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Anxiety Disorders Anxiety lWhat does anxiety feel like? lWhen does anxiety become a problem? A disorder? PPD Prevalence of Anxiety Disorders l18.1% of U.S. adults lCommonly co-occurs with depressive disorders or substance abuse (*dual diagnosis) lIndividuals may have multiple anxiety disorders lMost will have their first episode by age 21.5 (NIMH, 2008) Anxiety Disorders lWhere are the majority of patients with anxiety disorders initially seen? lWhy? Symptoms of Anxiety lPhysical lPounding heart lSweating lStomach upset lDizziness lFrequent urination/diarrhea lShortness of breath lTremors many end up re-structuring their lives to avoid the situations lSome also use alcohol to tolerate the phobia What is the cognitive process in social phobias? lOverestimation of anxiety symptoms lNegative misinterpretation of others responses lOverestimation of the degree to which others are paying attention to them (fear of embarrassment or rejection) lNegative filtering Treatments lCognitive behavioral therapy lCognitive therapy lBehavior therapy lBiofeedback lMedications help some lBeta-blockers, antidepressants, benzodiazepines, MAO inhibitors lChiropractic?may be a form of behavioral therapy (continued exposure to a positive environment) lSocial Anxiety Self Test /GettingHelp/SelfHelpTes ts/selftest_socialpho.asp Anxiety Disorders Association of America Obsessive-Compulsive Disorder lCharacterized by: lObsessions (which cause marked anxiety or distress) and/or lCompulsions (which serve to neutralize anxiety) OCD lObessions lRecurrent, persistent, intrusive thoughts (impulses, images) lCommon themes: Aggression, sex, safety, and religion lCause marked anxiety or distress lNot simply excessive worries about problems lDoes the person recognize that the thoughts are obsessive? OCD lCompulsions lRepeatedly performing seemingly unnecessary or bizarre rituals/actions lMental tasks lPhysical rituals lIn response to an obsession or rigidly applied rule OCD lCleaning lChecking lRepeating lHoarding lMental rituals OCD lCompulsions lDesigned to neutralize or prevent distress or some dreaded event or situation lExcessive lNot realistically connected with what they are meant to neutralize lDoes the person recognize the actions as compulsive? OCD lOther OCD criteria: lObsessions/compulsions cause marked distress lAre time-consuming lSignificantly interfere with the persons normal routine lNot due to the direct physiologic effects of a substance or general medical condition OCD lOCD Epidemiology l1-3% of the population lCan begin at any age, but most commonly in early adulthood OCD lTends to be a chronic disorder with episodic or continuous forms lTreatment lSee treatment for anxiety disorders OCD Spectrum lOCD spectrum disorder lTrichotillomania lBody dysmorphic disorder lTourettes syndrome lGlobus hystericus lCompulsive nail biting or skin picking lBowel or bladder obsessions lOlfactory reference syndrome Posttraumatic Stress Disorder lCharacterized by: lThe reexperiencing of an extremely traumatic event lAccompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma PTSD lTrauma experience is accompanied by feelings of: lintense fear lhelplessness lhorror PTSD lPatients subsequently develop a mix of: lFlashbacks and/or nightmares lPersistent avoidance of stimuli resembling the precipitating event lNumbing of general responsiveness lPersistent signs and symptoms of physiologic arousal PTSD lPTSD may also include: lsecondary depression lpanic attacks lsubstance abuse lunexplained physical symptoms laggressive behavior PTSD l7.7 million, 3.5% American adults Anxiety Disorders Association of America lCombat veterans PTSD prevalence: lVietnam 15-20% l1-5 Iraq and Afghanistan Veterans suffer from PTSD or Major Depression lOnly slightly more than half have sought treatment RAND Corporation PTSD lTreatment of PTSD lCognitive-behavioral therapy (CBT) lGroup therapy lExposure therapy lMedication Acute Stress Disorder lCharacterized by: lSymptoms similar to PTSD that occur immediately in the aftermath of an extremely traumatic event (1 month) lSymptoms include numbing, reduced awareness, depersonalization, derealization, amnesia References Anxiety Disorders Association of America. Anxiety disorders. Retrieved on April 28, 2009 from /GettingHelp/Briefovervie w.asp Nati