ANXIETY RELATED DISORDERS
Stage of resistance – when stress
*missing hehe*
Stress
Fight or Flight Response – acute stress
Cortisol – calm; w strong impact towards
immune system; if we are attacked w
stress = headache, tired, feel sick;
explains why there are physical
symptoms with stress.
Anxiety
- A subjective individual experience
characterized by feelings of
apprehension, uneasiness,
uncertainty, or dread that warns a
person of actual or imagines,
misperceived or misinterpreted
- *missing*
Types of Anxiety
1 Normal – healthy anxiety, mobilizes a
person to action
Woke up late for morning circle, so
you prepare yourself while thinking of
paraphernalia; arrived w complete
one
2 Acute – precipitated by imminent loss
or change that threatens sense of
security
Girl picture in bf’s phone but later on
find out its not what you think; OR
3 Chronic- anxiety that an individual has
lived for a long time
Gas-General Adaptation Syndrome
(HANS SELYE)
3 Stages of Gas
1. Alarm Stage – activate/releasing
of adrenaline, cortisol, leading to
physiologic experiences (flushing,
dilation of pupils, inc BP,
tachypnea, tachycardia); inc of
sugar/glucose int the blood stream
ready for the system to be used
2.
stimulates the digestive system to
reduce function, hyperventilation,
heart beats faster, you inhale and
exhale = calming
3. Stage of exhaustion/adaptation
Overthinking = as habit; stress
cycle don’t stop and reaches to
exhaustion; person feel tired,
unable to cope, depress and the
feeling of anxiety
4 Levels of Anxiety
1. Mild (+1)
- Positive state of heightened
awareness % sharpened sense
- Increased problem-solving ability
Keeps you focused, attentive to
what you are doing this time
2. Moderate/Apprehension Level
(+2)
- Focus ins on the immediate task
only (tunnel vision)
- Decrease attention span
- Ability to learn is still present
- Use of palliative coping to
alleviate anxiety
*relaxation techniques
- Madala pa ug deep breathing
3. Severe/Free Floating (+3)
- creates a feeling that something
bad is going to happen or feelings
of an impending doom
- Individual cannot be redirected to
a task
- Behavior is geared towards
relieving anxiety and not on
problem solving
o Give short explicit
directions
o Medications may be given
o Ensure safety
4. Panic (+4)
- loss of rational thought,
helplessness
 - Alteration in sensory perceptions,
complete physical immobility
muteness
- May lead to exhaustion and death
o Ensure safety/dec
environmental stimuli
o Do not touch the patient
unless really needed
o Give medications
You don’t touch the client
this time
Anxiety Related Disorders
- Formerly known as “Neurotic
Disorders”
- Used of rigid, repetitive, ineffective
behaviors to displace anxiety
(phobia, conversion, dissociative
d/o, hypochondriasis) or to fix it
- Common DM used: repression,
displacement (anger to mother,
transferred to dog), and
symbolization (person w deep
meaning within self, reflected in
tattoo)
- Reality testing is usually intact
- Judgement is typically unimpaired,
aware that thoughts are irrational
but cannot control it.
In-touched with reality, aware that
their thoughts are irrationalized
OA in the perspective of others
but in fact, they can’t just control it
- Illness is chronic
- Anxiety do differ from one
anothwe in the types of object or
situations that induce fear, anxiety
or avoidance behavior
- Differ from developmentally
normative fear (expected to feel
fear bc you are still a child, in
anxiety do, you still fear despite
age) by being excessive or
persisting beyond
developmentally appropriate
periods.
- Many of it developed in childhood
and tend to persist if not treated.
Anxiety Disorders
1. Separation Anxiety Disorder
2. Selective Mutism
3. Specific Phobia
4. Social Anxiety Disorder
You don’t join even if it is your
own party
5. Panic Disorder
6. Agoraphobia
7. Generalized Anxiety Disorder
Treatment Approach
1. Pharmacologic
2. Psychosocial (Cognitive
behavioral therapy)
3. Individual psychotherapy
4. Family therapy
Anxiety Disorders
1. Generalized Anxiety Disorders
- GAD, aka free-floating anxiety
- Persistence of anxiety that hounds
everyday existence of the person
- Always anticipates disaster
- Worried excessively – major or
minor issues
- May range from mild nervousness
to continuous feelings of dread
- Can be very debilitating- makes it
difficult to carry out even the most
ordinary or simple activities
- 2x more common in women than
in men
Essential Features:
A. Excessive anxiety/worry
occurring for at least 6 months
B. Difficulty controlling the worry
C. Presence of at least three
associated symptoms (one for
children)
 a. Restlessness Panic attacks fade by itself without
b. Being easily fatigued intervention
c. Diff concentrating or
- Does not seek treatment
min getting blank
- Leads to 3 serious side effects
d. Irritability
The problem is, person with this
e. Muscle tension
do don’t know that it will just fade
f. Sleep disturbance
D. Symptoms cause significant 3 Serious Side Effects
distress/impairment in
social/occupational functioning 1. Avoidance
E. Symptoms not due to a - Avoids activities, places or
substance and does not occur situations that can trigger attack
with mood disorder, psychotic wont go to mall anymore, wont
disorder or pervasive cross streets
developmental disorder 2. Agoraphobia
- Fear and avoidance of public
Management places
Wont go to movie house, park
1. Assist client in decreasing anxiety
3. Anticipatory Anxiety
2. Goal: develop adaptive coping
- Develops intense anxiety between
responses
episodes
3. Milieu: recreational activities,
- May abuse substance to cope,
group therapy: stress mgt,
develop depression
problem solving, self-esteem
What if today na ang attack kay
building
wala gahpon. Won’t go to school
diverts client from anxiety
because there is RD
4. Behavioral therapy: relaxation
training (inhale 5secs exhale with Panic Disorder Diagnostic Criteria
sound)
5. Medications: benzodiazepines Both (1) and (2)
(short term basis only – buspirone 1. Recurrent and unexpected panic
(Buspar) develops attachment attacks
(venlafaxine, ssris) 2. At least one of the attacks has
been followed by a month or more
2. Panic Disorder of at east one of the following:
- Core symptom is “panic attack” – a. Persistent concern or
overwhelming fear that occurs out worry about the
of the blue or without warning and implications of the attack
from no reason or its consequences
- May last for 10mins to an hour b. Significant change in the
- Occurrence, intensity, frequency behavior related to the
vary but is chronic attacks
- Affects woman 3x more than men 3. Presence/absence of agoraphobia
- Onset: late adolescence to early 4. Panic attacks are not due to the
adulthood effects of a substance or general
- Precipitating factors: stressful life medical condition
experience (unable to graduate, brain injury that affects amygdala
separation) (Responsible For fear)
 5. Panic attacks are not better
accounted for another mental
disorder (e.g. specific phobia,
OCD, PTSD)
Agoraphobia
Diagnostic Criteria:
A. Marked fear or anxiety about 2 or
more of the ff:
a. Using public transportation
b. Being in an open space
c. Being in enclosed places
d. Standing on line or being
in the crowd
e. Being outside of the home
alone
B. Fear is due to thoughts that
escape is difficult in the even of
developing panic-like symptoms
C. The agoraphobia always provokes
fear or anxiety
D. Situation is always avoided or
requires companion, endured with
intense fear
Management
1. Milieu
a. Stay with client and remain
calm
b. Remove the stimuli/move
the client to a less
stimulating environment
c. Provide paper bag if client
is hyperventilating
d. Speak in short, simple
sentences
e. Give q direction at a time
f. Do not touch
g. Allow patient to pace or cry
h. Teach relaxation exercises
when attack subsides
If during attack, they
cannot understand
i. Medications: anxiolytics or
antidepressants (TCAs,
SSRIs [DoC], MAOIs)
3. Phobias
- Uncontrollable, persistent and
irrational fear of an object, activity
or situation that is out of
proportion to the stimulus
- Use of DM: displacement,
symbolization, projection,
avoidance
- Repressed conflicts are projected
to the outside world and
eventually displaced onto an
object or situation
- Individual takes extreme
measures to avoid occupational
terror = impairment in social and
occupational functioning
- s/s similar to “panic attack” when
exposed
3 Major types of Phobia
1. Specific or Simple Phobia
- Marked and persistent fear that is
excessive or unreasonable due to
the presence or anticipation of a
specific object or situation
- Exposure to phobic stimulus
almost invariably evokes an
immediate anxiety response
- Person recognizes that the fear is
excessive or unreasonable
- Phobic situations are avoided or
endured with intense
anxiety/distress
- The avoidance, anxious
anticipation or distress of the
feared stimuli interferes with
social/occupational functioning
- In individuals under age 18, the
duration is at least 6 months
 - The anxiety, panic attacks or
phobic avoidance is not better
accounted for other mental
disorders (e.g. OCD, PTSD)
Subtypes for specific phobia
1. Animal phobia (snakes, spiders)
2. Natural environment (storms,
water, heights)
3. Blood, injection, injury
4. Situational
party
5. Others
Social Anxiety Disorder
A. Marked, persistent fear of social
or performance situations which
he is exposed to unfamiliar people
or to scrutiny by others
B. Exposure to feared social situation
C. *missing*
Separation Anxiety Disorder
A. Developmentally inappropriate and
excessive fear or anxiety concerning
separation from those to whom the
individual is attached as evidenced by
at least 3 of the following:
1. Separation from home
2. Worry of separation due to illness,
injury, death
3. Worry of getting lost, kidnapped,
meeting accidents
4. reluctance to go to school or work
due to fear of separation
5. refusal to sleep away from major
attachment figure
6. complains of physical s/s when
separated
B. anxiety lasting for 4 weeks
C. disturbance is not better accounted
for any other mental conditions
Management:
Behavior Therapy
1. Systemic desensitization
periodic, picture then let them
hold in the next
2. Flooding (more rapid than
desensitization)
3. Self-exposure
4. Accept the patient and their
fear in a noncritical attitude
5. Teach relaxation activities
Medications:
1. anxiolytics (alprazolam,
clonazepam)
2. TCA (imipramine)
3. MAO (phenelzine)
4. Obsessive – Compulsive Disorders
Consist of 2 Components:
1. Obsessions
- Frequently occurring intrusive
thoughts, images, impulses, or
emotion that cause a great deal of
anxiety but cannot be suppressed
2. Compulsions
- Uncontrollable urge to do
repetitive acts that alleviate the
person’s obsession but
recognizes as unnecessary and
unreasonable
they know it is not necessary but
they just do it because they can’t
control it
- RITUALS -are behaviors or
repetitive acts a person engages
in response to a compulsion =
aimed at reducing stress or divert
unacceptable thoughts
 - There is no pleasure in carrying
out rituals = only temporary relief
from anxiety
lessen anxiety and avoid intrusive
thoughts
o Course is variable but
progresses over time
o DM used: displacement,
undoing, repression
o An ego-dystonic disorder
OCD pt knows that I should no
wash my hands, it is against
my will but I still do it
o Equally present in both men
and women
o Onset: women (20-29); men
(6-15)
o Conscience driven, shy,
meticulous, precise about
bodily functions, dress,
religious duty and daily routine
o OCD runs in families
Diagnostic Criteria for OCD
A. Presence of either obsessions or
compulsions or both obsessions as
defined by 1 and 2
1. Recurrent and persistent
thoughts, impulses or images that
are experienced as intrusive and
inappropriate and cause marked
anxiety or distress
2. The person attempts to ignore or
suppress such thoughts, impulses
or images or try to neutralize them
with some thought or action
B. Compulsions as defined by 1 and 2
1. 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
2. the behaviors or mental acts are
aimed at preventing or reducing
distress or preventing some
dreaded event or situation
C. At some point, the person has
recognized that the obsessions or
compulsions are excessive and
unreasonable.
D. The obsession or compulsion case
marked distress, are time consuming
or significantly interfere with the
person’s normal routine, social or
occupational functioning
E. If another axis I disorder (eating
disorder) is present, the obsession or
compulsion is not restricted to it.
F. Not caused by substance or general
medical condition
Common Rituals:
1. Cleaning
a. Fear of real or imagine germs,
dirt, contamination
2. Repeating
a. Utters names, phrases
repeatedly
b. Fear against harm or injury
3. Completing
a. Performs series of
complicated tasks in exact
order until done perfectly
b. Fear something will go wrong
if not done perfectly
4. Checking
a. Repeatedly retraces routes,
routines
b. Fears harming self or others
by missing something in the
routine
c. Locking of door, checks stove
5. Meticulousness
a. Extreme neatness and order
b. Exact arrangements of things,
furniture, clothes, etc.
disruption causes massive
anxiety
6. Avoiding
 a. Stays away from cause of
anxiety and anything related to
it
b. E.g., anxious about chocolate
-avoids anything brown
7. Hoarding
a. Less common
b. Constant collection of useless
items
c. “need to have things” to avoid
anxiety
8. Slowness
a. Uncommon, mostly in men
b. Performs things very slow
c. To make sure nothing is
missed
9. Arranging
a. Arranges things in certain
order
b. Forbidden thoughts
10. Praying
a. A need to tell, ask, confess
11. Touching
a. Intrusive thoughts and sexual
urges
12. Counting
a. Excessive religious or moral
doubt