seem to be more sensitive to threat in general,
Anxiety Disorders, Trauma- and Stressor-Related,
and Obsessive-Compulsive and Related
Disorders (Summary)
The Complexity of Anxiety Disorders
Anxiety is a future-oriented state characterized by
negative affect in which a person focuses on the
possibility of uncontrollable danger or misfortune;
in contrast, fear is a present-oriented state
characterized by strong and immediate escapist
tendencies and a surge in the sympathetic branch
of the autonomic nervous system in response to
current danger.
A panic attack represents the alarm response of
real fear, but there is no actual danger.
Panic attacks may be (1) unexpected (uncued) or
(2) expected (cued), the distinction between which
is clearly whether or not the context of the attack
can be predicted based on past panic
experiences.
Panic and anxiety combine to create different
anxiety disorders.
Research evidence exists to support multiple
causes of anxiety, including biological models that
identify brain circuit and neurotransmitter
involvement as well as psychological and social
contributions. An integrated model of these factors
considers how they all contribute simultaneously
to the presence of abnormal, potentially
pathological levels of anxiety.
ANXIETY DISORDERS
Generalized Anxiety Disorder
In generalized anxiety disorder (GAD), anxiety
focuses on minor everyday events, not one major
worry or concern.
Both genetic and psychological vulnerabilities
seem to contribute to the development of GAD. In
particular is the fact that individuals with GAD
situations that produce severe anxiety, panic, or
particularly when the threat has some personal both. In specific phobia, the fear is focused on a
relevance. particular object or situation.
Although drug and psychological treatments may Phobias can be acquired by experiencing some
be effective in the short term, the most successful traumatic event; they can also be learned
long-term treatment may help individuals with vicariously or even be taught.
GAD focus on what is really threatening to them in Treatment of phobias is rather straightforward,
their lives. While benzodiazepine medications are with a focus on structured and consistent
useful for an acute, crisis stage of a week or two, exposure-based exercises.
recent evidence suggests that antidepressant
medications such as Paxil and Effexor provide
superior symptoms relief past that initial stage. Social Anxiety Disorder (Social Phobia)
Social anxiety disorder (SAD) is a fear of being
Panic Disorder and Agoraphobia around others, particularly in situations that call for
some kind of performance in front of other
Panic disorder is marked by repeated attacks of
people. The fear often centers around a worry of
debilitating, overwhelming anxiety that is often
behaving in some embarrassing or humiliating
accompanied by a myriad of physical symptoms. It
way that may bring negative judgment from
is sometimes, but not always, accompanied by
others.
agoraphobia, (a fear and avoidance of situations
One model for how people acquire SAD suggests
considered to be unsafe).
that those with the condition may be predisposed
We all have some genetic vulnerability to stress,
to be highly sensitive to negative messages from
and many of us have had a neurobiological
others, including anger, rejection, and criticism.
overreaction to some stressful eventthat is, a
These signals may be perceived in subtle facial
panic attack. Individuals who develop panic
expressions, contributing to the symptoms of the
disorder then develop anxiety over the possibility
disorder.
of having another panic attack.
Although the causes of SAD are similar to those of
Both drug and psychological treatments have
specific phobias, treatment has a different focus
proved successful in the treatment of panic
that includes rehearsing or role-playing socially
disorder. One psychological method, panic control
phobic situations. In addition, drug treatments
treatment (PCT), concentrates on exposing
have been effective.
patients to clusters of sensations that remind them
Selective mutism is a condition now categorized
of their panic attacks. The symptoms of
as an anxiety disorder, and is closely related to
agoraphobia that can accompany panic disorder
social anxiety disorder. It involves a lack of speech
can be effectively treated with gradual exposure
in situations where speaking is expected, and has
exercises, sometimes combined with anxiety-
a high level of comorbidity with SAD, and the
reducing coping mechanisms. These approaches
treatment is similar to that of SAD with a greater
do not cure the issue, however, as the panic
emphasis on speech.
attacks may persist and cause ongoing related
agoraphobic issues.
TRAUMA- AND STRESSOR-RELATED
Specific Phobia
DISORDERS
In phobic disorders, the individual avoids
Posttraumatic Stress Disorder psychological vulnerabilities seem to be involved those that fall below a specific value. This can
in the development of OCD. help to reduce anxiety that something truly
Posttraumatic stress disorder (PTSD) focuses on
Drug treatment seems to be only modestly important will be thrown away.
avoiding thoughts or images of past traumatic
successful in treating OCD. The most effective Trichotillomania (hair pulling disorder) involves
experiences. It is diagnosed when the symptoms
treatment approach is a psychological treatment, pulling out ones own hair from anywhere on the
emerge more than one month after the traumatic
exposure and ritual prevention (ERP). Medication body, including the head, eyebrows, arms, or other
event, or if the symptoms persist for longer than
has not been found to be superior to this locations. It can lead to great embarrassment as a
one month. If the symptoms occur within the first
intervention, either in terms of efficacy or relapse result of appearance-related issues, along with
month, the diagnosis is acute stress disorder.
prevention. In very severe cases of OCD that one going to great lengths to cover up the actions.
The precipitating cause of PTSD is obviousa
have not responded to other interventions and are Research suggests that there may be a genetic
traumatic experience. But mere exposure to
causing significant life interruption, psychosurgery mutation that explains many cases of this
trauma is not enough. The intensity of the
may be considered as a last resort. disorder.
experience seems to be a factor in whether an
Excoriation (skin picking disorder) is repetitive and
individual develops PTSD; biological
compulsive picking on or at ones skin, which can
vulnerabilities, as well as social and cultural Body Dysmorphic Disorder
lead to bruises, scabbing, scarring, and damage.
factors, appear to play a role as well.
In body dysmorphic disorder (BDD), a person who Both trichotillomania and excoriation were
Treatment involves reexposing the victim to the
looks normal is obsessively preoccupied with previously labeled as impulse-control disorders,
trauma and reestablishing a sense of safety to
some imagined defect in appearance (imagined but the anxiety that accompanies the behaviors
overcome the debilitating effects of PTSD.
ugliness). It was previously considered a have caused them to be recategorized in DSM-5.
Possibilities include a tendency for the client to
somatoform disorder because of the focus on a Psychological treatments seem to be the most
want to leave therapy, difficulty selecting one event
body issue, but more recently the emphasis on useful for bringing about improvement in both
for exposure if the client has had a history of
the anxiety caused by the exaggerated or disorders.
multiple traumas, difficulty getting the client to
imagined defect has caused it to be recategorized
engage emotionally with the memory, and an
as an anxiety disorder.
increase in anxiety symptoms in early stages of the
Patients suffering from BDD often turn to plastic
therapy.
surgery or other medical interventions, which
more often than not increase their preoccupation
Other conditions that are included trauma and
and distress.
stressor-related disorders are adjustment
disorders, attachment disorders, reacting
attachment disorder, and disinhibited social Other Obsessive-Compulsive and Related
engagement disorder. Disorders
Hoarding disorder is marked by a compulsive
OBSESSIVE-COMPULSIVE AND RELATED
tendency to collect objects often of no
DISORDERS
sentimental or material value and to have
Obsessive-Compulsive Disorder tremendous difficulty with discarding any
possession, and living with excessive clutter and
Obsessive-compulsive disorder (OCD) focuses on
disorganization, often to dangerous extremes.
avoiding frightening or repulsive intrusive thoughts
Hoarding disorder was previously thought of as an
(obsessions) or neutralizing these thoughts
extreme variation of OCD, but has recently been
through the use of ritualistic behavior
separated into its own diagnosis. Treatments may
(compulsions).
involve encouraging people to assign numerical
As with all anxiety disorders, biological and
values to specific objects, followed by discarding