anxiety disorders, obsessive compulsive disorders & trauma - & stress-related disorders
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Anxiety Disorders, Anxiety Disorders, Obsessive Compulsive Obsessive Compulsive Disorders & Trauma - & Disorders & Trauma - & Stress-Related DisordersStress-Related Disorders
Neurotic Beh
-Anxiety-based-No distortions in reality-Recognizes problem-No great personality disorganization
Psychotic
-Gross distortions in reality (e.g., perception)-Some personality disorganization-Does not recognize problem
Bo r d e r l i n e
Neurotic BehaviourNeurotic Behaviour
““Doing the same thing over and over Doing the same thing over and over expecting a different outcome” expecting a different outcome”
““You yourself produce the thing you fear You yourself produce the thing you fear thethe
most”most” Deals with anxiety-based disorders Deals with anxiety-based disorders
including:including:– Generalized AnxietyGeneralized Anxiety– PanicPanic– Obsessive ComplusiveObsessive Complusive– PhobiasPhobias– Others that have anxiety as a basisOthers that have anxiety as a basis
Neurotic BehaviourNeurotic Behaviour
Maladaptive behaviour pattern Maladaptive behaviour pattern that that does notdoes not involve gross involve gross distortions in reality or marked distortions in reality or marked personality disorganizationpersonality disorganization
Person recognizes that behaviour Person recognizes that behaviour is unacceptable or irrational (ego is unacceptable or irrational (ego dystonic dystonic apart from the ego) apart from the ego)
Neurotic AnxietyNeurotic Anxiety
Central component of anxiety disorders Central component of anxiety disorders and anxiety-based disordersand anxiety-based disorders
No obvious danger or threatNo obvious danger or threat Event or stimulus is, objectively, minor Event or stimulus is, objectively, minor
or insignificant (e.g., mouse, thunder, or insignificant (e.g., mouse, thunder, shopping mall, etc.)shopping mall, etc.)
Neurotic Paradox INeurotic Paradox I
Neurotic evaluates innocuous Neurotic evaluates innocuous events as anxiety provoking events as anxiety provoking inordinate anxiety responseinordinate anxiety response
Deals with anxiety in defensive Deals with anxiety in defensive fashion, usually avoidance fashion, usually avoidance reduces anxiety in short termreduces anxiety in short term
Neurotic Paradox IINeurotic Paradox II
This defensive behaviour results in This defensive behaviour results in self-defeating behaviour:self-defeating behaviour:– Does exactly opposite of what is Does exactly opposite of what is
healthy or adaptivehealthy or adaptive
Neurotic Paradox Neurotic Paradox OutcomesOutcomes
Blocks personal growthBlocks personal growth Relationship problems (especially Relationship problems (especially
intimacy)intimacy) Anxiety focus of lifeAnxiety focus of life Lack of energy and enthusiasmLack of energy and enthusiasm Egocentric concernsEgocentric concerns
Neurotic Paradox ProcessNeurotic Paradox Process
Maximize pleasureMaximize pleasure Minimize painMinimize pain Immediate Effect: Reduce AnxietyImmediate Effect: Reduce Anxiety Long Term: Don’t resolve the Long Term: Don’t resolve the
actual problemactual problem E.G. Doug, the Graduate StudentE.G. Doug, the Graduate Student
Neurotic Styles: Neurotic Styles: CharacteristicsCharacteristics
Deficit in behavioural repertoire Deficit in behavioural repertoire (Inhibition)(Inhibition)
Behaves in an inflexible and Behaves in an inflexible and exaggerated manner exaggerated manner oppositeopposite to to the deficient behaviourthe deficient behaviour
Behaviour does not fully contain Behaviour does not fully contain the anxietythe anxiety
Neurotic StylesNeurotic Styles
Aggression/Assertion InhibitionAggression/Assertion Inhibition Responsibility/Independence Responsibility/Independence
InhibitionInhibition Compliance/Submission InhibitionCompliance/Submission Inhibition Intimacy/Trust InhibitionIntimacy/Trust Inhibition
Aggression/Assertion Aggression/Assertion InhibitionInhibition
Person uncomfortable with aggression Person uncomfortable with aggression and/or assertion and avoids situations and/or assertion and avoids situations where need to engage in this behaviourwhere need to engage in this behaviour
Irrationally clings to cooperative stanceIrrationally clings to cooperative stance Thought to result in problems such as Thought to result in problems such as
hypertension,ulcers, migraines, other hypertension,ulcers, migraines, other stress-related disordersstress-related disorders
Potential sudden aggressive outburstsPotential sudden aggressive outbursts
Responsibility/Independence Responsibility/Independence InhibitionInhibition
Person has aversion to autonomyPerson has aversion to autonomy Avoids situations where they are in Avoids situations where they are in
charge or in control other others or charge or in control other others or themselvesthemselves
Appear incompetent in simple Appear incompetent in simple tasks to “pull” direction by otherstasks to “pull” direction by others
Poor relationships, helplessness, Poor relationships, helplessness, depressiondepression
Compliance/Submission Compliance/Submission InhibitionInhibition
Neurotic is often the “rebel” and Neurotic is often the “rebel” and avoids submission to authorityavoids submission to authority
Need to be non-compliant (i.e., Need to be non-compliant (i.e., self-reliant, independent, free-self-reliant, independent, free-thinking, to a fault)thinking, to a fault)
Intimacy/Trust InhibitionIntimacy/Trust Inhibition
Retreats from closeness and Retreats from closeness and withdraws from people who want withdraws from people who want deeper relationshipsdeeper relationships
All relationships short-term to All relationships short-term to avoid intimacyavoid intimacy
End relationships at crucial points End relationships at crucial points in the establishment of intimacy in the establishment of intimacy (not just romantic relationships, (not just romantic relationships, friendships too)friendships too)
Interpersonal Interpersonal ConsequencesConsequences
Some will result in depending too Some will result in depending too much on others that results in much on others that results in others feeling “used and others feeling “used and manipulated”manipulated”
Unpredictable demands on others Unpredictable demands on others that results in others feeling angry, that results in others feeling angry, frustrated, guilty, etc.frustrated, guilty, etc.
Interpersonal Aspects of Interpersonal Aspects of Neurotic Styles INeurotic Styles I
Extremely sensitive to acts, Extremely sensitive to acts, opinions, feelings of othersopinions, feelings of others
Lack of spontaneity (stilted, Lack of spontaneity (stilted, controlled, mechanical)controlled, mechanical)
Superficial relationships if anySuperficial relationships if any Relationships often stormyRelationships often stormy Private life is one of turmoil and Private life is one of turmoil and
inner tormentinner torment
Interpersonal Aspects of Interpersonal Aspects of Neurotic Styles IINeurotic Styles II
Don’t have large networks of Don’t have large networks of enduring relationshipsenduring relationships
Speculation that some Speculation that some complementary “hooking up” is complementary “hooking up” is match made in hellmatch made in hell– Two people with aggression/assertion Two people with aggression/assertion
inhibitioninhibition– One with responsibility/independence One with responsibility/independence
style and one with style and one with compliance/submsission stylecompliance/submsission style
Anxiety Disorders - Anxiety Disorders - SymptomsSymptoms
Mood SxMood Sx: Anxiety, tension, panic, : Anxiety, tension, panic, apprehensionapprehension
Cognitive SxCognitive Sx: Reflects the : Reflects the apprehension and concern about apprehension and concern about the “doom”the “doom”
Somatic SxSomatic Sx: : – ImmediateImmediate– DelayedDelayed
Motor SxMotor Sx: Reactivity: Reactivity
Anxiety Disorders: DSM-VAnxiety Disorders: DSM-V
Specific PhobiasSpecific Phobias Panic DisorderPanic Disorder Social Anxiety DisorderSocial Anxiety Disorder AgoraphobiaAgoraphobia Generalized Anxiety DisorderGeneralized Anxiety Disorder Selective MutismSelective Mutism
PhobiasPhobias
Persistent, excessive, irrational fear of a specific object, activity, or situation
Fears have no justification in reality or are out of proportion
Aware of the irrational nature of the fear
Avoidance is common response
Phobias EffectsPhobias Effects
1.1. Avoidance can result in Avoidance can result in unfortunate consequencesunfortunate consequences
2.2. If feared object cannot be If feared object cannot be avoided, person may experience avoided, person may experience overwhelming and uncontrollable overwhelming and uncontrollable fear and panicfear and panic
E.G. Student in class exampleE.G. Student in class example
Types of PhobiasTypes of Phobias
Agoraphobia: Anxiety in open Agoraphobia: Anxiety in open spacesspaces
Social Phobia: Anxiety regarding Social Phobia: Anxiety regarding being criticizedbeing criticized
Specific Phobia: Anxiety regarding Specific Phobia: Anxiety regarding object or situation other than open object or situation other than open spaces or personal criticism spaces or personal criticism (heights, pain, storms, blood, etc.)(heights, pain, storms, blood, etc.)Steve Social Phobia
Panic DisorderPanic Disorder
Brief periods of exceptionally Brief periods of exceptionally intense spontaneous anxietyintense spontaneous anxiety
Steven Panic 1, 2, 3
Panic DisorderPanic Disorder
Recurrent unexpected panic Recurrent unexpected panic attacksattacks
Persistent concern about Persistent concern about additional attacks for one additional attacks for one monthmonth
See Text & Student Guide See Text & Student Guide
Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder
Involves recurrent obsessions Involves recurrent obsessions and/or compulsionsand/or compulsions
OCD Chuck 1,2,3
ObsessionsObsessions
ObsessionsObsessions: persistent idea, : persistent idea, thought, image, impulse that thought, image, impulse that person cannot get out of his/her person cannot get out of his/her mind and that tend to be mind and that tend to be repugnantrepugnant
ExamplesExamples: Thoughts of violence, : Thoughts of violence, contamination, doubting one’s contamination, doubting one’s actionsactions
CompulsionsCompulsions
Behaviours performed in Behaviours performed in stereotypic fashion that reduce stereotypic fashion that reduce anxiety related to the obsessionsanxiety related to the obsessions
Examples: handwashing, counting, Examples: handwashing, counting, checking, touchingchecking, touching
Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder
Involves recurrent obsessions Involves recurrent obsessions and/or compulsionsand/or compulsions
OCD2
Obsessive Compulsive Obsessive Compulsive Disorder:Disorder:CasesCases Shoemaker (Handwashing)Shoemaker (Handwashing) Seventeen year old religious boySeventeen year old religious boy Police Officer/Lawyer Police Officer/Lawyer Classical Concert audience Classical Concert audience
membermember
Post Traumatic Stress Post Traumatic Stress DisorderDisorder Existed throughout historyExisted throughout history Major feature: Re-experiencing of a Major feature: Re-experiencing of a
traumatic and disturbing eventtraumatic and disturbing event Differ from other disorders in that Differ from other disorders in that
source of anxiety is externalsource of anxiety is external Extremely debilitating: May re-Extremely debilitating: May re-
experience event for months, years, experience event for months, years, decadesdecades
Post Traumatic Stress Post Traumatic Stress DisorderDisorder Severe psychological reaction to Severe psychological reaction to
experience of a traumaexperience of a trauma Often events involve actual or Often events involve actual or
threatened death, or serious injurythreatened death, or serious injury These events can include natural These events can include natural
disasters (floods) or human made disasters (floods) or human made disasters (war, rape, assault)disasters (war, rape, assault)
Can involve actual involvement with Can involve actual involvement with event, witnessing or being indirectly event, witnessing or being indirectly involvedinvolved
CharacteristicsCharacteristics
May take form of recurrent painful May take form of recurrent painful memories, dreams, nightmaresmemories, dreams, nightmares
FlashbacksFlashbacks General numbing of General numbing of
responsiveness and decreased responsiveness and decreased involvement with external worldinvolvement with external world
Post Traumatic Stress Post Traumatic Stress DisorderDisorder Trauma persistently re-experienced by Trauma persistently re-experienced by
personperson Person persistently avoids stimuli Person persistently avoids stimuli
associated with the traumaassociated with the trauma Persistent symptoms of increased Persistent symptoms of increased
arousalarousal Impaired concentration and memoryImpaired concentration and memory Depression, social withdrawal, Depression, social withdrawal,
decreased sexual interest, numbnessdecreased sexual interest, numbness
Post Traumatic Stress Post Traumatic Stress DisorderDisorder Differ from other disorders in that Differ from other disorders in that
source of anxiety is externalsource of anxiety is external Extremely dibilitating: May re-Extremely dibilitating: May re-
experience event for months, years, experience event for months, years, decadesdecades
Symptoms appear usually quickly Symptoms appear usually quickly after the eventafter the event
May be incubation periodMay be incubation period
Post Traumatic Stress Post Traumatic Stress Disorder: CasesDisorder: Cases
Five year old & DaughterFive year old & Daughter Jessica Russell CaseJessica Russell Case Heather Thomas CaseHeather Thomas Case Marine CaseMarine Case RCMP (Airline, vehicle deaths)RCMP (Airline, vehicle deaths)
PDM ApproachPDM Approach
Include Anxiety Personality DisordersInclude Anxiety Personality Disorders– Characterological anxiety:Characterological anxiety:
Phobic Personality DisorderPhobic Personality Disorder Anxious Personality DisorderAnxious Personality Disorder Obsessive-Compulsive Personality DisorderObsessive-Compulsive Personality Disorder
Describes the internal experience of anxiety Describes the internal experience of anxiety disorders (conscious & unconscious)disorders (conscious & unconscious)– Some similar to Sx in DSM but also include relationship Some similar to Sx in DSM but also include relationship
problems that arise from themproblems that arise from them– Fears of rejection, guilt, blaming, dependency, Fears of rejection, guilt, blaming, dependency,
smotheredsmothered Great Importance on Trauma and PTSD SpectrumGreat Importance on Trauma and PTSD Spectrum