This document discusses the nature and types of anxiety disorders. It defines fear and anxiety, and describes the fight or flight response. The main types of anxiety disorders covered include generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, obsessive-compulsive disorder, post-traumatic stress disorder, and their key symptoms. Biological, psychological, and cognitive factors that may contribute to the development and maintenance of anxiety disorders are also summarized.

1. Anxiety Disorders
Chapter 4

2. Nature of Anxiety and Fear
• Fear – present-oriented,
fight or flight response to
danger or threat
– Activates sympathetic
nervous system
– Hypothalamus triggers
adrenaline release 
optimal physical
functioning

3. Fight or flight response…
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 4.1 The
Sympathetic and the
Parasympathetic nervous
system
Adapted from Lilienfeld, et al., Psychology: From
Inquiry to Understanding (p.121). Pearson/Allyn and
Bacon. Copyright © 2009 Pearson Education, Inc.
Reprinted by permission of Pearson Education, Inc.

4. Nature of Anxiety and Fear
• Anxiety – future-oriented
apprehension
– Often when no real danger is present
– Somatic symptoms of tension, decreased
physical reactivity
– Characterized by negative
affect, negative thought
pattern, and
escape/avoidance
behaviors

5. How it Works…
What if the snake strikes
me and it’s poisonous?
You are walking
on a path at a
local park and all
of a sudden you
see a snake
slither out in
front of you.
Elements of Anxiety
As soon as you see
the snake, your
heart starts racing
and your breathing
increases (body’s
response).
You scream for
help or run in the
other direction.
Copyright © 2012 by Pearson Education, Inc. All rights reserved.

6. Negative Reinforcement Increases Avoidance
Behavior and Anxiety
Copyright © 2012 by Pearson Education, Inc. All rights reserved.

7. Anxiety Disorders
• Occasional anxiety = normal
• Most common class of disorders
– 31.2% of US adults
• Avg. age onset = 11 yrs
• 57% have comorbid second
anxiety disorder or depression

8. Panic Attack
• Palpitations, pounding heart,
or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of
breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded
or faint
• Derealization (feelings of unreality)
or depersonalization (being
detached from oneself)
• Fear of losing control or going crazy
• Fear of dying
• Parasthesias (numbness or tingling)
• Chills or hot flushes
Panic attack - discrete period of intense fear or
discomfort and multiple physical symptoms; typically
peaks in 10 minutes; 4 or more symptoms
DSM-5
p. 119

9. Panic Attacks
• Expected
• Unexpected
• Often mistaken for heart attack
• Can occur in any disorder
• 28% of adults have had a panic attack;
5% have panic disorder
• Types:

10. Panic Disorder
• Recurrent unexpected panic attacks and:
– Persistent concern about more attacks
– Worry about implications or consequences
– Significant change in
behavior related to
attacks
DSM-5
p. 119

11. Panic Disorder
• Typically begins in early adulthood
• Women > men
• 94% seek treatment
• Few symptom-free periods w/o treatment
• Medications - short-term solution

12. Agoraphobia
• Agoraphobia - fear of
being in public places or
situations where escape
might be difficult
– Avoid going out or require
a trusted companion or
safety objects
– > 6 mos.

13. Generalized Anxiety Disorder
• Excessive anxiety and uncontrollable worry about
many events and activities
• ≥ 3 symptoms present for 6 months
– Restlessness, feeling on edge
– Easily fatigued
– Difficulty concentrating or mind
going blank
– Irritability
– Muscle tension
– Sleep disturbance

14. Generalized Anxiety Disorder
• Difficulty tolerating uncertainty
• Believe worrying may help to prevent
negative consequences
• Onset often associated with unexpected,
negative, or very important
life events

15. Generalized Anxiety Disorder
• Typically starts in late teens or 20s
• Gradual onset, but chronic
• Most seek treatment from PCP
• 5-10% lifetime prevalence
• More common in racial/ethnic
minorities and lower SES

16. Social Anxiety Disorder
• Severe fear of social or
performance situations
• Subtype:
– Performance
– Generalized
• >50% have another anxiety disorder and
depression
• May use alcohol to cope

17. Social Anxiety Disorder
• Average onset: 11-13 yrs.
• >85% recover with treatment
• 12-13% of adults
• Chronic, dysfunction increases with age

18. Social Anxiety Disorders:
Developmental Differences
Social Situations Children Adolescents Adults
Giving oral presentations 83% 88% 97%
Attending parties/social events 58% 61% 80%
Working in a group 45% 62% 79%
Initiating, maintaining conversations 82% 91% 77%
Dating 8% 47% 54%
Using public bathrooms 17% 30% 18%
Eating in the presence of others 16% 34% 25%
Writing in the presence of others 50% 67% 12%

19. Specific Phobia
• Severe and persistent fears of specific objects
or situations
• 5 Types:
– Animal phobias
– Natural Environment phobias
– Blood/injection/injury phobia
– Situational Phobias
– Other
• >6 mos.

20. Percentage of Adults with a Specific
Phobia in USA
Type of Fear
Seeing insects, snakes, birds, or other animals 4.7%
Being in high places (tall buildings, bridges, or mountains) 4.5%
Experiencing storms, thunder, or lightning 2.0%
Being in or on the water 2.4%
Flying 2.9%
Being in closed places (cave, tunnel, or elevator) 3.2%
Being in crowd 1.6%
Traveling in buses, cars, or trains 0.7%
Seeing blood or getting an injection 2.1%
Going to the dentist 2.4%
Visiting or being in the hospital 1.4%
Other specific objects or situations 1.0%

21. Specific Phobia
• Often multiple phobias
• Few seek treatment
• 12.5% of adults, 3.5% of kids
• Avg. onset = 7 years
• More common among girls and younger
children
• Women: situational, animal, and natural
environment phobias
• Men and women: heights and B-I-I situations

22. OBSESSIVE-COMPULSIVE AND
RELATED DISORDERS

23. Obsessive-Compulsive Disorder
Obsessions – recurrent, persistent, intrusive, and
distressing thoughts
• Attempts to ignore, suppress, or neutralize them
with a thought or action

24. Compulsions – repetitive
behaviors, done in response
to obsessions or according
to rigid rules
• Observable or mental
• Magical quality
• Maintained by negative
reinforcement
Obsessive-Compulsive
Disorder

25. Obsessive-Compulsive
Disorder
• Obsessions/compulsions are time-consuming
(>1 hr/day) or interfere with routine,
functioning, or
relationships
• Recognition that obsessions/
compulsions are excessive or
unreasonable

26. Obsessive-Compulsive Disorder
• Usually does not remit without treatment
• Lifetime prevalence – 1.6%
• Onset in late teens or early adulthood, but
signs present earlier
• Equal rates across genders
– Boys develop earlier and
have more family members
with disorder

27. Hoarding
• Persistent difficulty discarding possessions, regardless
of value
• Distress and perceived need to save
• May cause physical dangers

28. Body Dysmorphic Disorder
• Preoccupation with imagined physical defect
• Ideas of reference
• Suicidality common

29. Body Dysmorphic Disorder
• Statistics
– More common in females
– Onset - early 20s
– Most remain single
– Many seek out plastic surgeons

30. Trichotillomania
• Repetitive hair-pulling
• Unable to stop

31. Excoriation Disorder
• Recurrent skin picking resulting in skin lesions
• Unable to stop

32. TRAUMA AND STRESSOR-RELATED
DISORDERS

33. Post-traumatic Stress Disorder
• Exposure to actual or threatened death,
serious injury, or sexual violence
DSM-5

34. Post-traumatic Stress Disorder
• Intrusion symptom (1):
– Recurrent, involuntary, intrusive, and distressing
memories
– Recurrent, distressing dreams
– Acting or feeling if event recurring
– Intense distress at exposure to
internal or external cues of the event
– Physiological reactivity to cues
DSM-5

35. Post-traumatic Stress Disorder
• Avoidance of stimuli associated with trauma (1)
– Thoughts, feelings, conversations related to trauma
– Places or people that trigger recollections
DSM-5

36. – Negative changes in mood and cognitions (2)
– Inability to recall important aspect
– Negative beliefs about self, others, or the world
– Distorted cognitions about cause or consequences
leading to misplaced blame
– Persistent negative emotional state
– Diminished interest/participation in significant
activities
– Feeling detached from others
– Unable to experience positive emotions
Post-traumatic Stress Disorder
DSM-5

37. Post-traumatic Stress Disorder
• Increased arousal (2)
– Irritability/outbursts of anger
– Reckless or self-destructive behavior
– Sleep disturbance
– Difficulty concentrating
– Hypervigilance
– Exaggerated startle response
• > 1 month
DSM-5

38. Post-traumatic Stress Disorder
• Onset - any age
• Symptoms of civilian trauma decline with time
• Combat-related less responsive to treatment

39. Post-traumatic Stress Disorder
• Civilian – 6.8%
• Combat-related – 18.5%
• Women: 50% of cases associated
with sexual assault
• Closer proximity to event
increases chances of disorder

40. Etiology of Anxiety Disorders
• Biological Perspective
– Genetic factors account for 25-50% of the
variance in anxiety disorders
• Trait anxiety – general vulnerability factor

41. Etiology of Anxiety Disorders
• Biological Perspective (cont’d)
– Amygdala and hippocampus more active
– Neurotransmitters:
• Low serotonin levels
• Low GABA
– Temperament
• Behavioral inhibition – risk
factor for social phobia

42. Etiology of Anxiety Disorders
• Biological Perspective (cont’d)
Chronic Stress / Early Adverse Experiences
Increased Stress Hormones
Changed Brain Activity
Increased Vulnerability to Anxiety Disorders

43. Etiology of Anxiety Disorders
(Psychological)
• Behavioral Theories of Fear Acquisition
– Classical conditioning
– Vicarious learning / modeling
– Information transmission

44. Etiology of Anxiety Disorders
• Cognitive Perspective
– Maladaptive, negative thoughts and inaccurate
interpretations of internal and external events
• Maintained by never attempting to determine if
thoughts are true
– Fear of fear model – panic disorder

45. Treatment of Anxiety Disorders
• Biological and psychological treatments (i.e.,
BT or CBT) - 70% remission

46. Biological Treatments
• Medication
– Disorders associated with
low serotonin
– Stimulates neuron to release more serotonin, OR
– Blocks reuptake of serotonin (SSRI’s)
• Prozac, Luvox, Zoloft, Paxil
• Biological treatment of choice
• Relapse common when withdrawn
• Caution needed with kids and young adults

47. Biological Treatments
• Medication
– Benzodiazepines (e.g., Valium and Xanax) affect
GABA
• For panic, GAD, and social phobia
• May cause physical and psychological dependence
• Withdrawal effects more risky – seizures possible
• Psychosurgery – last resort for OCD
– Cingulotomy

48. Psychological Treatments
• Behavioral and Cognitive-Behavioral Therapy
– Psychosocial treatments of choice
– All incorporate some form of exposure
• In vivo vs.
Imaginal vs.
Interoceptive
• Graduated vs.
flooding
– Enhance w/ cognitive
restructuring

49. Psychological Treatments
–Combining exposure w/ other treatments may
enhance efficacy
• Social phobia – training in social skills and
assertiveness
• Relaxation training – decreases general physical
arousal; esp. beneficial for GAD
• Biofeedback – monitoring autonomic nervous
system behaviors with relaxation training
– Combining CBT w/ medication typically does NOT
enhance treatment