ANXIETY DISORDERS

PRESENTED BY :
Acni Mulyani
Agustina
Agus Maulana
Ahmad Saputra
Annisa Jasmine Firdaus

Apriliani
Ayu Ashari
Bella Tata Kharisma
Chairul Hisyam Tamani
Chindy Ardiana Wati

ANXIETY DISORDERS
As Anxiety disorders, as the term suggests, has
an unrealistic, irrational fear or anxiety of
disabling intensity at its core and its principal and
most obvious manifestation.
AGORAPHOBIA: Anxiety about being in places
or situations from which escape might be difficult
or in which help may not be available in the event
of having an unexpected panic attacks or paniclike symptoms.
PANIC ATTACKS: A discrete period of intense
fear or discomfort which developed abruptly and
reached a peak within 10 minutes.

TYPES OF ANXIETY
DISORDER
Panic disorder
Panic disorder with agoraphobia or without agoraphobia

Phobic disorder
Specific Phobias
Social Phobias

Generalized Anxiety Disorder (GAD)

Obsessive Compulsive Disorder (OCD)
Post-traumatic Stress Disorder (PTSD)
Acute Stress Disorder (ASD)

PANIC DISORDERS

PANIC DISORDER
Panic disorder defined as the
occurrence of unexpected panic
attacks.
Panic disorder with
agoraphobia characterized by
both recurrent unexpected panic
attacks and agoraphobia.
Panic disorder without
agoraphobia characterized by
recurrent unexpected panic
attacks.
Symptoms: 1. persistent concern of
having attack.

 COURSE AND PREVALENCE:

Age at onset for panic disorder
varies but lay between late
adolescence and mid-30s.
Lifetime prevalence of panic
disorder reported to be high as
3.5% and one year prevalence rate
are between 0.5% and 1.5%.
Duration: at least one month
Differential Diagnosis: Panic disorder
is not diagnosed , if panic attacks are judged to be
direct physiological consequence general medical
condition or substance. In panic disorder avoidance is
associated with anxiety of having a panic attack but in
other disorders it is associated with concern about
harmful consequence of feared object or situation. In
Panic disorder with agoraphobia fear of having

PHOBIC DISORDER

PHOBIC DISORDER
A persistent and disproportionate fear of some
specific object or situation that presents little or no
actual danger to person.
Specific phobias: is characterized by clinically
significant anxiety provoked by exposure of specific
feared object or situation, often leading to avoidance.

Specific types:
Animal type: feared cued by animal or insect
Natural Environment type: feared cued by object in
natural environment like storm, water or height.
Blood Injection type: fear cued by receiving injection or
seeing blood.
Situational type: fear cued by situation such as tunnels

Course and Prevalence

Age onset for specific phobia lay between
childhood to mid-20s.
In community samples current prevalence rate
ranges from 4% to 8.8% and lifetime prevalence
rates ranges from 7.2% to 11.3%.
Duration: at least 6 months.
Differential Diagnosis:

Social phobia.
Post-traumatic stress disorder
Obsessive Compulsive disorder
Hypochondrias
Anorexia Nervosa and Bulimia Nervosa

SOCIAL PHOBIA
Is characterized by clinically
significant anxiety provoking by
exposure to certain types of social
or performance situation, which
people exposed to unfamiliar
people or to scrutiny by others.
The individual fears that he or she
will act in a way that will be
humiliating or embarrassing.
Duration: at least 6 months.

Course and Prevalence:

It has an onset in the mid-teens.
Studies have reported a lifetime
prevalence of social phobia ranging
from 3% to 13%.

DIFFERENTIAL DIAGNOSIS

Separation Anxiety disorder

Generalized Anxiety disorder
Schizoid Personality disorder
performance anxiety, stage fright and shyness

OBSESSIVE COMPULSIVE
DISORDER

OBSESSIVE COMPULSIVE
DISORDER

Obsessive Compulsive Disorder characterized

by obsessions(which cause marked anxiety)
and by compulsions( which serve to neutralize
anxiety)
Obsession: are persistent thoughts, ideas,
impulses, or images that seem to invade a
persons consciousness.
Compulsions: are repetitive and rigid
behavior or mental act that a person feels
compelled to perform to reduce distress or
anxiety. :
Types

Course and Prevalence

Community studies have estimated a lifetime
prevalence of 2.5% and 1 year prevalence of 0.5%2.1% in adults. OCD prevalence is similar in many
different cultures.
Age onset is earlier in males than females: between
age 6 and 15 for males and between age 20 and 29
years for females.
Differential diagnosis:

OCD is not diagnosed if the content of thoughts or activities related to

another mental disorder like Body Dysmorphic disorder or Specific
phobia.
Major depressive disorder.
Generalized Anxiety disorder.
Hypochondrias.

GENERALIZED ANXIETY
DISORDER

GENERALIZED ANXIETY
DISORDER
Excessive anxiety and worry
occurring more days than not for
at least 6 months about number
of events and activities.
Symptoms:
Restlessness or feeling keyed up or on
edge
Being easily fatigue
Irritability & muscle tension
Sleep disturbance
Difficulty concentrating or mind going
blank

Course and prevalence:

Onset occurring after age 20

Differential
Diagnosis
GAD should be made only when
the focus of the anxiety and worry
is unrelated to other disorder like
Panic disorder
Obsessive Compulsive disorder
Hypochondrias
Separation Anxiety disorder
Post-traumatic Stress disorder.

Posttraumatic Stress
Disorder
PTSD is characterized by the re-experiencing of an
extremely traumatic event accompanied by the
symptoms of increased arousal and by avoidance of
stimuli associated with trauma.

Symptoms:
Nightmares

Sleep disturbances
Startle responses
Anger outburst
Regressive behavior
Detachment
Avoidance of trauma recollections
Avoidance of talk of trauma
Distress at exposure to similar stimuli

Course and Prevalence

PTSD can occur at any age, including
childhood.
Community based studies reveal a lifetime
prevalence for PTSD approximately 8% of
adult population in United States.
Duration:
Acute: duration of symptoms less than 3 months.
Chronic: duration of symptoms last 3 months or
longer.
With Delayed onset: 6 months have passed
between the traumatic event and the onset of

Differential
Diagnosis
Acute Stress disorder
Adjustment disorder
Flash backs in PTSD should also
be
distinguished
from
hallucinations, illusions and other
perceptual disturbances.

ACUTE STRESS
DISORDER

Acute Stress Disorder (ASD) is

characterized by symptoms similar
to those PSTD that occur
immediately in the aftermath of an
extremely traumatic event.
Symptoms:
Depersonalization.
Dissociative amnesia (inability to recall
traumatic events).
Subjective sense of numbing, detachment or
emotional responsiveness.
De realization.

Traumatic event is persistently re-experienced

Thoughts.
Recurrent images.
Flashback episode.

 Marked symptoms of anxiety or increased arousal

difficulty in sleeping.

irritability
poor concentration
hyper vigilance
motor restlessness
exaggerated startle response

Course and Prevalence

Symptoms experienced during or immediately after
the trauma, last for at least 2 days, and maximum 4
weeks and occur within 4 weeks of the traumatic
event.
ASD in few available studies, rates ranging from 14%
to 33% have been reported in individuals exposed to

Differential Diagnosis
Distinguish from mental disorder due to
general medical condition( e.g. head
injury) and from Substance Induced
disorder (e.g. related alcohol intoxication.
Major depressive disorder in diagnosed in
addition to the diagnosis of Acute stress
disorder.
PTSD
Adjustment Disorder

THEORIES ON
ANXIETY DISORDER
The Psychodynamic
Theory
The HumanisticExistential Theory
The Behavioral Theory
The Neuroscience Theory
The Cognitive Theory
The Socio-cultural Theory

THE PSYCHODYNAMIC
THEORY
The fundamental concept is that anxiety
is at the root of neurosis.
Anxiety stemmed in the form of
unacceptable ID impulses attempting to
break through into consciousness and
behavior.
In all neurosis the relief of anxiety is
sought
through
various
defense
mechanism.
For example, in panic attack, the cause that is id
impulse moves closer to the boundaries of conscious mind,

THE HUMANISTICEXISTENTIAL THEORY

Humanistic- existential theorists describe
anxiety as the outcome of the conflict
between the individual and society.
According to humanists the source of
neurosis is the discrepancy between the
self concept and the ideal self.
If the way we perceive ourselves is very
different from the way we would like to be,
we feel incapable of meeting lifes
challenges, and anxiety results.

THE BEHAVIORAL
THEORY

According to behaviorists
avoidance is a response learned
to relieve anxiety.
For example, Agoraphobia is a
strategy to avoid panic attacks
in public.
Avoidance learning is a major
source of anxiety and is twostage process:
1) Through respondent conditioning, a
neutral stimulus becomes anxiety
arousing.
2) The avoidance response relieves
anxiety through negative

THE NEUROSCIENCE
THEORY
Anxiety disorders appear to
have genetic basis.
In Norwegian study, the
concordance rate for panic
disorder in MZ twins was 31
percent, as opposed to 0
percent for D twins (Torgersen,
1983).
Abnormalities in the
neurotransmitters gammaamino butyric acid (GABA) and
serotonin may have a particular
role in susceptibility to
generalized anxiety disorder.

THE COGNITIVE THEORY

According to the cognitive theory, people
with anxiety disorders misperceive or
misinterpret internal and external stimuli.
Events that are not really threatening, and
anxiety results.
In the case of panic disorder, if a person
upon experiencing unusual bodily
sensations catastrophically, as a signal
that he or she is about to pass out or have
a heart attack, then panic could result.

THE SOCIO-CULTURAL
THEORY
According to socio-cultural
theorists,
phobic and GAD are more likely to develop
in people who are confronted with societal
pressure.
Stressful changes have occurred in the
society
have
also
increased
the
prevalence of anxiety disorders.

TREATMENT OF
ANXIETY DISORDER

PSYCHOLOGICAL
TREATMENT FOR
ANXIETY DISORDER

Systematic Desensitization
Flooding and Implosive Therapy
Modeling
Exposure Treatment
Group Therapy
Rational-emotive behavior therapy
Self-instruction training
Relaxation training
Biofeedback training
Crisis intervention therapy

REFERENCES
Barlow. D. H & Durand. V. M., (2002). Abnormal Psychology An Integrative Approach. (3rd Ed). Published by Wadsworth
Group , Belmont, USA.
Bootzin. R. R., Accocella. J. R & Alloy. L. B., (1972). Abnormal Psychology Current Perspectives. (6th Ed). Published by McGrawHill-Inc, New York.
Carson. R.C., Butcher J. N & Mineka. S., (2001). Abnormal Psychology and Modern Life. ( 11th Ed). Published by Pearson
education, Inc. and Dorling Kindersley Publishing Inc.
Comer. R. J., (1995). Abnormal Psychology. (2nd Ed). Published by W. H. Freeman and Company, USA.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSMIV). Washington,
DC: APA.