Lesson 5: Anxiety, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders

Attention

When does “normal” anxiety become a disorder? What is the difference between fear and anxiety? How bad does a fear have to be before you are considered phobic? Does medication help? What about therapy? Are you crazy if you need to see a psychiatrist or a psychologist?

This chapter introduces you to the Anxiety Disorders (some fear disorders are included here, but all are called anxiety disorders). I call this the alphabet soup category. Why? Well, we often refer some of these disorders by acronyms such OCD, GAD, or PTSD. By the end of the chapter, you will be able to tell the difference between them all and several more.

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Identify the difference between anxiety and fear.
  • Apply the use of DSM-V diagnostic criteria to diagnose anxiety disorders in case presentations.
  • Discuss the difference between a phobia and a fear.
  • Discuss the etiology and treatment of anxiety disorders.
  • Identify the various anxiety disorders by name and recognize the differences in symptomatology between them.

Teaching

Chapter 5-Anxiety, Trauma- and Stressor-Related, and Obsessive-Compulsive Related Disorders

Imagine that you are required to take an unexpected business trip to California. You have to be there in two days, so you have to fly. Now, imagine that, while making your airline reservations Online, you start to sweat and experience difficulty thinking clearly enough to book the ticket. Your mouth is dry, your hands are shaking, you feel nauseated and your heart begins to pound harder and harder. At some point, you almost pass out. As soon as you move away from the computer, you start to feel better. After an hour or so, you are back to normal and completely confused as to why you reacted as you did. The next day at work, you explain to your boss that you can’t go on the trip because your mother is very ill and needs your assistance. She accepts your excuse. While you feel guilty for lying, you are completely relieved that you “got out of it.” As long as you don’t have to consider flying, you are fine.

Now, imagine that you were the victim of a burglary at home. While no one was home at the time, you feel incredibly violated and can’t stop worrying that someone else will come into your home. You have trouble sleeping at night and jump at the slightest noise. At times, the worry is so bad that you have trouble focusing on what you are doing. It has been several months since the crime was committed, yet, you can’t seem to stop worrying that it will happen again. You have the locks changed, install a burglar alarm, and get a large dog, but, you still worry. You have chronic diarrhea, stiff neck aches, and nausea, but, you can’t stop worrying.

The DSM V

First published in 1952 by the American Psychiatric Association, the DSM is now in the 5th edition. Given this, the current version of the manual is labeled as DSM-V. You do not need to have a copy of the DSM to complete this class, but copies are available in the Library.

This Lesson outlines are first encounter with the diagnostic criteria used to categorize a set of symptoms into a diagnosis.

Anxiety-Related Disorders

Chapter 5 in the textbook covers a number of "anxiety-related" disorders. Simply put, these disorders share in common the experience described in the text above. Intense emotional reactions, stress, fear, etc.

Some of these are well know to many of you through personal experience (with others or yourself):

  • Anxiety Disorder
  • Panic Attacks
  • Panic Disorder and Agoraphobia
  • Specific Phobias (fears of specific things)
  • Social Anxiety
  • PTSD
  • OCD

We are certainly familiar with many of these terms.

One of the more challenging aspects of having one of these disorders is the deep sense of being aware that you are doing something "odd" Individuals who suffer from these conditions often feel deeply shamed by them and feel they are "going crazy."

Isn't this sort of...normal?

Another peculiar consideration with many of these disorders is the fact that, in some cases, fear and anxiety might be justified. If someone has a fear of snakes (Ophidiophobia) there is a degree of "normalness" to this when you consider that you SHOULD be fearful and avoid poisonous snakes.

Likewise, a person with Obsessive-Compulsive Behavior may have an immaculate house and may gain a lot of rewards for it.

The "issue" is when these fears or obsessions begin to interfere in day-to-day functioning.

Example - Ophidiophobia

My mom had a a phobia of snakes. When she was young she was riding her bike and ran over a garter snake. The snake, rightfully surprised, leaped up and wrapped around her leg. (Any of you with any degree of this are now cringing in your chairs!)

She developed a deep fear for snakes, which is not a problem as Maine is not full of snakes everywhere. However, over the years this fear began to generalize to anything like a snake: worms, pencils, string, wire, cracks in the sidewalk.

Although she functioned fairly well through her life, she was often stuck at home when it rained because worms would come out on the sidewalks. She simply could not leave the house and walk to her car!

She never received treatment because it never got to the point that she lost her job or became house bound, but you can see by this example how a fear such as this could develop.

CLASS ACTIVITIES

Lesson 5 Assignment - Case Study

Review the case study by clicking HERE. Write a brief paper answering the questions listed at the end of the study.

Lesson 5 Discussion

Please post at least one response to one of the first two questions. Everyone must respond to question three as well.

1. Click HERE to visit a list of links providing an overview of PTSD. Read each section on this page and respond to the following statement: “I think that anyone who gets PTSD in the military is either looking to get out or is weak-minded. Lots of people go into active duty and don’t come home with these “problems” at all.” Do you agree or disagree and why? By the way, this statement was made by one of my patients when he came back from Iraq with PTSD.

2. After reading the DSM-V diagnostic criteria for each anxiety disorder in the text, pick one specific disorder and tell us what you think about the diagnostic criteria. Are they clear? Is anything missing that YOU would add? Do you agree with the time the symptoms must be present prior to giving a diagnosis (symptom duration). Please be specific.

3. Assume that you have OCD. You have had it for several years, but you just now sought treatment because your spouse is threatening to leave if you don’t get help. Your psychiatrist wants you to begin a course of Zoloft and Ativan. Look up both medications Online and tell me why you would or wouldn’t want to take the medication. Be specific. What would it be like to seek treatment from a psychiatrist or clinical psychologist? Would you want anyone to know?