Anxiety Disorders & OCD

Anxiety Disorders & OCD

  • Etiologies of anxiety disorders

    • Genetic susceptibility

    • Behavioral risks

    • Interpersonal stressors

    • Amygdala sensitivity

    • Poverty and financial stress

    • personality/temperament

      • Neuroticism: uncomfortable feelings (worry, anxiety, sadness)

      • Behavioral inhibition: staying within safe bubble/comfort zone

    • Attentional bias to threat

    • Childhood maltreatment and trauma

    • Respiratory illness

    • Negative core beliefs

    • Maternal anxiety

  • Separation anxiety

A. Excessive fear or anxiety about being separated from attachment figures.

B. Distress when anticipating or experiencing separation from home or major attachment figures.

C. Persistent worry about losing major attachment figures or possible harm to them.

D. Reluctance or refusal to go out, away from home, to school, or other places because of fear of separation.

E. Fear of being alone or without major attachment figures at home or in other settings.

F. Reluctance or refusal to sleep away from home or go to sleep without being near a major attachment figure.

G. Repeated nightmares about separation.

H. Physical symptoms (such as headaches, stomachaches, nausea) when separation from major attachment figures is anticipated or occurs.

I. The fear, anxiety, or avoidance lasts at least four weeks in children and typically six months or more in adults.

J. The fear, anxiety, or avoidance causes significant distress or problems in daily life.

K. The symptoms are not better explained by another mental disorder.

  • Selective mutism

A. Consistent failure to speak in specific social situations where there is an expectation for speaking (e.g., at school) despite speaking in other situations.

B. The disturbance interferes with educational or occupational achievement or with social communication.

C. The duration of the disturbance is at least one month (not limited to the first month of school).

D. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

E. The disturbance is not better explained by a communication disorder (e.g., childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

  • Specific phobia

A. Strong fear or anxiety about a specific object or situation.

B. The object or situation almost always triggers immediate fear or anxiety.

C. The object or situation is avoided or endured with intense fear or anxiety.

D. The fear or anxiety is out of proportion to the actual danger.

E. The fear, anxiety, or avoidance lasts six months or more.

F. The fear, anxiety, or avoidance causes significant distress or problems in daily life.

G. The fear, anxiety, or avoidance is not better explained by another mental disorder.

  • Panic disorder

A. Recurrent unexpected panic attacks, which are sudden surges of intense fear or discomfort that reach a peak within minutes and include at least four of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate

  • Sweating

  • Trembling or shaking

  • Shortness of breath or smothering sensations

  • Feelings of choking

  • Chest pain or discomfort

  • Nausea or abdominal distress

  • Feeling dizzy, unsteady, light-headed, or faint

  • Chills or heat sensations

  • Numbness or tingling sensations

  • Feelings of unreality or being detached from oneself

  • Fear of losing control or "going crazy"

  • Fear of dying

B. At least one of the attacks has been followed by one month (or more) of one or both of the following:

  • Persistent worry about having more panic attacks or their consequences

  • Significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks)

C. The disturbance is not due to the physiological effects of a substance or another medical condition.

D. The disturbance is not better explained by another mental disorder.

  • Agoraphobia

A. Marked fear or anxiety about two (or more) of the following situations:

  • Using public transportation

  • Being in open spaces

  • Being in enclosed places

  • Standing in line or being in a crowd

  • Being outside of the home alone

B. 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 embarrassing symptoms.

C. The agoraphobic situations almost always provoke fear or anxiety.

D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.

F. The fear, anxiety, or avoidance is persistent, typically lasting for six months or more.

G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H. If another medical condition is present, the fear, anxiety, or avoidance is clearly excessive.

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

  • Generalized anxiety disorder

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past six months):

  • Restlessness or feeling keyed up or on edge

  • Being easily fatigued

  • Difficulty concentrating or mind going blank

  • Irritability

  • Muscle tension

  • Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. 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).

F. The disturbance is not better explained by another mental disorder.

  • Etiologies of obsessive-compulsive and related disorders

    • Genetic susceptibility for first degree relatives

    • Dysfunction in orbitofrontal cortex, anterior cingulate cortex, and striatum

    • Neuroticism -> personality/temperament (born with it)

    • Infectious agents in environment, those influencing autoimmune disorder

    • Childhood maltreatment and trauma (neglect and abuse)

  • Obsessive-compulsive disorder

    • Insight: how rationale/accurate individual believes their thoughts are

      • Awareness that experience of symptoms is mental illness

  • Body dysmorphic disorder

A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing their appearance with that of others) in response to the appearance concerns.

C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

  • Trichotillomania (hair pulling)

A. Recurrent pulling out of one’s hair, resulting in hair loss.

B. Repeated attempts to decrease or stop hair pulling.

C. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition).

E. The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder).

  • Excoriation (skin picking) Disorder

A. Recurrent skin picking resulting in skin lesions.

B. Repeated attempts to decrease or stop skin picking.

C. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies).

E. The skin picking is not better explained by the symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder).

  • Hoarding disorder

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.

B. The difficulty is due to a perceived need to save the items and to distress associated with discarding them.

C. The difficulty discarding possessions results in the accumulation of items that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).

D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).

F. The hoarding is not better explained by the symptoms of another mental disorder

  • Role of Avoidance in Anxiety Cycle

    • Anxiety provoking situation

    • Increased symptoms

    • escape/avoidance

    • Short-term relief

    • Long-term consequences