Self concept: The mental image or perception that one has of oneself.Ideal self : is an idealized version of yourself created out of what you have learned from your life experiences, the demands of society.
Anxiety Disorder: Symptoms, Diagnostic Criteria N Treatment
PRESENTED BY : WUZNA HAROON
As Anxiety disorders, as the term suggests, has an
unrealistic, irrational fear or anxiety of disabling
intensity at its core and its principal and most
AGORAPHOBIA: Anxiety about being in places or
situations from which escape might be difficult or in
which help may not be available in the event of
having an unexpected panic attacks or panic-like
PANIC ATTACKS: A discrete period of intense fear or
discomfort which developed abruptly and reached a
peak within 10 minutes.
Panic disorder defined as the occurrence
of unexpected panic attacks.
Panic disorder with agoraphobia
characterized by both recurrent
unexpected panic attacks and
Panic disorder without agoraphobia
characterized by recurrent unexpected
Symptoms: 1. persistent concern of having attack.
2. Worry about the implications of attack.
3. A significant change in behavior related
• COURSE AND PREVALENCE:
• Age at onset for panic disorder varies but
lay between late adolescence and mid-30s.
• Lifetime prevalence of panic disorder
reported to be high as 3.5% and one year
prevalence rate are between 0.5% and
• Duration: at least one month
• Differential Diagnosis: Panic disorder is not diagnosed
, if panic attacks are judged to be direct physiological consequence
general medical condition or substance. In panic disorder avoidance
is associated with anxiety of having a panic attack but in other
disorders it is associated with concern about harmful consequence
of feared object or situation. In Panic disorder with agoraphobia
fear of having unexpected panic attack with avoidance of multiple
situations and in specific phobia or social phobia it to specific
A persistent and disproportionate fear of some specific
object or situation that presents little or no actual danger
Specific phobias: is characterized by clinically significant
anxiety provoked by exposure of specific feared object or
situation, often leading to avoidance.
Animal type: feared cued by animal or insect
Natural Environment type: feared cued by object in natural environment like
storm, water or height.
Blood Injection type: fear cued by receiving injection or seeing blood.
Situational type: fear cued by situation such as tunnels bridges, elevator.
Other type: fear of choking, vomiting, contracting illness.
Course and Prevalence
• Age onset for specific phobia lay between childhood
• In community samples current prevalence rate
ranges from 4% to 8.8% and lifetime prevalence rates
ranges from 7.2% to 11.3%.
• Duration: at least 6 months.
• Differential Diagnosis:
Post-traumatic stress disorder
Obsessive Compulsive disorder
Anorexia Nervosa and Bulimia Nervosa
Is characterized by clinically significant
anxiety provoking by exposure to certain
types of social or performance
situation, which people exposed to
unfamiliar people or to scrutiny by others.
The individual fears that he or she will act
in a way that will be humiliating or
Duration: at least 6 months.
Course and Prevalence:
It has an onset in the mid-teens.
Studies have reported a lifetime prevalence of
social phobia ranging from 3% to 13%.
Separation Anxiety disorder
Generalized Anxiety disorder
Schizoid Personality disorder
performance anxiety, stage fright and shyness
OBSESSIVE COMPULSIVE DISORDER
Obsessive Compulsive Disorder characterized by
obsessions(which cause marked anxiety) and by
compulsions( which serve to neutralize anxiety)
Obsession: are persistent thoughts, ideas, impulses, or
images that seem to invade a person’s consciousness.
Compulsions: are repetitive and rigid behavior or mental
act that a person feels compelled to perform to reduce
distress or anxiety. :
Verbal compulsion: compel them to repeat expressions, phrases.
Touching rituals: must touch or avoid touching certain items
Counting compulsion: driven to count the things they see around them.
Course and Prevalence
studies have estimated a lifetime prevalence
of 2.5% and 1 year prevalence of 0.5%-2.1% in adults. OCD
prevalence is similar in many different cultures.
Age onset is earlier in males than females: between age 6
and 15 for males and between age 20 and 29 years for
• OCD is not diagnosed if the content of thoughts or activities related to another mental
disorder like Body Dysmorphic disorder or Specific phobia.
• Major depressive disorder.
• Generalized Anxiety disorder.
• Additional diagnosis of delusional disorder or psychotic disorder not otherwise
Excessive anxiety and worry occurring
more days than not for at least 6 months
about number of events and activities.
Restlessness or feeling keyed up or on edge
Being easily fatigue
Irritability & muscle tension
Difficulty concentrating or mind going blank
Course and prevalence:
• Onset occurring after age 20 years.
• 1 year prevalence rate for GAD was 3%
and lifetime rate was 5%.
GAD should be made only when the focus
of the anxiety and worry is unrelated to
other disorder like
• Panic disorder
• Obsessive Compulsive disorder
• Separation Anxiety disorder
• Post-traumatic Stress disorder.
Posttraumatic Stress Disorder
PTSD is characterized by the re-experiencing of an
extremely traumatic event accompanied by the
symptoms of increased arousal and by avoidance of
stimuli associated with trauma.
Avoidance of trauma recollections
Avoidance of talk of trauma
Distress at exposure to similar stimuli
Course and Prevalence
PTSD can occur at any age, including childhood.
Community based studies reveal a lifetime prevalence
for PTSD approximately 8% of adult population in United
Acute: duration of symptoms less than 3 months.
Chronic: duration of symptoms last 3 months or longer.
With Delayed onset: 6 months have passed between the traumatic
event and the onset of symptoms.
Acute Stress disorder
Flash backs in PTSD should also be
distinguished from hallucinations, illusions
and other perceptual disturbances.
ACUTE STRESS DISORDER
Acute Stress Disorder (ASD) is
characterized by symptoms similar to those
PSTD that occur immediately in the
aftermath of an extremely traumatic event.
• Dissociative amnesia (inability to recall traumatic events).
• Subjective sense of numbing, detachment or emotional
• De realization.
Traumatic event is persistently re-experienced
Sense of reliving the experience.
Distress on exposure to reminders of traumatic events.
Marked symptoms of anxiety or increased arousal
• difficulty in sleeping.
exaggerated startle response
Course and Prevalence
• Symptoms experienced during or immediately after the
trauma, last for at least 2 days, and maximum 4 weeks
and occur within 4 weeks of the traumatic event.
• ASD in few available studies, rates ranging from 14% to
33% have been reported in individuals exposed to
Distinguish from mental disorder due to general
medical condition( e.g. head injury) and from
Substance Induced disorder (e.g. related alcohol
Major depressive disorder in diagnosed in addition
to the diagnosis of Acute stress disorder.
THEORIES ON ANXIETY
The Psychodynamic Theory
The Humanistic- Existential Theory
The Behavioral Theory
The Neuroscience Theory
The Cognitive Theory
The Socio-cultural Theory
THE PSYCHODYNAMIC THEORY
The fundamental concept is that anxiety is at the
root of neurosis.
Anxiety stemmed in the form of unacceptable ID
impulses attempting to break through into
consciousness and behavior.
In all neurosis the relief of anxiety is sought through
various defense mechanism.
For example, in panic attack, the cause that is id impulse moves
closer to the boundaries of conscious mind, resulting in rapid building up
of anxiety. The ego responds with desperate effort to repression, once the
ego regain upper hand the impulse once again safely repressed.
Humanistic- existential theorists describe anxiety as
the outcome of the conflict between the individual
According to humanists the source of neurosis is the
discrepancy between the self concept and the ideal
If the way we perceive ourselves is very different
from the way we would like to be, we feel incapable
of meeting life’s challenges, and anxiety results.
THE BEHAVIORAL THEORY
According to behaviorists avoidance is a
response learned to relieve anxiety.
For example, Agoraphobia is a strategy to
avoid panic attacks in public.
Avoidance learning is a major source of
anxiety and is two-stage process:
Through respondent conditioning, a neutral
stimulus becomes anxiety arousing.
The avoidance response relieves anxiety through
negative reinforcement and becomes habitual.
Another way of acquiring fear reactions is
THE NEUROSCIENCE THEORY
Anxiety disorders appear to have genetic
In Norwegian study, the concordance rate
for panic disorder in MZ twins was 31
percent, as opposed to 0 percent for D
twins (Torgersen, 1983).
Abnormalities in the neurotransmitters
gamma-amino butyric acid (GABA) and
serotonin may have a particular role in
susceptibility to generalized anxiety
Serotonin is a major player in OCD and
THE COGNITIVE THEORY
According to the cognitive theory, people with
anxiety disorders misperceive or misinterpret
internal and external stimuli.
Events that are not really threatening, and anxiety
In the case of panic disorder, if a person upon
experiencing unusual bodily sensations
catastrophically, as a signal that he or she is about to
pass out or have a heart attack, then panic could
THE SOCIO-CULTURAL THEORY
According to socio-cultural theorists, phobic and
GAD are more likely to develop in people who are
confronted with societal pressure.
Stressful changes have occurred in the society have
also increased the prevalence of anxiety disorders.
FOR ANXIETY DISORDER
Flooding and Implosive Therapy
Rational-emotive behavior therapy
Crisis intervention therapy
• Do you become anxious when you face anything that reminds
you of that traumatic event?
• Are you afraid that you will be in a situation where you will
not be able to escape?
• Do you feel that you worry excessively about many things?
• What is the differential diagnosis of panic disorder with
agoraphobia with specific phobias?
• How can anxiety disorder can be treated through systematic
• What is psychodynamic view regarding anxiety disorders?
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