditioned Fear Reactions • Relaxation training • Panic control therapy (PCT) Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

GENERALIZED ANXIETY DISORDER • Anxiety that is not associated with a particular object, situation, or event • A constant feature of a person's day-to-day existence Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

OBSESSIVE-COMPULSIVE AND RELATED DISORDERS • Obsession: Persistent and intrusive idea, thought, impulse, or image. • Compulsion: Repetitive and seemingly purposeful behavior performed in response to: • Uncontrollable urges or according to a ritualistic or stereotyped set of rules Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

OBSESSIVE-COMPULSIVE DISORDER • Recurrent obsessions that are inordinately timeconsuming or that cause significant distress or impairment Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

OBSESSIVE-COMPULSIVE DISORDER • 4 major dimensions • Obsessions associated with checking compulsions • Need for symmetry and order • Obsessions about cleanliness associated with washing compulsions • Hoarding-related behaviors Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

OBSESSIVE-COMPULSIVE DISORDER • Most effective biological treatments available for OCD • Treatment with clomipramine • Treatment with other serotonin reuptake inhibiting medications • Fluoxetine (Prozac) Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

BODY DYSMORPHIC DISORDER • A disorder in which individuals are preoccupied with the idea that a part of their body is ugly or defective. • People with BDD perform compulsive behaviors. • People with BDD may check themselves constantly, groom themselves to an excessive degree, or constantly seek reassurance from others about how they look. • BDD is frequently comorbid with major depressive disorder, social anxiety disorder, obsessive-compulsive disorder, and eating disorders. Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

BODY DYSMORPHIC DISORDER MODIFICATION OF THE YALEBROWN OBSESSIVE-COMPULSIVE SCALE (BDD-YOCS) Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

HOARDING DISORDER • A compulsion in which people have persistent difficulties discarding things, even if they have little value. • They believe these items to have utility, to have aesthetic or sentimental value, but in reality the items often consist of old newspapers, bags, or left over food Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

TRICHOTILLOMANIA (HAIR-PULLING DISORDER) • The compulsive, persistent urge to pull out one’s own hair. • Relief, pleasure, or gratification is typically experienced after pulling out their hair. Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

EXCORIATION (SKIN-PICKING) DISORDER • Recurrent picking at one’s own skin which can be healthy skin, or skin with mild irregularities. • When they are not picking their skin, they think about picking it and try to resist their urges to do so. • Prevalence is estimated at least 1. 4% of adults, threequarters of whom are female Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

TRAUMA- AND STRESSOR-RELATED DISORDERS Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

REACTIVE ATTACHMENT DISORDER • A disorder involving a severe disturbance in the ability to relate to others. • The individual is unresponsive to people, is apathetic, and prefers to be alone rather than to interact with friends or family. • These children are emotionally withdrawn and inhibited and show little positive affect and an ability to control their emotions. • When distressed, they do not seek comfort Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

DISINHIBITED SOCIAL ENGAGEMENT DISORDER • Diagnosis given to children who engage in culturally inappropriate, overly familiar behavior with people who are relative strangers. Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

TRAUMA- AND STRESSOR-RELATED DISORDERS • These disorders are placed among the trauma- and stressor-related disorders because they are found in children who have experienced an abuse pattern of social neglect, repeated changes of primary caregivers, or rearing in institutions with high child-to-caregiver ratios. • Consequently, such children are significantly impaired in their ability to interact with other children and adults. Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

ACUTE STRESS DISORDER AND POSTTRAUMATIC STRESS DISORDER • Traumatic experience: Disastrous or extremely painful events. • Has severe psychological and physiological effects • Flashbacks • Nightmares Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

TRAUMA-INDUCED DISORDERS • Acute stress disorder: is an anxiety disorder that develops after a traumatic event, and lasts for up to 1 month. • Symptoms • • Intrusion of distressing reminders of the event Dissociative symptoms Avoidance of situations that serve as reminders of the event Hyper-arousal Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

TRAUMA-INDUCED DISORDERS • Post-traumatic stress disorder: Individual experiences several distressing symptoms for more than a month following a traumatic event. • Symptoms fall into categories: • Intrusions • Dissociation • Avoidance Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

The following are examples of people with PTSD: • A firefighter quits his job two years short of retirement because of persistent fiery nightmares and chest pains. • A young girl has become hyperactive since her tonsillectomy nine months before. • A previously studious teenaged boy is no longer able to concentrate on his school work and is failing his classes since the death of his grandmother last year. He no longer enjoys going to school, and is becoming increasingly house-bound. • A Middle Eastern refugee is arrested after a fight in a bar. He says all he remembers is a smell that reminded him of the prison where he was tortured, then he woke up in a police cell. • A war veteran still awakes screaming from nightmares of combat, thirty years after he was discharged from service. • A woman who was molested when she was six years old begins to be disturbingly over-protective of her own six year old daughter. • A man seeks psychotherapy because he is suffering from persistent anxiety and panic attacks. • A boy is observed aggressively trying to stick pencils and crayons under the tails of his stuffed animals. Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

POST-TRAUMATIC STRESS DISORDER: THEORIES AND TREATMENT • Hippocampus • SSRI antidepressants • Combines exposure (in vivo or imaginal) with relaxation and cognitive restructuring • EMDR Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

ANXIETY, OBSESSIVE-COMPULSIVE, AND TRAUMAAND STRESSOR-RELATED DISORDERS: THE BIO-PSYCHOSOCIAL PERSPECTIVE • Problems • Differences and similarities in symptoms and causes • Unique combination represented in that person’s life by: • Confluence of genetics, brain functioning, life experiences, and social context Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.

• For more information on material covered in this chapter, visit our Web site: • http: //www. mhhe. com/whitbourne 7 eupdate Copyright © 2014 Mc. Graw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of Mc. Graw-Hill Education.