lecture 12 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University, includes DSM-IV TR psychiatric disorders including Post-traumatic stress disorder, phobias, Generalized Anxiety Disorders, Obsessive Compulsive Disorder, anterior cingulate

1. Psychological Disorders I:
Anxiety
Brian J. Piper, Ph.D., M.S.
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2. Goals
• History of Psychological Disorders
• Anxiety Disorders
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3. Evil Spirits
• Release the demons!
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4. The Moral Model
Philippe Pinel from France insisted that madness
was not due to demonic possession but an
ailment of the mind.
Philosophy:
•Treat each patient as an individual
•Employ former patients
•Use psychological interventions before
biological ones.
1745-1826
“the treatment of insanity (l’aliénation mentale) without
considering the differentiating characteristics of the patients
[la distinction des espèces] has been at times superfluous, rarely
useful, and often harmful”

5. Medical Model
When physicians discovered that syphilis led to
mental disorders, they started using medical models
to review the physical causes of these disorders.
• Etiology: Cause and development of the
disorder.
• Diagnosis: Identifying (symptoms) and
distinguishing one disease from another.
• Treatment: Treating a disorder in a psychiatric
hospital.
• Prognosis: Forecast about the disorder.
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6. The Biopsychosocial Approach
Assumes that biological, socio-cultural, and
psychological factors combine and interact to
produce psychological disorders.

7. International
Classification of
Diseases-10
• Published by the World Health Organization to
provide uniformity.
• International Statistical Classification of Diseases
and Related Problems uses 6 digit codes.
• Started in 1900, included mental disorders in 1949

8. Diagnostic & Statistical Manual
(DSM)
• Published by American Psychiatric Association
• DSM-I: 1952: consists of 106 mental disorders
• DSM-II: 1968: psychodynamic
• DSM-III: 1980: responds to Rosenhan
criticisms
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9. Diagnostic & Statistical
Manual of Mental
Disorders (DSM)
• Published by American Psychiatric Association
• DSM-I: 1952: consists of 106 mental disorders
• DSM-II: 1968: psychodynamic
• DSM-III: 1980: responds to Rosenhan criticisms
• DSM-IV: 1994: 297 disorders
• DSM-V: in planning for 2013

10. Example: ADHD: Inattentive
• Symptoms present at school/work and home
• 6+ symptoms that have persisted 6+ months
and are inconsistent with developmental
level
– Often fails to give close attention or makes careless
mistakes at school or at work.
– Has difficulty sustaining attention in tasks or play.
– Does not listen when spoken to directly.
– Often does not follow through on instructions.
– Has difficulty organizing activities.
– Is easily distracted.
– Is often forgetful in daily activities. 10

11. ADHD: Hyperactive-Impulsive
• Symptoms present at school/work and home
• 6+ symptoms that have persisted 6+ months
and are inconsistent with developmental
level
– Often fidgets with hands or feet, leaves seat
when staying seated is expected, runs or climbs
excessively
– Often acts as “driven by a motor”
– Often blurts answer before ? Completed
– Has difficulty waiting turn
– Often interrupts others 11

12. Joel T. Nigg, Ph.D.

13. Labels

14. Anxiety
• Anxiety (future) versus Fear (current)
• Timing
<-
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15. Measuring Anxiety I:
Open-field

16. Measuring Anxiety II: Elevated
Plus Maze
• Developed by Sandra File, Ph.D.
• Valium Type Drugs: decrease anxiety
• http://www.youtube.com/watch?v=PLcX2MbpmdY
----------------------
Chlordiazepoxide
Pellow et al. (1985). J Neurosci Methods 14, 149-167.

17. Anxiety Disorders
 Panic Disorder
 Phobias
 Generalized Anxiety Disorder
 Obsessive-Compulsive Disorder
 Post-Traumatic Stress Disorder

18. Panic Disorder
Panic Attack: discrete period of intense fear, 4+
symptoms develop abruptly and peak within 10
minutes:
1) palpitations
2) sweating
3) trembling
4) shortness of breath
5) choking feeling
6) chest pain
7) dizziness
8) nausea
9) losing control
10) fear of dying

19. Panic Disorder
Panic Attack: discrete period of intense fear, 4+
symptoms develop abruptly and peak within 10
minutes
Individual Differences: multi/day versus 1/week
Agoraphobia: fear of open-spaces
Treatment: anti-anxiety & anti-depressant drugs
1st 2:30
http://www.youtube.com/watch?v=2gNGUartUEI

20. Phobia
• Marked & persistent fear that is excessive
or unreasonable, cued by presence or
anticipation of object/situation
• The avoidance interferes significantly with
normal routine, occupational or social
activities.
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21. Kinds of Phobias
Arachonophobia Phobia of spiders.
Acrophobia Phobia of heights.
Claustrophobia Phobia of closed spaces.
Hemophobia Phobia of blood.

22. Systematic Desensitization
Spider
• 1) Create hierarchy of fears ↓
• 2) Relaxation techniques
• 3) Combine
Joseph Wolpe, M.D.
1915-1997

23. Obsessive-Compulsive Disorder
(OCD)
Obsessions: recurrent thoughts, images, or feelings
Compulsions: ritualistic behaviors, performed to stop
obsession and associated anxiety
Common Obsessions:
6)Dirty 2) Aggression 3) Religion 4) Sex
Differentiation
Quantitative: High intensity, frequency,
duration ( > 1 hour/day)

24. Quantification
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To take test: http://www.psymed.info/psymed/default.aspx?m=Test&id=52&l=3

25. OCD
• 1st Two Minutes:
• http://www.youtube.com/watch?v=44DCWslbsN
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26. Cingulate Cortex
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27. Anterior Cingulate & OCD
• OCD and controls
completed a difficult
continuous performance
test during fMRI.
• OCD > controls in
Anterior Cingulate
Cortex
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Ursu et al. (2003). Psychological Science, 14, 347-353.

28. Generalized Anxiety Disorder
DSM-IV-TR Criteria
A. Excessive anxiety and worry (apprehensive
expectation), occurring more-days-than-not for at least
6 months.
B. The person finds it difficult to control the worry.
C. three (or more) of the following six symptoms:
2. Restlessness
3. Being easily fatigued
4. Difficulty concentrating
5. Irritability
6. Muscle tension
7. Sleep disturbance

29. Post-Traumatic Stress
Disorder
Four or more weeks of the following symptoms
constitute Post-Traumatic Stress Disorder (PTSD):
Re-experiencing: nightmares, flashbacks, intrusive
thoughts
Avoidance: situation & associated
Physical Arousal: sleep, concentration, irritability
Significant social or occupational impairment
:
3 min http://www.youtube.com/watch?v=7aFs6695VyQ

30. PTSD
• Lifetime Prevalence: 5% men, 10%
women
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31. Resilience to PTSD
Only about 10% of women and 20% of men
react to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience
against traumatic situations.

32. Origins of Anxiety
• Learn: videotapes of fear response to fake snake or
plastic flower
• Test: show a stimuli
Mineka, S. (1985). J Abnormal Psychol

33. Origins of Anxiety
• Learn: videotapes of fear response to fake snake or
plastic flower
• Test: show a stimuli
• Response: Snake-Fear; Flower- No Fear
• Supports Social-Learning & Evolutionary
Psychology

34. Summary
• Psychological Disorders & ICD/DSM
• Anxiety Disorders
– Panic Disorder
– Phobias
– GAD
– OCD
– PTSD
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