norm ~

abnorm ~

response to threatening situation feelings o apprehension + physiological e:g o physio : HR, BP, respi, muscle tension, sympathetic actvt

response = norm ~ BUT out o propotion to threat &/or > prolong when x threat

Peripheral manifestation o anxiety : D Restlessness Dizziness, light headedns Syncope Hyperhidrosis Tachycardia Hyperreflexia Tingling in extrenities HPT Upset stomach *butterflies* Palpitation Urinary fq, hesistancy, urgency Pupillary mydriasis Tremors anxiety Response to threat that is unknown, internal, vague or conflictual fear Response to a known, external, definite or nonconflictual threat

Affects: Thinking confusion Perception distortion o perception Learningintefere w learing Emotion selectivity o attention Manifestation :

Anxiety disorder
Yerkes-Dodson Law :an empirical relationship between arousal and performance The law dictates that performance increases with physiological or mental arousal, but only up to a point. When levels of arousal become too high, performance decreases. The process is often illustrated graphically as a curvilinear, inverted U-shaped curve which increases and then decreases with higher levels of arousal.

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Panic d/o w Agoraphobia A. Must hv : Recurrent unexpected panic attack 1 o attack has been followed by 1/12 of 1 o following : Persistent concern about having additional attacks Worry about implication o attack or its consequences Significance in in behavior related to attacks B. Presence o agoraphobia C. Panic attack not d/t : Direct physio effect o substance General medical condition D. Panic attack not better accounted for by another mental disorder such as ; Social phobia Specific phobia OCD Posttraumatic stress disorder Separation anxiety disorder

Specific Phobia A. Marked & persistent fear that is xs or unreasonable, cued by d presence or anticipation o a specific object or situation B. Exposure to phobic stimulus almost invariably provokes an immediate anxiety response, which may take d form of a situationally bound or situationally predisposed panic attack C. D person recognized that fear is xs or unreasonable (children : may B absent) D. D phobic situation is avoided or else is endured w intense anxiety or distress E. The avoidance, anxious anticipation, or distress is in feared situation interferes significantly w persons norm routine, occupation(or academic) functioning or social activities or r/ship, or there is marked distress about having phobia F. In individual 18y/o the duration 6 mnths G. D anxiety, panic attack, or phobic avoidance a/w specific object or situation r x btter accounted by another mental d/o : OCD PTSD Separation anxiety d/o Social phobia Panic d/o w agoraphobia Panic d/o w/out agoraphobia

Anxiety d/o Social Phobia A. Marked persistent fear 1 social or performance situations in which person is exposed to unfamiliar ppl or to a possible scrutiny by others. D individual fear that he/she might act in a way (or show anxiety symptoms) that will b humiliating or embarrassing B. Exposure to d almost invariably may take d form or situationally attack feared social situation provokes anxiety which of a situationally bound predisposed to panic

GAD A. Xs anxiety & worry (apprehensive expectation), occurring > days than not 6 mnths about a number o events & activities B. Person finds it difficult to control d worry C. D anxiety & worry a/w 3 symp (w at least some sympt present for more days than not for past 6 months) Chlidren : require only 1 1. Restlsns or feeling keyed up or on d edge 2. Being easily fatigue 3. Diff concentrating or ming going blank 4. Irritability 5. Muscle tension 6. Sleep disturbance (diff falling or staying asleep or restls unsatisfying sleep) D. D focus of anxiety & worry is x confined to features of Axis 1 d/o E. The anxiety, worry or physical symptoms causes clinically significant distress or impairment in social, occupational or other important areas of functioning F. The disturbance id x d/t direct physiological effects of a substance or GMC & does x occur exclusively during : 1. Mood d/o 2. Psychotic d/o 3. Pervasive dvlpmntl d/o

C. D person recognized that fear is xs or unreasonable (children : may B absent) D. D feared social or performance situation is avoided or else is endured w intense anxiety or distress E. D avoidance, anxious anticipation, or distress in feared social or performances situation interferes significantly w persons norm routine, occupation(or academic) functioning or social activities or r/ship, or there is marked distress about having phobia F. In individual 18y/o d duration 6 mnths G. D fear or avoidance x d/t direct physiological effects o subst or GMC & is x btter accounted by another mental d/o : Panic d/o w or w/out agoraphobia Body dysmorphic d/o Pervasive dvlpmnt d/o Schizoid personality d/o H. If GMC or another mental d/o is present, d fear in criterion A is unrelated to it

OCD 1- Either obsession or compulsion Obsession defined by recurrent & persistent thought, impulses or images (T/I/I) that r xperienced at some time during d disturbances, as intrusive & inappropriate & that cause anxiety or distress that thought, impulse or image r x simply xcessive worries bout real life prob px attempts to ignore or suppress T/I/I or neutralize T/I/I w some other thought or action px recognize that d obsession T/I/I r product o px own mind Compulsion defined by repetitive behavior or mental act that px feels driven to perform in response to obsession or according to rules that must b applied rigidly. - D behavior or mental act aimed to : Reducing stress Prevent some dreaded events / situations However, these behavior or mental act r x connected in realistic ways w what they r designed to neutralize or prevent or r x clearly xcessive 2- at some point during course o o disorder, px hv recognized that d O or C r excessive or unreasonable Note : this does x apply to children 3- O-C cause marked distress, time consuming (>1hr/d)or significant interfere w px norm routine, occupation, academic, fx, usual social actvt,or r/ship 4- if another Axis I disorder is present, d content o O-C is x restricted to it 5- d disturbance not d/t direct physiological effects o substance or a general medical condition

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Panic attack Discrete period o intense fear or discomfort in which 4 following symptoms dvlp abruptly & reached peak w/in 10 min : 1. Palpitation, punding o , accelerated HR 2. Sweating 3. Trembling or shaking 4. Sensation o SOB or smothering 5. Feeling o choking 6. Chest pain or discomfort 7. Nausea & abd distress 8. Feeling dizzy, unsteady, lightheaded or faint 9. Derealization(feeling o unreality) or depersonalization (being detached from oneself) 10. Fear o losing control or going crazy 11. Fear o dying 12. Paresthesias (numbness or tingling sensation) 13. Chills or hot flushes

Agoraphobia Anxiety about being in a place or situation from in which escape might be diff (or embarrassing) or in which help may x b available in d event of having an unexpected situation or situationally predisposed panic attack or panic-like symptoms The situation r avoided or else r endures w marked distress or w anxiety about having a panic attack or panic or require present of companion D anxiety or phobic avoidance is x better accounted for another mental d/o : Social phobia Specific phobia OCD PTSD Separation anxiety d/o

PTSD A. D person hv been exposed to a traumatic event in which both of following were present: 1. D person experienced witnessed or was confronted w an event that involved actual or threatened death or serious injury or a treat to physical integrity of self or others 2. D persons response involved intense fear, helplsns, or horror B. D traumatic event is persistently re-experienced in 1 of following ways : 1. Recurrent & intrusive distressing recollection of d event including image, thoughts or perceptions. Children: repetitive play may occur in which themes or aspect of trauma r expressed 2. Recurrent distressing dreams of d event 3. Acting or feeling as if traumatic event were recurring (include a sense of reliving d experience illusions hallucinations & dissociative flashback episodes, including those that occur on awakening or when intoxicating) Children: trauma-specific reenactment may occur 4. Intense psychological distress at exposure to internal/ xternal cues symbolize or resemble an aspect o traumatic event 5. Physiological reactivity on exposure to internal or xternal that symbolize or resemble an aspect of traumatic event C. Persistent avoidance of atimuli a/w trauma & numbing general responsivens (x present b4 trauma), as indicated by 3 of : 1. Effort to avoid thoughts, feeling, or conversation a/w trauma 2. Effost to avoid activities, places or ppl that arouse recollections of trauma 3. Inability to recall an important aspect of trauma 4. Marked diminished interest or participation in significant activities 5. Feeling detachment or estrangement from others 6. Restricted range of affect 7. Sense of foreshortened future D. Persistent symptoms of arousal (x present b4 trauma) as indicated by 2 : 1. Difficult falling or staying asleep 4. Hypervigilance 2. Irritability or outburst of anger 5. Exaggerated startle response 3. Diff to concentrate E. Duration of disturbance (B +C+D) 1 month F. Disturbance cause clinically significant distress or impairment in social, occupational or other important areas of functioning
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Acute stress d/o A. D person hv been exposed to a traumatic event in which both of the following were present : 1. D person experienced, witnessed, or was confronted w an event or events that involved actual or threatened death or serious injury or a threat to d physical integrity of self or others 2. D persons response involved intense fear, helplsns, or horror B. Either while experiencing or after experiencing d distress event, d individual hs 3 of following dissociative sympt : 1. A subjective sense of numbning, detachment, or absence of emotional responsivens 2. A reduction in awarens of his/her surrounding 3. Derealization 4. Depersonalization 5. Dissociative amnesia C. D traumatic event is persistently re-experienced in 1 of following ways : recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving d experience or distress on exposure to reminders of traumatic event

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