Anxiety Disorders and Legal issues of Psychology

Anxiety

Future-oriented mood state, often involving worry and anticipation of potential danger.

Fear

present-oriented mood state, linked to immediate threat or danger.

Prevalence

• Anxiety disorders are highly prevalent and often chronic, with strong genetic and environmental components.

Comorbidity

Comorbidity is common, particularly between anxiety disorders and depression.

Family history of anxiety

Family history of anxiety increases risk, as does having overprotective parents.

Gender differences

Anxiety disorders are more common in women than men.

Generalized Anxiety Disorder (GAD)

Characterized by excessive, chronic worry; commonly seen in older adults.

Social Anxiety Disorder

Involves fear of being around, talking to, or performing in front of others.

Specific Phobias

Marked by irrational fear of specific objects or situations, leading to avoidance.

Separation Anxiety Disorder

More common in children; intense fear of separation from caregivers.

Selective Mutism

A rare childhood disorder where a child consistently fails to speak in certain settings despite having the ability to speak.

Post-Traumatic Stress Disorder (PTSD)

Develops after trauma; symptoms include re-experiencing (e.g., nightmares, flashbacks), avoidance, hyperarousal, and negative mood changes.

Adjustment Disorder

Emotional or behavioral symptoms in response to a stressor, less severe than PTSD.

The role of the fight-or-flight system in anxiety responses.

The fight-or-flight system is activated by the sympathetic nervous system and prepares the body to respond to perceived threats, leading to physical symptoms like increased heart rate, rapid breathing, and muscle tension, which are often experienced during anxiety attacks.

Compulsions

Repetitive behaviors (e.g., washing, checking, counting) performed to reduce distress caused by obsessions.

OCD Patterns

Germs and symmetry are the most common obsessions/compulsions. Some individuals only have obsessive thoughts without compulsions.

Body Dysmorphic Disorder (BDD)

Preoccupation with imagined physical flaws (in self, not others).

Myths and realities related to body dysmorphic disorder.

Common myths about body dysmorphic disorder (BDD) are that it's about vanity, only affects women, goes away in adulthood, and can be fixed with cosmetic surgery

Trichotillomania

Recurrent urge to pull out one’s hair.

Excoriation Disorder (Dermatillomania)

Repetitive skin-picking behavior

Cognitive Behavioral Therapy (CBT)

The most effective psychotherapy for anxiety disorders.

Medications

Benzodiazepines and antidepressants are commonly prescribed.

Prevention & Coping

Safety plans, exposure-based strategies, and building resilience through support systems are key

M’Naghten Rule 

Origin of the insanity defense. Based on an individual’s inability to distinguish right from wrong. 

Durham Rule

More inclusive than M’Naghten. The crime was the “product” of mental illness. 

Considerations for insanity defense

Knowledge of right vs. wrong. Ability to exercise self-control, reduced (diminished) capacity due to mental illness 

How Infrequently Insanity is Used 

• The insanity defense is very rare. 

• Used in less than 1% of criminal cases. 

• Even when used, it is rarely successful. 

• Individuals found NGRI (Not Guilty by Reason of Insanity) often spend more time in a mental hospital than they would have spent in prison. 

Public Misconceptions 

• Media contributes to the belief that the insanity defense is a loophole, which is incorrect. 

• High-profile cases (e.g., John Hinckley Jr.) created public outrage, leading many states to restrict or reform the defense. 

Standards for Action 

clinicians must take protective action when: 

• There is a serious and credible threat of harm, AND 

• The potential victim is identifiable. 

unsure about threat

When unsure, therapists should consult with colleagues—a standard of good professional practice. 

Actionable Danger Requires

• specific threat 

• Not vague references like "I feel like hurting someone." 

• An identifiable target 

• A person named or clearly implied. 

• Credibility 

• The threat is realistic, intentional, and feasible. 

• Clinical judgment 

• Mental health professionals assess the likelihood of violence. 

Non-actionable statements 

• General anger, frustration, or hypothetical comments. 

• Threats without a specific target. 

• Threats lacking credibility or feasibility. 

Mental Illness vs. Legal Mental Illness 

• Mental illness in the legal system is a legal term, not a clinical one. 

• Someone can have a DSM disorder but still be legally responsible for their actions. 

Accountability and Insanity

• Legal responsibility depends on the defendant’s mental state at the time of the crime. 

• The insanity defense applies only when illness severely impairs judgment or self-control. 

• Most people with mental illness are still legally accountable for their actions. 

Dangerousness and Responsibility

Most individuals with mental illness are NOT dangerous, despite stereotypes. 

Courts use mental health evaluations to determine: 

• Competency to stand trial (ability to understand charges and assist in defense) 

• Criminal responsibility  (mental state during the crime) 

Criminal Commitment

• Competency to stand trial focuses on the defendant’s current ability. 

• The insanity defense focuses on the defendant’s mental state at the time of the crime. 

• If someone is found incompetent, they are committed for treatment but retain certain legal protections. 

Mental illness does not automatically remove accountability