Anxiety Disorders

Calinisan, Janer, Rana, Yngson

Anxiety

According to the American Psychological Association (APA), anxiety is defined as “an

emotion characterized by feelings of tension, worried thoughts and physical changes
like increased blood pressure.”

Anxiety is our body’s response to stress. When a person feels stress, our body goes
into a fight-or-flight response where our brain releases chemicals that prepare our
body to either fight a stressor or flee from it. Once the threat has passed, our body
goes back to its normal state.

When an anxiety becomes more frequent, persistent, and triggers even without a
stimulus, it could become an anxiety disorder.
2 pics, 1 word
Post-traumatic Stress Disorder
and Acute Stress Disorder
What is PTSD?

- Is diagnosed when people who have experienced a trauma

persistently reexperience the traumatic event, avoid stimuli
related to the event, and have symptoms of anxiety and
hyperarousal

- Symptoms must last at least a month to be classified as PTSD

Subtypes/Classifications for PTSD

- Victim-related trauma: People with this type of PTSD were either witnesses of a criminal attack, or they
were the victims of the attack.
- Natural-disaster trauma: Earthquakes, tornadoes, hurricanes, and flooding are rarely caused by human
intervention. They take place due to a natural process over which humans have very little control.
- Survivor trauma: Some incidents that spark PTSD involve one victim and one antagonist, but sometimes,
the event has more than one victim.
- Perpetrator guilt: Most forms of PTSD involve the thoughts and feelings of a person who was helpless in
the face of fear, but people in this subtype had at least something to do with the event.
- PTSD not otherwise specified: Some traumatic events come with ripples that can touch people hours or
days after the issue has been resolved.
PTSD DSM-5 Criterion

● Stressor - Direct exposure to the event

● Intrusion symptoms - Nightmares and flashbacks
● Avoidance - Trauma-related thoughts or feelings and Trauma-related
external reminders
● Negative alterations in cognitions and mood - Inability to recall key
experiences from the traumatic event and decreased interest of
activities.
● Alterations in arousal and reactivity - irritability or aggression and being
hypervigilant
● Duration - symptoms must last for more than a month to be classified
as PTSD
● Symptoms are not due to medication, substance use, or other illnesses
Origin of PTSD

- In 1952 the American Psychiatric Association, establishes the

first DSM and in that it included gross stress reaction
- In 1968 the APA added adjustment reaction to adult life. It
was only limited to three criteria. The three criteria are
unwanted pregnancy with suicidal thoughts, fear linked to
military combat, and Ganser syndrome
- In 1980 the APA officially added PTSD in the DSM III after
conducting research on Vietnam war veterans, holocaust
survivors, and sexual trauma victims
Theories explaining PTSD

Genetic Factors
- Some people are more at risk of getting PTSD because of their
genetics

Culture
- Culture can help determine which PTSD symptoms are more
prominent

Psychological Factors
- People that have depression or other psychological disorders are
more at risk getting PTSD
Treatment for PTSD

● Prolonged exposure - talking about the traumatic

experience with a therapist

● Cognitive Processing Therapy - Teaches you to reframe

negative thoughts about the trauma.

● Eye-movement desensitization and processing - involves

calling the trauma to mind while paying attention to a
back-and-forth movement or sound

● Antidepressants - sertraline, paroxetine, fluoxtine,

venlafaxine
Youtube Video

https://www.youtube.com/watch?v=Xf
kmyKrQk-w
2 pics, 1 word
Phobia
What is Phobia?

● Irrational fear of many objects and situations

● DSM 5 divided Phobia into Specific Phobias
● Phobia can be focused on objects, animals, places or agoraphobia
● Most phobias develop during childhood
● Considered as one of the most common mental disorders
● 90% of those with specific phobias never look for treatment
Subtypes/Classifications for Phobia

● Animal-type phobias
○ Specific animals
○ Snakes and spiders are the most common for this phobia
○ Will be considered a phobia when they continue to live in terror of
encountering a snake or a spider or making their lives live around to
avoid these specific animals
● Natural environmental type phobias
○ Events or situations in the natural environment
○ Examples are storms, heights, or water
Subtypes/Classifications for Phobia

● Situational type phobias

○ Fear of public transportation, tunnels, bridges, elevators, etc.
○ Claustrophobia is a common phobia of this type
● Blood-injection-injury type phobia
○ Fear of seeing blood or an injury
○ Can also increase heart rate, blood pressure, or a fight-or-flight
response
Subtypes/Classifications for Phobia

● Agoraphobia
○ Fear of places where they might have trouble getting help or
escaping
○ Public transportation, open spaces, theaters, crowded places in
general are examples
○ Fear they will embarrass themselves if noticed that they are
creating efforts to escape during an attack
○ 50% of people with this phobia have a history of panic attacks
○ Other half can have a history of another anxiety disorder, or
depression
○ More common in women than men
○ Will seclude themselves to their homes to avoid these situations
Criteria for Phobia

● Specific Phobias
○ Marked fear or anxiety about a specific object or situation (e.g.,
flying, heights, animals, receiving an injection, seeing blood)
■ Note: In children, the fear or anxiety may be expressed by
crying, tantrums, freezing, or clinging
○ The phobic object or situation almost always provokes immediate
fear or anxiety
○ The phobic object is out of proportion to the actual danger posed
by the specific object or situation and to the sociocultural context
○ The fear, anxiety, or avoidance is persistent, typically lasting for 6
months or more
Criteria for Phobia

● Specific Phobias
○ The fear, or anxiety or avoidance causes clinically significant
distress or impairment in social, occupational, or other important
areas of functioning
○ The disturbance is not better explained by the symptoms of
another mental disorder, including fear, anxiety, and avoidance of
situations associated with panic-like symptoms or other
incapacitating symptoms (as in agoraphobia); objects or situations
related to obsessions (as in obsessive-compulsive disorder);
reminders of traumatic events (as in posttraumatic stress disorder);
separation from home or attachment figures (as in separation
anxiety disorder); or social situations (as in social anxiety disorder)
Criteria for Phobia

● Agoraphobia
○ Marked fear or anxiety about two (or more) of the following five
situations:
■ Using public transportation(e.g., automobiles, buses, trains,
ships, planes)
■ Being in open spaces (e.g., parking lots, marketplaces, bridges)
■ Being in enclosed places (e.g., shops, theaters, cinemas)
■ Standing in line or being in a crows
■ Being outside of the home alone
Criteria for Phobia

● Agoraphobia
○ The individual fears or avoids these situations because of thoughts
that escape might be difficult or help might not be available in the
event of developing panic-like symptoms or other incapacitating or
embarassing symptoms ( e.g., fear of falling in the elderly; fear of
incontinence)
○ The agoraphobic situations almost always provoke fear or anxiety
○ The agoraphobic situations are actively avoided, requre the
presence of a companion or are endured with intense fear or
anxiety
○ The fear or anxiety is out of proportion to the actual danger posed
by the agoraphobic situations and to the sociocultural context
Criteria for Phobia

● Agoraphobia
○ The fear, anxiety, or avoidance is persistent, typically lasting for 6
months or more
○ The fear, anxiety , or avoidance causes clinically significant distress
or impairment in social, occupational, or other important areas of
functioning
○ If another medical condition (e.g., inflammatory bowel disease,
Parkinson’s disease) is present, the fear, anxiety or avoidance is
clearly excessive
Criteria for Phobia

● Agoraphobia
○ The fear, anxiety, or avoidance is not better explained by the
symptoms of another mental disorder -- for example, the
symptoms are not confined to specific phobia, situational type; do
not involve only social situations (as in social anxiety disorder),
perceived defects or flaws in physical appearance (as in body
dysmorphic disorder), reminders of traumatic events (as in
posttraumatic stress disorder), or fear of separation (as in
separation anxiety disorder)
■ Note: Agoraphobia is diagnosed irrespective of the presence of
panic disorder. If an individual’s presentation meets criteria for
panic disorder and agoraphobia, both diagnoses should be
assigned
Origin of Phobia

● “Phobos” is the Greek word for “fear”, or “aversion”

Theories explaining Phobia

● Freud (1909): phobias result when unconscious anxiety is displaced onto

a neutral or symbolic object
○ A little boy named Hans has a phobia due to seeing a horse fall and
shake violently
○ The horses were actually his fear of his father castrating him, which
is related to Freud’s phenomenon called Oedipus Complex
● Mowrer’s (1939): classical conditioning is how people gain object
phobias, while operant continues the phobia
○ Little Albert Experiment
● Some theorists: observational learning can create phobias as well
○ Parents afraid of snake, child will be afraid of it as well
Theories explaining Phobia

● Prepared Classical Conditioning

○ Evolution based
● Biological theories
○ First-degree relative or genetic basis
Treatment for Phobia

● Behavioral treatments
○ Systematic desensitization
■ Relaxation techniques
■ Hierarchy of fears
■ Applied tension technique (fear of blood)
○ Modeling
■ Therapist → client
○ Flooding
■ Intensively exposing the client
● Biological treatments
○ Benzodiazepines
■ Anxiety reducer
Video

● https://www.youtube.com/watch?v=
PCOg2G797ek
2 pics, 1 word
Social Anxiety Disorder (SAD)
What is Social Anxiety Disorder?

● It is the fear of being rejected judged, or humiliated in public or a social

situation.
● People with social anxiety disorder may tremble, and perspire, feel
confused and dizzy, have heart palpitations, and eventually have full
panic attack
● It is relatively common with a lifetime prevalence of about 3 to 7
percent outside US.
● Women with social anxiety disorder have worse social fears than men.
● Tends to develop in either the early preschool years or adolescence.
● Often co-occurs with mood disorders and other anxiety disorders.
● Tends to be chronic if left untreated
Criteria for Social Anxiety Disorder

A. Marked fear or anxiety about one or more social situations in which the
individual is exposed to possible scrutiny by others. Examples include
social interactions, being observed, and performing, in front of others.
B. The individual fears that he or she will act in a way or show anxiety
symptoms that will be negatively evaluated.
C. The social situations almost always provoke fear or anxiety.
D. The social situations are avoided or endured with intense fear and
anxiety.
E. The fear or anxiety is out of proportion t the actual threat posed by the
social situation and to the sociocultural context
F. The fear, anxiety, or avoidance caused clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
Criteria for Social Anxiety
Disorder
G. The fear, anxiety, or avoidance causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning.

H. The fear, anxiety, or avoidance is not attributable to the physiological

effects of a substance or other medical condition.

I. The fear, anxiety, or avoidance is not better explained by the symptoms of

another mental disorder, such as panic disorder, body dysmorphic disorder,
or autism spectrum disorder

J. If another medical condition (e.g. Parkinson’s disease, obesity,

disconfigurement from burns or injury) is present, the fear, anxiety, or
avoidance is clearly unrelated or is excessive.
Origin/Etiology
● Literary descriptions of shyness can be traced back to the days of Hippocrates
around 400 B.C.
● Hippocrates described someone who ‘through bashfulness, suspicion, and
timorousness, will not be seen abroad; loves darkness as life and cannot endure
the light or to sit in lightsome places; his hat still in his eyes, he will neither see, nor
be seen by his good will.. He dare not come in company for fear he should be
misused, disgraced, overshoot himself in gesture or speeches, or be sick; he thinks
every man observes him’.
● In the 1930s extremely shy people were described to have “social neurosis”
● In the 1960s, social phobia was accepted by the American Psychological
Association and added social phobia to the DSM-III
● Social phobia was renamed to social anxiety disorder in the DSM-IV
Theories explaining Social Anxiety Disorder

Genetic factors

● It runs in the family

● Do not appear to lead specifically to anxiety about social situations, however, but rather
to a more general tendency toward the anxiety disorder

Cognitive perspective

● People with anxiety disorder have excessively high standards for their social
performance
● They are exquisitely attuned to their self-presentation and their internal feelings and
tend to assume that, if they feel anxious, it is because the social interaction is not going
well
● After a social interaction, they ruminate excessively about their performance and the
other person’s reaction
Treatment
● Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-norepinephrine
Reuptake Inhibitors (SNRIs) have been shown to be efficacious in reducing
symptoms of anxiety though symptoms tend to return if medication is stopped.
● Cognitive-behavioral theory is also useful for treating social anxiety.
○ The behavioral component involves exposing clients to social situations that
make them anxious, starting with the least anxiety-producing situations and
working up to the more anxiety-producing situations through role play tests,
accompanied with relaxation techniques.
○ The cognitive component involves identifying negative cognitions clients
have about themselves and about social situations and teaching them how to
dispute these situations.
○ Can be administered in a group setting
Treatment
● Mindfulness-based interviews
- It teaches individuals to be less judgemental about their own thoughts and
reactions and more focused on, and relaxed in, the present moment.
Youtube Video

https://www.youtube.com/watch?v=QL
jPrNe63kk
2 pics, 1 word
Panic Disorder
What is Panic Disorder
● A type of anxiety disorder that causes recurrent unexpected panic attacks.
○ Panic attacks are short but intense periods during which a person
experiences many symptoms of anxiety such as heart palpitations, trembling,
a feeling of choking, dizziness, intense dread, etc.
● Panic attacks can appear “out of the blue” or be triggered by specific situations or
events
● Some people may have episodes in a short period of time, such as everyday for a
week, and then go for weeks or months without any episodes, followed by another
period of frequent attacks. Others have less frequent attacks but more regularly,
such as once every week for months and they may experience minor bouts of
panic in between full-blown attacks.
Criteria for Panic Disorder
A. Recurrent unexpected panic attacks during which time four (or more) these symptoms
occur:
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of shock
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, 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
Criteria for Panic Disorder
B. At least one of the attacks has been followed by 1 month or more of 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.

C. The disturbance i not attributable to the physiological effects of substance (e.g., drug abuse,
or medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders)

D. the disturbance is not better explained by another mental disorder (social anxiety disorder,
specific phobia, obsessive compulsive disorder, PTSD, or separation anxiety disorder).
Origin/etiology of Panic Disorder
Theories explaining Panic Disorder
Biological Factors

● Heritability of panic disorder is about 43 to 48 percent. No genes have been

consistently identified as causing panic disorder
● Fight-or-flight response appears to be poorly regulated for these people, due to
poor regulation of norepinephrine, serotonin, gamma-aminobutyric acid (GABA),
and cholecystokinin.
● Neuroimaging studies show differences between people with and w/out panic
disorder in several areas of the limbic system such as the amygdala,
hypothalamus, and hippocampus.
● Dysregulation of norepinephrine systems in the area of the brainstem called the
locus ceruleus.
● The hormone progesterone can affect the activity of both the serotonin and GABA
neurotransmitter systems.
Theories explaining Panic Disorder
Cognitive Factors

● Cognitive theorists argue that people prone to panic attacks tend to (1) pay very
close attention to their bodily sensations, (2) misinterpret these sensations in a
negative way, (3) engage in snowballing catastrophic thinking, exaggerating
symptoms and their consequences.
○ Anxiety sensitivity - the unfounded belief that bodily symptoms have harmful
consequences
○ Interoceptive awareness - a heightened awareness of bodily cues (such as
slight sensations of arousal or anxiety) that may signal a coming panic attack.
○ These bodily cues have occured at the beginning of previous panic attacks
and have become conditioned stimuli signaling new attacks, a process called
interoceptive conditioning
Theories explaining Panic Disorder
Integrated Model

● Avoidance response - some people begin to associate certain situations with

symptoms of panic. By avoiding these places, they reduce their symptoms,
thereby reinforcing their avoidance behavior.
Treatment
Biological treatments

● Selective Serotonin Reuptake Inhibitors (SSRIs, such as Paxil, Prozac, Zoloft),

Serotonin-norepinephrine Reuptake Inhibitors (SNRIs, such as Effexor), and
tricyclic antidepressants.
● Benzodiazepines which suppress the central nervous system and influence
functioning in the GABA, norepinephrine, and serotonin neurotransmitter systems
work quickly to reduce panic attacks and reduce symptoms of anxiety
Treatment
Cognitive-behavioral therapy

● Clients are are to confront the situations or thoughts that arouse anxiety. Confrontational
is helpful because it allows clients to challenge and change irrational about these
situations, and it helps them extinguish anxious behaviors
1. Clients are taught relaxation and breathing exercises.
2. The clinician guides clients in identifying the catastrophizing cognitions they have about
changes in the bodily sensations
3. Clients practice relaxation and breathing exercises while experiencing panic symptoms
during the session.
4. The therapist challenges clients’ catastrophizing thoughts about their bodily sensations
and teaches them to challenge these thoughts themselves, using cognitive techniques
5. The therapist uses systematic desensitization therapy to expose clients gradually to the
situations they fear most while helping them maintain control over their symptoms
Video

https://www.youtube.com/watch?v=1aDglTzfNp
M
2 pics, 1 word
Obsessive-Compulsive Disorder
What is Obsessive Compulsive Disorder

- Obsessive Compulsive Disorder (OCD) is a mental health

disorder that affects people of all ages and walks of life, and
occurs when a person gets caught in a cycle of obsessions and
compulsions. Obsessions are unwanted, intrusive thoughts,
images or urges that trigger intensely distressing feelings.
Compulsions are behaviors an individual engages in to attempt
to get rid of the obsessions and/or decrease his or her distress.
Subtypes/Classifications for OCD

- Checking
- Contamination / Mental Contamination
- Symmetry and ordering
- Ruminations / Intrusive Thoughts
- Hoarding
DSM 5 Criterion for OCD

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the
disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them
with some other thought or action (i.e., by performing a compulsion).

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause
clinically significant distress or impairment in social, occupational, or other important areas of
functioning.
DSM 5 Criterion for OCD

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive
worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic
disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in
trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies,
as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with
substances or gambling, as in substance-related and addictive disorders; preoccupation with having an
illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in
disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder;
thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic
disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Origins of OCD

- OCD was first discovered in the 17th century by Robert Burton he reported a case in his
compendium, the Anatomy of Melancholy (1621): "If he be in a silent auditory, as at a
sermon, he is afraid he shall speak aloud and unaware, something indecent, unfit to be
said." this statement was made for one of his patients.

- Only in the late twentieth century were we able to learn more about the biology of OCD
because of the evolution of technology and different brain imaging techniques
Theories explaining OCD

Neurological Factors
- frontal cortex (especially the orbital frontal cortex the lower parts
of the cortex, behind the eyes) and the basal ganglia function
abnormally in OCD patients
- OCD is associated with larger amounts of gray matter in the frontal
lobes and smaller amounts in the posterior portions of the brain

Neural communication
- People with OCD lack the neurotransmitter serotonin

Genetic Factors
- OCD is more common among relatives of OCD patients
Treatment for OCD
- Cognitive behavioral therapy
- Exposure and Response prevention
- Medications
● Clomipramine (Anafranil) for adults and children 10 years and older
● Fluoxetine (Prozac) for adults and children 7 years and older
● Fluvoxamine for adults and children 8 years and older
● Paroxetine (Paxil, Pexeva) for adults only
● Sertraline (Zoloft) for adults and children 6 years and older
Youtube video for OCD

https://www.youtube.com/watch?v=FYCTpa
zS9rU
2 pics, 1 word
Separation Anxiety Disorder

“demanding, intrusive, in need of constant attention”

Adults: appear dependent and overprotective
What is Separation Anxiety Disorder?

● Excessive fear or anxiety about separation from home or an

attachment figure
● Present at all stages of life
● Normal stage in an infant’s development
Diagnostic Criteria
A. Developmentally 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.
4.Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere
because of fear of separation.
Diagnostic Criteria
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, stomach aches,
nausea, vomiting) when separation from major attachment figures occurs or is
anticipated.
Diagnostic Criteria
B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and
adolescents and typically 6 months or more in adults.
C. The disturbance causes clinically significant distress or impairment in social, academic,
occupational, or other important areas of functioning.
D. The disturbance is not better explained by another mental disorder, such as refusing
to leave home because of excessive resistance to change in autism spectrum disorder;
delusions or hallucinations concerning separation in psychotic disorders; refusal to go
outside without a trusted companion in agoraphobia; worries about ill health or other
harm befalling significant others in generalized anxiety disorder; or concerns about
having an illness in illness anxiety disorder.
Associated Features
•Social withdrawal, apathy, sadness, difficulty concentrating work
•Fear (relative to age)
•Misery
•School refusal
•Aggression
•Unusual perceptual experience
•Resentment and conflict in the family
Prevalence
Children > adolescents > adults
•In children, 4%
•Adolescents, 1.6%
•Adults, 0.9%-1.9%

Children: females = males

Community: females > males
Etiology
Biological Factors
- Neurotransmitters: serotonin & dopamine
Family Factors
- Hereditary (no precise role of genetics)
- Learned anxiety
Environmental Factors
- Traumatic experience
Theories
Bowlby’s Attachment Theory
- children come into the world biologically
pre-programmed to form attachments with others,
because this will help them to survive
Ainsworth Attachment Styles
- Secure vs insecure
Treatment
Cognitive Behavioral Therapy
- recognizing, understanding, and changing dysfunctional
thoughts, emotions, and behaviors
- Child: how to face and manage
- Parents: emotional support and independence
Selective Serotonin Reuptake Inhibitors (SSRIs)
- + CBT for severe symptoms
Video

● https://www.youtube.com/watch?v=
r_5eiYIo1XM
2 pics, 1 word
Generalized Anxiety Disorder
(GAD)
What is Generalized Anxiety Disorder (GAD)?

● Worries about almost all situations in life

● Example:
○ Anxious about being late to class
○ Anxious about losing a friend
● Instead of focusing on just one situation to handle, they usually get
anxious about many things
● Physiological symptoms
○ Muscle tension
○ Sleep disturbances
○ Chronic restlessness
DSM 5 Criterion for GAD
● Excessive anxiety and worry (apprehensive expectation), occuring more
days than not for at least 6 months, about a number of events or
activities (such as work or school performance)
● Individual finds it difficult to control the worry
● Anxiety and worry anr associated with three (or more) of the following
six symptoms (with at least some symptoms having been present for
more days than not for the past 6 months):
○ Restlessness or feeling keyed up or on edge
○ Being easily fatigued
○ Difficulty concentrating or mind going blank
○ Irritability
○ Muscle tension
○ Sleep disturbance
DSM 5 Criterion for GAD
● Anxiety, worry, or physical symptoms cause clinically significant distress
or impairment in social, occupational, or other important areas of
functioning
● The disturbance is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical
condition (e.g., hyperthyroidism)
● The disturbance is not better explained by another mental disorder
Origin of GAD

● Appeared in the 3rd DSM in the 1980s

● Anxiety neurosis → GAD and panic disorder
Theories explaining GAD

● Emotional and Cognitive factors

○ Intense negative emotions
○ Heightened reactivity in the amygdala
○ Maladaptive assumptions
○ Stressors or trauma during childhood
● Biological Factors
○ Abnormalities or deficiency in the GABA
○ Can be heritable
Treatment for GAD

● Cognitive-Behavioral treatments
○ Confront the issues they worry most
○ Challenge the negative thinking
○ Develop coping strategies
● Biological Treatment
○ Benzodiazepine drugs
○ Tofranil (tricyclic antidepressant imipramine)
○ Paxil (Selective serotonin reuptake inhibitor paroxetine)
○ Effexor (Venlafaxine)
Video

● https://www.youtube.com/watch?v=
9mPwQTiMSj8t