Chapter four: General theoretical explanation

about the nature, cause and treatment

mechanisms of different mental disorders
4.1. Anxiety disorder
4.2. Mood disorder
4.3. Personality disorder
4.4. Schizophrenias and other Psychotic
disorder
4.5 Dissociative and somatoform disorder
Anxiety disorder

Anxiety disorder
Anxiety disorder

• Anxiety is a general term for several disorders that cause

nervousness, fear, apprehension, and worrying.

• Anxiety disorders affect how we feel and behave, and they can
manifest real physical symptoms.

• People often experience a general state of worry or fear before

confronting something challenging such as a test, examination,
presentation, or interview.

• Generally speaking anxiety isn't necessarily a problem. But when it

becomes persistent, powerful and interferes with daily life, it's called an
anxiety disorder.
 Anxiety disorder---

• Anxiety disorders can be classified into several more specific types. The
most common:
• Generalized anxiety
• Panic attack
• Post traumatic stress disorder
• obsessive compulsive disorder
• phobia
• Agora phobia
• specific phobia
• social phobia
 Anxiety disorder---

Generalized Anxiety Disorder

 Generalized anxiety disorder (or GAD) is characterized by

excessive, exaggerated anxiety and worry about everyday life events
with no obvious reasons for worry (for example, worries about
health family, finances).

 Generalized anxiety disorder involves continuous worry about daily life

experiences. Anxiety occurs for a period of at least six months

 Gender difference; Generalized anxiety occurs more often in

women, with a sex ratio of about 2 women to 1 man
 Anxiety disorder---

• Characteristics of person with Generalized Anxiety

• Feeling of anxious or worry most of time takes 10 to 15 minutes or it last 6
month

• People are always in some state of discomfort

• Usually have no good explanations for feelings of anxiety

• function in social situations but with full of suspicion

• Particularly prone to drug and alcohol abuse.

• Of people experiencing disorder, 79 percent experience two or more different

disorders - co morbidity

• Daily life became constant state of worry, fear and dread

• Worry is unrealistic or out of proportion for the situation

 Anxiety disorder…

Symptom of GAD
GAD affects the way a person thinks, but the anxiety can
lead to physical symptoms, as well. Symptoms of
GAD can include‘
• Restlessness

shortness of breath

accelerated heart rate

 dry mouth

 Tiredness

 dizziness

 Sweating
 Anxiety disorder…
Case 1 of GAD
“I’ would have terrible sleeping problems. There were times I’d
wake up wired in the middle of the night. I had trouble
concentrating, even reading the newspaper or a novel.
Sometimes I’d feel a little dizzy. My heart would race or pound.
And that would make me worry more. I was always imagining
things were worse than they really were. When I got a
stomachache, I’d think it was an ulcer and fear I would die.”
 Anxiety disorder…
Panic anxiety

• A panic attack is a discrete period of strong fear or

discomfort that is associated with numerous somatic and
cognitive symptoms (DSM-IV).

• Panic Anxiety is characterized by intense physical

symptoms and sudden overpowering feelings of terror.

• People having panic attacks sometimes believe they are

having heart attacks, losing their minds, or on the
verge of death

• People with panic attack could not predict when or where an

attack will occur
Anxiety disorder…
Symptoms of Panic Disorder

• Symptoms of a panic attack, which often last about 10 minutes,

include:

Difficulty breathing.

Pounding heart or chest pain.

Intense feeling of terror.

Sensation of unpleasant or overwhelming.

Dizziness or feeling faint.

Trembling or shaking.

Sweating

Nausea or stomachache.

Tingling or numbness in the fingers and toes.

 Anxiety disorder…

Case 2 panic attack

“It started 10 years ago, when I had just graduated from college
and started a new job. I was sitting in a business seminar in a hotel and
this thing came out of the blue. I felt like I was dying my heart pounds
really hard, I feel like I can’t get my breath, and there’s an
overwhelming feeling that things are crashing on me.”
 Anxiety disorder…
Phobia
• Phobia is an irrational, intense and persistent fear of certain
situations, activities, things, animals, or people. In most cases, the
phobia involves a sense of endangerment or a fear of harm.

• The main symptom of this disorder is the excessive and

unreasonable desire to avoid the feared stimulus.

• Gender difference; more common in women than in men.

• Types of phobia

• Social phobia

• agora phobia

• Specific phobia
 Specific phobia
Case I’m scared to death of flying, and I never do it anymore. I
used to start dreading a plane trip a month before I was due to leave. It
was an awful feeling when that airplane door closed and I felt trapped.
My heart would pound, and I would sweat bullets. When the airplane
would start to ascend, it just reinforced the feeling that I couldn’t get
out. When I think about flying, I picture myself losing control, freaking
out, and climbing the walls, but of course I never did that
 Anxiety disorder---

• Specific phobias Specific Phobia is characterized by intense,

irrational fear reactions to a particular object, place or
situation leading people to dread confronting common,
everyday situations, or avoid them altogether, even though
they know that there isn't any threat of danger in reality.
 Anxiety disorder…
• There are four major types of specific phobias:

• The natural environment—fear of lightening, water, storms,

etc.
• Animal—fear of snakes, rodents, spiders, etc.
• Medical-fear of seeing blood, receiving injections, visiting a
doctor,
• Situational—fear of bridges, leaving the home, driving, etc.
• Some examples of specific phobias are;
• Bacteriophobia - Fear of bacteria.
• Cynophobia - Fear of dogs
• Dentophobia - Fear of dentist
• Equinophobia - Fear of horses.
• Gynophobia - Fear of women.
•
 Anxiety disorder…
Social phobia
• Case “When I would walk into a room full of people, I’d turn red and
it would feel like everybody’s eyes were on me. I was embarrassed to
stand off in a corner by myself, but I couldn’t think of anything to say
to anybody. It was humiliating. I felt so clumsy, I couldn’t wait to get
out.”

• This is described as a persistent fear of social or

performance situations in which embarrassment may
occur (DSM-IV).

• The fear tends to be of being in the center of other

people’s attention and of being judged.
 Anxiety disorder…

• Most people with social anxiety disorder fear more than one social
situation. Situations that commonly provoke anxiety include:
• Eating or drinking in front of others.
• Writing or working in front of others.
• Being the center of attention.
• Interacting with people, including dating or going
to parties.
• Asking questions or giving reports in groups.
• Using public toilets.
• Talking on the telephone.
 Anxiety disorder…
Symptoms of Social phobia

• Many people with social anxiety disorder feel that there is

"something wrong," but don't recognize their feeling as a sign of
illness. Symptoms of social anxiety disorder can include:
• Intense anxiety in social situations.
• Avoidance of social situations.
• Physical symptoms of anxiety, including confusion,
pounding heart, sweating, shaking, embarrassed,
muscle tension, upset stomach, and diarrhea.
 Anxiety disorder…

• ’Agoraphobia" is an English adoption of the Greek words agora

and Phobos. The term "agora" refers to the place where ancient
Greeks used to gather and talk about issues of the city,

• This is a fear of public places. It's the most common of anxiety

disorders, accounting for about half of all cases. People with
agoraphobia experience anxiety in supermarkets and
department stores, crowded places of all kinds, confined
spaces, public transport, lifts, freeways and heights. To avoid this
happening, they often stay at home and won't leave.
 Anxiety disorder…
Gender difference; Agoraphobia occurs about twice as
commonly among women as it does in men

Symptoms of Agoraphobia

• The list of signs and symptoms mentioned in various sources

for agoraphobia includes:
Fear of crowds
Fear of public transport
Restriction to home or neighbor hood
Social isolation
Unable to leave home alone
Panic attack
 Anxiety disorder…
Obsessive-compulsive disorder (OCD)

• Obsessive-compulsive disorder (OCD) is a type of anxiety disorder, a

potentially disabling illness that traps people in endless cycles of repetitive
thoughts and behaviors.

• People with OCD are plagued by recurring and distressing thoughts, fears,
or images (obsessions) that they cannot control.

• The anxiety (nervousness) produced by these thoughts leads to an urgent

need to perform certain rituals or routines (compulsions). People with
OCD may also worry about things being "out of order" or not "just right
 Anxiety disorder…
•The disturbing thoughts are called obsessions, and the rituals are
called compulsions.

• Obsessions are ideas or thoughts that involuntarily and

persistently intrude into awareness.

• Compulsions constantly intruding, repetitive acts or behaviors.

example person with an unreasonable fear of germs who constantly

washes his or her hands. These rituals are usually time-consuming and
interfere with normal life. People with this disorder are often
extremely embarrassed about it and keep it a secret from mothers.
 Anxiety disorder…
Symptoms of OCD

• The symptoms of OCD, which are the obsessions and compulsions,

may vary. Common obsessions include:

• Fear of dirt or contamination by germs.

• Fear of causing harm to another.
• Fear of making a mistake.
• Fear of thinking evil or sinful thoughts.
• Need for order, symmetry, or exactness.
• Excessive doubt and the need for constant
reassurance.
 Anxiety disorder…
Common compulsions include:

• Repeatedly bathing, showering, or washing .

• Refusing to shake hands or touch doorknobs.
• Repeatedly checking things, such as locks
• Constantly arranging things in a certain way.
• Eating foods in a specific order.
• Repeating specific words, phrases, or
prayers.
• Needing to perform tasks a certain number of
times.
• Collecting or hoarding items with no apparent
value
 Anxiety disorder…
Posttraumatic stress disorder

• Posttraumatic stress disorder (PTSD) is an emotional illness

that is classified as an anxiety disorder and usually develops as
a result of a terribly frightening, life-threatening, or otherwise
highly unsafe experience.

• PTSD sufferers re-experience the traumatic event or events in

some way, tend to avoid places, people, or other things that
remind them of the event (avoidance), and are exquisitely
sensitive to normal life experiences (hyper arousal).
 Anxiety disorder---
Different names where given for PTSD

 when combat veterans were referred to as suffering from

"soldier's heart.“

 In World War I, symptoms that were generally consistent with this

syndrome were referred to as "combat fatigue."

Soldiers who developed such symptoms in World War II were said

to be suffering from "gross stress reaction," and

 many troops in Vietnam who had symptoms of what is now

called PTSD were assessed as having "post-Vietnam
syndrome." PTSD has also been called battle fatigue" and
"shell shock."
 Anxiety disorder…
Traumatic events that can lead to PTSD include:
War
Natural disasters
Car or plane crashes
Terrorist attacks
Sudden death of a loved one
Rape
Kidnapping
Assault
Sexual or physical abuse
Childhood neglect
 Anxiety disorder…
While everyone experiences PTSD differently, there are three
main types of symptoms:

1.Symptoms of PTSD: Re-experiencing the traumatic event

•Intrusive, upsetting memories of the event
•Flashbacks (acting or feeling like the event is happening
again)
•Nightmares (either of the event or of other frightening
things)
•Feelings of intense distress when reminded of the trauma
2. Symptoms of PTSD: Avoidance and numbing
•Avoiding activities, places, thoughts, or feelings that
remind you of the trauma
•Inability to remember important aspects of the trauma
•Loss of interest in activities and life in general
 Anxiety disorder…
3. Symptoms of PTSD: Increased anxiety and emotional arousal
•Difficulty falling or staying asleep
•Irritability or outbursts of anger
•Difficulty concentrating
• Other common symptoms of post-traumatic stress
disorder
•Anger and irritability
•Guilt, shame, or self-blame
•Substance abuse
•Feelings of mistrust and betrayal
•Depression and hopelessness
• At least one re-experiencing symptom, three
avoidance/numbing symptoms, and two hyper-arousal
symptoms must be present for at least one month and must
cause significant distress to be diagnosed as PTSD