1. Anxiety exists on a continuum from functional to dysfunctional, with dysfunctional anxiety meeting criteria for an anxiety disorder. 2. Anxiety disorders include generalized anxiety disorder, panic disorder, phobias like agoraphobia and social phobia, and obsessive compulsive disorder. 3. Common symptoms of anxiety disorders include excessive and unrealistic worry and fear, physical symptoms of anxiety, and safety behaviors used to cope with anxiety like avoidance or checking behaviors.

2. Anxiety Disorders

3. Fear and Anxiety Along the
Continuum
DysfunctionalFunctional

4. Functional
• Fear is response to objectively threatening events
(fearing you will fail a class after failing midterm)
• Fear of appropriate severity given the threat
(being concerned because you need to graduate)
• Fear subsides when threat has passed
• Fear leads to adaptive behaviors to confront or avoid
threat
(asking your instructor if you can improve your grade
with extra work)
DysfunctionalFunctional

5. • Fear may be somewhat unrealistic (fear of
appearing foolish when giving presentation in
class)
• Fear may be somewhat more than is warranted
given the severity of the threat (being unable to
sleep the night before)
• Fear persists after the threat has passed (after
you give the presentation, analyzing it and
worrying about what people thought)
• Fear leads to behaviors that may be somewhat
inappropriate (taking a tranquilizer before the
presentation to relax)
DysfunctionalFunctional

6. Potentially meets diagnostic criteria for an anxiety
disorder:
• Fear is moderately unrealistic (fearing a car
accident if you drive on Friday the 13th)
• Fear is definitely more than is warranted given the
severity of the threat nervous when forced to drive
on Friday the 13th)
• Fear persists for quite a while after the threat has
passed (worrying about the next friday the 13th
• fear leads to behaviors that are potentiatlly dangerous or
impairing
DysfunctionalFunctional

7. Likely meets diagnostic criteria for an anxiety disorder:
• Fear are completely unrealistic (fear that every ache or
pain is a sign of terminal illness)
• Fears are excessive given the objective threat (Thinking
one is dying when one feels pain)
• Fears persist long after the threat ha passed and chronic
anticipatory anxiety exist (believing one has terminal
illness despite physician reassurance)
• Fear leads to dangerous behavior or impairment
(seeking out surgery to cure terminal illness your
physician says do not have)
DysfunctionalFunctional

8. Worry, Anxiety, Fear and Anxiety
Disorders: What are they?
• Worry – cognitive or “thinking” concept
that refers to concerns about possible
future threat.
> Not necessarily bad thing because it helps
prepare for future events and solve
problems (Shearer & Gordon, 2006)

9. • Anxiety – is an emotional state that occurs as
threatening event draws close.
3 parts of anxiety
1. Physical feeling – may involve racing heart,
sweating, dry mouth, shaking, dizziness.
2. Thoughts – belief that one will be harmed or
lose of control of the situation.
3. Behaviors – avoiding certain situations or
constantly asking others if everything will be
okay
(Beidel &Turner,2005)

10. • Fear – an intense emotional state that occurs as
a threat is imminent or actually occurring.
• > A very specific reaction that is clear and
immediate: fright, increased arousal and
overwhelming urge to get away.

11. Worry Anxiety Fear
Potential threat Approaching threat Imminent threat
Little arousal
(Physical feelings)
Moderate arousal Severe arousal
Heavily cognitively
Moderately
cognitive
Scarcely cognitive
Little avoidance
Moderate
avoidance
Severe avoidance
General and slow
reaction (caution)
More focused and
quicker reaction
(apprehensiveness)
Very confused and
fast reaction (fight
or flight)

12. We worry about the safety of our children.
Become anxious when about to perform or
interview before others and are frightened when
airplanes experience sever turbulence.

13. Anxiety Disorder
• Worry, anxiety and fear may become
severe and create enormous trouble for a
person.
1. Generalized and Panic Anxiety Disorders
2. Phobias
3. Obsessive-Compulsive Disorders

14. Panic attack
• Involves specific period of time, usually 10 minutes or
so in which a person experiences intense feelings of
fear, apprehension that something terrible will happen
and physical symptoms (APA,2000)

15. DSM 5
SYMPTOMS
• palpitations, pounding heart
• Sweating
• Trembling
• Sensations of shortness of breath
• Feeling choking
• Chest pain or discomfort
• Nausea or abdominal distress
• feeling dizzy, unsteady , light headed or faint
• Chills or heat sensations
• Paresthesias (numbness)
• Fear of dying
• Fear of losing control

16. Depersonalization
> Persistent or reoccurent experiences of feelings detached from
and as if one were an outside observer of one’s mental process
or body

17. Derealization
> Persistent or recurrent experiences of
unreality of surroundings

18. a. Panic Disorders
• Regular experience of uncued panic attacks
(DSM –IV – TR)
1. A person has little idea when a panic attack
might happen.
2. Panic attacks are not harmful , but many
people with panic disorder become terrified of
their own internal sensations of dizziness,
heart palpitations or other panic attack
symptoms.

19. DSM-IV-TR Features of Panic Disorder
All of the following symptoms are present:
• Recurrent, unexpected panic attacks
One or more of the attacks has been followed by at
least 1 month of one or more of the following:
• Persistent concern about having additional attacks
• Worry about the implications or consequences of a
panic attack
• Change in behavior following the attacks, such as
avoiding places
Not due to a substance or medical condition or
another mental disorder

20. b. Generalized Anxiety disorder
> Vague, uneasy sense of tension and apprehension
sometimes referred to as free-floating anxiety.

21. DSM – IV – TR Features of Generalized Anxiety Disorder
All of the following symptoms are present:
• Excessive anxiety and worry more days than not for at least 6
months
• Persons finds it difficult to control the worry
Anxiety and worry are associated with three or more of the
following
*Restlessness *Easily fatigued *trouble
concentrating
*Irritability * Muscle tension * sleep disturbance
Anxiety and worry are not part of another mental disorder
Significant interference with daily living and functioning significant
distress
Not due to a substance, medical condition or another mental
disorder

22. Phobias
• Intense and unrealistic fear.
• Anxiety is focused so intensely on some objects
or situations that the individual is acutely
uncomfortable around it and will often go to
great pain to avoid it.

23. Agoraphobia
• Refers to anxiety about being in places where a
panic attack may occur especially places where
escape might be difficult.
• avoiding those place or enduring them with
great anxiety or dread.

24. DSM-IV-TR Features of Agoraphobia
All of the following symptoms are present:
*Anxiety about being in situations where a
panic attack could occur or from which
escape might be difficult
*These situations are avoided or endured
with substantial anxiety
*Not due to another mental disorder

25. Social Phobia
• Social anxiety phobia
• Marked by intense and ongoing fear of
potentially embarrassing social or
performance situations.

26. DSM-IV-TR Features of Social Phobia/Social Anxiety Disorder
All of the following symptoms are present:
*Marked and persistent fear of social or performance situations and
fear of acting in a way that causes personal humiliation or
embarrassment
*Exposure to the feared social situation causes anxiety that may
come in the form of a situational bound or that may come in the
form of a situationally bound or predisposed panic attack
• Recognition that the fear is excessive or unreasonable
• Feared social or performance situations are avoided or endured
with intense anxiety
• Significant interference with daily living or functioning or marked
distress about having the disorder
• In children and adolescents, the disorder lasts at least six months
• Not due to a substance or medical condition or another mental
disorder

27. Specific Phobia
• excessive, unreasonable fear of a particular
object or situation.

28. DSM-IV-TR Features of Specific Phobia
All of the following symptoms are present:
• Marked, persistent, excessive, unreasonable fear of
specific object or situation
• Immediate anxiety response, perhaps in the form of a
situationally bound or situationally predisposed panic
attack when encountering the feared stimulus
• Recognition that the fear is excessive or unreasonable
• Phobic situation is avoided or endured with intense
anxiety
• Significant interference with daily living or functioning or
marked distress about having the disorder
• In children and adolescents, the disorder lasts at least 6
months
• Not due to another mental disorder

29. 5 types of Specific Phobias (APA, 2000)
1. Animal Phobias
2. Natural environment phobias
3. Blood-injection-injury phobias
4. Situational Phobias
5. Other phobias – involve any intense fear of a specific
object
Example:
Iophobia – fear of poison
Levophobia – fear of things to one’s left
Arachibutyyphobia – fear of peanut butter sticking to the
roof of the mouth
Hippotomonstrosesquippedaliophobia – fear of long
words

30. • Acrophobia – high places
• Agoraphobia - __________
• Algophobia – pain
• Astraphobia – storms, thunder and lightning
• Claustrophobia – closed places
• Hematophobia – blood
• Mysophobia – contamination or germs
• Monophobia – being alone
• Nyctophobia – darkness
• Ocholophobia – crowds
• Hydrophobia – water
• Pathophobia – disease
• Pyrophobia – fire
• Syphilophobia – syphillis
• Zoophobia – animals or some particular animals

31. Obsessive-Compulsive Disorder
A. Obsession – This is an anxiety provoking
thoughts that will not go away.
- constant ideas, impulses or even
images
B. Compulsions – This is an irresistible urge to
engage in behavior such as repeatedly touching a
spot in one’s shoulder, washing one hand’s or
checking the locks on doors
- ritualistic acts done repeatedly to
reduce anxiety from the obsession

32. Common obsessions:
• Doubt
• Need of order
• Impulses toward aggression
• Sexual imagery
Obsessions occur spontaneously, frequently
and intrusively meaning they are unwanted
by the person but uncontrollable.
(APA,2000)

33. Posttraumatic stress disorder - marked by
frequent re-experiencing of a traumatic event
through images, memories, nightmares,
flashbacks, illusions or other ways.
Acute stress disorder – refers to anxiety and
dissociative symptoms (feelings of detachment
from reality or disconnectedness from others)
following a trauma that last between 2 days and 4
weeks.

34. Separation anxiety
marked by substantial distress when
separation from a major attachment
figure occurs or is expected to occur.