UAPP3034

Abnormal Psychology: Adult and Ageing

Lecturer: Dr. Sonia Khodabakhsh

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Anxiety Disorders

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• Fear is the emotional response to real or
perceived imminent threat.
• Anxiety is anticipation of future threat.

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• Anxiety is an expectable part of
everyday life.

– Trait anxiety: how anxious a

person feels in general (as in
generalized anxiety disorder)

– State anxiety: how anxious a

person feels in response to
specific events (as in phobias)

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 Discussion

Do you think
anxiety is “good” or “bad”?

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 What is normal anxiety?
• Respond to threatening situation
• Defense or escape (fight or flight)

• Increased
– Heartrate
– Blood pressure
– Breathing
– Muscle tension
…
• Sympathetic nervous system activation
– Shaking
– Sweating
…
• Beneficial response

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 Pathologic Anxiety

• Pathologic anxiety is anxiety that is

excessive, harmful function.

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Cycle of anxiety

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 Anxiety Disorders
• Generalized Anxiety Disorder
• Separation Anxiety Disorder
• Selective Mutism
• Specific Phobia
• Social Anxiety Disorder (Social Phobia)
• Agoraphobia
• Panic Disorder
• Substance/Medication-Induced Anxiety Disorder
• Anxiety Disorder Due to Another Medical Condition
• Other Specified Anxiety Disorder
• Unspecified Anxiety Disorder

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Generalized Anxiety Disorder

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 Generalized Anxiety Disorder

A. Excessive anxiety and worry occurring more days, at

least 6 months, about a number of events or activities
(such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or
more) of the following six symptoms;
Note: Only one item is required in children.
1. Restlessness or feeling on edge.
2. Being easily fatigued

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 3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or
restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically

significant distress or impairment in social, occupational, or
other important areas of functioning.
E. The disturbance is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a medication)
or another medical condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by another mental
disorder

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 Risk Factors
Factors that may increase the risk of GAD
include:
 Family members with an anxiety disorder
 Increased stress
 Exposure to physical or emotional trauma
 Unemployment, poverty
 Drug abuse
 Medical condition or disability
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Separation Anxiety Disorder

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 Separation Anxiety Disorder cont’d1
A. Developmentally inappropriate and excessive anxiety concerning
separation from home or from those to whom the individual is attached, as
evidenced by at least three (or more) of the following:
(1) Recurrent excessive distress when separation from home or major
attachment figures
(2) Persistent and excessive worry about losing major attachment figures or
about possible harm to them, such as illness, injury, disasters, or death
(3) Persistent and excessive worry about experiencing an unpleasant event
(e.g., getting lost, being kidnapped, having an accident, becoming ill)
(4) Persistent reluctance or refusal to go out, away from the home, to school, to
work, or elsewhere because of fear of separation
(5) Persistently and excessive fear of or reluctance about being alone or without
major attachment figures at home or in other settings.
(6) Persistent reluctance or refusal to sleep away from home or to go to sleep
without being near a major attachment figure.
(7) Repeated nightmares involving the theme of separation
(8) Repeated complaints of physical symptoms (e.g., headaches,
stomachaches, nausea, vomiting) when separation from major attachment
figures occurs or is anticipated

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 Separation Anxiety Disorder cont’d2

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children
and adolescents and typically 6 months or more in adults
 C. The disturbance causes clinically significant distress or impairment in social,
academic (occupational), or other important areas of functioning.
D. The disturbance is not better explained by another mental disorder, such as
refusing to leave home because of excessive resistance to change in autism
spectrum disorder; delusions or hallucinations concerning separation in psychotic
disorders; refusal to go outside without a trusted companion in agoraphobia;
worries about ill health or other harm befalling significant others in generalized
anxiety disorder; or concerns about having an illness in illness anxiety disorder
Specify if: Early Onset: if onset occurs before age 6 years

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Selective Mutism

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 Selective Mutism
• A. Consistent failure to speak in specific social situations (in which there is an
expectation for speaking, e.g., at school) despite speaking in other situations.

• B. The disturbance interferes with educational or occupational achievement or

with social communication.

• C. The duration of the disturbance is at least 1 month (not limited to the first
month of school).

• D. The failure to speak is not due to a lack of knowledge of, or comfort with, the
spoken language required in the social situation.

• E. The disturbance is not better accounted for by a Communication Disorder

(e.g., Stuttering) and does not occur exclusively during the course of a Pervasive
Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

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Specific Phobia

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Phobic anxiety disorder

Phobic

Simple Social
phobia phobia Agoraphobia

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 Specific Phobia
• Marked or persistent fear (>6 months) that is
excessive or unreasonable, by the presence or
anticipation of a specific object or situation
– Anxiety must be out of proportion to the actual danger
or situation
– It interferes significantly with the persons routine or
function

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 Specific Phobia
A. Marked fear or anxiety about a specific object or situation (e.g. flying, heights, animals,
receiving an injection, seeing blood).
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or
clinging.
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or
anxiety.
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. The fear, anxiety, or avoidance is persistent, typically lasting for 6months or more.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
G. The disturbance is not better explained by the symptoms of another mental disorder,
including fear, anxiety, and avoidance of situations associated with panic-like symptoms
or other incapacitating symptoms (as in agoraphobia): objects or situations related to
obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in
posttraumatic stress disorder); separation from home or attachment figures (as in
separation anxiety disorder); or social situations (as in social anxiety disorder).

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Social Anxiety Disorder
(Social Phobia)

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 What is it?

 Is one of the most common psychiatric

disorder.
 Is often dismissed as shyness.
 Feel nervous in social situations.
 Social anxiety disorder also known as
social phobia.

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 common situations

 Meeting new people

 Going on date
 Making small talk or phone calls
 Public speaking or Speech
 Eating or drinking in public
 Using public bathrooms
 Performing on stage
 Attending parties or other social gathering
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 Emotinal and Behavioral signs

 Anxiety in everyday social situations

 Intense worry for days before upcoming
social situations
 Fear of being watched or judge others
 Fear that other will notice that you’re
nervous
 Difficulty making eye contact or taking

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 Physical signs

 Red face or blushing

 Shortness of breath
 Upset stomach
 Trembling or shaky voice
 Sweating
 Feeling dizzy
 Cold, clammy hands
 Muscle tension
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 Social Anxiety Disorder – DSM5
A. fear or anxiety specific to social settings, in which a person feels noticed, observed,
or scrutinized. In a adult, this could include a first date, a job interview, meeting
someone for the first time, delivering an oral presentation, or speaking in a class or
meeting. In children, the phobic/avoidant behaviors must occur in settings with peers,
rather than adult interactions, and will be expressed in terms of age appropriate
distress, such as cringing, crying, or otherwise displaying obvious fear or discomfort.
B. typically the individual will fear that they will display their anxiety and experience
social rejection,
C. social interaction will consistently provoke distress,
D. social interactions are either avoided, or painfully and reluctantly endured,
E. the fear and anxiety will be grossly disproportionate to the actual situation,
F. the fear, anxiety or other distress around social situations will persist for six months
or longer and
G. cause personal distress and impairment of functioning in one or more domains, such as
interpersonal or occupational functioning,
H. the fear or anxiety cannot be attributed to a medical disorder, substance use, or adverse
medication effects or
I. another mental disorder, and
J. if another medical condition is present which may cause the individual to be excessively self
conscious- e.g., prominent facial scar, the fear and anxiety are either unrelated, or
disproportionate. The clinician may also include the specifier that the social anxiety is
performance situation specific - e.g., oral presentations.

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Agoraphobia

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 Agoraphobia
• the person experiences anxiety
• in situations that are unfamiliar,
• from which they cannot escape,
• or in which they perceive they have little
control.

• Leads to avoidance

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Panic Disorder

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 Panic Disorder
Panic attack Panic disorder
• Intense fear • Recurrent panic attacks

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 Panic Disorder
include 4 or more attacks in a 4-week period, or 1 or more attacks followed by
at least 1 month of fear of another panic attack.

The following are potential symptom manifestations of a panic attack:

 Palpitations, pounding heart, or accelerated heart rate
 Sweating
 Trembling or shaking
 Sense of shortness of breath or smothering
 Chest pain or discomfort
 Nausea or abdominal distress
 Feeling dizzy, unsteady, lightheaded, or faint
 Derealization or depersonalization (feeling detached from oneself)
 Fear of losing control or going crazy
 Fear of dying
 Numbness
 Chills or hot flashes
 During the episode, patients have the urge to flee or escape and have a
sense of impending doom (as though they are dying from a heart attack or
suffocation).
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Anxiety Disorders Treatment

Treatment

Psychological
treatment Pharmacotherapy

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 Treatment
Cognitive-Behavioral Therapy
• Self-monitoring
• Relaxation
• Self-Management
...

Medication

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Self-Management
 Changes in diet and nutrition.
 Regular exercise.

 Use relaxation strategies.

 Learning new problem solving strategies.
 Join support groups.

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