1. An uncomfortable feeling of apprehension
2. An unpleasant emotion associated with a general sense of danger
3. A negative mood state characterized by bodily symptoms of physical tenstion and by apprehension about the future

• Chronic pervasive nervousness
• Tense and worried about everything and anything (indiscriminate)
• Unproductive anxiety
• Worrying about minor things

1. Restlessness
2. Fatigue
3. Difficulty concentrating
4. Irritability
5. Muscle Tension ** (most important)
6. Sleep disturbance

You must have at least 3 and they must last as least 6 months.

12 month prevalence: 2.9% adults, .9% adolescents, 9% lifetime risk

2 times more likely in women than men; median age onset: 31.

Bio: it is about 33% genetic; they lack autonomic restrictors and can't "slow things down;" muscle tension and high sensitivity to threat

Psych: early stressful events; learned response that the world is dangerous and out of control; no coping mechanisms

• Drug: benzodiazephines (short term tranquilizers that slow down the CNS, are extremely addictive) and buspirone (mild tranq, slow but less addictive and sedating).
• Psych: CBT and meditation

• Panic attacks and nocturnal attacks (next card)
• A persistent concern about these attacks which turns out to be more detrimental than the attacks themselves
• Change in behavior related to the attacks (e.g. avoiding certain things and places)

• Episodes of intense terror and panic; acute bursts of extreme anxiety
• Nocturnal Attacks: ~30% of people; between 1:30-3:30AM; happing during slow wave sleep; cannot relax into a deeper sleep

1. Triple Vulnerability
2. Misinterpreting Information
3. Cognitive Distortions

• Dichotomus reasoning (all or nothing; success or failure)
• Selective Abstraction (pulling out only negatives)
• Disqualifying the positive
• Mind reading (assuming that others know what you're thinking or vice versa)
• Catastrophizing

• Drugs: benzodiaphines, SSRI's (stop attacks) and SNRI's
• Psych: exposure based (gradually facing fear) and systematic desensitization
• Panic Control Treatment: exposing patients to the same physciological sensations they feel during an attack and talking them through it

• It's a fear of public situations
• Actively avoid all the situations that they fear
• Anxiety is out of proportional to actual fear

12 month: 1.7%

Lifetime: 4.7%

Average onset: 17; 75% women

• A persistent and irrational fear of stimulus
• Intense anxiety when exposed to fear
• Avoiding the situation or phobic object
• Types: animal, natural environmental, blood injection, situational, other

12 month: 7-9%

Lifetime: 12.5%

• Fear or anxiety of social situations of being observed or judged (for children must occur with peers).
• Individual fears that they will act in a way that will be negatively judged
• Social situations almost always invoke fear or anxiety

Need them for 6 or more months

What are the causes of phobias (all)?

What's necessary for sustaining phobias?

• Real Alarm: they began with an unusually traumatic event that caused it (DiNardo and the dog phobia study)
• False Alarm: had a panic attack when the stimulus was present (Mineka and Zinbarg car)
• Vacarious Experience: experiencing someone elses fear (hearing screams at the dentist)
• Information trasmission: being told

Operant Conditioning

Behavioral Therapy: being directly exposed to the fear

1. Systematic: slow and gradual; start with imagined exposure and then move to in-vivo
2. Flooding: all out, completely surrounded exposure all at once

1. Separation Anxiety Disorder (home or people)
2. Selective Mutism (not speaking when one is expected)
3. Substance/Medication Induced

• Obsessions: unwanted and upsetting thoughts that are intrusive. Ex: need for symmetry, cleanliness; forbidden or tabboo thinking; fear of harming others
• Compulsions: irrational rituals repeated in an attempt to control anxiety; repetitive behaviors

Obession ---> obsession causes anxiety ---> compulsion ----> compulsion relieve anxiety

• Lifetime: 1.6%
• 12 Month: 1.2%

Fairly equal between men and women; avg. onset at 19.

What are two potential causes of OCD disorder?

Genetics?

1. Early Experiences: taught "excessive responsibility:" this is the mind set that all the thoughts and processes are impure and need to be controlled and pure.
2. Thought-Action Fusion: having a thought of something is the equivalent of doing it (sexual thought = performing the sexual act).

Yes! .57 MZ and .22 DZ

• Meds (SSRI)
• Behavioral: exposing them ot action provoking stimuli and preventing the compulsions
• CBT
• Psychosurgery-cingulotomy

• Not the same as anorexia or bulimia!
• Percieved flaws with the body that others do not see.
• Leads to repetitive actions (like working out nonstop), but these do NOT relieve anxiety
• Takes up 3-8 hours a day
• About 50-50, but that's due to muscle dysmorphia for males

Usually onsets around 13

• Pulling out hairs (or specific) hairs from any place or all over your body
• Have to try to stop but unable to
• Can also pick them off of other people

1-2%, more likely in females and onsets after puberty

• Skin picking disorder
• Several hours a day for months or years
• Have to be unable to stop
• 1.4%, usually onsets when acne starts

• When a child does not turn to a caregiver or protective figure for support, comfort or protection
• Usually results from severe neglect

• When a child will socialize with and appraoch strangers and have no fear of going off with that person
• Usually caused from neglect again
• Very, very rare

• No long an anxiety disorder, now in the "trauma and stressor related" section
• There are 4 diagnostic sections instead of 3
• New words "intense fear, trauma and horror"

1. Child abuse
2. Domestic violence
3. War
4. Natural Disasters
5. Rape
6. Car accident

1. Re-occurrence: distressing images, memories and dreams; physiological arousal when reminded of event
2. Avoidance: avoid anything that reminds them of the accident (places, objects, physiological feelings)
3. Negative Cognitions and Mood: misplacing blame; dissociation from others; loss of interest
4. Arousal: difficulty sleeping; hyper vigilant; irratibility and recklessness

• Just about barely over half of men and women have experienced one traumatic even in their life. But...
• Lifetime: 6%

1 months time only.

• Dissociative: feeling detached from one's own body and feelings; expriencing the world like it's a dream
• Preschool: for the younguns (under 6).

• STAIR and NTS: both are story telling methods that enable/encourage them to talk about the event until it is no longer distressing
• Cog. Processing Therapy
• Eye Movement
• Prolonged Exposure
• Children: story telling and parent interaction training
• SSRIs and SNRIs

• Must happen with 4 weeks of the event and lasts 2 days to 1 month
• If more than a month, PTSD
• Everything else is the same

Major Depressive Episode has 9 Criteria.............................................. LAME

How many and long must they last for?

1. ***Must have depressed mood most of the day
2. ***Must have diminshed pleasure/interest in activities
3. Sig. weight loss or gain
4. Insomnia or hypersomnia
5. Restless or lethargy
6. Fatigue or loss of energy
7. Feelings of worthlessness/guild
8. Difficulty making decisions
9. Suicidal thoughts, ideal or attemp

5+ for at least 2 weeks, but can last 6 months, or even years

What are the symptoms of a manic episode? (7)

How many and long must they be around?

1. Inflated self esteem or grandiosity
2. Decreased need for sleep
3. Excessive talking
4. Racing thoughts
5. Extreme distractibility
6. Increased goal directed activity
7. Excessive pleasure/foolishness

3 symptoms for at least a week

• Hypo: 3 symptoms still, but only for 4 days and no sig. impairment
• Dysthymia: not as "deep;" only 3 symptoms but for at least 2 years