Anxiety, Trauma- and Stressor-Related, and obsessive compulsive and related

Anxiety is a negative mood state characterized by bodily symptoms of physical tension and by
apprehension about the future.

“Howard Liddell called Anxiety the “shadow of Intelligence.” He thought the human ability to plan in
some detail for the future was connected to that gnawing feeling that things could go wrong and we had
better be prepared for them.

Fear is an immediate emotional reaction to current danger characterized by strong escapist action
tendencies and, often, a surge in the sympathetic branch of the autonomic nervous system.

Panic is experiencing the alarm response of fear when there is nothing to be afraid of. In other words,
panic is experiencing the symptoms of fear, without the presence of an actual threat.

Panic attack is defined as an abrupt experience of intense fear or acute discomfort, accompanied by
physical, symptoms that usually include Heart palpitations, chest pain, shortness of breath, and,
possibly, dizziness. Two basic types of panic attacks are described in DSM-5: Expected and unexpected.

Expected (cued) panic attack – you know you are afraid of high places or of driving over long bridges,
you might have a panic attack in these situations but not anywhere else.

Unexpected (uncued) panic attack – you don’t have a clue when or where the next attack will occur.

Causes of Anxiety and Related Disorders

Biological Contributions

 There are two brain circuits identified by Jeffrey Gray:

 Behavioral inhibition system (BIS), when activated produces the tendency for us to freeze,
experience anxiety, and apprehensively evaluate the situation to confirm that danger is present.
 Fight/flight system (FFS), When stimulated in animals, this circuit produces an immediate alarm-
and-escape response that looks very much like panic in humans.

Psychological Contributions

 A sense of control (or lack of it) that develops from early (childhood) experiences is the
psychological factor that makes us more or less vulnerable to anxiety in later life.
 A true alarm is a strong fear response that occurs initially during extreme stress or perhaps as a
result of a dangerous situation in the environment.
 False or learned alarm is when the initial emotional response becomes associated with external
and internal cues. These cues, or conditioned stimuli, provoke the fear response and an
assumption of danger, even if the danger is not actually present.

External cues are places or situations similar to the one where the initial panic attack occurred.

Internal cues are physical sensations (like increasing of heart rate or respiration) that were associated
with the initial panic attack, even if they are now the result of normal circumstances (such as exercise)

Social Contributions
Stressful life events trigger our biological and psychological vulnerabilities to anxiety. Most are social
and interpersonal in nature—marriage, divorce, difficulties at work, death of a loved one, pressures to
excel in school, and so on. Some might be physical, such as an injury or illness.

TRIPLE VULNERABILITY THEORY

1.Generalized biological vulnerability.

Tendency to be uptight or high-strung might be inherited. But a generalized biological vulnerability to

develop anxiety is not sufficient to produce anxiety itself

2.Generalized psychological vulnerability.

That is, you might also grow up believing the world is dangerous and out of control and you might not
be able to cope when things go wrong based on your early experiences.

3.Specific psychological vulnerability in which you learn from early experience, such as being taught by
your parents.

Anxiety Disorder

1. GENERALIZED ANXIETY DISORDER

Generalized anxiety disorder (GAD) is a mental health condition that causes fear, worry and a constant
feeling of being overwhelmed. It’s characterized by excessive, frequent and unrealistic worry about
everyday things, such as job responsibilities, health or chores.

Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6
months.

 3.1% of the population meets criteria for GAD during a given 1-year period and 5.7% at some
point during their lifetime. In developed countries, two-thirds of individuals with GAD are
female. But in other countries, like South Africa, GAD was more common in males.
 The median age of onset for people with GAD is 31 years old.

Causes

The tendency to become anxious is inherited (although not GAD itself). People with GAD have been
called autonomic restrictors. People with GAD are chronically tense. Early stressful experiences might
have caused people with GAD to learn that the world is dangerous and out of control.

Treatment

Benzodiazepines are most often prescribed for generalized anxiety. A cognitive-behavioral treatment
(CBT) for GAD is developed in which 0atients evoke the worry process during therapy sessions and
confront anxiety-provoking images and thoughts head-on, so that they will feel (rather than avoid
feeling) anxious. The patient learns to use cognitive therapy and other coping techniques to counteract
and control the worry process.

GENERALIZED ANXIETY DISORDER

Diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)
include the following:

Excessive anxiety and worry for at least six months

Difficulty controlling the worrying.

The anxiety is associated with three or more of the below symptoms for at least 6 Months:

1.Restlessness, feeling keyed up or on edge

2.Being easily fatigued

3.Difficulty in concentrating or mind going blank, irritability

4.Muscle tension

5.Sleep disturbance

6.Irritability

The anxiety results in significant distress or impairment in social and occupational areas.

The anxiety is not attributable to any physical cause

Panic Disorder and Agoraphobia

In DSM-IV, panic disorder and agoraphobia were integrated into one disorder called panic Disorder with
agoraphobia, But investigators discovered that many people experienced panic disorder without
developing agoraphobia and vice versa. Most of the time, however, they go together.

Panic Disorder and Agoraphobia

Agoraphobia, coined by Karl Westphal, originally referred to fear of the marketplace. And it still an
appropriate term because one of the most stressful places for individuals with agoraphobia today is the
shopping mall, the modern-day agora.

Agoraphobic avoidance is when people prefers to stay in a safe place or at least with a safe person who
knows what they are experiencing. When people with agoraphobia do venture outside their homes,
they always plan for rapid escape.

Other methods of coping with panic attacks include using (and eventually abusing) drugs and/or alcohol.

Most patients also display another cluster of avoidant behaviors that we call Interoceptive avoidance, or
avoidance of internal physical sensations.

Specific Phobia

A specific phobia is an irrational fear of a specific object or situation that markedly interferes with an
individual’s ability to function.

 Blood–Injection–Injury Phobia - marked by the dropping of heart rate and blood pressure, and
feeling like they're about to faint. The average age of onset for this phobia is approximately 9
years.
  Situational Phobia - fear of public transportation or enclosed places. It tends to emerge from
midteens to mid-20s. The main difference between situational phobia and panic disorder is that
people with situational phobia never experience panic attacks outside the context of their
phobic object or situation.
 Natural Environment Phobia - Fears of situations or events that occur in nature. These phobias
have a peak age of onset of about 7 years.
 Animal Phobia - Fears of animals and insects. Again, these fears are common but become phobic
only if severe interference with functioning occurs. The age of onset for these phobia, peaks
around 7 years.

Separation Anxiety Disorder – is characterized by children’s unrealistic and persistent worry that
something will happen to their parents or other important people in their life or that something will
happen to the children themselves that will separate them from their parents (be lost, kidnapped, Killed,
or hurt in an accident). In treating separation anxiety in children, parents are often included to help
structure the exercises and also to address parental reaction to childhood anxiety.

Social Anxiety Disorder (Social Phobia)

Individuals with just performance anxiety, which is a subtype of SAD, usually have no difficulty with
social interaction, but when they must do something specific in front of people, anxiety takes over and
they focus on the possibility that they will embarrass themselves.

Anxiety-provoking physical reactions include

Blushing, sweating, trembling, or, for males, Urinating in a public restroom (“bashful bladder” or
Paruresis).

SELECTIVE MUTISM

Now grouped with the anxiety disorders in DSM-5, selective mutism (SM) is a rare childhood disorder
characterized by a lack of speech in one or more settings in which speaking is socially expected. As such,
it seems clearly driven by social anxiety, since the failure to speak is not because of a lack of knowledge
of speech or any physical difficulties, nor is it due to another disorder in which speaking is rare or can be
impaired such as autism spectrum disorder. In order to meet diagnostic criteria for SM, the lack of
speech must occur for more than one month and cannot be limited to the first month of school