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Disorder Separation Anxiety Disorder Specific phobia OCD* PTSD (Outline) GAD Panic Disorder Social anxiety Disorder Crux Fear of harm to attached when separated Actively avoided object with out- of-proportion anxiety Intrusive thoughts/ Compulsive acts (thoughts) A1 Exposure A2 Fear B Re-experience C Avoid/*numb* D hyper arousal Excessive worry about the every day Fear is of having a panic attack, not what lead to it Fear of acting in a way that will be embarrassing or humiliating Criteria -Distress on separ. from home or attachment fig. -Worry about losing people to death, etc. - Worry about event that will cause separation - Refusal to go out, to school, work, etc. - Fear of being alone - Wont sleep away from attached fig. - Nightmares about sep. - Physical symp. when anticipates separation -Fear of something specific (duh) - Object always provokes fear -Object is actively avoided - Anxiety out of proportion Obsessions - Intrusive and unwanted thoughts -Attempts to ignore or suppress thoughts Exposure through: -Experiencing -Witnessing -Close family -Repeated first- hand exposure -Intrusive, distressing memories -Bad dreams -Dissociation (re- experiencing) -Distress about cues -Physiological reaction -Avoid associated stimuli -Anxiety -Can’t control worry -Restlessness -Easily fatigued -Prob. Concentrating -Irritability -Muscle tension -Sleep problem -About minor, everyday events Panic attack: - Heart -Sweating -Trembling -Resp. distress - Choking -Chest pain -Nausea -Dizzy -Chills -Numbness -Derealization -Fear of losing control -Fear of dying All in <10 mins. Worry about more PA’s for 1 month -Fear of social interactions in peer group -Fear of humiliation, embarrassment, rejection, etc. -Social situations provoke fear - In children, anxiety may be crying, tantrums, mutism, etc. - Social situations avoided - Fear is out of proportion -If medical condition, fear is unrelated Types: -Animal -Environment -Blood -Situational (e.g. Airplanes) -Other (e.g. vomiting) Compulsions -Repetitive behaviors in response to obsess. -Aimed at reducing anxiety -Time consuming Time 4 weeks child 6 months adult 6 months 1 month 6 months 6 months 6 months Risk factors Parent SAD Female, young, poor Young, female, family history of same Strep/virus (PANDAS) Trauma intensity Twin studies Female Poor Female Poor Early loss Other anxiety dis If early, female, long, low GAF ->Bad Treatment Physical torture Exposure SSRI, CBT* CBT, exposure, imaginal Benzos, anti-D, CBT, meditate Exposure, CBT, breathing, IPT CPT, IPT, meds Specifiers/ (Notes) (Developmentally inappropriate) (Multiple phobias Predicts depression, substance use) -Good insight -Poor insight -No insight/ delusional -Tic-related Depersonalization Derealization Delayed expression (60% Comorbid w/depression 58% w/ other anxiety) Performance only? (Seek treatment: 18% adol. 24% adult) Changes from DSM 4 Not Anxiety. Now in OC and related disorder From anxiety dis to “trauma and stressor related” DSM 5 – Expected vs. unexpected Prevalence 4% Mean age 7 12% last 12 months -Most common anx. disorder -Earliest onset -1.6% life -1%/yr. -Female>male -Childhood reversed -7% life -3.5%/yr. (Assault, accident, combat - common) ~6% life ~3%/year 1-3% life 1-2% / year 1-13% Public speaking common Course and outcomes Followed by nearly all other anxiety disorders Very stable (10 yrs.) 40% persist Male 14 Female 22 Early adulthood Persistent Adolescent and 30’s ê w/ age é Risk for depress. Lasts ~16 yrs. Rare after 30 40% 5 yr. recover

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Page 1: Anxiety Disorder Chart

Disorder SeparationAnxietyDisorder

Specificphobia

OCD* PTSD(Outline)

GAD PanicDisorder

SocialanxietyDisorder

Crux Fearofharmtoattachedwhenseparated

Activelyavoidedobjectwithout-of-proportionanxiety

Intrusivethoughts/Compulsiveacts(thoughts)

A1ExposureA2FearBRe-experienceCAvoid/*numb*Dhyperarousal

Excessiveworryabouttheeveryday

Fearisofhavingapanicattack,notwhatleadtoit

Fearofactinginawaythatwillbeembarrassingorhumiliating

Criteria -Distressonsepar.fromhomeorattachmentfig.-Worryaboutlosingpeopletodeath,etc.-Worryabouteventthatwillcauseseparation-Refusaltogoout,toschool,work,etc.-Fearofbeingalone-Wontsleepawayfromattachedfig.-Nightmaresaboutsep.-Physicalsymp.whenanticipatesseparation

-Fearofsomethingspecific(duh)-Objectalwaysprovokesfear-Objectisactivelyavoided-Anxietyoutofproportion

Obsessions-Intrusiveandunwantedthoughts-Attemptstoignoreorsuppressthoughts

Exposurethrough:-Experiencing-Witnessing-Closefamily-Repeatedfirst-handexposure-Intrusive,distressingmemories-Baddreams-Dissociation(re-experiencing)-Distressaboutcues-Physiologicalreaction-Avoidassociatedstimuli

-Anxiety-Can’tcontrolworry-Restlessness-Easilyfatigued-Prob.Concentrating-Irritability-Muscletension-Sleepproblem-Aboutminor,everydayevents

Panicattack:-Heart-Sweating-Trembling-Resp.distress-Choking-Chestpain-Nausea-Dizzy-Chills-Numbness-Derealization-Fearoflosingcontrol-FearofdyingAllin<10mins.WorryaboutmorePA’sfor1month

-Fearofsocialinteractionsinpeergroup-Fearofhumiliation,embarrassment,rejection,etc.-Socialsituationsprovokefear-Inchildren,anxietymaybecrying,tantrums,mutism,etc.-Socialsituationsavoided-Fearisoutofproportion-Ifmedicalcondition,fearisunrelated

Types:-Animal-Environment-Blood-Situational(e.g.Airplanes)-Other(e.g.vomiting)

Compulsions-Repetitivebehaviorsinresponsetoobsess.-Aimedatreducinganxiety-Timeconsuming

Time 4weekschild6monthsadult

6months 1month 6months 6months 6months

Riskfactors ParentSADFemale,young,poor

Young,female,familyhistoryofsame

Strep/virus(PANDAS)

TraumaintensityTwinstudies

FemalePoor

FemalePoorEarlylossOtheranxietydis

Ifearly,female,long,lowGAF->Bad

Treatment Physicaltorture Exposure SSRI,CBT* CBT,exposure,imaginal

Benzos,anti-D,CBT,meditate

Exposure,CBT,breathing,IPT

CPT,IPT,meds

Specifiers/(Notes)

(Developmentallyinappropriate)

(MultiplephobiasPredictsdepression,substanceuse)

-Goodinsight-Poorinsight-Noinsight/delusional-Tic-related

DepersonalizationDerealizationDelayedexpression

(60%Comorbidw/depression58%w/otheranxiety)

Performanceonly?(Seektreatment:18%adol.24%adult)

ChangesfromDSM4

NotAnxiety.NowinOCandrelateddisorder

Fromanxietydisto“traumaandstressorrelated”

DSM5–Expectedvs.unexpected

Prevalence

4%Meanage7

12%last12months-Mostcommonanx.disorder-Earliestonset

-1.6%life-1%/yr.-Female>male-Childhoodreversed

-7%life-3.5%/yr.(Assault,accident,combat-common)

~6%life~3%/year

1-3%life1-2%/year

1-13%Publicspeakingcommon

Courseandoutcomes

Followedbynearlyallotheranxietydisorders

Verystable(10yrs.)40%persist

Male14Female22

EarlyadulthoodPersistent

Adolescentand30’sêw/ageéRiskfordepress.

Lasts~16yrs.Rareafter3040%5yr.recover

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