HD 3700 1st Edition Lecture 18 Outline of Last Lecture I R D Laing s revolutionary approach II Subtypes of SCZ III Hamlet s speech to the players IV Prelim Study Guide Outline of Current Lecture Anxiety and Everyday Life I Normal Anxiety and common ways of coping with it II Obsessive Compulsive Disorder and its neuro anatomical circuit III The range of anxiety disorders IV Hamlet and Horatio Current Lecture I Normal Anxiety and common ways of coping with it The role of anxiety in everyday life anxiety is a necessary part of everyday life o Big changes generate anxiety going to college break up etc Anxiety as a motivator not much difference between anxiety and excitement heart beat increases Anxiety as an inhibitor the mind is associative the speed range of associations can be constricted limited by anxiety boring people have a constricted range of associations Anxiety and temperament you can categorize people by temperament some people have a depressive style some have a manic style some have an anxious style Anxiety and early experience orphans children who were traumatized in early childhood tend to have high anxiety cortisol levels and the way that the brain organizes itself gets set up in early experience Anxiety and defenses o Defenses are always fueled by anxiety o If something makes you anxious you will associate to it easily o Defenses are ways of distorting suppressing associations Some of the defenses against anxiety in everyday life o Magical thinking wearing same underwear on game day o Obsessions o o o o o Compulsions checking that you locked the door multiple times Perfectionism Rumination thinking about it over and over and over Dissociation just not letting yourself think about it Eating disorders are really anxiety disorders with a distorted component o Drugs alcohol Three component model of anxiety o Potential stressors failures personal losses frightening events time pressure insults o Stressor perceived as a threat o Bodily effects automatic emergency response shallow breathing pounding heart tense muscles sleep disturbances fatigue psychosomatic illness o Upsetting thoughts anger fears preoccupations self doubts negative self talk repeated danger thoughts worry about body reactions and health o Ineffective behavior escape avoidance indecision aggression inflexible responses poor judgment inefficiency drug use II Obsessive Compulsive Disorder Obsessions preoccupation with o Dirt germs environmental toxins o Something terrible happening o Symmetry order exactness o Excessive praying or religious concern o Bodily wastes or secretions o Forbidden aggressive or perverse sexual thoughts o Fear you might harm others or yourself o Lucky or unlucky numbers o Intrusive nonsense words sounds or music Compulsions o Ritualized hand washing bathing o Repeating rituals o Checking o Rituals to remove contact with contaminants o Ordering or arranging o Counting o Hoarding or collecting rituals o Rituals of clearning An important distinction o Many if not most people who struggle with anxiety and many if not most people struggle with anxiety find themselves thinking obsessively or doing some things compulsively o These symptoms can cause enough distress to send someone into therapy to work on the sources of the anxiety o However Obsessive Compulsive Disorder OCD is much more severe is related to Tourette s Syndrome schizophrenia and other developmentalbrain disorders Diagnostic criteria o Obsessions are recurrent and persistent thoughts impulses or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress o Compulsions are defined by repetitive behaviors or mental acts that the person feels driven to perform in response to an obsessions or according to rules that must be applied rigidly The behaviors or mental acts are aimed at prevention or reducing distress or preventing some dreaded event of 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 OCD as a movement disorder o The theory goes like this there is a pathway between the orbitofrontal cortex where your thoughts and feelings generate and the cingulum embedded in the cingulate gyrus which in turn activates the caudate nucleus which runs your automatic body movements With OCD this pathway is unmodulated so that thoughts can set off compulsive movements o and feelings aroused by the amygdala can also contribute to the system by setting off compulsive thoughts and fears OCD brain scans o Pathways between thinking and action appear to be dismodulated III Range of anxiety disorders Types of anxiety disorders o o o o o o o o Phobias Generalized Anxiety Disorder Panic Attacks Panic Disorder Panic Disorder with Agoraphobia Social Anxiety Disorder Obsessive Compulsive Disorder Eating Disorders Anorexia Bulimia o Body Dysmorphic Disorder o Post Traumatic Distress Disorder Prevalence o Close to SCZ because Segal thinks it is also an organic brain disorder o A lot of people have these disorders and don t tell anyone o Anxiety Disorders panic OCD PTSD GAD social phobia phobias 18 1 of the general population o Panic Disorder 2 7 o Obsessive Compulsive Disorder 1 o Post Traumatic Stress Disorder 3 5 o Generalized Anxiety Disorder 3 1 o Social Phobia 6 8 Generalized Anxiety Disorder o Generalized anxiety disorder GAD is much more than the normal anxiety people experience day to day It s chronic and exaggerated worry and tension even though nothing seems to provoke it Having this disorder means always anticipating disaster often worrying excessively about health money family or work Sometimes though the source of the worry is hard to pinpoint Simply the thought of getting through the day provokes anxiety o People with GAD can t seem to shake their concerns even though they usually realize that their anxiety is more intense than the situation warrants People with GAD also seem unable to relax They often have trouble falling or staying asleep Their worries are accompanied by physical symptoms especially trembling twitching muscle tension headaches irritability sweating or hot flashes They may feel lightheaded or out of breath They may feel nauseated or have to go to the bathroom frequently Or they might feel as though they have a lump in the throat o Many individuals with GAD startle more easily than other people They tend to feel tired have trouble concentrating and sometimes