Chapter 7.  Powerpoint outline on Anxiety inferred disorders

Anxiety felt and inferred

active coping
Fear disorders:

• phobia
• PTSD

Anxiety disorders:

• generalized anxiety disorder
• panic disorder

Anxiety is inferred:

• obsessive-compulsive disorder
• conversion disorder
• dissociative disorders

Slide 2. Obsessive compulsive disorder (APA, 1994)

(A) either obsessions or compulsions; obsessions as defined by (1),
(2), (3), and (4);

(1) recurrent and persistent thoughts, impulses, or images that are  experienced, at some time during the disturbance, as intrusive  and inappropriate and that cause marked anxiety or distress;
(2) the thoughts, impulses, or images are not simply excessive  worries about real-life problems;
(3) the person attempts to ignore or suppress such thoughts,  impulses, or images, or to neutralize them with some other  thought or action;
(4) the person recognizes that the obsessional thoughts, impulses,  or images are product of his or her own mind (not imposed  from without as in thought insertion);

compulsions as defined by (1) and (2);

(1) repetitive behaviors (i.e. hand washing, ordering,  checking) or mental acts (i.e. 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;
(2) the behaviors or mental acts are aimed at preventing  or reducing distress or preventing some dreaded  event or situation, however, these behaviors or   mental acts either are not connected in a  realistic  way with what they are designed to neutralize or  prevent or are clearly excessive;

(B) at some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable;
(C) the obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships;
(D) if another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it;
(E) the disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Slide 3. OCD or OCPD?

Obsessive compulsive disorder

• ego-alien, distressing, unwanted, difficult to control
• Highly co-morbid with depression
• Obsessions and compulsions increase with stress

Obsessive compulsive personality disorder

• A liked part of self associated with little distress

Slide 4. Treatment of OCD

Medications (Anafranil and SSRIs)

• 40-60% experience moderate to marked improvement
• Marked relapse
• Moderate side effects

Behavior therapy

• 50-60% experience moderate to marked improvement
• 10-20% relapse
• No side effects

Slide 5. Time to think...

Do you think finding “the Truth” is an important part of therapy?  If so, what would you do to increase a person’s ability to tell it?

Slide 6. A way of seeing anxiety

• Can the stimulus be avoided or separated from other parts of self?
• Does awareness of stimulus cause anxiety?

Slide 7. Dissociative identity disorder (APA, 1994)

(A) the presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self);
(B) at least two of these identities or personality states recurrently take control of the person's behavior;
(C) inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness;
(D) the disturbance is not due to the direct physiological effects of a substance or a general medical condition (in children, the symptoms are not attributable to imaginary playmates or other fantasy play).

Slide 8. Figure 06.02

Slide 9. What do memories mean?

• an accurate portrayal of information?
• stories that we tell to make sense of our life?
• frequently inaccurate and baseless?
• perhaps inaccurate but representative of basic themes in life?

Slide 10. Problems with recovered memories

• Inconsistent with our knowledge of childhood memories
• Demand characteristics
• Can history of abuse be diagnosed by presence of vague symptoms?
• Memories, even of highly dramatic events can be inaccurate.
• interview subjects about Challenger explosion the day after the explosion and three years later.   1/3 reported vivid and grossly inaccurate memories (Neisser & Harsch, 1992)
• Clients recant.

Slide 11. What are costs and benefits?

Client inaccurately identifies a perpetrator and is believed.

• Someone who is innocent is trashed.

Client tells the truth, but is not believed.

• Client is not validated, believed or protected.
• Others can continue to be hurt

Client tells the truth and is believed.

• Client is validated, believed or protected.
• Others are helped/protected.

Last modified October 3, 2001