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1. by
Alaaeddine El Ghazawi
Med III
© 2015 John Wiley & Sons, Inc. All rights reserved.

2.  Anxiety
• Apprehension about a future threat
 Fear
• Response to an immediate threat
 Both involve physiological arousal
• Sympathetic nervous system
 Both can be adaptive
• Fear triggers “fight or flight”
 May save life
• Anxiety increases preparedness
 “U-shaped” curve (Yerkes & Dodson, 1908)
 Absence of anxiety interferes with performance
 Moderate levels of anxiety improve performance
 High levels of anxiety are detrimental to performance

3.  Anxiety is a normal response to danger.
  Normal emotion/mood
  Enhances performance
  Useful in 3 ways: fight, flight, freeze
  Closely coupled with somatic, autonomic and
psychological components
 Abnormal, when out of proportion or outlasts the
threat
What is Anxiety?

4. Stress Diathesis model :
Appear to be caused by stressors acting on
a personality predisposed by a
combination of genetic factors and
environmental influences in childhood

5. Stressful life events
Genetic causes
Psychoanalytical
theories
Cognitive – behavioral
theory
Neurobiological
mechanisms

6. Anxiety disorder are
associated with
neurotransmitter
imbalances, including
:
• Increase activity of
noradrenaline
• Reduce activity of
gamma-aminobutyric
acid (GABA) and
serotonin

7. Psychological arousal:
 fearful anticipation
 irritability
 sensitivity to noise
 restlessness
 poor concentration
 worrying thoughts

8. Autonomic arousal:
CARDIAC: Palpitation, tachycardia, hypertension
PULMONARY :Shortness of breath, choking
sensation
NEUROLOGICAL: Dizziness, light headedness,
hyperreflexia, mydriasis (pupil dilation), tremors,
tingling in the peripheral extremities

9. Somatic symptoms:
• Muscle tension
• Hyperventilation
• Sleep disturbance

10. Abnormal states in which the most striking
features are mental and physical symptoms of
anxiety, occurring in the absence of organic
brain disease or another psychiatric disorder.
Pathological anxiety is inappropriate (there is either no
real source of fear or the source is not sufficient to
account for the severity of the symptoms)
• People with anxiety disorder, the symptoms will interfere
with daily functioning and interpersonal relationship.

12. © 2015 John Wiley & Sons, Inc. All rights reserved.
Epidemiology

15. I. Clinical Descriptions of Anxiety Disorders
II. Common Risk Factors Across the Anxiety
Disorders
III. Etiology of Specific Anxiety Disorders
IV. Treatments of Anxiety Disorders

16. DSM-5 Anxiety Disorders
• Specific phobias
• Social anxiety disorder
• Panic disorder
• Agoraphobia
• Generalized anxiety disorder
Most common psychiatric disorders
28% report anxiety symptoms
Most common are phobias

17. DSM-5 criteria for each disorder:
• Symptoms interfere with important areas of
functioning or cause marked distress
• Symptoms are not caused by a drug or a medical
condition
• Symptoms persist for at least 6 months or at least 1
month for panic disorder
• The fears and anxieties are distinct from the
symptoms of another anxiety disorder

18.  Disruptive fear of a particular object or situation
• Fear out of proportion to actual threat
• Awareness that fear is excessive
• Must be severe enough to cause distress or interfere with
job or social life
 Avoidance

19.  Disproportionate fear of a particular object or
situation
• Common examples: fear of flying, snakes, heights, etc.
• Fear out of proportion to actual threat
• Awareness that fear is excessive
• Most specific phobias cluster around a few feared objects
and situations
• High comorbidity of specific phobias

20.  Conditioning
 Mowrer’s two-factor
model
• Pairing of stimulus with
aversive UCS leads to
fear (Classical
Conditioning)
• Avoidance maintained
though negative
reinforcement (Operant
Conditioning)

21.  Marked and disproportionate fear consistently
triggered by specific objects or situations
 The object or situation is avoided or else
endured with intense anxiety
 Symptoms persist for at least 6 months

23.  Previously called Social Phobia
• Causes more life disruption than other phobias
 More intense and extensive than shyness
• Persistent, intense fear and avoidance of social situations
• Fear of negative evaluation or scrutiny
• Exposure to trigger leads to anxiety about being humiliated
or embarrassed socially
• Onset often adolescence
 33% also diagnosed with Avoidant Personality Disorder
• Overlap in genetic vulnerability for both disorders

24.  Marked and disproportionate fear consistently
triggered by exposure to potential social scrutiny
 Exposure to the trigger leads to intense anxiety about
being evaluated negatively
 Trigger situations are avoided or else endured with
intense anxiety
 Symptoms persist for at least 6 months

25.  Frequent panic attacks unrelated to specific
situations
 Panic attack
• Sudden, intense episode of apprehension, terror, feelings
of impending doom
 Symptoms reach peak intensity within 10 minutes
• Physical symptoms can include:
 Labored breathing, heart palpitations, nausea, upset stomach, chest
pain, feelings of choking and smothering, dizziness, sweating,
lightheadedness, chills, heat sensations, and trembling
• Other symptoms may include:
 Depersonalization
 Derealization
 Fears of going crazy, losing control, or dying
 25% of people will experience a single panic attack (not the
same as panic disorder)

26. Uncued panic attacks
• Occur unexpectedly without warning
• Panic disorder diagnosis requires recurrent uncued
attacks
• Causes worry about future attacks
Cued panic attacks
• Triggered by specific situations (e.g., seeing a snake)
 More likely a specific phobia

27. Recurrent unexpected panic attacks
At least 1 month of concern about the
possibility of more attacks, worry about the
consequences of an attack, or maladaptive
behavioral changes because of the attacks

28. From the Greek word “agora” or marketplace
Anxiety about inability to flee anxiety-
provoking situations
• E.g., crowds, stores, malls, churches, trains, bridges,
tunnels, etc.
• Causes significant impairment
In DSM-IV-TR, was a subtype of Panic Disorder
• At least half of agoraphobics do not suffer panic attacks

29.  Disproportionate and marked fear or anxiety about at
least 2 situations where it would be difficult to escape
or receive help in the event of incapacitation or panic-
like symptoms, such as:
• being outside of the home alone; traveling on public
transportation; open spaces such as parking lots and
marketplaces; being in shops, theaters, or cinemas; standing
in line or being in a crowd
 These situations consistently provoke fear or anxiety
 These situations are avoided, require the presence of
a companion, or are endured with intense fear or
anxiety
 Symptoms last at least 6 months

30.  Involves chronic, excessive, generalized,
uncontrollable worry
• Lasts at least 6 months
• Interferes with daily life
 Often cannot decide on a solution or course of action
 Other symptoms:
• Restlessness, poor concentration, tiring easily,
restlessness, irritability, muscle tension
 Common worries:
• Relationships, health, finances, daily hassles
 Often begins in adolescence or earlier
• I’ve always been this way

31.  Excessive anxiety and worry at least 50 percent of days about at
least two life domains (e.g., family, health, finances, work, and
school)
 The person finds it hard to control the worry
 The worry is sustained for at least 3 months
 The anxiety and worry are associated with at least three (or one in
children) of the following:
• 1. restlessness or feeling keyed up or on edge
• 2. being easily fatigued
• 3. difficulty concentrating or mind going blank
• 4. irritability
• 5. muscle tension
• 6. sleep disturbance
 The anxiety and worry are associated with marked avoidance of
situations in which negative outcomes could occur, marked time and
effort preparing for situations that might have a negative outcome,
marked procrastination, difficulty making decisions due to worries,
or repeatedly seeking reassurance due to worries

32. 50% of those with anxiety disorder meet criteria
for another anxiety disorder
75% of those with anxiety disorder meet criteria
for another psychological disorder
• Disorders commonly comorbid with anxiety:
 60% with anxiety also have depression
 Substance abuse
 Personality disorders
 Medical disorders, e.g. coronary heart disease

34.  Psychologic therapy
 CBT :
- Reduce fear and worry
- Helps overcome sleep disturbance
Stress management sessions
 Counseling sessions
 Lifestyle changes
 Exercises and sports

35. Psychological treatments emphasize
Exposure
• Face the situation or object that triggers anxiety
 Should include as many features of the trigger as possible
 Should be conducted in as many settings as possible
 70-90% effective
 Systematic desensitization
• Relaxation plus imaginal exposure

41. Thank You
 Done By : Alaaeddine El Ghazawi
Med III