Hello

Pangilinan, Primo, Ramos, Ranoa,

Resurreccion, Ronquillo, Sahagun
 Anxiety
disorders
Anxiety: a state of unpleasant apprehension and tension in
which a person fears some type of future negative experience.
 The American Psychiatric Association (APA)
purports that each of the Anxiety Disorders share
features of fear and anxiety

RESURRECCION, Gino Paulo

 The Fear and Anxiety Response Patterns

fear anxiety
an alarm reaction that occurs in
response to immediate danger. a general feeling of apprehension
about possible future danger.

Most common way of distinguishing between fear and anxiety

response patterns, all lies on whether there is a clear or obvious
source of danger.

RESURRECCION, Gino Paulo

 Fear
A basic emotion, involving the activation of the fight-or-
flight response of our autonomic nervous system.
Almost instantaneous to any imminent threat.
When the fear response triggers when there is no obvious
external danger, a spontaneous or uncued panic attack occurs.

Panic attack accompanied by a subjective sense of impending

doom.

RESURRECCION, Gino Paulo

 Fear and panic: three components
cognitive-subjective
I feel afraid. ; I am terrified.

physiological
Increased heart rate, heavy breathing, heightened amount of sweating, and
shaking/rattling of hands.

behavioral
A strong urge to flee, run away, or hide.

RESURRECCION, Gino Paulo

 anxiety
A complex blend of unpleasant emotions and cognitions; focusing
on the future and more detached than fear.

Adaptive value: plan and prepare for possible threats or events.

Mild to moderate cases: enhances learning and performance.
Chronic or severe: maladaptive.

RESURRECCION, Gino Paulo

 anxiety: three components
cognitive-subjective
Negative mood, worrying about the future, and a sense of being unable to
control or predict future threats.

physiological
Creates a state of tension, and chronic overarousal.
Aids in readiness for danger should it occur.
Primes a person for the fight-or-flight response.

RESURRECCION, Gino Paulo

 anxiety: three components

behavioral
Strong tendency to avoid events or situations where danger may be
encountered.
No immediate urge to flee as with fear.

RESURRECCION, Gino Paulo

 anxiety
Today, the DSM have identified anxiety disorders, which share obvious symptoms of
clinically significant fear or anxiety.
Anxiety Disorders are associated with an increased prevalence of a number of medical
conditions: asthma, hypertension, and cardiovascular disease.
According to Freud, anxiety was a sign of an inner battle between the id
(primitive desire) and the ego, and superego (prohibiting such expression).
Anxiety was not obvious in some cases due to psychological defense mechanisms
able to mask it.
DSM III dropped the term neurosis in favor of grouping smaller sets of
disorders that share more obvious symptoms.

RESURRECCION, Gino Paulo

 Sources of fear & anxiety
Are learned.
Conditioned stimulus (neutral or novel stimuli)
Unconditioned stimuli
(various kinds of physical or psychological trauma)
Conditioned response (elicit fear or anxiety)

RESURRECCION, Gino Paulo

 DSM-IV
DSM5
ICD-10

RESURRECCION, Gino Paulo

 DSM-IV-TR DSM-5
7 Primary
PrimaryDisorders
Disorders 5 Primary Disorders

1. Specific Phobia
2. Social Phobia 1. Specific Phobia
3. Panic Disorder with or without 2. Social Phobia
Agoraphobia (including Agoraphobia 3. Panic Disorders
without Panic) 4. Agoraphobia
4. Generalized Anxiety Disorder 5. Generalized Anxiety Disorder
5. Obsessive-Compulsive Disorder
6. Acute Stress Disorder
7. Posttraumatic Stress Disorder

RESURRECCION, Gino Paulo

 1. Fear/Panic VERSUS Anxiety Symptoms that are
experienced.
2. Kinds of objects or situations that most concern
them.

RESURRECCION, Gino Paulo


F40 Phobic anxiety
disorders
F40.0 Agoraphobia
.00 Without panic disorder
.01 With panic disorder
F40.1 Social phobias
F40.2 Specific (isolated)
phobias
F40.8 Other phobic anxiety
disorders
F40.9 Phobic anxiety
disorder, unspecified
ICD-10
F41 Other anxiety F42 Obsessive-
disorders compulsive disorder
F41.0 Panic disorder
F42.0 Predominantly
[episodic paroxysmal anxiety]
obsessional thoughts or
.00 Moderate
ruminations
.01 Severe
F42.1 Predominantly
F41.1 Generalized anxiety
compulsive acts [obsessional
disorder
rituals]
F41.2 Mixed anxiety and
F42.2 Mixed obsessional
depressive disorder
thoughts and acts
F41.3 Other mixed anxiety
F42.8 Other obsessive-
disorders
compulsive disorders
F41.8 Other specified
F42.9 Obsessive-
anxiety disorders
compulsive disorder,
F41.9 Anxiety disorder,
unspecified
unspecified
 SPECIFIC or social PANIC DISORDER GENERALIZED
PHOBIA ANXIETY DISORDER
Experience frequent
Exhibit anxiety panic attacks, and General sense of
symptoms about the intense anxiety diffuse anxiety and
possibility of based on the worry about many
encountering their possibility of having potentially bad
phobic situation. another one. things to happen.
May also experience Probably occasional
fear or panic when panic attack; but not
they actually the focus of their
encounter the anxiety.
situation

RESURRECCION, Gino Paulo

 OBSESSIVE - POST-TRAUMATIC
COMPULSIVE STRESS DISORDER
DISORDER OR ACUTE STRESS
Intense anxiety or DISORDER
distress in response
to intrusive thoughts Caused by extreme
and images. traumatic stressors.
Compelling need to Avoidance, and
engage in hyper-arousal.
compulsive,
ritualistic behavior
to ease their anxiety.

RESURRECCION, Gino Paulo

 SIMILARITIES
Biological Causal Factors:
The Limbic System
Neurotransmitters: GABA, Norepinephrine, and Serotonin

Psychological Causal Factors:

Conditioning of fear, panic, or anxiety.
People who have perceptions of lack of control of themselves or their
environment seem more vulnerable to developing anxiety disorders.

Social Causal Factors:

Environment raised in.
Parenting Styles

RESURRECCION, Gino Paulo

 COMMONALITIES
IN TREATMENT.
Most powerful therapeutic ingredient: Graduated exposure to feared cues,
objects, and situation- until fear or anxiety begins to habituate.

Cognitive Restructuring Techniques: Help the individual understand

their anxiety- driven and distorted thought patterns and helping them
realize it can be changed.

Medication: Antianxiety (Anxiolytics) and antidepressants.

RESURRECCION, Gino Paulo

 ANXIETY DISORDERS:

Etiology, Signs, Symptoms, Treatments

PRIMO, Diane Noelle

 Phobia

PRIMO, Diane Noelle

 Phobia

PRIMO, Diane Noelle

 Specific phobia

PRIMO, Diane Noelle

 Specific phobia

PRIMO, Diane Noelle

 Specific phobia

PRIMO, Diane Noelle

 Specific phobia

PRIMO, Diane Noelle

 Avoidance

PRIMO, Diane Noelle

 Phobic Responses

PRIMO, Diane Noelle

 DSM-IV-TR

PRIMO, Diane Noelle


A. Marked fear or anxiety about a specific object or situation
(e.g., flying, heights, animals, receiving an injection, seeing
blood).
Note: In children, the fear or anxiety may be expressed by crying,
tantrums, freezing, or clinging.
B. The phobic object or situation almost always provokes immediate
fear or anxiety.
C. The phobic object or situation is actively avoided or endured
with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger
posed by the specific object or situation and to the sociocultural
context.
E. The fear, anxiety, or avoidance is persistent, typically lasting for
6 months or more.
PRIMO, Diane Noelle
DSM-5
F. The fear, anxiety, or avoidance causes clinically significant distress
or impairment in social, occupational, or other important
areas of functioning.
G. The disturbance is not better explained by the symptoms of
another mental disorder, including fear, anxiety, and avoidance
of situations associated with panic-like symptoms or other
incapacitating symptoms (as in agoraphobia); objects or situations
related to obsessions (as in obsessive-compulsive disorder);
reminders of traumatic events (as in posttraumatic stress
disorder); separation from home or attachment
figures (as in separation anxiety disorder);
or social situations (as in social
anxiety disorder).
 DSM-5

PRIMO, Diane Noelle

 ICD-10
A. Either (1) or (2):
(1) marked fear of a specific object or situation not included in agoraphobia (F40.0) or social phobia (F40.1);
(2) marked avoidance of such objects or situations.

Among the most common objects or situations are animals, birds, insects, heights, thunder, flying, small enclosed
spaces, sight of blood or injury, injections, dentists and hospitals.

B. Symptoms of anxiety in the feared situation at some time since the onset of the disorder, as defined in
criterion B for F40.0 (Agoraphobia).

C. Significant emotional distress due to the symptoms or the avoidance, and a recognition that these are
excessive or unreasonable.

D. Symptoms are restricted to the feared situation, or when thinking about it.
If desired, the specific phobias may be subdivided as follows:
- animal type (e.g. insects, dogs)
- nature-forces type (e.g. storms, water)
- blood, injection and injury type
- situational type (e.g. elevators, tunnels)
- other type

PRIMO, Diane Noelle

 Specific Phobias

Animal snakes, spiders, dogs, insects, birds

Natural environment Storms, heights, water

Blood-injection-injury Seeing blood or an injury, receiving an

injection, seeing a person in a
wheelchair
Situational Public transportation, bridges,
elevators, flying and driving
Other Choking, vomiting

PRIMO, Diane Noelle

 Avoidance

PRIMO, Diane Noelle

 prevalence, age of onset,
gender difference

PRIMO, Diane Noelle

 Specific phobia: prevalence rate

PRIMO, Diane Noelle

 Specific Phobia:
Psychological Causal Factors

PRIMO, Diane Noelle

 Specific Phobia:
Psychological Causal Factors

PRIMO, Diane Noelle

 Specific Phobia:
Psychological Causal Factors

PRIMO, Diane Noelle

 Specific Phobia:
Psychological Causal Factors

PRIMO, Diane Noelle

 Specific Phobia:
Psychological Causal Factors

PRIMO, Diane Noelle

 Specific Phobia:
Psychological Causal Factors

PRIMO, Diane Noelle

 The Inflation Effect

PRIMO, Diane Noelle

 Specific Phobia:
Psychological Causal Factors

PRIMO, Diane Noelle

 Specific Phobia:
Biological Causal Factors

PRIMO, Diane Noelle

 Specific Phobia:
Biological Causal Factors

PRIMO, Diane Noelle

 treatments

A form of behavior therapy called exposure therapy is the best treatment

for specific phobias. It involves controlled exposure to the stimuli or
situations that elicit phobic fear.
Clients are encouraged to expose themselves (either alone or with
the aid of a therapist or friend) to their feared situations for long
enough periods of time so that their fear begins to subside.
Participant Modeling
therapist calmly models ways of interacting with
the phobic stimulus or situation
more effective than exposure alone.
PRIMO, Diane Noelle
 treatments

known to facilitate extinction of conditioned fear in animals

may enhance the effectiveness of small amounts of exposure therapy
for fear of heights in a virtual reality environment
However, D-cyloserine by itself, has no effect.

PRIMO, Diane Noelle

 ANXIETY DISORDERS:

Etiology, Signs, Symptoms, Treatments

PRIMO, Diane Noelle

 Social anxiety
Disorder is not
Extreme shyness.

PRIMO, Diane Noelle

 Shyness

Less than 25%

PRIMO, Diane Noelle

 Social phobia

Fear of scrutiny & potential

negative evaluation
Fear that the person may act
in an humiliating manner

PRIMO, Diane Noelle

 Generalized social phobia
Significant fears of most social situations
and often comes diagnosed with avoidant
personality disorder.

Non-Generalized social phobia

Person is not excessively anxious unless they
are in particular types of social situations.
performance situations

PRIMO, Diane Noelle

 Social Anxiety Disorder: Signs and Symptoms

PRIMO, Diane Noelle

 Social Anxiety Disorder: Signs and Symptoms

PRIMO, Diane Noelle

 Social Anxiety Disorder: Diagnostic
criteria according to dsm-iv-tr
A. 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; 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 anxiety
C. The person recognizes that the fear is
excessive or unreasonable
D. The feared social situations are avoided or
else endured with intense anxiety or distress
PRIMO, Diane Noelle
E. The avoidance, anxious anticipation or distress in
the feared social situation(s) interferes significantly with
the persons normal routine, occupational (academic)
functioning, or social activities or relationships or there
is marked distress about having the phobia
F. Individuals under age 18: duration is at least 6
months
G. fear or avoidance is not due to the direct
physiological effects of a substance or general
medical condition and is not better acounted for by
another mental disorder
H. If first criteria is unrelated to a general medical
condition or another mental disorder that is present,
the fear is not of Stuttering, trembling in Parkinsons
Disease, or exhibiting abnormal eating behavior in
Anorexia Nervosa or Bulimia Nervoa
 Social Anxiety Disorder: Diagnostic
criteria changed in dsm-5
A person no longer has to recognize that their anxiety is excessive or unreasonable in order to
receive the diagnosis (also applies for Agoraphobia and Specific Phobia)
According to APA, This change is based on evidence that individuals with such disorders
often overestimate the danger in phobic situations and that older individuals often
misattribute phobic fears to aging.
The anxiety should now be out of proportion to the actual threat or danger the situation poses, after
taking into account all the factors of the situation
Symptoms must be 6 months for all ages now
This is intended to help minimize over-diagnosis of occasional fears

PRIMO, Diane Noelle

 Social Anxiety Disorder:
Diagnostic criteria accdg. to icd

All of the following criteria should be fulfilled for a definite diagnosis:

(a)the psychological, behavioral, or autonomic symptoms must be
primarily manifestations of anxiety and not secondary to other symptoms
such as delusions or obsessional thoughts
(b)the anxiety must be restricted to or predominate in particular social
situations
(c)the phobic situation is avoided whenever possible.

PRIMO, Diane Noelle

 Prevalence, age of onset,
Gender differences

PRIMO, Diane Noelle

 Prevalence, age of onset,
Gender differences

PRIMO, Diane Noelle

 Prevalence, age of onset,
Gender differences

PRIMO, Diane Noelle

 Social Anxiety Disorder
Psychological Causes

PRIMO, Diane Noelle

 Social Anxiety Disorder
Psychological Causes

PRIMO, Diane Noelle

 Social Anxiety Disorder
Psychological Causes

PRIMO, Diane Noelle

PRIMO, Diane Noelle
 Social Anxiety Disorder
Psychological Causes

PRIMO, Diane Noelle

 Social Anxiety Disorder
Psychological Causes

PRIMO, Diane Noelle

 Social Anxiety Disorder
Psychological Causes

PRIMO, Diane Noelle

 Social Anxiety Disorder
Psychological Causes

PRIMO, Diane Noelle

 Social Anxiety Disorder:
biological Causes

PRIMO, Diane Noelle

 Social Anxiety Disorder:
treatments

PRIMO, Diane Noelle

 Social Anxiety Disorder: treatments

PRIMO, Diane Noelle

 Social Anxiety Disorder: treatments

PRIMO, Diane Noelle

 Social Anxiety Disorder: treatments

PRIMO, Diane Noelle

 Social Anxiety Disorder: treatments

PRIMO, Diane Noelle

 ANXIETY DISORDERS:

Etiology, Signs, Symptoms, Treatments

RAMOS, Kazel Mae

 Panic Disorder
Defined and characterized by the occurence of
panic attacks that often seem to come out of the
blue

must have been persistently concerned about having

another attack or worried about the consequences of
having an attack for at least a month

RAMOS, Kazel Mae

 Panic Attack
Is an abrupt surge of intense fear or intense
discomfort that reaches a peak within minutes
unexpected & uncued
Panic AttackIs an abrupt surge of intense fear or intense
discomfort that reaches a peak within minutes
unexpected & uncued

May also be situationally disposed,

occuring only during a particular situation

- During relaxation and sleep (nocturnal panic)

- First panic attack often occurs after feelings
- of distress or some highly stressful life circumstance
Panic Disorder Signs and Symptoms
Experiencing frequent, unexpected panic attacks that arent tied to a specific
situation
Worrying a lot about having another panic attack
Behaving differently because of the panic attacks, such as avoiding places where
youve previously panicked
Avoidant of:
- Being far away from home
- Going anywhere without the company of a "safe" person
- Physical exertion (because of the belief that it could trigger a panic attack)
- Going to places where escape is not readily available
- Driving
- Places where it would be embarrassing to have a panic attack, such as a social
gathering
- Doing anything that could possibly provoke panic
 Panic Disorder
Criteria for Panic Disorder according to DSM-5

8. Felling dizzy, unsteady, light-

1. Palpitations, pounding heart, or headed, or faint.
accelerated heart rate. 9. Chills or heat sensations.
2. Sweating. 10. Paresthesias (numbness or
3. Trembling or shaking. tingling sensations).
4. Sensations of shortness of breath 11. Derealization (feelings of
or smothering. unreality) or Depersonalization
5. Feelings of choking. (being detached from oneself).
6. Chest pain or discomfort. 12. Fear of losing control or going
7. Nausea or abdominal distress. crazy
13. Fear of dying.

RAMOS, Kazel Mae

 Panic Disorder
Criteria for Panic Disorder according to DSM-5

1. Persistent concern or worry about additional panic attacks or their consequences.

2. A significant maladaptive change in behavior related to the attacks.

RAMOS, Kazel Mae

Panic Disorder
Diagnostic Criteria Accdg. to DSM-IV-TR
A.Both (1) and (2)
1. Recurrent unexpected Panick Attacks
2. At least one of the attacks has been followed by at least 1 month of one (or more)
of the following
a. Persistent concern about having additional attacks
b. Worry about the implication of the attack or its consequences
c. A significant change in behavior related to attacks
B.Presence of Agoraphobia (Absence of Agoraphobia if PD without Agoraphobia)
C.Panic attacks not due to direct physiological effects of a substance or a general medical
condition
D.The Panic Attacks are not better accounted for by another mental disorder
Panic Disorder

For a definite diagnosis, several severe attacks of autonomic anxiety should have
occurred within a period of about 1 month:
(a) in circumstances where there is no objective danger
(b) without being confined to known or predictable situations
(c) with comparative freedom from anxiety symptoms between attacks
(although anticipatory anxiety is common).
Agoraphobia
- Fear and avoidance of crowded places
- Anxious about being in places or situations where escape
would be difficult, embarrassing or immediate help would be
unavailable
- Frightened by their bodily sensations
They may avoid activities that create arousal
At first, people will avoid situations they associate with panic attacks
then situations where they might happen again and, in severe
cases, these people may avoid leaving their home altogether
- Does not neccessarily need to occur with a prior panic attack
Fear of threatening outside environment
- May also be caused by some other unpredictable physical
ailment that makes the person afraid of being suddenly
incapacitated
Agoraphobia
Criteria for Agoraphobia According to DSM-5
A. Marked fear or anxiety about two (or more) of the ff: F. The fear, anxiety, or avoidance is persistent, typically
1. Using public transportations lasting for 6 months or more.
2. Being in open space G. The fear, anxiety or avoidance causes clinically different or
3. Being in enclosed spaces impairment in social, occupational, or other important areas
4. Standing in line or being in a crowd of functioning.
5. Being outside of the home alone H. If another medical condition is present, the fear , anxiety, or
B. The individual fears or avoids these situations because of avoidance is clearly excessive.
thoughts that escape might be difficult or help might not be I. The fear, anxiety, or avoidance is not better explained by
available in the event of developing panic-like symptoms the symptoms of another mental disorder.
or other incapacitating or embarrassing symptoms.
C. The agoraphobic situations almost always provoke fear or *Note: agoraphobia is diagnosed irrespective of the presence
anxiety of panic disorder. If an individuals presentation meets criteria
D. The agoraphobic situations are actively avoided, require the for panic disorder and agoraphobia, both diagnoses should be
presence of a companion, or are endured with intense fear assigned.
or anxiety.
E. The fear of anxiety is out of proportion to the actual danger
posed by the agoraphobic situations and to the sociocultural
context.
Panic Disorder and Agoraphobia

Panic Disorder and Agoraphobia are now recognized as two seperate disorders
APA found that a significant number of people with agoraphobia do not
experience panic symptoms.
Agoraphobia symptom criteria remain unchanged from DSM-IV:
A. Presence of Agoraphobia is related to fear of developing panic-like
symptoms
B. Criteria have never been met for Panic Disorder
C. The disturbance is not due to the direct physiological effects of a
substance or a general medical condition
D. If an associated general medical condition is present, the fear described
in A is in excess of that usually associated with the condition
Prevalence, age of onset,
& Gender differences
Average age of onset is 23-34 years
It occurs much more frequently in women than in men
2% lifetime prevalence in men
5% prevalence in women
The most common explanation of the pronounced
gender difference is a sociocultural one
 Panic Disorder
Etiology Biological Causes

Has moderate heritable component Fear network

People with a history of social or - Amygdala at the center of it
specific phobias are at heightened with connections to the lower
risk of developing a Panic Disorder areas of the brain (locus
coerulus) and higher areas
- prefrontal cortex)

- Locus coeruleus and norepinephrine
-Involved in panic attacks
Amygdala plays a more central role
compared to the locus coerulus
- Involved in fear
- Panic Attacks occur when the fear
network is activated either by cortical
inputs or inputs from lower brain areas
- Likely to develop in people
with sensitive fear networks
 Panic Disorder
Etiology Biological Causes

The Brain
- The Hippocampus also involved in generating
conditioned anxiety and possibly also learned
avoidance in agoraphobia
- Periaqueductal gray in the midbrain may also be
involved in panic attacks
-The higher cortical centers likely mediate that
cognitive symptoms in panic attacks and
overreactions about the danger posed by
threatening bodily sensations
 Panic Disorder
Etiology Biological Causes

- Panic provocation procedures

- Neurobiological processes
- No single neurobiological mechanisms can be implicated
2 neurotransmitter systems are most implicated with panic attacks
- Noradrenergic
Can stimulate cardiovascular symptoms associated
with panic
-Serotonergic
Decreases noradrenergic activity
SSRI (selective serotonin reuptake inhibitors)
-Medications used to treat PD increase serotonergic
activity
 Panic Disorder
Etiology Biological Causes

GABA neurons
- Implicated in the anticipatory anxiety people
have about experiencing another panic attack
- Known to inhibit anxiety and has been shown
to be low in parts of the cortex in people
with panic disorder
 Panic Disorder
Etiology Psychological Causes

- Initial internal bodily sensations of anxiety or

arousal become interoceptive conditioned stimuli
associated with higher levels of anxiety or arousal
- Initial panic attacks become associated with
initially neutral internal and external cues through
an interoceptive or exteroceptive conditioning.
- Primary effect: becomes conditioned to these
bodily sensations and the more intense the attack, the
more robust the conditioning
- This kind of conditioning gives opportunities
for the development of anticipatory anxiety and
agoraphobic fears (two components of panic disorder)
- Panic attacks themselves (third component)
are also likely to be conditioned to certain internal cues
 Panic Disorder
Etiology Psychological Causes

- Hypersensitivity to bodily sensations

- People with PD are prone to giving these bodily
sensations the direst possible interpretation
- This may cause more physiological
symptoms of anxiety which fuels these
thoughts even further
- Person is not necessarily aware of these
automatic thought processes but they
are, in a sense, triggers of panic
 Panic Disorder
Etiology Psychological Causes

Anxiety Sensitivity
- Trait-like belief that certain bodily symptoms have harmful
consequences
- At high levels, people are more prone to developing panic
attacks and maybe even panic disorder
Sense of perceived control
- Reduces anxiety and even blocks panic
- If the person is with a safe person when undergoing panic
provocation procedure, the person is likely to show reduced
distressed, lowered physiological arousal and reduced
likelihood of panic than those who came alone
People with high sense of anxiety sensitivity or agoraphobia also may be
protected against panic attacks if they have a sense of perceived control
over their life situation
 Panic Disorder
Etiology Psychological Causes

Safety Behaviors
- Disconfirmations in believing panic attacks are the result
of physical problems do not occur in people with panic
disorder because they frequently engage in safety behaviors
- Causes them to mistakenly attribute the lack of
catastrophe to their having engaged in safety behavior
- It is important during treatment that the person identifies
his/her safety behaviors so that he/she can learn to give
them up and see that catastrophe did not occur
 Panic Disorder
Etiology Psychological Causes

Cognitive Biases
- People with PD are biased in the way they process
information
- They interpret ambiguous bodily sensations as
threatening
- They also interpret ambiguous situations as more
threatening than normal
- Attention is automatically drawn to threatening
information in their environment
 Panic Disorder
Intervention
Medications
- Anxiolytics from the benzodiazepine category
Anti anxiety medications
Alprazolam (Xanax)
Clonazepam (Klonopin)
- Sides effects: drowsiness and sedation
resulting in impaired cognitive and motor
performance
- Prolonged use: dependence followed by
withdrawal symptoms when discontinued
Antidepressants
- tricyclics, SSRIs, SNRI
- Advantages: No physiological dependence, can alleviate
any comorbid depressive symptoms or disorder
- Disadvantages: 4 weeks to have beneficial effects
 Panic Disorder
Intervention

Behavioral Treatment
- Prolonged exposure to the feated situations
-Clients would gradually face the situations they feared and
learn that there was nothing to fear
- Limitation: did not specifically target panic attacks
Interoceptive exposure
- deliberate exposure to feared internal sensations
- Fear of the internal sensations should be treated in the
same way that fear of external agoraphobic situations is
treated
-Prolonged exposure to internal sensations so that the fear
may extinguish
 Panic Disorder
Intervention
Cognitive restructuring
- Integrative cognitive-behavioral treatment or panic control treatment
- Targets both agoraphobic avoidance and panic attacks
-Produces better results than the original exposure-based techniques
Greater magnitude of improvement with CBT than medications
Also useful in treating people with nocturnal panic
Combination of therapy and medication
Short term:
- produces slighter superior results than either type of treatment
alone
- Fewer medication side effects and fewer dropouts
Long term:
- After medication was diminished or stopped, clients who have
been on medication with or without cognitive or behavioral
treatment show greater likelihood of relapse
- Attributed gains to medication rather than personal efforts
ANXIETY DISORDERS:

Etiology, Signs, Symptoms, Treatments

 GAD
Free-floating anxiety
Must occur on more days than not for at least 6 months
and is difficult to control
Accompanied by at least 3 of the six symptoms
Basic anxiety disorder
Most common spheres of worry family, work, finances,
and personal illnesses
Signs & Symptoms
 GAD
A. Excessive anxiety & worry occurring more
days than not for at least 6 months, about a
number of events or activities
B. Has difficulty controlling ones worrying
C. Anxiety & worry are associated with three
(or more) of the following six symptoms
1. restlessness
2. being easily fatigued
3. difficulty concentrating
4. irritability
5. muscle tension
6. sleep disturbance
D. Anxiety, worry, or physical symptoms
cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning
E. Disturbance is not attributable to the
physiological effects of a substance or another
medical condition
F. Disturbance is not better explained by
another mental disorder
 GAD
A. Primary symptoms of anxiety
should be present
B. Apprehension
C. Motor tension
D. Autonomic overactivity

In children, frequent need for

reassurance & recurrent somatic
complaints may be prominent
Prevalence, Age of Onset, and
Gender Differences
Comorbidity
PSYCHOANALYTIC VIEWPOINT

Freud believed that it was primarily sexual & aggressive impulses

that had been either blocked from expression or punished upon
expression
Defense mechanisms may become overwhelmed when a person
experiences frequent & extreme levels of anxiety
Difference from phobia defense mechanisms do not work
PERCEPTION OF UNCONTROLLABILITY & UNPREDICTABILITY

Uncontrollable & unpredictable aversive events create more fear &

anxiety
May have a history of many uncontrollable & unpredictable events
More likely to have had history of trauma in their childhood
Disturbed by not being able to predict the future
Stems from a lacking of safety signals from the environment
A SENSE OF MASTERY: THE POSSIBILITY OF IMMUNIZING
AGAINST ANXIETY

History of control over ones environment is important

THE CENTRAL ROLE OF WORRY AND ITS POSITIVE FUNCTIONS

Most people with GAD think that they benefit from worrying by
1. Superstitious avoidance of catastrophe
2. Avoidance of deeper emotional topics
3. Coping & preparation
Positive beliefs sustain worrying
Emotional & physiological responses to aversive imagery are actually
suppressed
NEGATIVE CONSEQUENCES OF WORRY

Worrying is not an enjoyable activity

Leads to a greater sense of danger and anxiety
Tend to have more negative intrusive thoughts
Enhanced perception of being unable to control them
COGNITIVE BIASES FOR THREATENING INFORMATION

Process information in a biased way because they have prominent danger

schemas
Threat cues may occur before information has entered the persons
conscious awareness
Attentional biases play a causal role
Thinks that bad things are likely to happen in the future
GENETIC FACTORS

Heritability
15-20% - due to genetic factors
May have the same genetic predisposition as those with a depressive
disorder
Development depends on specific environmental experiences
NEUROTRANSMITTER & NEUROHORMONAL ABNORMALITIES

Highly anxious people have a kind of functional deficiency in GABA

Benzodiazepine reduces anxiety by increasing GABA
Deficiency in GABA as a cause or consequence of anxiety is not yet
known but it promotes the maintenance of anxiety
GABA, Serotonin, Norepinephrine
CORTICOTROPIN-RELEASING HORMONE SYSTEM & ANXIETY

Corticotropin-releasing hormone (CRH) anxiety-producing hormone

Activated by stress or perceived threat

CRH ACTH CORTISOL

NEUROBIOLOGICAL DIFFERENCES BETWEEN ANXIETY & PANIC

More diffuse emotional state

Limbic system, GABA, & CRH are mostly in play
People with GAD have smaller left hippocampal region
MEDICATIONS

Benzodiazepine (Anxiolytic)
1. Xanax
2. Klonopin
Buspirone
Antidepressants used to treat panic disorder
COGNITIVE-BEHAVIORAL TREATMENT

Combination of behavioral techniques

1. Applied muscle relaxation
2. Cognitive restructuring techniques
Changes on most symptoms were seen after CBT
Useful in helping people who have used benzodiazepines for over a year
 ANXIETY DISORDERS:

Etiology, Signs, Symptoms, Treatments

PANGILINAN, Cyrene
 Obsessive-Compulsive and
Related Disorders
new category in the DSM-5
used to be under the Anxiety Disorders category

obsessive-compulsive disorder
hoarding disorder
excoriation (skin-picking) disorder
bodydysmorphic disorder
trichotillomania
 Obsessive-Compulsive
disorder
defined by the occurrence of unwanted, persistent,
recurrent, and intrusive thoughts, images, or
distressing images, usually accompanied by
repetitive overt behaviors or covert mental rituals
intended to undo, suppress, or neutralize them
 obsessions

order and exactness, contamination, fears of harming oneself or others

doubt, need for symmetry, sexual obsessions, religion
Aggression, violence
- consistent cross-culturally
 compulsions
repetitive, ritualistic, and
repetitive, ritualistic, and time-consuming
time-consuming behavior
behavior or
or mental
mental a
act a person
person feels feels
drivendriven to perform
to perform in order
in order to resist,
to resist, suppress, or
suppress, or neutralize
neutralize obsessions obsessions

have very rigid rules regarding exactly how

these should be performed:
cleaning, checking, ordering
hoarding, arranging, counting, mental rituals
 Obsessions & compulsions
exist in a continuum.

normal to abnormal
differing primarily in the frequency, intensity, and in
the degrees to which the obsessions and compulsions
are resisted and are troubling
 Obsessions & compulsions
exist in a continuum.

OCD NOT OCD

A man who washes his hands 100
times a day until they are red and raw
A woman who locks and relocks her
door before going to work every day
for half an hour
A woman who unfailingly washes her
hands before every meal
A woman who double-checks that her
apartment door and windows are
locked each night before she goes to
bed.
 Obsessions & compulsions
exist in a continuum.

OCD NOT OCD

A college student who must tap on the A musician who practices a difficult
door frame of every classroom 14 passage over and over again until its
times before entering perfect
A man who stores 19 years of A woman who dedicates all her spare
newspapers just in case with no time and money to building her record
system for filling or retrieving collection
 OCD CYCLE
Obsessions

Relief Anxiety

Compulsions
 Diagnostic criteria for obsessive-
compulsive disorder
Dsm-iv-tr
A. Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3), and (4):
(1) recurrent and 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 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 (not imposed from without as
in thought insertion)
Compulsions as defined by (1) and (2):
(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental
acts (e.g., praying, counting, repeating words silently) that the person feels
driven to perform in response to an obsession, or according to rules that
must be applied rigidly
(2) the behaviors or mental acts are aimed at preventing or reducing
distress or preventing some dreaded event or situation; however, these
behaviors or mental acts either are not connected in a realistic way with
what they are designed to neutralize or prevent or are clearly excessive
Dsm-5
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or impulses that are
experienced, at some time during the disturbance, as intrusive and
unwanted, and that in most individuals cause marked anxiety or distress.
2.The individual attempts to ignore or suppress such thoughts, urges, or
images, or to neutralize them with some other thought or action (i.e., by
performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental
acts (e.g., praying, counting, repeating words silently) that the individual
feels driven to perform in response to an obsession or according to rules
that must be applied rigidly.
2.The behaviors or mental acts are aimed at preventing or reducing anxiety
or 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.
Note: Young children may not be able to articulate the aims of these
behaviors or mental acts.
 Diagnostic criteria for obsessive-
compulsive disorder

Dsm-iv-tr Dsm-5

B. The obsessions or compulsions are time-consuming (e.g., take

B. At some point during the course of the disorder,
the person has recognized that the obsessions or
compulsions are excessive or
unreasonable. Note: This does not apply to
children.
more than 1 hour per day) or cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.

C. The obsessions or compulsions cause marked

distress, are time consuming (take more than 1 hour
a day), or significantly interfere with the person's C. The obsessive-compulsive symptoms are not attributable to the
normal routine, occupational (or academic) physiological effects of a substance (e.g., a drug of abuse, a
functioning, or usual social activities or
relationships. medication) or another medical condition.
 Diagnostic criteria for obsessive-
Dsm-iv-tr
D. If another AXIS I disorder is present, the content
of the obsessions or compulsions is not restricted to it
(e.g., preoccupation with food in the presence of an
Eating Disorder; hair pulling in the presence of
Trichotillomania; concern with appearance in the
presence of Body Dysmorphic Disorder;
preoccupation with drugs in the presence of
a Substance Use Disorder; preoccupation with
having a serious illness in the presence
of Hypochondriasis; preoccupation with sexual
urges or fantasies in the presence of a Paraphilia; or
guilty ruminations in the presence of Major
Depressive Disorder).
compulsive disorder
Dsm-5
D. The disturbance is not better explained by the symptoms of another mental disorder
(e.g., excessive worries, as in generalized anxiety disorder; preoccupation with
appearance, as in body dysmorphic disorder; difficulty discarding or parting with
possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling
disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in
stereotypic movement disorder; ritualized eating behavior, as in eating disorders;
preoccupation with substances or gambling, as in substance-related and addictive
disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual
urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control,
and conduct disorders; guilty ruminations, as in major depressive disorder; thought
insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic
disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
 Diagnostic criteria for obsessive-
compulsive disorder

Dsm-iv-tr Dsm-5
Specify if:

With good or fair insight: The individual recognizes that obsessive-

E. The disturbance is not due to the direct compulsive disorder beliefs are definitely or probably not true or that they may
physiological effects of a substance(e.g., a or may not be true.
drug of abuse, a medication) or a general With poor insight: The individual thinks obsessive-compulsive disorder
medical condition. beliefs are probably true.

With absent insight/delusional beliefs: The individual is completely

convinced that obsessive-compulsive disorder beliefs are true.

Specify if:
With Poor Insight: if, for most of the time during the
current episode the person does not recognize that the
obsessions and compulsions are excessive or unreasonable
 Icd-10
F42 OBSESSIVE-COMPULSIVE DISORDER
A. Either obsessions or compulsions (or both), present on most days for a period of at least two weeks.
B. Obsessions (thoughts, ideas or images) and compulsions (acts) share the following features,
all of which must be present:
(1) They are acknowledged as originating in the mind of the patient, and are not imposed by
outside persons or influences.
(2) They are repetitive and unpleasant, and at least one obsession or compulsion must
be present that is acknowledged as excessive or unreasonable.
 Icd-10
(3) The subject tries to resist them (but if very long-standing, resistance to some
obsessions or compulsions may be minimal). At least one obsession or compulsion must be
present which is unsuccessfully resisted.
(4) Carrying out the obsessive thought or compulsive act is not in itself pleasurable.
(This should be distinguished from the temporary relief of tension or anxiety).
C. The obsessions or compulsions cause distress or interfere with the subject's social or individual
functioning, usually by wasting time.
D. Most commonly used exclusion criteria: not due to other mental disorders, such as
schizophrenia and related disorders (F2), or mood [affective] disorders (F3).
 Icd-10
- Presence of obsessions, compulsions, or both
- The obsessions or compulsions:
o causes distress
o time-consuming (more than 1 hour/day)
o interferes with functioning
- The obsessive-compulsive symptoms are not attributable to the physiological
effects of a substance or another medical condition
- The disturbance is not better explained by the symptoms
- Insight:
o DSM IV-TR: Poor
o DSM V: Good or Fair, Poor, Absent
 Prevalence, age of onset,
& Gender differences
Prevalence
1-year prevalence rate: 1.2%
Average lifetime prevalence: 2.3% to 3%
Both have obsessions and compulsions: 90% to 98%
Overrepresented by divorced (or separated) and unemployed people
Age of Onset
Generally begins in late adolescence or early adulthood and is most prevalent then
Not uncommon in children
 Prevalence, age of onset,
& Gender differences
Gender Difference
In adults: little to no gender difference (1.4 to 1, women to men)
In children or early adolescents: more common in boys than in girls
 Comorbidity with
Other disorders
Depression Post-Traumatic Stress Disorder
o Major depression: 25% to 50% Dependent Personality Disorder
o Depressive symptoms: 80% Avoidant Personality Disorder
Social Phobia Body Dysmorphic Disorder
Panic Disorder
Generalized Anxiety Disorder
 Psychological
Causal factors
Mowrers Two-Process Theory of Avoidance Learning
o Classical Conditioning: Neutral stimuli become associated with frightening thoughts
or experiences and come to elicit anxiety
o Operant Conditioning: Anxiety is reduced through compulsions, which are,
therefore, reinforced.
o Once learned, avoidance responses are extremely resistant to extinction
 cognitive
Causal factors
The Effects of Attempting to Suppress Obsessive Thoughts
- Paradoxical: Thought suppression leads to a general increase in obsessive-compulsive
symptoms beyond just the frequency of obsessions

Appraisals of Responsibility for Intrusive Thoughts

- People with OCD often seem to have an inflated sense of responsibility
- Thought-Action Fusion
 cognitive
Causal factors
Cognitive Biases and Distortions
- More focused on disturbing material
- Difficulty blocking out negative, irrelevant input or distracting information
- Low confidence in memory ability
- Have deficits in the ability to inhibit both motor responses and irrelevant
information
 cognitive
Causal factors
Genetic Factors
- Twin studies: high concordance rate for monozygotic twins and a lower rate for dizygotic twins
- Family studies: 3 to 12 times higher rates of OCD in first-degree relatives of OCD clients than
would be expected from current estimates of the prevalence of OCD
- Early-onset OCD has a higher genetic loading than later-onset OCD
 cognitive
Causal factors
Genetic Factors
- Tourettes syndrome
o A disorder characterized by sever chronic motor and vocal tics that is known to have
a substantial genetic basis
o A type of OCD that often starts in childhood
- Different polymorphisms are implicated in OCD with Tourettes syndrome and in OCD
without Tourettes syndrome
 - Cortico-basal-ganglionic-thalamic circuit
- normally involved in the preparation of complex
sets of interrelated behavioral responses used in
specific situations.

Ocd and the brain

o Orbital frontal cortex primitive urge
regarding sex, aggression, hygiene, and
danger (stuff of obsessions)
o Basal ganglia set of structures which are
involved in the execution of voluntary,
goal-directed movements
Caudate nucleus/Corpus Striatum
filters the urges, only allowing the
strongest to pass on to the thalamus
Globus pallidus
Substantia nigra
 o Thalamus important relay station that
receives all sensory input and passes it back

Ocd and the brain

to the cerebral cortex
- Baxters theory
o Overactivation of the orbital frontal cortex +
Dysfunctional cortico-basal-ganglionic-
thalamic circuit = OCD
o Abnormalities in white matter (involved in
connectivity between various brain
structures)
 Neurotransmitter
- Serotonergic Systems
abnormalities
o Serotonin sends messages between brain cells and it is thought to be involved in
regulating everything from anxiety, to memory, to sleep
increase results to OCD symptoms
Anafranil (clomipramine)
Prozac (fluoxetine)
Must be taken for at least 6 to 12 weeks
- Dopaminergic Systems, GABA, and Glutmate Systems also seem to be involved
 Treatments: Behavioral and
Cognitive-Behavioral Treatments
Exposure and response prevention
Most effective approach to treating obsessive-compulsive disorders
Involves having the patients with OCD to rate their anxiety during the
ceraint situation
Results show that 50-70% reduction of the symptoms after the treatment
Some people refuse such treatment of drop out early

RONQUILLO, Marc
RONQUILLO, Marc
 Treatments: MEDICATIONS

Clomipramine (Anafranil) and fluoxetine (Prozac)

Alter the functioning of the serotonin
Reduce the intensity of the symptom by atleast 25-35%

RONQUILLO, Marc
 Treatments: MEDICATIONS

Disadvantage
When the medication is discontinued, rates of relapse
are generally high

The doctors are now studying about the treatment of severe, intractable
OCD by using neurosurgical techniques.

RONQUILLO, Marc
RONQUILLO, Marc
 Body Dysmorphic Disorder
Perceived or Imagined flaws in their appearance
Have compulsive checking behaviors
They may focus on any body part
- Most common: skin, hair, nose, eyes, breast/chest/nipples, stomach and face
size/shape
People with BDD frequently seek reassurance from his/her friends and family, but
the reassurances provide very temporary relief.
They engage in excessive grooming behavior, trying to camouflage
their perceived defect through their hair, clothing or makeup

RONQUILLO, Marc
 Body Dysmorphic Disorder
Prevalence: equal in men and women
Men: likely to obsess about their genitals, body build and balding
Women: likely to obsess about their skin, stomach, breasts,
buttocks, hips and legs
Age of onset: Adolescence
Rates of comorbid social phobia and obsessive-compulsive disorder
are not as high as for depression
In 200 patients with BDD, 80% reported having suicidal ideation and
28% had a history of suicide attempt

RONQUILLO, Marc
 Body Dysmorphic Disorder
Patients often make their way to dermatologists instead of
going to a psychologist or a psychiatrist.
Often patients get the plastic surgery but after the surgery
their diagnosis of BDD is retained.

RONQUILLO, Marc
 Body Dysmorphic Disorder

DSM-IV-TR: classified as
somatoform disorder
DSM-5: classified into the related
disorders category of OCD

RONQUILLO, Marc
 Causal factor
The understanding of the causes of BDD are still in the preliminary
stage.
There is a possibility that it is because they are reinforced as children
for their overall appearance more than for their behavior.
if my appearance is defective then I am worthless
Another possibility is that they were teased or criticized for their
appearance

RONQUILLO, Marc
 treatment

Exposure and response prevention

- Produce marked improvement in
50 to 80% of treated patients

RONQUILLO, Marc
 Hoarding Disorder

RONQUILLO, Marc
 Hoarding Disorder
Individuals both acquire and fail to discard many
possessions that seem useless or of very limited value, but
only because of emotional attachment they developed to
their possessions.
Occurs in 10 to 40% of people diagnosed with OCD
4 out of 5 people show compulsive hoarding only

RONQUILLO, Marc
 Hoarding Disorder

DSM-IV-TR: criterion for obsessive-compulsive

personality disorder (OCPD) and a symptom
of obsessive-compulsive disorder (OCD)

DSM-5: under the category Obsessive Compulsive

and Related Disorders

RONQUILLO, Marc
 trichotillomania

Video

RONQUILLO, Marc
 trichotillomania
Known as compulsive hair pulling
Primary symptom is having the urge to pull out ones hair
from anywhere on the body resulting in noticeable hair loss.
Hair pulling is usually preceded by an increase of tension,
followed by pleasure, and gratification or relief when the hair
is pulled out.
The person often examines the hair root, and sometimes
pulls the strand between their teeth and/or eats it.

RONQUILLO, Marc
 trichotillomania
Onset: childhood

DSM-IV-TR: Impulse Control Disorder

ICD-10: Habit and Impulse Disorders

RONQUILLO, Marc
 ANXIETY DISORDERS:

Etiology, Signs, Symptoms, Treatments

SAHAGUN, Cirila
 Stress
Experience or perceive challenges to physical
or emotional well-being that exceed coping
resources and mechanisms
Fundamentally an interactive and dynamic
construct.
Stressors, Coping strategies
Eustress, Distress

SAHAGUN, Cirila
 trauma
the result of extraordinarily stressful events that shatter the sense
of security, leading to feelings of helplessness and vulnerability in a
dangerous world.
any situation that leaves you feeling overwhelmed and fearful can
be traumatic, even if it doesnt involve physical harm.

SAHAGUN, Cirila
 trauma
The more frightened and helpless you feel, the more likely you
are to be traumatized.
A traumatic event is thought to cause a pathological memory that
is at the center of the characteristic clinical symptoms associated
with the disorder

SAHAGUN, Cirila
 trauma

SAHAGUN, Cirila
 trauma
Risk factors

Being male
Having had conduct problems in childhood
Having a family history of psychiatric disorder
Scoring high on measures of extraversion and neuroticism

SAHAGUN, Cirila
 trauma
An event will most likely lead to trauma if:

It is unexpected
You felt powerless to prevent it.
It happened repeatedly.
It happened in childhood.

SAHAGUN, Cirila
 Acute Stress Disorder

SAHAGUN, Cirila
 Acute stress disorder (ASD)
Diagnostic category that can be used when symptoms develop
shortly after experiencing a traumatic event and last for at least
48 hours
was introduced into DSM-IV (1994) for the explicit purpose of
identifying within the first month following exposure to trauma
those individuals who, without intervention, are most likely to
develop PTSD.
Symptoms persisting beyond 4 weeks PTSD
ASD covers the time period from 48 hrs to 1 month.

SAHAGUN, Cirila
 DSM-IV-TR Diagnostic Criteria for
Acute Stress Disorder
A1. Exposure to catastrophic stressor
A2. Intense emotional reaction to stressor
B. During or after experiencing the distressing event, the individual has three (or more) of the
following dissociative symptoms:
Sense of numbing, detachment, or absence of emotional responsiveness

Reduction in awareness of surroundings (e.g., being in a daze)

De-realization

De-personalization

Dissociative amnesia

SAHAGUN, Cirila
 Acute stress disorder (ASD)
Dissociative symptoms
are reactions to trauma in which the mind splits off certain aspects of
the trauma from conscious awareness. These can affect the patient's
memory, sense of reality, and sense of identity, and include the
following:
A subjective sense of detachment, or absence of emotional
responsiveness
A reduction in awareness of the persons surroundings

SAHAGUN, Cirila
 Acute stress disorder (ASD)
Dissociative symptoms
De-realization: A sense that world is unreal, strange,
unfamiliar
De-personalization: Feelings of being an outside
observer of one's self
Dissociative amnesia: Such as the inability to recall
an important aspect of the trauma.

SAHAGUN, Cirila
 DSM-IV-TR Diagnostic Criteria for
Acute Stress Disorder
C. The traumatic event is persistently re-experienced in at least one of
the following ways: recurrent images, thoughts, dreams, illusions, flashback
episodes, or a sense of reliving the experience; or distress on exposure to
reminders of the traumatic event

D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g.,

thoughts, feelings, conversations, activities, places, people)

E. Marked symptoms of anxiety or increased arousal (e.g., difficulty

sleeping, irritability, poor concentration, hypervigilance, exaggerated startle
response, motor restlessness)

SAHAGUN, Cirila
 DSM-IV-TR Diagnostic Criteria for
Acute Stress Disorder
F. The disturbance causes significant distress or impairment
G. The disturbance lasts for a minimum of 2 days and a maximum
of 4 weeks and occurs within 4 weeks of the traumatic event
H. Disturbance is not due to the effects of substance use or medical
condition or is not better accounted for by brief psychotic disorder,
and is not merely an exacerbation of a pre-existing Axis I or II
disorder.

SAHAGUN, Cirila
 POST TRAUMATIC STRESS
DISORDER (PTSD)
It was first introduced into the Diagnostic and Statistical
Manual of Mental Disorders (DSM) in 1980
is a severe anxiety disorder that can develop after exposure to
any event that result in psychological trauma.
it must develop in direct response to an extreme traumatic
stressor
PTSD can only be diagnosed from 4 weeks.

SAHAGUN, Cirila
 POST TRAUMATIC STRESS DISORDER (PTSD)

SAHAGUN, Cirila
 DSM-IV-TR Diagnostic Criteria for
Post-Traumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of
the following were present:
A1) 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.

A2) The persons response involved intense fear, helplessness, or

horror.
.

SAHAGUN, Cirila
 DSM-IV-TR Diagnostic Criteria for
Post-Traumatic Stress Disorder
B. The traumatic event is persistently re-experienced in one (or more) of the following
ways:
B1) Recurrent and intrusive distressing recollections of the event, including images,
thoughts, or perceptions.
B2) Recurrent distressing dreams of the event.
B3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving
the experience; illusions, hallucinations, and dissociative flashback episodes, including those
that occur on awakening or when intoxicated). Note: In young children, trauma-specific re-
enactment may occur.
B4) Intense psychological distress at exposure to internal or external cues that symbolize
or resemble an aspect of the traumatic event.
B5) Physiological reactivity on exposure to internal or external cues that symbolize or
resemble an aspect of the traumatic event.

SAHAGUN, Cirila
 DSM-IV-TR Diagnostic Criteria for Post-
Traumatic Stress Disorder
C. Persistent avoidance of stimuli associated with the trauma and numbing of general
responsiveness (not present before the trauma), as indicated by three (or more) of the
following:
C1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma
C2) Efforts to avoid activities, places, or people that arouse recollections
C3) Inability to recall an important aspect of the trauma
C4) Markedly diminished interest or participation in significant activities
C5) Feeling of detachment or estrangement from others
C6) Restricted range of affect (e.g., unable to have loving feelings)
C7) Sense of a foreshortened future (e.g., does not expect to have a career, marriage,
children, or a normal lifespan)

SAHAGUN, Cirila
 DSM-IV-TR Diagnostic Criteria for Post-
Traumatic Stress Disorder
D. Persistent symptoms of increased arousal (not present before the
trauma), as indicated by two (or more) of the following:
(1) Difficulty falling or staying asleep
(2) Irritability or outbursts of anger
(3) Difficulty concentrating
(4) Hypervigilance
(5) Exaggerated startle response

SAHAGUN, Cirila
 symptoms
1. INTRUSION/ RE-EXPERIENCING
SYMPTOMS
2. AVOIDANCE
3. NEGATIVE COGNITIONS AND MOOD
4. AROUSAL AND REACTIVITY

SAHAGUN, Cirila
 symptoms
1. INTRUSION/ RE-EXPERIENCING SYMPTOMS
Flashbacks
Nightmares
Frightening thoughts
Re-experiencing symptoms may cause problems in a persons
everyday routine. They can start from the persons own thoughts and
feelings. Words, objects, or situations that are reminders of the event
can also trigger re-experiencing.

SAHAGUN, Cirila
 symptoms
2. AVOIDANCE SYMPTOMS
Making an effort to avoid thoughts, feelings or conversations
about the traumatic event
Making an effort to avoid places or people that remind the
person of the traumatic event
Keeping oneself busy to distract self from thinking about the
traumatic event

SAHAGUN, Cirila
 symptoms
3. HYPERAROUSAL
Having a difficult time falling or staying asleep
Feeling more irritable or having bursts of anger
Having difficulty concentrating
Being jumpy or easily startled
Hypervigilance

SAHAGUN, Cirila
 symptoms
4. NEGATIVE THOUGHTS AND BELIEFS
Difficulty remembering important parts of the traumatic
event
Loss of interest in past activities
Feeling distant from others
Experiencing difficulty having positive feelings

SAHAGUN, Cirila
 DSM-IV-TR Diagnostic Criteria for Post-
Traumatic Stress Disorder
E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more
than 1 month.
F. The disturbance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
Specify if:
Acute: < 3 months
Chronic: > 3 months
Specify if:
With Delayed Onset

SAHAGUN, Cirila
SAHAGUN, Cirila
 ICD-10 DIAGNOSTIC
CRITERIA FOR PTSD
Criterion A: stressor
Exposure to a stressor. Unlike DSM there is no subjective stressor criterion OR intense fear,
helplessness, or horror.

Criterion B: re-experiencing
Persistent remembering of the stressor in one of:
Intrusive flashbacks
Vivid memories or recurring dreams
Experiencing distress when reminded of the stressor

Criterion C: avoidance
Requires only one symptom of actual or preferred avoidance. DSM-IV-TR requires three
symptoms from this cluster,.

SAHAGUN, Cirila
 ICD-10 DIAGNOSTIC
CRITERIA FOR PTSD
Criterion D: hyperarousal
Inability to recall only or
Two or more of:
Sleep problems
Irritability
Concentration problems
Hypervigilance
Exaggerated startle response
Criterion E:
Onset of symptoms within six months of the stressor

SAHAGUN, Cirila Lecar J.

 DSM-5
Both Acute Stress Disorder and Post Traumatic Disorder are now under
Trauma- and Stressor-related disorders
Diagnostic criteria for PTSD has been tightened
-Traumatic event must be experienced DIRECTLY by the
person , either because the event happens to you or because
you witness, in person, something traumatic happening to
someone else

SAHAGUN, Cirila
 ASD VS PTSD
An ASD diagnosis requires that a person experience at least
three symptoms of dissociation (e.g., numbing, reduced
awareness, depersonalization, de-realization, or amnesia),
while the PTSD diagnosis does not include a dissociative
symptom cluster.
ASD refers to symptoms manifested during the period from 2
days to 4 weeks post trauma, whereas PTSD can only be
diagnosed from 4 weeks.

SAHAGUN, Cirila
 COMORBIDITY

Depression
Panic attacks
Substance Abuse
Other Anxiety Disorders

SAHAGUN, Cirila
 Prevalence, age of onset and
Gender differences
National Comorbidity Survey-Replication (NCS-R)
Lifetime prevalence is higher in women; 9.7% of women, 3.6% of men
which is interesting because studies show that men are much more likely to
be exposed to traumatic events
Women show higher rates of PTSD and tend to have more severe symptoms

PTSD is estimated to affect about 1 in every 3 people who have

a traumatic experience

SAHAGUN, Cirila
 Prevalence, age of onset and
Gender differences
Rates of PTSD throughout the world tend to be lower in
areas where people experience fewer natural disasters and
where wars and organized violence are less common

There is a higher risk of developing PTSD for those

individuals with high levels of negative affectivity
(neuroticism), and an avoidant coping style.

SAHAGUN, Cirila
 Prevalence, age of onset and
Gender differences
AgeOlder adults are less likely to develop ASD nor PTSD
Previous exposurePeople who were abused or experienced
trauma as children are more likely to develop ASD and PTSD as
adults
Biological vulnerabilityTwin studies indicate that certain
abnormalities in brain hormone levels and brain structure are
inherited, and that these increase a person's susceptibility to ASD
following exposure to trauma.

SAHAGUN, Cirila
 Prevalence, age of onset and
Gender differences
Support networksPeople who have a network of close friends and
relatives are less likely to develop ASD and PTSD.

Perception and interpretationPeople who feel inappropriate

responsibility for the trauma, regard the event as punishment for
personal wrongdoing, or have generally negative or pessimistic
worldviews are more likely to develop ASD and PTSD than those
who do not personalize the trauma or are able to maintain a balanced
view of life.

SAHAGUN, Cirila
 Prevalence, age of onset and
Gender differences
Rates of PTSD vary according to:

The type of trauma experienced: traumatic events resulting from human intent are
more likely to cause PTSD than accidents or natural disasters. (Shalev & Fredman,
2005)

The degree of direct exposure to the trauma: PTSD range between 30% and 40%
for adults who are directly exposed to disasters. The prevalence of PTSD in rescue
workers, on the other hand, tends to be lower (5-10%), probably because they are not
directly exposed to the traumatic event. (Neria, Nandi and Galea, 2008)

SAHAGUN, Cirila
 Prevalence, age of onset and
Gender differences

Rates of PTSD vary according to:

The way that PTSD is defined and the manner in which
it is assessed: Study of Dutch veterans in the Iraq war;
questionnaire assessments yielded rates of PTSD of 21%.
However, when structured diagnostic interviews were used,
only 4% of veterans meet criteria for PTSD.

SAHAGUN, Cirila
 CAUSAL FACTORS
NOT EVERYONE who is exposed to a traumatic
event will develop PTSD; some people are more
vulnerable to developing PTSD than others

Nature of the traumatic stressor and how directly it

was experienced can account for much of the
differences in stress response

SAHAGUN, Cirila
 CAUSAL FACTORS
INDIVIDUAL RISK FACTORS
NOT EVERYONE is at equal risk when it comes to
the likelihood that he or she will experience a
traumatic event
Certain occupations carry more risk than others
Rates of exposure to traumatic events are also higher
for black Americans than they are for white Americans

SAHAGUN, Cirila
 CAUSAL FACTORS
INDIVIDUAL RISK FACTORS
FACTORS INCREASING RISK FOR DEVELOPING PTSD:
Being female
Low levels of social support
Neuroticism (having tendency to experience negative affect)

SAHAGUN, Cirila
 CAUSAL FACTORS
INDIVIDUAL RISK FACTORS
FACTORS INCREASING RISK FOR DEVELOPING PTSD:
Having pre-existing problems with depression, anxiety as
well as having a family history of depression and substance
abuse
Also relevant are the appraisals people make of their own
stress symptoms shortly after the trauma

SAHAGUN, Cirila
 CAUSAL FACTORS
BIOLOGICAL RISK FACTORS

Having the s/s or high risk form of 5HTTPLR or

serotonin transport gene
Small hippocampal volume

SAHAGUN, Cirila
 CAUSAL FACTORS
SOCIOCULTURAL RISK FACTORS
Being a member of the minority group
Negative and unsupportive social environment
Lower socioeconomic status

SAHAGUN, Cirila
 PREVENTION
Prepare and provide people with
information and coping skills

Stress-inoculation training
prepares people to tolerate an
anticipated threat by changing the
things they say to themselves
before or during a traumatic
event.

SAHAGUN, Cirila
 TREATMENT
Telephone hotlines
Crisis intervention
Psychological debriefing
Prolonged-exposure

SAHAGUN, Cirila
 medications
The U.S. Food and Drug Administration (FDA) has approved
two medications for treating adults with PTSD:
SERTRALINE (Zoloft)
PAROXETINE (Paxil)
Both of these medications are antidepressants, which are also
used to treat depression. They may help control PTSD
symptoms such as sadness, worry, anger, and feeling numb
inside. Taking these medications may make it easier to go
through psychotherapy.

SAHAGUN, Cirila
SAHAGUN, Cirila