Anxiety disorders Fear biologically based response to dangerous or life-threatening situation. Anxiety is future oriented and global.

Individual is apprehensive, tense and uneasy about the prospect of something terrible happening. Anxiety has cognitive and affective components. Severe anxiety interferes with life. There are physical symptoms and mental reactions occur. It is severe when there is impairment such as not being able to get out of bed. Generalized anxiety disorder: More days than not for 6 months, high-level intense anxiety, affects functioning, causes distress. Have three or more: sleep reactions, restlessness, easily tired, difficulty concentrating, irritable, tense. Unrealistic fears and worries. More prevalent than all other disorders besides depression. Men are less likely to report. Biological Is correlated with neuroticism, can be traced to genetics. There are GABA, serotonin, and noradrenaline abnormalities. Cognitive distortions acan lead to anxiety disorders. Future oriented. Global worrying or worrying about everything all at once. Life stressors can lead to anxiety. Starts with a situation, if the situation is resolved and anxiety is still present. Treatment-antianxiety meds. SSRIs block receptors at synapse. Allows more serotonin. Also treats depression. People with anxiety can become depressed as well. -cognitive restructuring: the drugs break the cycle and clear mind to be able to use cognitive restructuring. Therapist tries to get client in frame of mind to used cognitive restructuring. Triggers of anxiety are identified and how to trigger a different response. Test theory of the anxious thoughts in order to disprove the idea. Phobias- not anxious all the time. Object of fear can trigger anxiety. Based in reality. Should be treated if it impairs functioning. Phobias develop from an actual event. Humans predisposed to develop adaptive fears to survive: snakes. Flooding is constant immediate intense exposure to object that causes fear. In vivo is actually there. Imaginal flooding object is not there. Graduated exposure is building up to. Systematic desensitization pushes clients to brink of panic attach in exposure therapy. Obsessive Compulsive Disorder-excessive and unreasonable obsessions or compulsions that significantly interfere with normal functioning. obsession is a persistent and intrusive thought that can cause anxiety. Person is aware the problem is theirs and not just a delusion and tries to suppress thoughts. Compulsion is a repetitive and seemingly purposeful behavior in response to uncontrollable urges or rituals. Compulsions alleviate anxiety. OCD: cycle that causes anxiety. Behavior alleviates the thought that is present. Checking and rechecking frequently is impairment. Sexual are common obsessions. Compulsions are repetitive behaviors. OCS is not as common and generalized anxiety. Males can get it in childhood/teen years. Female onset twenties. 1.6% of population. OCD can be a genetic disorder. OCD distorts regulation of behavior that happens in frontal lobe. OCD can develop because behavior is reinforcing or rewarding-operant conditioning. Cognitive in a sense that unwanted thoughts, real fears turn into obsessive fears, develops over time long after event passed. SSRI treat, proven to be most effective biological treatment. Thought stopping recommended to help reduce obsessional thinking. Response prevention may also be used in which the clinician instructs the client to stop performing compulsive behaviors either totally or in graduated steps. PTSD- entirely driven by situation not a chemical imbalance. Characterized as an anxiety disorder. Response to situation involved intense fear, helplessness, or horror. Feelings do not subside after one month. Feelings strengthen and interfere with daily functioning. 3 main symptom clusters: Re-experiencing/re-living- constantly going through experience, flashbacks, reminders, nightmares Avoidance and numbing-avoid place of trauma, use drugs, sex, video games. Lose interest in formerly enjoyed activities, may isolate from others. Some symptoms of depression may occur. Hyperarousal-constantly on guard even in safe place. Can lead to OCS symptoms. Exaggerated startle response. Stressful to be in hyperarousal creates cocktail for irritability. More women than men affected because of sexual assault. Causes-combat fatigue, natural disasters, unexpected negative event, rape, war. Emergency personnel experience. Sleep problems, loss of concentration, isolation, survival guilt. Symptoms of war-zone stressors at home- hypervigilance. Uncontrollable sense of danger. Nightmares. Preoccupation with concerns about personal and family safety. Overprotective parenting or avoiding family. Emotional numbing. Treatment-drugs that treat depression also treat anxiety. SSRIs, antidepressants, sleep aids and tranquilizers. Cognitive restructuring, exposure therapies, family and group therapies, eye movement desensitization and reprocessing (EMDR).

Somatoform Disorders-psychological root of problem, physical manifestation. No physiological reason. Comorbid with depression and anxiety. No physical abnormality that can explain the bodily complaint. Conversion Disorder-involuntary loss or alteration of a bodily function due to psychological conflict or need, causing the individual to feel seriously distressed or to be impaired in social, occupational, or other areas of life. Person is not intentionally producing the symptoms but clinicians cannot establish a medical basis for the symptoms and it appears the person is converting the psychological conflict or need into a physical problem. Hysterical neurosis(Freud) physical reaction to neurosis(anxiety). La belle indifference- lack of concern to indicate the individual is not distressed by what might otherwise be construed as very inconveniencing physical problems. Conversion is a protective mechanism. 4 conversion symptom categories- motor, sensory, seizures/convulsions, mixed. Somatization Disorder: psychological issues come out as physical problems Multiple and recurrent bodily issues. No physical cause. Diagnosis: 4 pain symtoms, 2 GI symptoms, 1 sexual difficulty, 1 conversion symptoms. Stress intensifies symptoms. Adolescent onset. Associated with people who lack ability to express emotion. Not a great success in therapy because they dont think symptoms are emotional and fail to see the connection. Body dysmorphic disorder-person is preoccupied almost to the point of being delusional with thte idea that a part of their boy is ugly or defective. Borders clinical delusion/paranoia. There is a severe dislike. Person is consumed with distress. More likely to commit suicide. Comorbidity with personality disorder. 1.7% of population. Hypochodriasis-people with somatoform disorder known as hypochoriasis believe or fear they have a serious illness when in fact they are merely experiencing normal bodily reactions. Person misinterprets symptom. 6 or more months of disorder to be diagnosed. Malingering-intentionally faking symptoms for an ulterior motive. Person who is malingering is motivated by gain ex missing work. It is a way to seek attention. They have a poor sense of self. Factitious disorder (maintain sick role) people fake symptoms or disorders not for the purpose of any particular gain but because of an inner need to maintain a sick role. The person wants to be sick because sick role means they dont have any responsibility. They invent physical symptoms. Malingerers intentionally invent symptoms. Munchausens syndrome injure oneself intentionally to go to the hospital. Very clever people with plan. Munchausens by proxy- seek medical attention through someone else. Usuallly caregiver through dependent. No financial gain, goal is to get medical attention. The primary gain is avoiding responsibility ex parent weary of taking care of child. The secondary is attention and sympathy. Dissociative Disorders-controverisial. Rooted in extreme mental conflict. There is a temporary alteration in consciousness. Beyond anxiety disorder level, it is extreme. There is a loss of identity, loss of control, loss of awareness of self. multiple personalities. Separation of part of personality. Separate entity no longer associating with part of self. Person develops more than one self or personality. These personalities are referred to as alters, in contrast to the core personality, the host. Formerly called multiple personality disorder Dissociative Identity disorder person has as few as 1 alternate and 1 core personality. At least two distinct identities or personality states, each with its own patter of perceiving, thinking, and relating as well as its own style of behavior, personal history, and self-image. Host-primary identity, passive and dependent, possibly depressed and guilty. Alters are usually strikingly different acting in ways that are hostile, demanding or self destructive. Host is unaware when alter is in control. Transition usually sudden. At any given moment only one alter interacts with the external environment. Other alters may be aware. Most of the personalities have a sense of lost or distorted experiences of time. Associated with childhood trauma. Controversy over diagnosis. It is hard to prove and easy to fake. Treatment-hypnosis. Structured clinical interview with specific questions. Dissociative amnesia- gaps in information surrounding trauma, no brain damage, drugs, or dementia. 4 kinds of dissociative amnesia: 1) localized-loss of all events within discreet time period 2) selective- some details missing but not all 3) generalized-everything gone, no memory 4) continuous-from certain date on, no memories formed Associated with traumas, occurs around a trauma Dissociative fatigue- proceeding trauma. Person may snap. May have no memory of history, may completely dissociate from previous life. Not a conscious decision. Dissociative fugue-person is confused about personal identity suddenly and unexpectedly travels to another place. It is temporary and person will remember history or identity. They are able to function fine in fugue state. Depersonalization disorder-alterations of mind-body perception, ranging from detachment from ones experiences to the feeling that one has stepped out of ones body. Is not a lack of awareness. People report feeling like they arent real. Report to be helpless and watch what happens to ones body.

Treatment-goal is to bring out stability. Drug therapies, anti-psychotics to calm. Cognitive restructuring. Integration to bring fragment into host personality to force to function as a whole. A lot of controversy especially in legal realm. DID is split in personality. Sexual Disorders-things we once considered sexually deviant may not be now. Children cannot consent. Mentally delayed cannot consent. Paraphilias are disorders in which an individual has recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving 1) non-human objects 2) children or other non-consenting persons or 30 the suffering or humiliation of oneself or a partner. Unusual sexual preferences occur in occasional episodes such as during periods in which the individual feels especially stressed. Conditions last at least 6 months. Personal distress felt if they do not actually fulfill their urges or fantasies. They are obsessed with them. Distress can be experienced by the person who is not actually engaging in the behavior. Pedophilia-a paraphilia in which an adult has uncontrollable sexual urges toward sexually immature children. 6+ months of duration. Fantasies acted on or distress caused by desire if its not acted on. Hebephilia- uncontrollable urges to have sexual relations with adolescents. Ephebophilia specifically attracted to male adolescents. Usually male perpetrator. Victim has to be under age of 18. Not incest. Treatment-biological/somatic-female hormone injections, castration, brain surgery, hypothalamotomy. Dont prevent sexual activity. Doesnt reduce cognitive desire. Cognitive and psychotherapy-abusers may have been victims. Family history of inappropriate attachment/emotion. Comorbid with antisocial personality, serial killers. Aversive conditioning- learning to associate negative images to children, shock therapy, stress control often taught Stress makes person act on desires. Other Parahilias- exhibitionism- exposure necessary to achieve sexual desire. Exposure of genitals to stranger. Fetishism- non-living objects, shoes. Become dependent on object for achieving sexual gratification. Tranvestic fetichism- heterosexual man whose only needs as sexual gratification is to be perceived as woman. Doesnt need sexual act, just perception. Frotteurism-rubbing against someone who doesnt consent. Typically male on female. Target is stranger. Sadism/masochism-sadism is inflicting. Masochism is having pain inflicted. Voyeurism observing unsuspected people naked or having sex Treatment- dealing with interaction of pleasure and distress. Group therapy. Gender Identity Disorder- Biological sex is genitals one has. Gender is the way one expresses self. Gender role is social norms. One may not match social norms within culture. Gender identity is ones own perception of ones gender. How you feel about the way you express yourself. Someone aware has penis and is male but feels incorrect way to express self. Sexuality is who you are attracted to Transsexual-surgery Transgender-expression or experience opposite of biology Gender spectrum complicated. Every transsexual was once transgender GID is disorder when causes distress and impairs ability to function. Possible chromosomal abnormality. May have something to do with birth order and how many hormones exposed to while in utero. Socioculturally which sex develops naturally. Biological aspects of both sexes. Treatment-assume something is wrong. Some transgenders dont think anything is wrong. Is the person seeking help? Depends on person if it is disorder or not. Therapy-focuses on self-esteem, rejection, depression, anxiety, accepting identity, exploring identity, therapists encourage person to experiment with gender roles that match biology to see what feels right. Psychological health improves for many who undergo surgery. Female to male report higher satisfaction maybe because of cultural element. Easier to become male. Not all transgenders experience gender identity disorder.