Anxiety Disorders

• Anxiety Disorders


  • PTSD
  • Panic Disorder
  • Obsessive-Compulsive Disorder
  • Generalized Anxiety Disorder
  • Social Anxiety Disorder
  • Specific Phobia
• PTSD (technically not an anxiety disorder anymore)
• Obsessive-Compulsive Disorder (also technically not an anxiety disorder anymore)
• Anxiety


  A future-related response to some event, situation, thought, or perception that involves biological, cognitive, and behavioral responses
• When confronted with a real or perceived threat, the human body responds almost automatically with an adaptive biological reaction called the "fight-or-flight" response
• Symptoms of fight-or-flight response

  • Pupils dilate
  • Salivary glands stop producing saliva
  • Heart rate increases
  • Lungs increase respiratory rate
  • Stomach slows digestion
  • Sweat glands kick in
  • Muscles that erect hairs might kick in
  • Intestines decrease activity
  • Skeletal muscles may also contract
• DSM-5 Criteria Format

  • Criterion A
  • Sometimes symptoms listed under a criterion descriptor
  • Criterion B, etc.
• PTSD Criteria

  1. Exposure to actual or threatened death, serious injury, or sexual violence

  2. Presence of 1 or more intrusion symptoms

  3. Persistent avoidance of stimuli related to event

  4. Negative alterations in cognitions and mood

  5. Marked alterations in arousal and reactivity

  6. Duration is longer than 1 month

  7. Causes significant impairment in social, occupational, and other functioning areas

  8. Not attributable to substance or other medical condition
• PTSD


  • Lifetime prevalence of 8.7%
  • Can develop at any point in life
  • Majority of people who experience a trauma will not develop PTSD
  • 80% of those with PTSD will meet criteria for some other disorder
• Panic Disorder

  • 12-month prevalence: 2.3% adults; lower in minorities (except Native Americans)
  • Females 2x higher rate than males
  • Median age of onset: 20-24 y/o
  • Neuroticism, anxiety sensitivity, smoking are risk factors
  • Has cultural similarities in Latin American and Cambodia
• Obsessive-Compulsive Disorder

  • 12-month prevalence of 1.3%
  • Females affected more in adulthood, male more in childhood
  • Around 75% of OCD diagnoses also have another anxiety disorder
  • ~60% have a depressive or bipolar disorder
  • Mean age of onset is 19.5 years
  • If untreated, OCD is typically chronic b/c it's self-reinforcing
• Common obsessions in OCD include cleanliness, symmetry, hoarding, taboo thoughts, fear of harm
• Generalized Anxiety Disorder Criteria


  1. Excessive anxiety and worry, occurring more days than not for at least 6 months

  2. Individual finds it difficult to control worry

  3. Anxiety and worry are associated with 3+ of the following: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

  4. Causes impairment

  5. Not caused by substance or medical condition

  6. Not better explained by another mental disorder
• Generalized Anxiety Disorder

  • 12-month prevalence of 0.9% among adolescents and 2.9% among adults
  • Females are 2X as likely as males to have GAD
  • Median age of onset is 30
  • Tends to be a chronic course with low rates of full remission
  • High comorbidity with other anxiety and depressive disorders
• Social Anxiety Disorder Criteria


  1. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others

  2. Fear that he/she will act in a way or show anxiety symptoms that will be negatively evaluated

  3. The social situations almost always provoke fear or anxiety

  4. Social situations are avoided or endured with intense fear/anxiety

  5. The fear or anxiety is out of proportion to the actual threat posed by the social situation

  6. Fear/anxiety and avoidance is persistent= 6+ months

  7. Impairment/not drugs or medical problem/not another d/o
• Social Anxiety Disorder

  • 12-month prevalence of 7%
  • Women more likely than men
  • Mean age of onset = 13 years
  • Cultural similarity with Taijin kyofusho in Japan
• Specific Phobia Criteria


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

  2. Provokes immediate fear or anxiety

  3. Object actively avoided or endured with intense fear

  4. Out of proportion to the actual danger posed by the object

  5. Persistent and last >6months

  6. Impairment/not drugs or medical problem/not another d/o
• Specific Phobia

  • 12-month prevalence of 7-9%
  • Females 2x more likely than males
• For anxiety disorders, behavioral and cognitive-behavioral approaches tend to be most effective. Avoidance is a key factor in anxiety disorders, so exposure is an important method of treatment.
• Psychoeducation


  ability to understand what you're experiencing
• Types of Exposure Therapy

  1. Imaginal Exposure
  2. Prolonged Exposure
  3. In Vivo
  4. Interoceptive
  5. Exposure and Response Prevention (ERP)
• Exposure and Response Prevention (ERP)

  1. Primarily used to treat OCD
  2. Exposes individual to anxiety provoking stimuli, and prevents them from engaging in avoidance behaviours
• Interoceptive

  1. Help confront "fear of fear"
  2. Mostly used for panic attacks
  3. Intentionally inducing fear sensations of panic:
  4. Dizziness, inability to breathe, heart pounding, depersonalization, spinning room
• In Vivo

  1. In the moment/environment
  2. Used to treat: specific phobia, PTSD, social anxiety
  3. Individual makes a hierarchy of fears and confront them in session and as homework
• Prolonged Exposure

  1. Effectively treats PTSD
  2. Use imaginal exposure and in vivo to have victim confront the traumatic event repeatedly in detail in their mind
  3. Person can re-learn and re-process they're no longer in danger and memories are harmless
  4. Sessions often recorded multiple times to be listened to repeatedly
• Imaginal Exposure

  1. Treatment for PTSD and anxiety disorders
  2. Recalling memory of the trauma in your mind
• Obsessive Compulsive Disorder Criteria

  1. Entails obsessions and compulsions
  2. Obsessions: (1) recurrent, persistent thoughts, urges, images which are intrusive and cause increased anxiety, (2) resulting in attempt to suppress/ignore
  3. Compulsions: (1) repetitive behaviors/mental acts, (2) which are employed to prevent/reduce anxiety from obsessions/to prevent feared outcome
  4. Obsessions and Compulsions are time consuming/cause clinically significant distress/impairment
  5. Not due to substance/medical condition
  6. Not better explained by another mental disorder
• Panic Disorder Criteria


  • Recurrent, unexpected panic attacks
  • 4+ of the following symptoms occur:
• Panic attack symptoms


  • palpitations, pounding heart, accelerated heart rate
  • sweating
  • trembling/shaking
  • shortness of breath
  • feelings of choking
  • chest pain/discomfort
  • nausea or abdominal distress
  • dizziness or light-headed
  • chills/heat sensations
  • numbness sensations
  • derealization (out of body experience)
  • fear of losing control/"going crazy"
  • fear of death
• Panic attack criteria


  1. Recurrent, unexpected panic attacks with 4+ of the symptoms
  2. 1+ of attacks were followed by 1 month or more of 1/both: (1) persistent concern/worry about additional panic attacks (2) significant maladaptive change in behavior related to attacks
  3. Not due to a medical condition/drug
  4. Not better explained by another mental disorder
• Panic Disorder is the fear of

  Fear itself