WHS AP Psychology

Unit 11: Mental Illness and Therapies

Essential Task 11-3:Discuss the major diagnostic category of anxiety disorders with specific attention to the diagnoses of panic disorder, agoraphobia, social phobia, specific phobias, OCD, GAD and PTSD, detail the defining symptoms of each and identify the best approach(es) for explaining the cause(es) of each.

Unit 11

Abnormal Psych:

Disorders

MoodDisorders

MoodDisorders

AnxietyDisordersAnxiety

Disorders

PersonalityDisorders

PersonalityDisorders

SchizophreniaSchizophrenia

ChildhoodDisorders

ChildhoodDisorders

DissociativeDisorders

DissociativeDisorders

SomatoformDisorders

SomatoformDisorders

History,DSM

We are here

Unit 11:

Treatment of Psychological

Disorders

Unit 11:

Treatment of Psychological

Disorders

Biological Treatment

s

Biological Treatment

s

Insight TherapiesInsight

Therapies

Cognitive TherapiesCognitive Therapies

Behavior TherapiesBehavior Therapies

Psychosurgery

Antipsychotic Drugs

Electroconvulsive Therapy Psychoanalysis

Stress Inoculation

Beck’s Cognitive Therapy

Aversion Therapy

Behavior ContractingFlooding

Systematic Desensitization

Client-Centered

Gestalt

Rational Emotive Therapy

Classical Operant

Token Economy

Anxiety Disorders

Panic DisorderAgoraphobiaSocial PhobiaSpecific PhobiaObsessive Compulsive DisorderGeneralized Anxiety Disorder(PTSD & Acute Stress Disorder)

Panic Attack (not a diagnosis)

A. Discrete period of intense fear or discomfort, in which 4 or more of the following develop abruptly and reach a peak within 10 minutes– Palpitations– Sweating– Trembling/aching– Sensations of shortness of breath or smothering– Feeling of choking– Chest pain/discomfort– Nausea/abdominal distress– Feeling dizzy/unsteady/lightheaded/faint– Derealization/depersonalization– Fear of losing control/going crazy– Fear of dying– Paresthesias (numbness or tingling sensation)– Chills/hot flushes

Agoraphobia (not a diagnosis)

A. 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 or situationally predisposed panic attack or panic-like symptoms.

B. The situations are avoided or are endured with marked distress

C. Not better accounted for by another mental disorder

Some help…

Panic Attacks

Agoraphobia

NO

YES

NO YES

Panic Disorder without Agoraphobia

A. Both 1 and 21. Recurrent, unexpected panic attacks2. At least one of the attacks has been followed by

1 or more months of 1 or more of the followinga. Persistent concern about having additional attacksb. Worry about the implications of the attack or its

consequencesc. Significant change in behavior related to the attacks

B. Absence of agoraphobiaC. Panic attacks are not due to a GMC or

substanceD. Panic Attacks are not better accounted for

by another mental disorder

Panic Disorder with Agoraphobia

A. Both 1 and 21. Recurrent, unexpected panic attacks2. At least one of the attacks has been followed by 1

or more months of 1 or more of the followinga. Persistent concern about having additional attacksb. Worry about the implications of the attack or its consequencesc. Significant change in behavior related to the attacks

B. Presence of agoraphobiaC. Panic attacks are not due to a GMC or

substanceD. Panic Attacks are not better accounted for by

another mental disorder

Agoraphobia without History of Panic DisorderA. Presence of Agoraphobia related to fear of

developing panic-like symptomsB. Criteria have never been met for Panic

DisorderC. Disturbance is not due to a GMC or

substanceD. If an associated GMC is present, the

agoraphobia is in excess of that usually associated with the condition

Social Phobia

A. Marked, persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way that will be humiliating or embarrassing.

B. Exposure to the feared social situation almost invariably provokes an anxiety response

C. The person recognizes that the fear is excessive or unreasonable

D. The phobic stimulus is avoided or endured with intense anxiety or distress

E. There is significant distress or an impairment in functioning

Specific Phobia

A. Marked, persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation

B. Exposure to the phobic stimulus almost always provokes an immediate anxiety response

C. The person recognizes that the fear is excessive or unreasonable

D. The phobic stimulus is avoided or endured with intense anxiety or distress

E. There is significant distress or an impairment in functioning due to the phobia

F. The phobia is not better accounted for by another mental disorder

Subtypes of Specific Phobia

• Animal type

• Natural environment type

• Blood-Injection-Injury type

• Situational type

• Other type

Phobia

Marked by a persistent and irrational fear of an object or situation that disrupts behavior.

Kinds of Phobias

Phobia of blood.Hemophobia

Phobia of closed spaces.Claustrophobia

Phobia of heights.Acrophobia

Phobia of open places.Agoraphobia

Don’t concept map this

• Acrophobia: Heights Aquaphobia: Water• Gephyrophobia: Bridges Ophidiophobia: Snakes• Aerophobia: Flying Arachnophobia: Spiders• Herpetophobia: Reptiles Ornithophobia: Birds• Agoraphobia: Open spaces Astraphobia: Lightning• Mikrophobia: Germs Phonophobia: Speaking aloud• Ailurophobia: Cats Brontophobia: Thunder• Murophobia: Mice Pyrophobia: Fire• Amaxophobia: Vehicles, driving Claustrophobia: Closed spaces• Numerophobia: Numbers Thanatophobia: Death• Anthophobia: Flowers Cynophobia: Dogs

Good Question…

If phobias are learned behaviors,why don’t they extinguish on their own???

Answer to the Good Question…

• Avoidance works!

• Fear is never tested

Obsessive-Compulsive Disorder

Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals

(compulsions) that cause distress.

Obsessive-Compulsive DisorderA. Either obsessions or compulsions:Obsessions as defined by 1, 2, 3, and 4

1. Recurrent, persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

2. The thoughts, impulses, or images are not simply excessive worries about real-life problems

3. The person attempts to ignore or suppress such thoughts, impulses, or images or tries to neutralize them with some other thought or action

4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind

Typical Obsessions

• Doubts (e.g. Did I turn off the stove? Did I lock the door? Did I hurt someone?)

• Fears that someone else has been hurt or killed• Fears that one has done something criminal• Fears that one may accidentally injure someone• Worry that one has become dirty or

contaminated• Blasphemous or obscene thoughts• NOT just excessive worries about real-life

problems

Obsessive-Compulsive Disorder

Compulsions as defined by 1 and 21. Repetitive behaviors or mental acts that the person

feels driven to perform in response to an obsession or according to rules that must be applied rigidly

2. The compulsions are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

Typical Compulsions

• Checking• Cleaning/washing• Doing things a certain number of times in a

row• Doing and then undoing things• Doing things in a certain order, with

symmetry• Mental acts such as praying, counting, etc.

Obsessive-Compulsive Disorder

B. The person has recognized that the obsessions or compulsions are excessive or unreasonable

C. There is significant distress or an impairment in functioning due to the obsessions or compulsions

D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to the other Axis I disorder

E. The disturbance is not due to a GMC or substance

OCD in Children

• Children have an average of 4 obsessions and 4 compulsions at any given time

• Often comorbid with Tourette’s syndrome and/or ADHD

Generalized Anxiety Disorder (GAD)

A. Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events

B. The person finds it difficult to control the worryC. The anxiety and worry are associated with 3 or more

of the following symptoms 1. Restlessness or feeling keyed up or on edge2. Being easily fatigued 3. Difficulty concentrating or mind going blank4. Irritability5. Muscle tension6. Sleep Disturbance

Generalized Anxiety Disorder (GAD)

D. The focus of the anxiety and worry is not confined to features of another disorder and do not occur exclusively during PTSD

E. There is clinically significant distress or impairment in functioning

F. Not due to a GMC or substance

Post-Traumatic Stress Disorder

A. The person has been exposed to a traumatic event and have experienced four or more weeks of one or more of the following symptoms:

1. Haunting memories

2. Nightmares

3. Social withdrawal

4. Jumpy anxiety

5. Sleep problems

Resilience to PTSD

Only about 10% of women and 20% of men react to traumatic situations and develop

PTSD.

Holocaust survivors show remarkable resilience against traumatic situations.

All major religions of the world suggest that surviving a trauma leads to the growth

of an individual.

Resilience to PTSD

Only about 10% of women and 20% of men react to traumatic situations and develop

PTSD.

Holocaust survivors show remarkable resilience against traumatic situations.

All major religions of the world suggest that surviving a trauma leads to the growth

of an individual.

Anxiety Disorders - Overview

• Most common mental disorders in the U.S.– At least 19% of the adult population suffer from at least

one anxiety disorder in any given year• All are more common in women, except for OCD• Except for Panic Disorder, ages of onset are most

likely going to be in childhood or adolescence (but do not have to be)

• Anxiety Disorders cost $42 billion each year in health care, lost wages, and lost productivity

Anxiety DisordersCultural Variations • Fear, Anxiety, and Anxiety Disorders exist in

all cultures• Prevalence rates vary, but are generally the

most common mental illness in all countries– Low rates: China (2.4%), Japan, Nigeria, and Spain– High rates: U.S. (19%), France, Colombia, and

Lebanon• Fear stimulus and content of anxiety differ

greatly between cultures

Dhat (India), Jiryan (India), Sukra Prameha (Sri Lanka), & Shen-k’uei (China)

• Severe anxiety, panic symptoms, somatic complaints, hypochondriachal symptoms associated with the discharge of semen

• Excessive semen loss is feared because of the belief that it represents the loss of one’s vital essence and can thereby be life threatening

Koro (South and Southeast Asia)

• Sudden and intense anxiety that one’s genitalia will recede into the body and possibly cause death

• Can occur in epidemics

Taijin Kyofusho (Japan)

• An intense fear that one’s body, its parts, or its functions (sweating, body odor, facial expressions, etc.) displease, embarrass, or are offensive to other people

• Similar to the DSM’s Social Phobia

Explaining Anxiety Disorders

Freud suggested that we repress our painful and intolerable ideas, feelings, and

thoughts, resulting in anxiety.

The Learning PerspectiveLearning theorists suggest that fear

conditioning leads to anxiety. This anxiety

then becomes associated with other objects or

events (stimulus generalization) and is

reinforced.

John Coletti/ Stock, B

oston

The Learning PerspectiveInvestigators believe that fear responses

are inculcated through observational learning. Young monkeys develop fear

when they watch other monkeys who are afraid of snakes.

The Biological PerspectiveNatural Selection has led our ancestors to

learn to fear snakes, spiders, and other animals. Therefore, fear preserves the

species.

Twin studies suggest that our genes may be partly responsible for developing fears

and anxiety. Twins are more likely to share phobias.

The Biological Perspective

Generalized anxiety, panic attacks, and

even OCD are linked with brain circuits like the

anterior cingulate cortex.

Anterior Cingulate Cortexof an OCD patient.

S. U

rsu, V.A

. Stenger, M

.K. S

hear, M.R

. Jones, & C

.S. Carter (2003). O

veractive action m

onitoring in obsessive-compulsive disorder. P

sychological Science, 14, 347-353.

Panic Disorder

• What Causes Panic Disorder? – We don’t really know; many factors.

• But: Strong evidence that norepinephrine is involved.

• Norepinephrine: neurotransmitter especially active in Locus ceruleus part of the brain.

Models of Abnormality

Biological model: Anatomy (structures)

Neo-Cortex

Corpus callosum

Amygdala

Locus ceruleus (Pons)

Panic Disorder

• Anti-depressant drugs that regulate norepinephrine successful in treating panic

• When Locus ceruleus stimulated in monkeys panic like behavior

• Locus ceruleus rich in norepinephrine carrying neurons

• Hypothesis: Norepinephrine dysregulation may well be implicated in Panic Disorder

Obsessive-Compulsive Disorder

• Anxiety rooted in repressed ID impulses

• Impulses = obsessive thoughts• Compulsions = ego defenses against

them• E.g.: Lady Macbeth: Anxiety/guilt over

her part in a murder compulsive hand washing to get rid of the imagined blood.

• How would you treat Lady Macbeth?

Psychodynamic Perspective

Obsessive-Compulsive Disorder

• Focus on compulsions, not obsessions• Theory: association forms randomly between

fear/anxiety reduction and the compulsive behavior

• Compulsive behavior becomes reinforcing because it reduces anxiety

• Therefore compulsion increases in frequency

Behavioral Perspective

Obsessive-Compulsive Disorder

• Drugs that increase Serotonin activity are somewhat effective in treating OCD

• Serotonin is also active in 2 brain areas that have been associated with OCD: the orbital region of the frontal cortex and caudate nucleus

Biological Perspective

Caudate nucleus

Orbital frontal cortex