anxiety disorders

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Understanding OCDObsessive Compulsive Disorder : 

Understanding OCDObsessive Compulsive Disorder Jackie Craft, M.Ed. Supervisor: Deborah Fahr, Ph.D.

Sources of Information Used in this Presentation : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 2 Sources of Information Used in this Presentation Diagnostic and Statistical Manual of Mental Disorders, 4th edition Text Revision, 2000 National Institute of Mental Health American Psychological Association

Anxiety Disorders : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 3 Anxiety Disorders Types of anxiety disorders: Panic Attack Panic Disorder Generalized Anxiety Disorder Obsessive-Compulsive Disorder (OCD) Post-Traumatic Stress Disorder (PTSD) Social Phobia (or Social Anxiety Disorder)

Panic Attack : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 4 Panic Attack A discrete period of intense fear or discomfort, in which 4 or more of the following symptoms developed abruptly and reached a peak within 10 minutes. Palpitations, pounding hear, or accelerated heart rate Sweating Trembling or shaking Sensation of shortness of breath or smothering Feeling of choking Chest pain or discomfort Nausea or abdominal distrss Feeling dizzy, unsteady. Lightheaded. Or faint

Slide 5: 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 5 Derealization (feelings of unreality) or depersonalization (being detached from oneself) Fear of losing control or going crazy Fear of dying Numbness or tingling sensation Chills or hot flushes Panic Attack continued…

Agoraphobia : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 6 Agoraphobia Anxiety about being in places or situations from which escape might be difficulty or embarrassing or in which help may not be available in the event of having unexpected panic attack or panic-like symptoms. Characteristic clusters include: fear of being outside the home alone; being in a crowd or standing in line; being on a bridge; traveling in a bus, train, or automobile. These situations are avoided or endured with marked distress or with anxiety about having a panic attack. The anxiety or phobia is not better accounted for by another mental disorder.

Panic Disorder : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 7 Panic Disorder Either with or without agoraphobia Recurrent, unexpected panic attacks At least one of the attacks followed by 1 month or more of one of the following: Persistent concern about having additional attacks Worry about the implications of the attack or its consequences (losing control, having a heart attack, going crazy) A significant change in behavior related to the attack Panic attacks are due to the direct physiological effects of a substance. Not accounted for by another disorder.

Specific Phobia : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 8 Specific Phobia Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (ex: flying, animals, receiving injections, seeing blood). Exposure to the phobic stimulus almost invariable provokes an immediate anxiety response (panic attack). In children the anxiety may be expressed by crying, tantrums, freezing or clinging. The person recognizes that the fear is excessive or unreasonable. The phobic situation is avoided or endure with intense anxiety or distress. The avoidance, anxious anticipation, or distress interferes significantly with the person’s normal routine, occupational functioning, or social activities.

Phobia Sub-types : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 9 Phobia Sub-types Animal Type – fear cued by animals or insects. Generally has a childhood onset. Natural Environmental Type - fear is cued by objects in the natural environment, such as storms, heights or water. Blood-Injection-injury Type: fear is cued by seeing blood or an injury or by receiving an injection or other invasive medical procedure. Situational Type: fear is cued by a specific situation such as public transportation, tunnels, bridges, elevators, flying, ect. Other Type: Fear is cued by other stimuli. Examples: fear of choking, contracting a illness, space phobia, fear of costumed characters.

Social Phobia : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 10 Social Phobia A marked and 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. Exposure to the feared social situation almost invariably provokes anxiety – which make that the form of a panic attack. The person recognizes that the fear is excessive ro unreasonable. The phobic situation is avoided or endure with intense anxiety or distress. The avoidance, anxious anticipation, or distress interferes significantly with the person’s normal routine, occupational functioning, or social activities.

Posttraumatic Stress Disorder : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 11 Posttraumatic Stress Disorder A. The person has been exposed to a traumatic event in which both of the following were present: The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others The person’s response involved intense fear, helplessness, or horror.

Posttraumatic Stress Disorder continued.. : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 12 Posttraumatic Stress Disorder continued.. B. The traumatic event is persistently reexperienced in one or more of the following ways: Recurrent and intrusive distressing recollections of the event, including images, thoughts and perceptions. Recurrent distressing dreams of the event. Acting or feeling as if the traumatic event were recurring (sense of reliving, illusions, hallucinations, dissociative flashbacks). Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Posttraumatic Stress Disorder continued.. : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 13 Posttraumatic Stress Disorder continued.. C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness as indicated by three or more of the following: Efforts to avoid thoughts, feeling or conversations associated with the trauma. Efforts to avoid activities, places or people that arouse recollections of the trauma. Inability to recall an important aspect of the trauma. Markedly diminished interest or participation in significant activities. Feelings of detachment or estrangement from others. Restricted range of affect (unable to have loving feelings. Sense of foreshortened future (does not expect to have a career, marriage, children, or a normal life span.

Posttraumatic Stress Disorder continued.. : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 14 Posttraumatic Stress Disorder continued.. D. Persistent symptoms of increased arousal as indicated by two or more of the following: Difficulty falling or staying asleep. Irritability or outbursts of anger. Difficulty concentrating. Hypervigilance. Exaggerated startle response. E. Duration of symptoms from B,C,D last more than 1 month. F. Disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Generalized Anxiety Disorder : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 15 Generalized Anxiety Disorder A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school). B. The person finds it difficult to control the worry. C. The anxiety and worry are associated with three or more of the following six symptoms (with as least some symptoms present for more days than not for the past 6 months). - Restlessness or feelings keyed up or on edge. - Being easily fatigued. - Difficulty concentrating or mind going blank. - Irritability - Muscle Tension - Sleep Disturbance.

Generalized Anxiety Disorder continued.. : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 16 Generalized Anxiety Disorder continued.. D. The focus of the anxiety and worry is not confined to features of other psychological disorders. E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. F. The disturbance is not due to the direct physiological effects of a substance or general medical condition.

Slide 17: 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 17 According to the National Institute of Mental Health (NIMH), almost 75% of those with an anxiety disorder will experience their first episode before they are 22 years old. Awareness of these disorders among college-aged students and their parents is essential. For many of the individual anxiety disorders, the age of onset often falls during the college years. The median age of onset for OCD is 19. OCD – why it is relevant to us

What are Obsessions? : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 18 What are Obsessions? Persistent ideas, thoughts, impulses or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress. Obsessions are “egodystonic” meaning that the individual senses that the content of the obsession is alien, not within his or her own control. The obsession is in conflict, or dissonant, with the needs and goals of the ego or the person's ideal self-image.. The individual is able to recognize that the obsessions are a product of his or her own mind and not imposed from the outside (as in thought insertion).

Common Obsessions : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 19 Common Obsessions Repeated thoughts about contamination Example: becoming contaminated by shaking hands Repeated doubts Example: wondering if the door was left unlocked A need to have things in particular order Example: intense distress when objects are disordered Pure Obsessions Repeating thoughts or needing answers to questi

Managing the Obsession : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 20 Managing the Obsession Individuals with obsessions attempt to suppress the thought or impulse or to neutralize them with other thoughts or actions (the compulsion). EXAMPLE: an individual plagued by doubts about having turned off the stove attempts to neutralize them by repeatedly checking to ensure that it is off.

What are Compulsions? : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 21 What are Compulsions? Repetitive behaviors or mental acts with the goal of preventing or reducing anxiety or distress, not providing pleasure or gratification. example: hand washing, ordering, counting, or pure obsessions. The individual feels driven to perform the compulsion to reduce the anxiety accompanied by an obsession or to prevent some dreaded event or situation. Example: a. Individuals have high anxiety due to obsessions about having left the door unlocked are driven to check the lock every few minutes.

Insight : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 22 Insight Adults with OCD have a ranging level of insight that their obsessions or compulsions are excessive or unreasonable. Children with OCD may lack sufficient cognitive awareness to make this judgment. Insight various across time and situations. Example: In a safe situation (with a therapist) an individual may recognize her compulsion to check the door as excessive and irrational. She can desire and attempt to resist it and work through the mounting anxiety. When home alone, after repeated failure to resist, she gives in and no longer resists. The compulsion is incorporated into her daily routine.

OCD Disruptivity : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 23 OCD Disruptivity Time Consuming – takes more than 1 hour per day. Distracting – obsessions and compulsions interferes with the individual’s normal routine. Useful and satisfying behaviors are replaced by intrusive cognitions and behaviors. Interference – OCD causes an individual to be ineffective in performing cognitive tasks requiring concentration: reading and computations. Avoidance – Individuals will avoid situations that provoke obsessions and compulsions. Avoidance can be extensive and restrict one’s general functioning.

Possible On-Set Factors : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 24 Possible On-Set Factors Several factors can increase the risk of developing obsessive-compulsive disorder, including: Family history: Having parents or other family members with the disorder can increase your risk of developing OCD. Researchers haven't identified any genes responsible for obsessive-compulsive disorder. Nature versus Nurture? Stressful life events: Overwhelming stress may trigger OCD symptoms like intrusive thoughts, rituals and emotional distress characteristic of obsessive-compulsive disorder. Pregnancy: Some studies suggest that on-set of OCD symptoms may occur in pregnancy or after delivery.

Treatment Options : 

12/17/2008 copyright 2006 www.brainybetty.com; All Rights Reserved. 25 Treatment Options PsychotherapyA type of therapy called cognitive behavior therapy has been shown to be the most effective form of therapy for OCD in both children and adults. Exposure and response prevention is a CBT technique used to treat OCD: it involves gradually exposing a client to a feared object or obsession, such as dirt, and teaching the client to take the risk. Learning the techniques takes effort, practice, time and courage. Most people with obsessive-compulsive disorder show improvement of signs and symptoms with CBT. OCD is also treated with medication prescribed by a psychiatrist.