1. ANXIETY DISORDERS

2. Definition
 Disorders in which the main symptom is excessive or
unrealistic anxiety and fearfulness
 Anxiety can be a fear of a specific object, or a general
emotion, such as unexplained worrying
 Free-floating anxiety – anxiety that seems to be
unrelated to any realistic, known factor, and is often
a symptom of an anxiety disorder.

3. Types of Anxiety Disorders
 Phobia
 Obsessive-compulsive
 Panic
 Generalised Anxiety
Disorder
 Post Traumatic Stress
Disorder

4. Prevalence
 Around 10% of the population at any given time
(AIHW, 1999b)
 Women in Australia are almost twice as likely as men
to be afflicted
 Gender difference exists by age six
Prevalence rates for anxiety disorders
Population 18- 25- 35-44 45-54 55-64 65 and Total
Group 24 34 over
Males 8.6 7.1 8.3 8.0 6.1 3.5 7.1
Females 13.8 12.4 14.5 15.9 9.5 5.4 12.1
Persons 11.2 9.8 11.4 11.9 7.8 4.5 9.7

5. Prevalence (cont’d)
 More commonly associated with depression than any
other disorder.
 Half the people with an affective or depressive
disorder in one Australian study also reported an
anxiety disorder (ABS, 1998).

6. PHOBIA
 At any given time, about 5% of the population has at
least one irrational fear.
 Social phobia (social anxiety disorder): fear of
interacting with others or being in a social situation.
Fears negative evaluations by others, so avoids
potentially embarrassing situation. Common types –
stage fright, fear of public speaking.
 Specific Phobias: irrational fear of some object or
specific situation.

7. Common Phobias and Their Scientific Names
Fear of Scientific Name
Washing and bathing Ablutophobia
Spiders Arachnophobia
Lightning Ceraunophobia
Dirt, germs Mysophobia
Snakes Ophidiophobia
Darkness Nyctophobia
Fire Pyrophobia
Foreigners, strangers Xenophobia
Animals Zoophobia
Agoraphobia: ‘fear of the marketplace’. Fear of being in a place or situation where
escape is difficult or impossible if something should go wrong. To be in, or even
think about, these situations can lead to extreme anxiety and panic attacks.
Between 1-2% of the population suffer at some point in their lives (Wilson &
Edwards, 1996)

8. OBSESSIVE COMPULSIVE DISORDER
 A disorder in which intruding thoughts that occur
again and again (obsessions) are followed by some
repetitive behaviour (compulsions) meant to lower
the anxiety caused by the thought.
 Common compulsions include: hand washing,
counting, touching.
 Typically begin during childhood, adolescence or
early adulthood
 Longitudinal study found that roughly half with the
disorder continued to have it over 40 years
(Skoog&Skoog, 1999)

9. PANIC DISORDER
 Characterised by attacks of intense fear and feelings of doom
or terror not justified by the situation, affecting one’s ability to
function in day-to-day life.
 Physiological Symptoms include shortness of breath,
dizziness, heart palpitations, trembling, ‘out of one’s body’
sensations, dulled hearing and vision, sweating, dry mouth
and chest pains.
 Psychological symptoms include fear of dying or going crazy.
 Attack occurs without warning and quite suddenly, lasting
between a few minutes to as long as half an hour. Most peak
within 10-15 minutes.
 Can often lead to Agoraphobia – fear of being in
places/situations from which escape might be difficult or they
may experience a panic attack.

10. GENERALISED ANXIETY DISORDER (GAD)
 Excessive free floating anxiety and worries occurring
more days than not for at least six months and have
no real source that can be pinpointed, nor can the
feelings be controlled.
 Plain worriers – they feel tense and edgy, get tired
easily, have trouble concentrating, have muscle aches
and tension, sleeping problems, often irritable.
 Often found occurring with other anxiety disorders
and depression.
 About 2% of the population have a generalised
anxiety disorder.

11. POST TRAUMATIC STRESS DISORDER (PTSD)
 Marked by flashbacks and recurrent thoughts of a
psychologically distressing event (i.e. witnessing a murder,
rape, victims of natural disasters).
 Only about 10% of people develop PTSD following a traumatic
event; violent assaults are most likely to trigger.
 Symptoms: nightmares, flashbacks, avoiding thoughts or
feelings about the event, hypervigilance (constant scanning),
exaggerated startle response.
 Often emerges only some time after the trauma. E.g. Study of
Gulf War veterans found rates of PTSD more than doubled
between 5 days and 2 yrs after returning home.
 Can last a lifetime.

12. Etiology (Causes) of Anxiety Disorders
 Genetics (contributes but not essential) – OCD shows
particularly high heritability (85% for identical twins and
50% for fraternal)
 Stressful life events – 80% of panic attack patients report
a –ve life event coinciding with their first attack.
Stressful childhood events predispose people to anxiety
in adulthood (Barlow, 2002)
 Personality, coping styles and intellectual functioning
can predispose people. Studies found war veterans using
avoidant coping strategies and/or with lower IQ
(assessed prior to service) were more likely to develop
PTSD.

13. David Barlow’s model of Anxiety Disorder
development
Association
of panic
Genetic
state with
Unpredictable
vulnerabilit autonomic panic attack, Low
y Initial cues (e.g. triggered by beliefs
panic rapid pulse, Anxious learned alarms, about
Early attack apprehension anxious self-
sweaty thoughts or
experience concerning efficacy in
palms) learned alarms provoking dealing
resulting in stimuli with
learned panic
Stress alarms
Development of
avoidance
behaviour and
search for stimuli
Cognitive-Behavioural Model associated with
safety

14. Other perspectives
 Psychoanalytic: repressed urges and conflicts threatening to
surface – phobia as displacement, where the phobic object
symbolises the true source of the fear buried deep in the
unconscious.
 Behaviourists: anxiety is learned – classically conditioned
responses
 Cognitive: result of illogical, irrational thought processes –
magnification (interpreting events as being far more
harmful, dangerous, or embarrassing than they actually are),
all-or-nothing thinking (belief that things must be perfect
– anything less is total failure), overgeneralisation
(jumping to conclusions without supporting facts),
minimisation (giving little or no emphasis to one’s success,
positive events or traits).
 Biological: GAD linked to imbalance of serotonin and GABA

15. Universality
 Found around the world, but form may differ across culture.
 i.e. in some Latin American cultures, anxiety can take the
form of fits of crying, uncontrollable shouting, sensations of
heat, and become high levels of aggression.
 Types of phobias can be specific to different cultures – i.e.
Koro: mainly in China and a few other South Asian and East
Asian countries… a fear that one’s genitals are shrinking
Taijin-kyofu-sho (TKS): Japan – excessive fear and anxiety
that one will so something in public that is socially
inappropriate or embarrassing such as blushing, staring or
having offensive body odour.
 Lifetime prevalence for panic disorder is in the range of 1.4-
2.9% cross-culturally (Canada, New Zealand and Lebanon)