Behavior Anxiety

Anxiety
Disorders
Anxiety
Anxiety is your body's natural response to stress. It's a
feeling of fear or apprehension about what's to come.
But if your feelings of anxiety are extreme, last for longer and
are interfering with your life, you may have an anxiety
disorder.
Stressful factors in our life
Classification Anxiety
• Generalized anxiety disorder (GAD)
• Phobias (specific and social)
• Obsessive-compulsive disorder (OCD)
• Panic disorder (with or without

agoraphobia)
• Post-traumatic stress disorder (PTSD)
• Acute stress disorder (ASD)

Generalized anxiety disorder
It's normal to feel anxious from time to time, however, excessive, ongoing
anxiety and worry that interfere with day-to-day activities is a sign of
generalized anxiety disorder.
Persistent anxiety symptoms including hyperarousal and worrying lasting 6
months or more
Symptoms:
•Motor tension (cant find place)
•Autonomic hyperactivity (tachycardia, sweating, chest pains),
hyperventilation
•Apprehension (fear, worry, rumination), difficulty concentrating
•Vigilance and scanning (impatient, hyperactive, distracted)
•Fatigue and sleep disturbances common, especially insomnia and
restlessness
Worrying about excessively worrying 

Generalized anxiety disorder
Persistent worrying or anxiety about a number of areas that
are out of proportion to the impact of the events.
Overthinking plans and solutions to all possible worst-case
outcomes
Inability to relax, feeling restless, and feeling keyed up or on
edge
There may be times when your worries don't completely
consume you, but you still feel anxious even when there's no
apparent reason
Fear VS Anxiety
Fear is a normal reaction to a known, external source of danger.
Anxiety is individuals fearful state, which interferes with normal life (!!!)
BUT the source of the danger is NOT known, NOT recognized, or
inadequate to account for the symptoms.
Fear VS Anxiety
Anxiety is often accompanied
by nervous behavior (walking
back and forth, somatic complaints
and rumination)
•Shakiness and sweating
•Palpitations (subjective experience

of tachycardia)
•Tingling in the extremities and

numbness around the mouth
•Dizziness and syncope (fainting)
•Gastrointestinal and urinary

disturbances (e.g., diarrhea and
urinary frequency)
•Mydriasis (pupil dilation)

Fear vs Phobia
Phobias
Phobias
Social Phobias Specific Phobias
Fear of social situation. An irrational fear of certain

Exaggerated fear of things (e.g., elevators,
embarrassment in social spiders, rats, fire, snakes,
situations (e.g., public speaking, or closed-in areas, flying,
eating in public, using public heights, injections,
restrooms) animals)
The fear and anxiety is out of proportion to any real danger, or it

is more intense than needed. However, an intense fear of snakes
in an environment populated by poisonous snakes, or the fear of
darkness in high crime areas might not be out of proportion to the
real danger. In these cases, the diagnostic criteria might not be
met. It is important to keep in mind that a diagnosis is not
warranted if there is no marked impairment in functioning or
significant distress.
Specific Phobias
A phobia is an unreasonable fear of an
object that poses little real danger but
provokes anxiety and avoidance.
The phobic object or situation nearly

always provokes an immediate fearful
or anxious response.
The fear and anxiety is out of proportion
to any real danger, or it is more intense
than needed
Treat with behavioral modification

(systematic desensitization, exposure,
flooding)
Social Phobias
•Leads to dysfunctional circumspect behavior, e.g., inability to urinate in public

washrooms, go to restaurants, and speak in public
•Fear of feeling or being embarrassed or
humiliated. They have an intense fear of appearing foolish, weak, or otherwise
inadequate. Also, like other phobias, phobic situations are avoided or tolerated with
great distress.
•Blushing, trembling, or difficulty speaking are frequently evident during cued
(expected) panic attacks. In children, the symptoms may be expressed as crying,
tantrums, freezing, clinging to caregivers, shrinking away from social interactions, or a
failure to speak in social situations.
•Prevalence: 1 % of general population

•May accompany avoidant personality disorder
•Treat with SSRI
•Discrete performance anxiety (stage fright): atenolol or propranolol (beta blocker)
Social Phobia
Obsessive-compulsive disorder (OCD)
anxiety disorder characterized by
intrusive thoughts that produce
uneasiness, apprehension, fear or
worry (obsessions)
followed by the repetitive behaviors

aimed to reduce the associated
anxiety (compulsions)
They usually aware about the

problem and want cure
Defenses: undoing, reaction formation

A diagnosis of OCD requires the presence of
obsession and/or compulsions that are time-
consuming (more than one hour a day), cause major
distress, and impair work, social or other important
function.
Obsessions are recurrent and persistent thoughts,
impulses, or images that cause distressing emotions
such as anxiety or disgust.
Compulsions are repetitive behaviors or mental acts
that a person feels driven to perform in response to an
obsession. The behaviors are aimed at preventing or
reducing distress or a feared situation. In the most
severe cases, a constant repetition of rituals may fill
the day, making a normal routine impossible.
• Washers are afraid of contamination. They usually have cleaning or
hand-washing compulsions.
• Checkers repeatedly check things (oven turned off, door locked, etc.)
that they associate with harm or danger.
• Doubters and sinners are afraid that if everything isn’t perfect or done
just right something terrible will happen or they will be punished.
• Counters and arrangers are obsessed with order and symmetry. They
may have superstitions about certain numbers, colors, or arrangements.
• Hoarders (keepers) fear that something bad will happen if they throw
anything away. They compulsively keep things that they don’t need or
use
• 1 .5% have disorder, 3% lifetime prevalence

• 50% remain unmarried
• Males = females
• Major depression among two-thirds over lifetime
Panic Disorder
Episodic (about twice weekly) periods of intense anxiety (panic
attacks). Cardiac and respiratory symptoms and the conviction that
one is about to die or lose one's mind.
A panic attack is a sudden episode of intense fear that triggers severe
physical reactions when there is no real danger or apparent cause.
Panic attacks typically begin suddenly, without warning. They can
strike at any time — when you're driving a car, at the mall, sound
asleep or in the middle of a business meeting.
You may feel fatigued and worn out after a panic attack subsides.
One of the worst things about panic attacks is the intense fear that
you'll have another one.
Panic attack symptoms can also resemble symptoms of other serious
health problems, such as a heart attack, so it's important to get
evaluated by your primary care provider if you aren't sure what's
causing your symptoms.
Panic Disorder
• Three attacks in 3-week period and

worry about next, probable attack
• No clear circumscribed stimulus;
• Abrupt onset of symptoms, peak within

10 minutes
• Symptoms of a panic attack

• tachycardia
• Sweating
• breathing problems
• weakness
• Dizziness
• feeling hot or a cold chill
• tingly or numb hands
• chest pain or stomach pain
Panic Disorder - example
Paula’s story
Paula had her first panic attack six months ago.

She was in her office preparing for an important work presentation when,
suddenly, she felt an intense wave of fear. Then the room started spinning
and she felt like she was going to throw up. Her whole body was shaking,
she couldn’t catch her breath, and her heart was pounding out of her
chest. She gripped her desk until the episode passed, but it left her deeply
shaken.
Paula had her next panic attack 3 weeks later, and since then, they’ve
been occurring with increasing frequency.
She never knows when or where she’ll suffer an attack, but she’s afraid of
having one in public.
Consequently, she’s been staying home after work, rather than going out
with friends.
She also refuses to ride the elevator up to her 12th floor office out of fear
of being trapped if she has another panic attack.
Post-Traumatic Stress Disorder (PTST)
Post-traumatic stress disorder (PTSD) is a mental health condition that's
triggered by a terrifying event - either experiencing it or witnessing it.
Symptoms occurring after a catastrophic (life-threatening or potentially fatal
event (e.g., war, house fire, serious accident, rape, robbery) affecting the
patient or the patient's close friend or relative.
Who are these people?
• Combat exposure
• Childhood neglect and physical abuse
• Sexual assault
• Physical attack
• Being threatened with a weapon
Symptoms can be divided into four types:
•Flashbacks - sudden, usually powerful, re-experiencing of a past experience or

elements of a past experience (intrusive memories of the event and nightmares)
•Hyperarousal (anxiety, increased startle response, impaired sleep, hypervigilance)
•Emotional numbing (e.g., difficulty connecting with others)
•Avoidance (survivor's guilt, dissociation, and social withdrawal)
• Survivor's guilt is an intense feeling of guilt, when a person believes that they have
done wrong by surviving a situation that others did not. Survivor's guilt may lead to self-
punishment, crippling, depression and self-blame.
• "what could I have done to prevent the catastrophe?"
• "Why did I get spared?"
• "Why did I deserve to live while others died?"
In PTSD, symptoms last for more than 1 month (sometimes years) and may have a
delayed onset
In ASD, symptoms last only between 2 days and 4 weeks. When symptoms develop
immediately after exposure and persist for up to a month, the condition may be called
acute stress disorder.
Most of the cases it has a long latency period
Ex: person experienced abuse at childhood, manifests symptoms as an adult

Delayed expression of PTSD can occur if symptoms arise six months or more following the
onset of trauma.
Prognosis:
•Onset of symptoms is directly proportional to the prognosis - Quicker onset

correlates with better prognosis
•Patient age – adults overcome easier then children or elders

Behavior Anxiety

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Anxiety

• Generalized anxiety disorder (GAD)

• Phobias (specific and social)

• Obsessive-compulsive disorder (OCD)

• Panic disorder (with or without

• Post-traumatic stress disorder (PTSD)

• Acute stress disorder (ASD)

Worrying about excessively worrying 

•Shakiness and sweating

•Palpitations (subjective experience

•Tingling in the extremities and

•Dizziness and syncope (fainting)

•Gastrointestinal and urinary

•Mydriasis (pupil dilation)

Social Phobias Specific Phobias

Fear of social situation. An irrational fear of certain

The fear and anxiety is out of proportion to any real danger, or it

The phobic object or situation nearly

Treat with behavioral modification

•Leads to dysfunctional circumspect behavior, e.g., inability to urinate in public

•Prevalence: 1 % of general population

followed by the repetitive behaviors

They usually aware about the

Defenses: undoing, reaction formation

• 1 .5% have disorder, 3% lifetime prevalence

• Three attacks in 3-week period and

• No clear circumscribed stimulus;

• Abrupt onset of symptoms, peak within

• Symptoms of a panic attack

Paula had her first panic attack six months ago.

Who are these people?

•Flashbacks - sudden, usually powerful, re-experiencing of a past experience or

Ex: person experienced abuse at childhood, manifests symptoms as an adult

•Onset of symptoms is directly proportional to the prognosis - Quicker onset

•Patient age – adults overcome easier then children or elders

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