Anxiety & Related

Disorders
Chapters 5 and 6
videos
 General anxiety overview
http://www.adaa.org/about-adaa/press-room/multimedia/
videos
 GAD http://www.youtube.com/watch?v=KbY4HG4Uod4
 Social anxiety http://www.adaa.org/about-adaa/press-
room/multimedia/videos
 Specific phobia https://www.youtube.com/watch?
v=JDvDCqLCdEE
 Ptsd
http://www.istss.org/SurvivorsTalkAboutTrauma/3278.htm
 Panic video
http://www.youtube.com/watch?v=2gNGUartUEI
 Panic adaa https://www.adaa.org/node/2762
 OCD
https://www.adaa.org/about-adaa/press-room/multimedia/
videos
 Treating OCD ADAA
 https://www.adaa.org/about-adaa/press-room/multimedia/
VIDEOS

 hoarding
https://www.youtube.com/watch?v=ZYD645OVoPA
 Humanizing hoarding https://www.youtube.com/watch?
v=ZV-5I2RMTGM
 PTSD female veteran story http://www.istss.org/public-
resources/survivors-talk-about-trauma.aspx
 PTSD Gina’s story
https://www.youtube.com/watch?v=nZLD9z6_bFI
 What is prolonged exposure
 https://www.youtube.com/watch?v=AUOYFQTm9lE

 WHAT IS cpt:
 https://www.youtube.com/watch?v=Tx3KdKDZOS8
 Introduction
 Anxiety Disorders
 The most common type of mental disorder
• current = 18%, lifetime = 29% (1 in 3)
 Defined by negative emotional responses, like
mood disorders
 However:
• Involve preoccupation with
-and/or-
• A persistent, maladaptive avoidance of anxiety-
provoking thoughts or situations
 Definitions

 Fear – physiological and emotional response to a

real, immediate danger

 Anxiety – more general physiological and

emotional response to a vague sense
of threat or danger – out of proportion to the
situation
 Involves anticipation of future danger

 Worry – Sequence of negative, emotional thoughts

concerned with future threats
 “self-talk”
 Normal vs. pathological anxiety

1. Quantity
 How often does the person worry
and about how many things?

2. Quality
 What is the person worrying about?
• Negative content
• Less controllable
• Less realistic
Anxiety disorders what is normal?
• https://adaa.org/about-adaa/press-
room/multimedia/videos
Symptoms, Epidemiology,
and Treatment of Anxiety
Disorders
Anxiety Disorders

 Generalized Anxiety Disorder (GAD)

 Specific Phobias (e.g., flying)
 Social Phobia
 Panic Disorder
 Obsessive Compulsive Disorder
(OCD)
 Hoarding Disorder
 Post Traumatic Stress Disorder
 Comorbidity
 Overall:
 High comorbidity

between anxiety
disorders &
with depression,
substance abuse
 80-90% of people with anxiety disorders will experience
some other disorder in their lifetime

Specific Anxiety Disorders and comorbidity:

 GAD: depressive disorders (60% comorbid), substance
abuse, other anxiety
 Social Phobia: avoidant PD, depression, substance abuse
 Differences among groups…

 Gender:
 Higher % anxiety disorders in Females than
Males (except OCD)

 Age:
 Lower prevalence among the elderly in general

 Culture:
 Some differences with respect to stressors,
descriptions, and symptoms
• e.g. target of anxieties (work vs. religion/family)
Generalized Anxiety
Disorder (GAD)
 Generalized Anxiety Disorder (GAD)
 Excessive worry about many events &
activities (free-floating anxiety)
 Worry is uncontrollable and leads to significant
distress/impairment

 At least 3 of 6 physical symptoms:

• Restlessness • Irritability
• Easily fatigued • Muscle tension
• Poor concentration • Sleep disturbance
 > 6 month duration of symptoms
 GAD
GAD By the Numbers

 4% of US population in any 6 month

period, 6% lifetime

 Commonly develops in childhood or

adolescence; tends to be chronic

 Women:Men = 2:1
 High comorbidity
 GAD: Sociocultural View

 More likely to develop in people who are facing

societal conditions that are truly dangerous (e.g.
war, poverty, racial prejudices)
• 2x higher in low income people

 Nervios (“nerves”)
 Culturally-bound syndrome experienced by
Hispanics in U.S. and Latin America.
 Similar to GAD, but more somatic
 GAD: Cognitive Perspective
 GAD is primarily caused by basic irrational
assumptions
 --”It is awful and catastrophic when things are not the way one would very
much like them to be”
 --”If something is or may be dangerous or fearsome, one should be terribly
concerned about it and should keep dwelling on the possibility of its
occurring”

 Interpret stressful events as dangerous and

threatening because of these assumptions
 People with GAD worry in an attempt to
predict and prevent negative events.
 What are the odds of that?

 Dying on your next trip in a car 1 in 4 million

(0.00000025%)

1 in 100
 Being audited by the IRS (1%)

 Your carton will contain a 1 in 10

broken egg. (10%)

 You will die after being struck 1 in 84K

(0.000012%)
by lightning.
How does it develop?

 People with GAD may have had lives

characterized by unpredictable
negative events
 At one point, remaining constantly
vigilant and ready to react was helpful
 Now, it may no longer be beneficial to
do so
 Second Generation
Cognitive Explanations
 Metacognitive Theory (Wells)
 People with GAD implicitly hold both
positive and negative attitudes toward
worry
• Believe worrying is a useful way of appraising and
coping with threatening circumstances
• Believe that worrying is harmful and uncontrollable
 Avoidance Theory (Borkovec)
 People with GAD have higher bodily
arousal (e.g., high heart rate) and
worrying serves to reduce this arousal
Biological Perspective

 Modest heritability (15% vs. 4-6% of

general population). Trait anxiety very
heritable and risk of GAD

 Problem w/ GABA inactivity?

 GABA inhibits neurons from firing so if GABA
is too low, neurons fire too much.
 Inductive reasoning from studies on
benzodiazepines in brain – mimic
effect of GABA
 GAD Treatments
 Cognitive Therapies
 GAD caused by irrational assumptions
 Mindfulness-based CT  acceptance
 Anxiolytics & Antidepressants
Electromyograph
 Relaxation training
 Biofeedback – learn

to control physiological
process like heart rate and muscle
tension
 Is CBT or Relaxation more effective
for treating GAD?

 Borkovec & Costello (1993): 3 conditions

• Cognitive Behavioral Therapy (CBT)
• Applied Relaxation (AR)
• Non-directive control (ND)

 Active vs. control differed at post-treatment

• CBT and relaxation better than non-directive

 12-month follow-up results: more CBT clients

(58%) met high end state criteria than
relaxation clients (38%)
 Phobias

Two types:
-Specific Phobias
-Social Phobia
 Specific Phobias
 Symptoms:
 Fear in presence or anticipation of a
specific stimulus (e.g., dog, heights, spiders)
 Exposure leads to immediate fear response
 Fear is persistent, narrowly-defined, excessive
and/or irrational
 Avoidance of feared stimuli
 > 6 month duration of symptoms
Dog phobia https://www.youtube.com/watch?
v=JDvDCqLCdEE
Specific Phobia - Subtypes

Animal Type
 dogs, spiders, horses
Natural Environment Type
 heights, storms, water
Situational Type
 airplanes, elevators, enclosed places
Other Type
 in children: loud sounds, costumed
characters, clowns
Blood-Injection-Injury Type
Specific Phobias By the
Numbers
 Specific
 4-9 % current, 7-11% lifetime
 W:M  2:1

 Cultural: Phobias exist in all cultures

 Themes are culturally relative
 Course: Typically begin in childhood
 Social Phobia
(AKA Social Anxiety Disorder)
 Symptoms:
 Fear and avoidance of social situations
• Performance or interpersonal categories
• FEAR OF NEGATIVE SOCIAL EVALUATION
 Exposure leads to immediate fear response
 Avoid phobic situation (or endure w/ distress)
 Fear disproportionate to actual event
 > 6 month duration of symptoms
• Public speaking subtype vs. generalized
• Social anxiety
http://www.adaa.org/about-adaa/press-room/multim
edia/videos
Social Phobia By the Numbers
 Lifetime: Men = 11%, Women = 14%
 W:M  3:2
 Onset
 Early childhood; Adolescence
 Course
 Tends to be chronic because few seek tx
 Behavioral View
(2-Factor Theory)
 Some persistent, irrational fears seem to
develop after the person has experienced a
stressful/traumatic event
 Classical Conditioning:
 Previously neutral stimulus (dog) is paired with
UCS (bite) and UCR (fear) -
 E.g., Dog bite (UCS) = paired with dog (CS) to
elicit fear (CR)
 Stimulus generalization (all dogs elicit fear)
 2-factor theory cont’d
 Operant conditioning principles may
be involved in the maintenance of a
phobia
 Operant conditioning:
 Avoiding stimulus (e.g., dogs) =
operant response
 Relief from anxiety = negative
reinforcement
 What classical creates, operant
maintains
 Behavioral-Evolutionary
Perspective
 Preparedness Theory
 Some fears more likely from
evolutionary perspective
 What do you think these

would be??

 Modeling
 May explain why phobias can be “handed
down” (don’t touch that!)
 Specific Phobia Tx
 Systematic Desensitization
• Create hierarchy of fears
• Teach relaxation exercises
• Work up the hierarchy from
least to most feared

 In vivo exposure
• More common than SD; no relaxation
• Effect in as little as 1 2-3hr session

 Flooding *** not used frequently

 Modeling (AKA vicarious conditioning) –

 Sample hierarchy
10: Let large dog that is off leash lick face while petting it
9: Let large dog that is on leash lick face
8: Let small dog off leash lick face
7: Let small dog on leash lick face
6: Pet small dog while is on leash
5: Small dog next to me on leash
4: Small dog 1 foot away on leash
3: Small dog 2 feet away on leash
2: Small dog across the room on leash
1: Small dog in next room on leash
 Theories of Social Phobia
 Many are similar to specific phobia - trait anxiety,
traumatic experience of embarrassing one’s self, even
preparedness theory suggesting we are bio prepared to
fear violent or disapproving faces
 Cognitive Theories
 Excessive high standards (self-schema)
 Negative automatic assumptions
 Attention to negative cues
 Developmental Influences
 Anxious, overprotective and critical parents
 Temperament – behaviorally inhibited
 Social Phobia Tx

 Social Phobia:
 Antidepressant medication

 Exposure therapy

 Cognitive therapy
• also CBT Group Treatment
• Exposure to feared situations
• Teach social skills
• Challenge harsh beliefs

 Social skills training

Panic Disorder
 Panic Attack
 An abrupt surge of intense fear or discomfort that
reaches a peak within about 10 minutes
 Attacks include at least 4 of the following:

 Palpitations, pounding heart  Feeling dizzy, unsteady, light-headed

 Sweating
 Trembling/shaking
 Shortness of breath/smothering
 Feelings of choking
 Chest pain/discomfort
 Nausea/abdominal distress
or faint.
 Chills or heat sensations
 Numbness/tingling sensations
 Feeling detached from oneself or like
things aren’t real
 Fear of losing control or “going crazy”
 Fear of dying
 Panic Disorder
 Symptoms
 Recurrent, unexpected panic
attacks
 With > 1 month of:
• Worry about future panic attacks
• Concern about consequences of panic
attacks
• Change in behavior due to the attacks

 Fear of fear itself

 http://www.youtube.com/watch?v=
2gNGUartUEI
 Agoraphobia

 Persistent, excessive, irrational fear of

places where escape is difficult or
embarrassing
 Avoid situations that may trigger panic
 e.g., being in crowds, bus, bridges, standing
in line

 DSM-5 makes this its own disorder

 Previously was subtype/variety of panic dx
 Commonly comorbid
Panic Disorder by the #s

 Prevalence
 Lifetime: 3-4% (M= 2%, W = 4%)
 One-year: 1-2%

 Age of onset
 Late adolescence to mid-thirties
 Course tends to be chronic, but may
wax and wane
 Panic is seen in nearly all cultures
 Biological
Perspective
 2 theories:
 Changes/spikes in norepinephrine activity
in the midbrain
 Antidepressants change activity of NE
and reduce panic attacks, suggesting
that NE activity is irregular in people
with panic disorder
 Role of brain circuits —brain areas
triggering each other to “alarm and
escape” (kindling model)
• Includes amygdala and locus ceruleus
 Cognitive Perspective
 People with panic disorder misinterpret their
sensations in catastrophic ways
• For instance, a person who notices his heart
pounding may interpret it to mean he is having a
panic attack
 High degree of anxiety sensitivity
• More likely to notice changes in their bodily
sensations, allowing for misinterpreting why their
bodily state changed
 Misinterpretation of bodily symptoms
• Over-reaction cues a catastrophic
misinterpretation cycle
*none of these explicitly rule out biological factors
Catastrophic
Misinterpretation Trigger Stimulus
Cycle (internal/external)

Perceived Threat

Interpretation of
Sensations as Apprehension
Catastrophic

Body Sensations
Treatments for Panic
Disorder
 Drug Therapy
 Antidepressants
 Benzodiazepines

 CBT
 C = address catastrophic thoughts/beliefs
 B = exposure to avoided situations and
sensations
• Relaxation Techniques, Breathing Exercises
• Interoceptive Exposure = exposure to bodily panic
symptoms/physical cues
Stop here
Obsessive Compulsive
Disorder (OCD)
 Obsessive-Compulsive Disorder
(OCD)
 Obsessions
 Persistent repetitive thoughts/images/impulses
 Are intrusive, unwanted, inappropriate
• Often appear to come ‘out of the blue’
• Often involve socially inappropriate or horrific
themes or diseases and germs
 Cause marked distress

 Impulses, images, doubts, thoughts

 Obsessive-Compulsive Disorder
(OCD)
 Compulsions
 Repetitive behaviors or mental acts
 In response to obsessions
 Used to reduce anxiety/distress of obsessions
• Do not produce pleasure

 Touching/checking, balance/order, counting,

cleaning, rituals (especially w/ specific #s)
 OCD Diagnostic Criteria

 Obsessions or compulsions are time consuming

(at least 1 hour per day) or cause clinically
significant distress or impairment
OCD By the Numbers
 0.5-2.1% prevalence, 1.5% lifetime

 Equally common males and females &

ethnicity/race
 Kids: more common in boys, earlier onset

 Starts in young adulthood; gradual

 40% of people with OCD seek

treatment
 Biological Perspective

 Twin studies: 53% concordance in MZ

 Dysfunction in areas associated with
primitive behavior/brain circuits
• Aggression, sexuality, bodily excretion
• Dysfunction in these areas may make it difficult to stop
an impulse once it starts
• Low serotonin levels in these areas

 Tx: Antidepressants that affect serotonin

 Behavioral Perspective
 Compulsions reduce anxiety (negative
reinforcement)
 Tx: Exposure and Response Prevention
 Graded exposure; expose client to the feared
obsessive situation & prevent compulsion
• Have an ordered list of contaminating situations client finds
distressing – e.g., getting hands dirty and not washing
• More difficult when compulsion mental (e.g., praying,
counting, etc.)
 Mantras for self-talk during exposure
It’s just OCD. I can handle this.
 Modeling
 Prevent development of new compulsions
 Cognitive Perspective
 Modeling/Observational Learning
 Difficulty “turning off” intrusive thoughts
 Thoughts are appraised as dangerous
 Attempts to suppress thoughts fail
• “Big White Bears”
 Inflated sense of responsibility
 Thought-action fusion: If think it, just as bad as doing it
Foa et al.
(2005)
Take home message:
Single treatment with
therapy (EX/RP)
preferred
 Hoarding

How does this problem fit

in with anxiety disorders?
 Hoarding Disorder
A. Persistent difficulty discarding/parting with
possessions, regardless of their actual value
B. Due to need to save items & distress
associated w/ discarding
C. Possessions clutter living areas & compromise
their intended use. If living areas uncluttered,
only b/c of others’ interventions.
D. Clinically significant distress or impairment
(including maintaining safe environment).
 Associated features
 May engage in compulsive buying or may
go through others’ trash.
 Difficulty making decisions & sorting items.

 Become attached to objects and think of

objects as having human qualities (feelings,
etc).
 75% have a comorbid mood or anxiety
disorder.
Humanizing hoarding
 https://www.youtube.com/watch?v=ZV-
5I2RMTGM
 Prevalence & Course
 Point prevalence: 2-6%
 Epidemiological samples suggest that mostly
males but clinical samples are mostly
females.
 3X more prevalence in older adults (55-94
y.o.) than younger adults (34-44 y.o.)
 Typical onset 11-15 y.o., starts interfering in
functioning by mid 20s, causes clinically sig
impairment by mid 30s.
 Risk factors

 Genetic: 50% have a relative who hoards &

50% of variability is due to genes.
 Often report experiencing traumatic events
Tx for Hoarding

 CBT = most efficacious.

 Includes exposure to discarding,
teaching how to sort items & make
decisions about what to keep and
why, identification of triggers for
acquisition (stress, etc)
 Medications are not very effective.
Trauma and Stress
Related Disorders
 Traumatic Stress and Stress
Disorders
 During and immediately after a trauma, we may
temporarily experience levels of arousal,
anxiety, and depression
 For some, symptoms persist well after the trauma
• These people may be suffering from:
• Acute stress disorder
• Posttraumatic stress disorder (PTSD)
 The situations that cause these disorders would
be traumatic to anyone (unlike other anxiety
disorders)
 PTSD Dx: Criterion A
 Traumatic event in which was actual or threatened
death or serious injury to self/others
 Person experienced, witnessed, or learned about
an event that occurred to a close family
member/friend event
 Experienced repeated or extreme exposure to
aversive details of the traumatic events (e.g., first
responders collecting human remains, police
officers exposed to details of child abuse).
• Exposure via media, TV, movies, etc doesn’t count
 Criterion A Trauma Types
 Natural disasters
 Floods, earthquakes, fires, hurricanes
 Abuse/Assault
 Physical, sexual
 Combat & War related trauma
 Recent study estimates 13% of Army and
Marines soldiers could be diagnosed with PTSD
 “Common” Traumatic events
 Car accidents, learning of the
death/disease/severe injury of a loved one,
medical problems
 PTSD DX: Criterion B
 1+ INTRUSIVE SXS associated w/ trauma:
 Recurrent & intrusive recollections of event, out
of the blue / untriggered
 Recurrent & distressing dreams of event
 Flashbacks (act or feel as if event happening
again)
 Intense emotional distress at exposure to
reminders
 Physiological reactivity to reminders
 PTSD Dx: Criterion C

 1+ AVOIDANCE of stimuli associated w/ trauma

 Avoidance of memories, thoughts, or feelings
associated w/ event.
 Avoidance of external reminders (people, places,
conversation, etc) that arouse distressing
memories, thoughts, or feelings aboutt trauma.
 PTSD Dx: Criterion D
 2+ Negative Alterations in THOUGHTS OR MOOD
associated w/ trauma
 Inability to remember important aspects of trauma
 Persistent, exaggerated negative beliefs about self,
others, or world (I am bad, No one can be trusted)
 Persistent, distorted thoughts about cause or
consequences of the trauma  blame self / others
 Persistent negative emotional state
 Decreased interest or participation in activities
 Feeling detached or estranged from others
 Persistent inability to experience positive emotions
 PTSD Dx: Criterion E
 2+ Alterations in AROUSAL
• Irritability or anger
• Reckless or self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Problems w/ concentration
• Sleep disturbance
Diagnostic Criteria cont’d
 F. Sxs 1+ months
 G. Clinically significant
distress/impairment.

PTSD female veteran story

http://www.istss.org/public-resources/surviv
ors-talk-about-trauma.aspx
 PTSD Gina’s story
https://www.youtube.com/watch?v=nZLD
9z6_bFI
 PTSD by the #s

 Prevalence - Lifetime: W 20%, M8%

 At-risk population as high as 50%
 One-year rates depend on many factors
• Example: September 11th, 2001
• Rates ranged from 44% in Oct, declined to 21% by Dec
 Course depends on several factors
• Gender, SES, trauma severity, social support,
environment, other mental health problems
 High comorbidity with depression, other anxiety
disorders, substance abuse
 Theories of PTSD

 The cause of PTSD is clear = Trauma

 Why do some people experience PTSD and
others do not?
 Vulnerability and maintenance factors
• Social, Psychological, and Biological
 Environmental & Social Risk
Factors
 Severity, Duration, & Proximity of Trauma
 More severe & longer-lasting trauma  greater
risk
• e.g. frontline soldiers, POW’s, Ground Zero, sexual
assault
• Repeated traumas, multiple tours of duty, repeated and/or
violent rape

 Social Support
 Low social/emotional support post trauma
• Culture and societal factors
• Communal structure / immigrants in support community
 Psychological Risk Factors
 Shattered assumptions/negative beliefs
 Personal Invulnerability  hypervigilance
 Just World Hypothesis
• “the world is meaningful and just, and things
happen for a reason”
• assumption is shattered when senseless,
unjust, evil things happen (terrorism, school
shootings, rape)
• . We are left to make sense of the senseless—if the
world isn’t fair and just, then it must be evil
 Bad things don’t happen to Good people
• “If bad things do happen, I am a bad person”
• Self-blame – “I deserved it”
Psychological Risk Factors
 Preexisting Distress
 Mental health problems (especially
anxiety, depression); poor
interpersonal relationships; racism
 Coping Styles
 Self-destructive or avoidant strategies
 Dissociation
• Process of “detaching” from the trauma
 “Making sense” of the trauma
Biological Risk Factors for
PTSD
 Physiological Hyperreactivity
 Structural & Chemical abnormalities
• Amygdala and hippocampus
• Low baseline cortisol
 Dysfunctional activity of the amygdala
and hippocampus
 chronic over-arousal & intrusive
memories (flashbacks)

 High concordance in twin studies

 Treatments for PTSD
 Prolonged Exposure (PE)
 Eye-Movement Desensitization & Reprocessing (EMDR)
 Cognitive Processing Therapy (CBT)
 Stress Innoculation Therapy
 SSRIs (e.g., Zoloft)

 General goals:
 End / manage lingering stress reactions
 Gain perspective on painful experiences
 Return to constructive living
 Prolonged Exposure (PE)
Components of PE:
1. Psychoeducation
2. Relaxation
3. In vivo exposure Edna Foa

4. Imaginal exposure
--the major component

What is PE:
https://www.youtube.com/watch?
v=AUOYFQTm9lE
 Eye-Movement
Desensitization &
Reprocessing (EMDR)
 Clients move eyes in a saccadic
manner while flooding mind with
images of stimuli they avoid Francine
Shapiro

 Controversy over mechanism

(eye movements) and efficacy
eye movements likely irrelevant
exposure drives benefits
 • Exposure
showed a
larger
effect,
tended to
do so
faster, and
resulted in
more
people no
longer
meeting
PTSD
criteria
From Taylor et al. (2003) JCCP
 Cognitive Processing
Therapy
 Modify excessively negative
appraisals of the trauma
 Reduce re-experiencing of memories
 Drop dysfunctional behaviors
 What is CPT:
https://www.youtube.com/watch?
v=Tx3KdKDZOS8
 Early Intervention in PTSD

 Critical Incident Stress Debriefing

• Victims encouraged to talk extensively (e.g.
3-4 hours) about the trauma soon after it
occurs
• Normalize responses to the disaster
• Encourage expressions of anxiety, anger, and frustration
• Teach self-help skills
• Provide referrals

 Is it effective?
 Generally no better off than those without and
in 1 study it increased rate of PTSD
 Conclusions

 For some people, traumatic situations can

prompt the occurrence of a stress disorder, in
the short-term (ASD) or long-term (PTSD).
 Some treatments for these disorders have
been shown to be effective (ex: PE), whereas
some treatments for these disorders have been
questioned for their efficacy or the mechanisms
by which they see their effects.
Stop and review material
 Diagnostic Criteria for Specific Phobia

A. Marked fear or anxiety about a specific object or situation

B. Exposure to phobic stimulus almost always provokes an immediate anxiety
response
C. Phobic situation avoided or endured with intense anxiety or distress
D. The fear or anxiety is out of proportion to the actual danger posed by the
specific object or situation and to the sociocultural context.
E. Fear or anxiety is persistent typically lasting for 6 months or more.
F. Fear must interfere significantly with person’s life, or they are markedly
stressed by the fear.
G. Not better accounted for by another condition/disorder
 Subtypes:
 Animal Type (e.g., dogs, spiders, horses, etc.)
 Natural Environment Type (e.g., heights, storms, water, etc.)
 Blood-Injection-Injury Type
 Situational Type (e.g., airplanes, elevators, enclosed places)
 Other Type (e.g., in children: loud sounds, costumed characters, clowns)
 GAD DSM-5 criteria
A. Excessive anxiety & worry, more days than not, at least
6 mos, about several situations
B. Difficult to control the worry.
C. Assoc w/ 3 or more of the following (w/ at least some
present for more days than not for the past 6 mos)
restlessness or feeling keyed up
easily fatigued
diff concentrating or mind going blank
irritability
muscle tension
sleep disturbance
D. Causes clinically sig distress or impairment.
 Social Anxiety Disorder (Social Phobia)
A. Marked & persistent fear in soc. Situat. where exposed to
possible scrutiny by others.
B. Fear that will act in a way or show anxiety that will be neg.
evaluated by others
C. Social situations almost always provoke fear/anxiety
D. Avoid social sit or endure w/ intense anxiety/distress
E. Fear/anxiety out of proportion to actual threat.
F. Fear/anx./avoidance persistent, typically lasting 6 mnths or
more.
G. Fear/anx./avoidance causes clinically sig distress or
impairment
H. Fear/anx./avoidance not due to a sub. or med. condition.
I. Fear/anxiety/avoidance not better explained by another psych
disorder.
J. If another medical condition (burns, obesity, etc) is present,
fear/anxiety/avoidance unrelated to this or is excessive.
 Specify if performance only (public speaking/performing)
 Panic Attack
 An abrupt surge of intense fear or discomfort that
reaches a peak w/i minutes
 Attacks include at least 4 of the following:

 Palpitations, pounding heart  Feeling dizzy, unsteady, light-headed

 Sweating
 Trembling/shaking
 Shortness of breath/smothering
 Feelings of choking
 Chest pain/discomfort
 Nausea/abdominal distress
or faint.
 Chills or heat sensations
 Numbness/tingling sensations
 Feeling detached from oneself or like
things aren’t real
 Fear of losing control or “going crazy”
 Fear of dying
 DSM criteria for Panic Disorder
A. Recurrent, unexpected panic attacks
B. At least 1 of the attacks has been followed by 1 mnth or
more of :
 Persistent concern or worry about having another attack or their
consequences (losing control, having heart attack, going crazy).
 Significant maladaptive change in behav. Related to the attacks
(avoidance of exercise, unfamiliar situations, etc).
C. Not due to a substance.
D. Not better explained by another psych disorder.
Video clip Wiley & Sons #6.
 Obsessive Compulsive Disorder
 DSM-5 Diagnostic Criteria
 Obsessions or compulsions are time consuming
(at least 1 hour per day) or cause clinically
significant distress or impairment
Specify if:
 With good or fair insight: recognizes that beliefs
are probably not true.
 With poor insight: thinks beliefs are probably
true
 With absent insight/delusional beliefs:
completely convinced that beliefs are true.