Anxiety based disorders. This ppt has been specifically designed for the Post Graduate Diploma in Guidance and Couselling students of GJUS&T, Hisar and affiliated College. FGM Govt. College Adampur have such diploma. the total seats are 20. We have well furnished lab. The students have exposure to various activities during their session at college. For more information and Psychology videos click on the following handle Dr. Rajesh Verma @Psychologywala

1. Anxiety: An introduction
Dr Rajesh Verma
Assistant Professor of Psychology
Govt. College Adampur, Hisar (Haryana)

2. Meaning-cum-Definition
Meaning - “an intense feeling of worry or fear
or feelings that produced due to frightening situation”
“The term anxiety is usually defined as a
diffused, vague, very unpleasant feeling of
fear and apprehension” NCERT.
“An emotion characterized by feelings
of tension, worried thoughts and
physical changes like increased blood
pressure” (APA).
Anxiety even in mild form can shorten the life
span (https://www.webmd.com/mental-health/
news/20120731/mild-anxiety-may-shorten-persons-life#1).

3. Introduction
Anxiety in mild form and occasional is the integral
part of stress response pattern of human beings.
Anxiety is anticipation of future threat. The levels of
worrry that are distressing and interfere with day-to-day effective
functioning indicate the presence of anxiety.
It keeps the individual in a constant state
of tension, worry and diffused uneasiness. It
can range from being mild and transient to
becoming severe and disruptive.
Life situations that can trigger anxiety
(i) Impending examination or waiting for results
(ii) Job interview
(iii) लड़का या लड़की देखने जाना
(iv) Results of medical test (Covid-19)

4. Causes of
Anxiety
(i) Genetics
(Personality disposition).
(ii) Changes in neurological or brain
chemistry.
(iii) Disruptive life events.
(iv) Physical and emotional stress.
(v) Traumatic event.
(vi) Substance abuse.
(vii) Stress.
(viii) Other anxiety disorder.
(ix) Depression.
(x) Environmental stressors.

5. Psychological Symptoms
(i) Panic attacks with constant state of
fear.
(ii) Feeling of severe physical problem or
failure of an organ.
(iii) Loss of control over psychological &
physical self.
(iv) Excessive worry and nervousness.
(v) Worrying of being rejected.
(vi) Escape ideation.
(vii) Insomniac reaction.
(viii) Phobic reactions (Irrational fear).
(ix) Repeated thoughts or regular
flashback of some uneventful past event.
(x) Mental discomfort.

6. Behavioural Symptoms
(i) Feeling of nervousness and excessive emotional
expression.
(ii) Marked variation in regular life.
(iii) Experience of fear without any significant
cause.
(iv) Avoiding social gathering such as party or function.
(v) Feeling of uneasiness in the event of being alone.
(vi) Moving out of crowded places.
(vii) Master of tendering excuses or procrastination.
(viii) Hesitation in speaking with or in front of other
peoples.
(ix) Disproportionate response pattern.
(x) Uncontrollable obsessive thoughts,
nightmares and ritualistic behaviors, such as
repeated hand washing.

7. Physiological Symptoms
(i) Pounding heart or palpitations.
(ii) Mouth going dry and problem in
swallowing.
(iii) Excessive sweating.
(iv) Feeling weak at the knees.
(v) Stomach churning and feeling sick.
(vi) Increased characteristics
trembling of body limbs.
(vii) Tingling and numbing
sensation.
(viii) Excessive muscular tension.
(ix) Increased respiration rate.
(x) Feeling light giddiness.

8. Salient Features of Anxiety
(i) Anxiety is a psycho-physiological
response.
(ii) It is the
apprehension of future events.
(iii) Anxiety is a negative emotional state.
(iv) Arousal is the by-product of anxiety.
(v) A general state of nervousness,
fear, apprehension, and worrying.
(vi) More often it occurs without any real
cause.
(vii) The intensity of response is out of
proportion with the magnitude of the problem
real or imaginary.

9. Anxiety Type According to
Intensity
(i) Common or usual Anxiety
– The anxiety symptoms i.e.
uneasiness or nervousness due to normal life events e.g.
exams, relationships, financial hardship, loss in business
/agricultural produce etc. The symptoms are relatively for
lesser duration and intensity and clinically non-significant.
(ii) Mild Anxiety – The feeling of nervousness and fear
that have significant impact on daily life yet clinically non
-significant. The borderline state that can trigger unusual
response pattern from an usual event. The symptoms stay
for longer duration with increased intensity than of
common or usual anxiety.
(iii) Severe Anxiety – The excessive feeling of worry
and nervousness that requires clinical interventions.

10. Other Anxiety Types
(i) Cognitive Anxiety – The
experience of worry and apprehension
in thought process and other cognitive
components.
(ii) Somatic Anxiety – The magnitude of physiological
expression of worry and apprehension.
(iii) State Anxiety – It reflects the psycho-physiological
transient reactions pattern in response to a unpleasant situation.
(iv) Cognitive State Anxiety – The magnitude and intensity
of worry and negative thought process.
(v) Somatic State Anxiety – The perception of even subtle
changes in the physiological arousal.
(vi) Trait Anxiety – The predisposition to experience anxiety.
Personality type that are genetically predisposed or acquired the
tendency to be anxious. It is an important characteristic of
clients with anxiety disorders.

11. Classification of Anxiety
(i) Reality Anxiety – It is the basic
form of anxiety developing due to
perception about the dangers and
threats that may emanates from real life situations. In
terms of Psychoanalysis the anxiety faced by Ego due to
the external environment. For
example fear of LPG cylinder
blast, fear of occurrence of
road accident, being constantly
watched by someone (Yaksha
Yudhister Samvad).

12. (ii) Moral Anxiety – This type of anxiety is
based upon the ‘Feeling of guilt’. It occurs
when an individual feels that his behaviour
has violated his value system, moral code of
conduct or not able to meet the social
expectations. It is a kind of is unconscious fear that can arise on
both occasions i.e. done something or not
done any thing. In Psychoanalysis terms it
is a fear that superego might excessively
interfere in an individual’s life leading to
criticism and punishment. उमराव जान फिल्म
क
े एक गाने फजसक
े बोल हैं यह क्या जगह है दोस्ोों यह
कौन सा दयार है में कफव शहरयार फलखते हैं की “तमाम
उम्र का फहसाब माोंगती है फजोंदगी ये मेरा फदल कहे तो
क्या, ये ख़ुद से शममसार है”। (Arjuna Krishna Samvad).

13. (iii) Neurotic Anxiety – The fear that Id
might override the role of ego and takes
control of the individual’s
behaviour. The fear of
consequences arising due to expression of
improper demands of Id. In other words
fear of disturbing the balance between Id
and Superego. It may lead to punishment
and social repulsion.

14. (iv) Generalised Anxiety – It consists of
prolonged, vague, unexplained and
intense fears that are not attached to
any particular object, event or
phenomenon. In this condition the individual worries
about the quality of their social and nonsocial
performance and tends to overestimate the danger in
situations. Uncontrolled
generalized anxiety may leads
to muscular pain, insomnia,
trembling, and gastro
intestinal problems.

15. Anxiety Based Disorders
Separation Anxiety Disorder
Panic Disorder
Generalized Anxiety Disorder
Obsessive Compulsive Disorder
Phobia

16. Separation Anxiety Disorder
Defining Feature
Periods of heightened separation anxiety from attachment figures.
Development and Course
Onset of separation anxiety disorder may be as early as
preschool age and may occur at any time during childhood and
more rarely in adolescence.

17. Separation Anxiety Disorder
Diagnostic Criteria
Inappropriate and excessive fear or anxiety concerning separation
from those to whom the individual is attached, as evidenced by at
least three of the following:
1. Recurrent excessive distress when anticipating or
experiencing separation from home or from 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
untoward event (e.g., getting lost, being kidnapped, having an
accident, becoming ill) that causes separation from a major
attachment figure.

18. 4. Persistent reluctance or refusal to go out, away from home,
to school, to work, or elsewhere because of fear of separation.
5. Persistent 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.

19. Panic Disorder
Defining Feature
Panic disorder refers to recurrent unexpected panic attacks.
A panic attack is an abrupt surge of intense fear or intense
discomfort that reaches a peak within minutes.
The term unexpected refers to a panic attack for which there
is no obvious cue or trigger at the time of occurrence.

20. Panic Disorder
Diagnostic Criteria
A. Recurrent unexpected panic attacks. A panic attack is an
abrupt surge of intense fear or intense discomfort that reaches a
peak within minutes, and during which time four (or more) of the
following symptoms occur;
Note: The abrupt surge can occur from a calm state or an anxious
state.
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.

21. 5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization
(being detached from oneself).
12. Fear of losing control or “going crazy.”
13. Fear of dying

22. B. At least one of the attacks has been followed by 1 month (or
more) of one or both of the following:
1. Persistent concern or worry about additional panic attacks
or their consequences (e.g., losing control, having a heart attack,
“going crazy”).
2. A significant maladaptive change in behavior related to the
attacks (e.g., behaviors designed to avoid having panic attacks,
such as avoidance of exercise or unfamiliar situations).

23. Generalize Anxiety Disorder
GAD is one of the types of anxiety disorders. It consists
of prolonged, vague, unexplained and intense fears that are
not attached to any particular object, event or phenomenon.
In this condition the individual worries about the quality of
their social and nonsocial performance and tends to
overestimate the danger in situations.
The key features of generalized anxiety disorder are
persistent and excessive anxiety and worry
about various domains, that the individual
finds difficult to control. In addition, the
individual experiences physical symptoms,
including restlessness; being easily fatigued;
difficulty concentrating; irritability; muscle
tension; and sleep disturbance. Female are
at the double the risk of getting into the
GAD trap than males.

24. Symptoms
(i) Increased heart rate & shortness of breath,
(ii) Difficulty in decision making,
(iii) Inability to concentrate,
(iv) Fainting & dizziness,
(v) Extreme sensitivity,
(vi) Tremors,
(vii) Sleeplessness,
(viii) Loss of appetite,
(ix) Excessive sweating,
(x) Frequent urination,
(xi) Discouragement,
(xii) Sustained muscular tension, and
(xiii) Hypervigilance (constantly scanning the
environment for dangers).

25. Diagnostic Criterion
The individual with chronic anxiety who is eligible for
specified GAD criteria and does not meet the criteria for
any other anxiety disorder or any other mental disorder
should be diagnosed as having generalized anxiety disorder.
Before pronouncing an individual with GAD the cultural
and gender factors must be taken into account.
(i) Excessive anxiety and worry occurring more days
than not for at least 6 months, about a number of events or
activities.
(ii) The individual finds it
difficult to control the worry.
(iii) The symptoms cause
clinically significant distress or
impairment in social, occupational,
or other important areas of functioning.

26. Diagnostic Criterion
(iv) The anxiety and worry are associated with three
or more of the following six symptoms: -
Note: Only one item is required in children.
(a) Restlessness.
(b) Being easily fatigued.
(c) Difficulty concentrating.
(d) Irritability.
(e) Muscle tension.
(f) Sleep disturbance.
(v) The disturbance is not due to the physiological
effects of a substance (drug or medication) or another
medical condition.
(vi) The disturbance is not better explained by
another mental disorder.

27. Characteristics of GAD
(i) Social worries are common in GAD.
(ii) Excessive and uncontrollable ‘worry’ (apprehensive
expectation) is defining symptom of GAD which has shifting
nature from one topic to another.
(iii) It leads to distress and impairment in daily life.
(iv) The worries typically interfere significantly with
psychosocial functioning.
(v) The worries are more pervasive,
pronounced, and distressing; have
longer duration; and frequently occur
without precipitants.
(vi) GAD rarely occurs prior to
adolescence.
(vii) The clinical expression of GAD is
relatively consistent across the lifespan.
(viii) GAD manifests more severe
symptoms in younger adults than adults.

28. OCD
“Obsessions are defined as persistent thoughts,
impulses or images that occur repeatedly and are experienced
as intrusive, inappropriate and distressing”.
“Compulsions are repetitive behaviours or mental acts
that an individual feels compelled to perform in response to
an obsession or some rigid rules”.
“Being preoccupied with
certain thoughts that are viewed
by the person to be embarrassing
or shameful, and being unable to
check the impulse to repeatedly
carry out certain acts like checking,
washing, counting, etc.”

29. Examples of Obsession and Compulsion
Obsessions – Occurrence of a repetitive thought
(How dare he? Who is he to call me names?), fear
of harming others, I may commit a
mistake etc.
Compulsions – Repetitive
Washing, Counting, Cleaning,
Checking etc.

30. Why an Individual Engage in Obsessive Thoughts and
Compulsive Acts
It brings a feeling of reduced tension and
satisfaction (Quoted by Coleman, 1988). If the person
tries to resist the compulsion, he is overcome with
anxiety.
OCD types
(i) Hoarding,
(ii) Contamination,
(iii) Rumination,
(iv) Orderliness, and
(v) Checking.

31. Some Obvious Symptoms
(i) Repetitive actions & activities (Washing hands).
(ii) Ritualized patterns of behaviour.
(iii) Obsessive [tormenting] thoughts on variety of topics
(bodily functions, committing immoral acts, attempting
suicide, or finding the solution to unsolvable problems).
(iv) Individual feels inadequate and insecure.
(v) Tendency of feeling guilt.
(vi) Display symptoms of fear,
worry, depression and anxiety
frequently.
(vii) Their actions are slow and to
the level of perfection.
(viii) Frequent bout of anger and
irritative behaviour.

32. Important Causes and Determinants
Causes
(i) Genetics,
(ii) Environment,
(iii) History of Psychiatric
Disorders, and
(iv) Emotional Trauma.
Determinants
(i) Substitutive thoughts and activities – Defending self from
anxiety [produced by threatening thoughts] by thinking
something else or diverting to another activity. It’s a kind of
escape-from-the-problem system.
(ii) Guilt and fear of punishment – OCB usually stems from
feelings of guilt and self-condemnation.
(iii) Assurance of order and predictability – Maintaining
meticulously methodical and rigid pattern of behaviour. Rigid
behaviour provide mental solace and security against anything
going wrong.

33. Diagnostic Criterion
The diagnosis must be done by expert, qualified and
experienced individual on the set scientific standards. Some
of them are described below (DSM V): -
(i) The individual must experience that the obsession or
compulsion are excessive and
interfering in day to day life.
(ii) Spent more than 1 hour per
day in OCB.
(iii) Cause clinically significant
distress or impairment in
social, occupational, or other
important areas of functioning.
(iv) OCB is not the result of
some physiological substance
such as drug or medication.

34. Characteristics of OCD/N
(i) OCB (behaviour) is maladaptive.
(ii) It represents irrational and exaggerated behaviour in
the face of nonthreatening stresses.
(iii) It reduces behavioural flexibility
of the individual.
(iv) Individual feels inadequate,
insecure and highly vulnerable to
threats.
(v) Compulsive acts are performed
in response to the obsessive thoughts.
(vi) Thoughts can be in the form of
language or images.
(vii) OCD is neither a trait nor part of personality, rather a
mental illness.
(viii) OCB is the manifestation of anxiety not stress.
(ix) OCD is gender neutral in its occurrence.

35. Phobia
“Irrational fears related to specific objects,
interactions with others, and unfamiliar
situations.” NCERT.
A phobia is a persistent fear
of some object or situation that
presents no actual danger to the
person or in which the danger is
magnified out of all proportion to
its actual seriousness
(Coleman, 1988).

36. Key Feature of Phobia
The fear or anxiety is
circumscribed to the presence of a
particular situation or object.

37. Main Types of Phobia
Phobias can be grouped into three main
types: -
(i) Specific phobias,
(ii) Social phobias (Social
anxiety disorders), and
(iii) Agoraphobia

38. Some Specific Phobia
1. Acrophobia (high places),
2. Astraphobia (pain),
3. Claustrophobia (closed places)
4. Hematophobia (blood),
5. Mysophobia (contamination or germs),
6. Monophobia (being alone)
7. Nyctophobia (darkness)
8. Ochlophobia (crowds),
9. Pathophobia (disease),
10. Pyrophobia (fire),
11. Syphilophobia (syphilis),
12. Zoophobia (animals), and
13. Nomophobia (being without mobile phone)
14. Allodoxaphobia means (an irrational fear of opinions)

39. Symptoms
(i) Excessive, unreasonable, persistent feelings of
fear or anxiety triggered by a particular object, activity
or situation.
(ii) Feelings are either irrational or out of proportion
to any actual threat.
(iii) Avoidance of the object, activity or situation that
triggers the phobia.
(iv) Anxiety-related
physical symptoms such as
tremors, palpitations,
sweating, shortness of
breath, dizziness, nausea
etc.).

40. Causes
Specific phobia usually develops in early childhood,
with the majority of cases developing prior to age 10 years
(DSM V). Amygdala plays a pivotal role in fear.
(i) Experiencing a traumatic event.
(ii) Observation of a traumatic event.
(iii) Unexpected panic attack.
(iv) Information transmission.
(ii) Unfortunate experiences
(Experiential-specific phobia).
(iii) Genetic factors (25 to 65%).
(iv) Environmental factors.

41. Proteins and Chemicals (Neurotransmitters)
Responsible for Phobia
(i) GABA (Inhibition of amygdala)
(ii) Dopamine (Activate the amygdala)
(iii) Norepinephrine (Activate the amygdala)

42. Risk and Prognostic Factors
(i) Specific phobia was found to associate with cardiac
diseases, gastrointestinal diseases, respiratory diseases,
arthritic conditions, migraine, and thyroid diseases
(Harvard Medical School).
(ii) Impairment in psychosocial functioning and
decreased quality of life
(iii) Impairments in occupational and
interpersonal functioning.
(iv) Reduced mobility and reduced
physical and social functioning due to
fear of falling.

43. Diagnostic Criterion
(i) The fear or anxiety must be intense or severe.
(ii) Fear or anxiety should evoke almost every time the
individual comes into contact with the object of phobia (phobic
stimulus).
(iii) The fear or anxiety should
occur immediately as the phobic
object or situation is encountered.
(iv) The fear, anxiety, or
avoidance is persistent, typically lasting for 6 months or more,
which helps distinguish the disorder from transient fears.
(v) The specific phobia must cause clinically significant
distress or impairment in social, occupational, or other important
areas of functioning in order for the disorder to be diagnosed.
(v) Meticulous examination of symptoms and family history
of mental disorders.
Note: Before diagnosing an individual with phobia sociocultural
context should also be taken into account.

44. Characteristics of Phobia
(i) The fear in the phobia is unrealistic and
irrational.
(ii) It is persistent and excessive.
(iii) The fear causes overwhelming distress.
(iv) The reaction to the stimuli is
disproportionate.
(v) Phobia
results from
exposure to
objects or
situations.

45. Certain Phobic Stimuli (DSM V)
(i) Animal (e.g., spiders, insects, dogs).
(ii) Natural environment (e.g., heights, storms,
water).
(iii) Blood-injection-injury (e.g., needles,
invasive medical procedures).
(iv) Situational (e.g., airplanes, elevators,
enclosed places).

46. References:
1. Coleman, C. J. (1988). Abnormal psychology and
modern life. Bombay, India: D. B. Taraporevala Sons & Co.
2. Generalized anxiety and generalized anxiety disorder:
description and reconceptualization. (1986). American
Journal of Psychiatry, 143(1), 40–44. doi:10.1176/ajp.143.1.40
3. NCERT. (XII). Psychology Book.
4. DSM V Manual. Published by APA.
5. Kaur, S. & Singh, R. (2017). Role of
different neurotransmitters in anxiety: a
systemic review. IJPSR, 8 (2), 411-421.