Anxiety Disorders: HCS 3041 Mental Health Education

Anxiety Disorders
HCS 3041 Mental Health Education
Sheung-Tak Cheng
Chair Professor of Psychology and Gerontology, EdUHK

Hon. Chair, Norwich Medical School, Univ. of East Anglia
Hon. Professor, Gender Studies Program, Chinese Univ. of HK
People with Anxiety Disorders
have fears that are
 Out of proportion to the dangers that they

truly face
 Chronic and frequent enough to interfere with
functioning
Hypothalamus-Pituitary-
Fight-or-flight syndrome
Adrenal Axis
(eg, Cortisol)
Symptoms of Anxiety
Somatic Emotional Cognitive Behavioral
Muscles tension Terror Anticipation of harm Escape

Pains Restlessness Exaggerating of Avoidance
Heart rate increases Irritability danger Aggression
Problems in
Respiration accelerates Freezing
concentrating
Sweating increases Startled
Hypervigilance
Digestive fluids Worried, ruminative response
decrease thinking
Salivation decreases Fear of losing
Decreased appetite control
Stomach pain Fear of dying
Sense of unreality
Phobic Disorders
Specific Phobias Fear of specific objects, places or
 Animal type situations
 Natural environment type
 Situational type
 Blood-injection-injury type
Social Phobia Fear of being judged or embarrassed by

others
Agoraphobia Fear of places where help might not be

available in case of an emergency
Claustrophobia
The problem of
secondary gain
Panic Seemingly unpredictable
Feeling
Possible causes
• Biological theories
– Genetic vulnerability and poor regulation of neurotransmitters (inc.
norepinephrine, serotonin, and perhaps GABA and CCK) in the locus
ceruleus and limbic systems, causes panic disorder
• Kindling model
– Poor regulation in the locus ceruleus causes panic attacks,
stimulates and kindles the limbic system, lowering the threshold
for stimulation of diffuse and chronic anxiety
• Suffocation false alarm theory

– The brains of people with panic disorder are hypersensitive to
carbon dioxide and induce the fight-or-flight response with small
increases in carbon dioxide
• Cognitive theories
– People prone to panic attacks (1) pay very close attention to
their bodily sensations, (2) misinterpret these sensations, and (3)
engage in snowballing, catastrophizing thinking
Generalized Anxiety Disorder
(GAD)
 Excessive anxiety and worry

 Difficulty in controlling the worry
 “Floating anxiety”
 Restlessness or feeling keyed-up or on edge
 Easily fatigued, yet difficulty with getting sleep
 Difficulty concentrating
 Irritability
 Muscle tension and sleep disturbance
 Poor problem solvers
Possible Causes
Biological theories
 Genetic vulnerability predisposing negative affectivity
and stress reactivity
Cognitive theories
 Attentional biases leading to threat recognition
 Worry used to cope with perceived threat by lowering
emotional reactivity (i.e., cognitive avoidance theory)
Obsessive-Compulsive Disorder
Obsessions
 Recurrent and persistent thoughts, impulses, or
images that are experienced as intrusive and
unwanted and that cause anxiety or distress
 Thoughts, impulses, or images that are not simply
excessive worries about real life problems
 Thoughts, impulses or images that the person
attempts to ignore or suppress or to neutralize with
some other thought or action
 Obsessive thoughts, impulses or images that the
person recognizes are a product of his or her own
mind
Compulsions
 Repetitive behaviors (such as hand washing,

ordering, checking) or mental acts (such as praying,
counting, repeating words silently) that the person
feels driven to perform in response to an obsession
or according to rules that must be applied rigidly
 Behaviors or mental acts that are aimed at
preventing or reducing distress or preventing some
dreaded event or situation; however, these
behaviors or mental acts are not necessarily
connected in a realistic way with what they should
prevent
Obsessions Compulsions
Contamination Cleaning
Doubts Checking
Sins Confession
Aggression ??
Sexual ??
Mediated by the cortico-striatal-thalamo-cortical circuitry
(Paul et al., 2014, Nat Neurosci Rev)
Post-traumatic Stress Disorder
 Placed under Trauma and Stress-related Disorders

in DSM-5
 Reexperiencing of the traumatic event (nightmares,
flashbacks… )
 Emotional numbing and detachment
 Hypervigilance and chronic arousal
 “Survival Guilt”
Events which Induce PTSD
Usually life-threatening or involving sexual violence
 Disasters
– Tornadoes, floods, earthquakes, fires
 Common Traumatic Events
– Car accidents, sudden deaths of loved ones
 Combat and War-Related Traumas
– 911
 Abuse
– Physical, emotional, sexual
DSM-5 vs. DSM-4
 OCD in a separate “chapter” called Obsessive-
Compulsive and Related Disorders to include body
dysmorphic disorder, skin picking disorder, hair pulling
disorder …
 PTSD in a new chapter called Trauma- and Stress-
Related Disorders to include Reactive Attachment
Disorder, Disinhibited Social Engagement Disorder, Acute
Stress Disorder, Adjustment Disorder …
 Anxiety disorders to include selective mutism
 Panic disorder and agoraphobia separated

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Anxiety Disorders

HCS 3041 Mental Health Education

Chair Professor of Psychology and Gerontology, EdUHK

 Out of proportion to the dangers that they

Muscles tension Terror Anticipation of harm Escape

Social Phobia Fear of being judged or embarrassed by

Agoraphobia Fear of places where help might not be

• Suffocation false alarm theory

 Excessive anxiety and worry

 Repetitive behaviors (such as hand washing,

 Placed under Trauma and Stress-related Disorders

Usually life-threatening or involving sexual violence

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