Anxiety Spectrum & Trauma and Stressor-Related Disorders

Stress

Usually an external trigger

Anxiety

Persistent, excessive worry that doesn’t go away despite absense of stressors

• Survival response

• Often related to physiological symptoms

Anxiety Disorders are Characterized By:

• Anxiety

• Fear

• Behaviors used to combat them

• Significantly high levels or persistent

Panic Attack

• Sense of foreboding, impending doom, sense of diaster

• Irregular or rapid heartbeat

• Breathing troubles and/or chest pain

• Can begin abruptly and build rapidly to a peak, usually lasting less than an hour

• Common (30% of adults have had at least 1)

• Sometimes triggered by specific situations or arise spontaneously

• Aren’t codable or inherently pathological by themselves

Panic Disorder

Recurrent unexpected panic attacks, an abrupt surge of intense fear or discomfort that reaches a peak within minutes and paired with 4 or more symptoms

Panic Disorder Symptoms

Four or more of:

• Heart palpatations or pounding

• Sweating

• Trembling or shaking

• Breathing issues

• Feelings of choking

• Chest pain

• Nausea

• Dizziness

• Chills or hot flashes

• Numbness or tingling sensation

• Fear of dying or fear of “going crazy”

• Depersonalization or Derealization

One panic attack must be followed by at least one

• Persistent worry about having an additional panic attack

• Significant maladaptive change in behavior to avoid having another panic attack

• Not attributed to substances or another medical condition

Panic Disorder Treatment

• Therapy

• Exposure & Response Prevention

• Psychoeducation

• Breath work & grounding exercises

• Medications

Agoraphobia

Fear of having to be in any situation or place where escape seems difficult or help would be unavailable

Marked fear or anxiety about two or more:

• Using public transportation

• Being in open spaces or enclosed spaces

• Standing in line or being in a crowd

• Being outside or home alone

  • Always provoke fear and are actively avoided

  • Being outside of the home alone

Specific Phobia

• Marked fear about a specific object or situation

• Phobic object or situation always provokes immediate fear or anxiety

• Object or situation is always avoided

• Response is disproportionate to object or situation

• Symptoms last 6 months or longer

Social Anxiety Disorder

• Intense fear or anxiety about one or more social situations where person is exposed to scrutiny of others

  • Social situations, conversations, meeting new people, eating in public, being observed, or performing

  • Fear of being negatively evaluated by others

  • Avoidance or endured with intense anxiety

  • Symptoms disproportionate with actual threat posed

  • Symptoms persistent (6 months or longer)

Social Anxiety Disorder con.

• Onset early to middle teenage years

• More specific criteria for children

• Affects males and females roughly equally, tends to be higher in LGBTQ+

Selective Mutism

• Reserved for children who remain silent expect when alone or with a small group of intimates

• Consistent mutism in social situations where speaking is an expectation

• Interferes with educational or social achievement

• Not related to language development or acquisition

• Onset usually ages 2-4 once language develops

• Uncommon (~1 in 1,000)

Separation Anxiety Disorder

Developmentally inappropriate and excessive anxiety with separation from attachment figures

Need 3 of 8 for Separation Anxiety Disorder:

• Distress in separation

• Worry about harm

• Anticipatory anxiety about a potential outcome

• Reluctance or refusal to go out

• Refusal to be or sleep alone

• Nightmares of separation and physical symptoms

  • Persistent fear or anxiety lasting at least 4 weeks in children and 6 months in adults

  • Significant disturbance in social, educational, or occupational functioning

Generalized Anxiety Disorder

• One of the most common diagnoses

• Symptoms are unfocused and nonspecific, nervousness is lowkey and chronic, panic attacks not required

• Result in physical and mental complaints

• Excessive anxiety and worry occurring more days than not for at least 6 months

• Difficult to control worry

Social Anxiety Disorder: Associated with at least 3 symptoms for adults and 1 for children

• Muscle tension

• Restlessness

• Easily tired

• Irritability

• Poor concentration

• Trouble with sleep

Trauma Disorders

Results when exposure to a traumatic or stressful event results in intense psychological distress and can even result in the fragmentation of the psyche

• When abhorrent experiences need internal resources

Post-Traumatic Stress Disorder

• Negative psycho-emotional physiological reactions to traumatic events

• Symptoms may not develop immediately after a traumatic event

• Client normally relives the event and tries to avoid thinking about it

• Remembering is involuntary, reliving is not

PTSD Criteria

In clients older than 6, exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:

• Directly experiencing the event

• Witnessing in person the event as it occurred to others

• Learning that a traumatic event occurred to a close family member or friend

• Experiencing repeated or extreme exposure to adverse details of the traumatic events

PTSD: Presence of one or more intrusive symptoms associated with traumatic event beginning after the fact:

• Recurrent, involuntary, and intrusive distressing memories of the event

• Recurrent distressing dreams/nightmares where content is related to the event

• Dissociative reactions (flashbacks)

• Intense or prolonged psychological distress

• Persistent avoidance of stimuli associated with the event

• Negative alterations in cognitions and mood associated w/ event

• Alterations in arousal and reactivity

• Duration of disturbance is longer than 1 month

Signs of PTSD in children and teens

• Nightmares

• Insomnia

• Increased irritability

• Withdrawal from friends and beloved activities

• Difficulty with school and concentrating

• Depression and numbness

  • Different criteria for children 6 and younger

PTSD Treatments

• Sensorimotor Psychotherapy

• EMDR

• Cognitive Processing Therapy

• Trauma Focused CBT

• Hypnotherapy

• Internal Family Systems

• Psychodynamic

Acute Stress Disorder

• Developed upon observation that some people develop symptoms immediately after a traumatic event

• Different in number and distribution of symptoms, criteria embody same elements present for PTSD

Religious & Spiritual Trauma

• Psychological and emotional distress caused by harmful religious experiences often involving fear, shame, control, or abuse within a religious context

• Emotional Impact: anxiety, depression, guilt, or identity confusion

• Cognitive Dissonance: struggles reconciling beliefs with personal values or lived experiences

• Social Isolation: loss of community or strained relationships after leaving or questioning faith

• Spiritual Abuse: manipulation or control using religious doctrine or authority

Adjustment Disorder

• Development of emotional or behavioral symptoms in response to identifiable stressors occurring within 3 months of stress onset (often major life transitions)

• Clinically significant distress disproportionate to severity of the stressor

Prolonged Grief Disorder

When intensity of grief symptoms lasts longer than 12 months

Symptoms of Prolonged Grief Disorder

• Intense yearning/longing for deceased person

• Preoccupation with thoughts or memories

• Since death, 3 or more emotionally disturbing symptoms consistently

  • Identity disruption (part of self has died), intense emotional pain, avoidance of reminders, numbness, etc.

  • Duration & severity after death exceeds expected social, cultural, or religious norms