 Axis I listed the primary or principal diagnoses that

needed immediate attention; this included recording of

clinical disorders as well as “Other Conditions That May
Be a Focus of Clinical Attention” (e.g., life stressors,
impairments in functioning; APA, 2000, p. 27).
 Axis II contained pervasive psychological issues such as
personality disorders, personality traits and mental
retardation (now intellectual disability disorder) that
shaped responses to Axis I disorders.
 Axis III was intended to cue reporting of medical or
neurological problems that were relevant to the
individual’s current or past psychiatric problems.
 Axis IV required clinicians to indicate which of nine
categories of psychosocial or environmental stressors
influenced client conceptualization or care (e.g., recent
divorce, death of partner, job loss).

 Finally, Axis V included the opportunity to provide a Global

Assessment of Functioning (GAF) rating, a number between 0
and 100 intended to indicate overall level of distress or
impairment.
 Axes I, II and III have been eliminated in the DSM-5 (APA,
2013). Clinicians can simply list any disorders or conditions
previously coded on these three Axes together and in
order of clinical priority or focus (APA, 2013).
 ANXIETY AND MOOD DISORDERS
Ch. 16 Psychological Disorders
ANXIETY DISORDERS
 anxiety disorders: psychological disorders
characterized by distressing, persistent anxiety or
maladaptive behaviors that reduce anxiety
 There are several types of anxiety disorders,
including:
 generalized anxiety disorder
 panic disorder
 phobias
 Former Anxiety disorders given their own separate
classification
 obsessive-compulsive disorder
 PTSD
The DSM-5 added a new category of disorders called
Obsessive-Compulsive and Related Disorders
(OCRDs) (also called Obsessive-Compulsive
Spectrum Disorders in the research literature).

The OCRDs category includes the familiar obsessive-

compulsive disorder. It also includes two newly defined
disorders with obsessive-compulsive features.
These are hoarding disorder and excoriation (skin-
picking) disorder. Also included in the new OCRD
category are body dysmorphic disorder
(previously classified as a Somatoform Disorder)
and trichotillomania (hair-pulling, previously
classified as an Impulse Control Disorder Not
Elsewhere Classified).
Generalized Anxiety
Disorder
 An anxiety disorder in which a person is
continually tense, apprehensive, and in a state of
autonomic nervous system arousal
 Tension and apprehension might be observable
through furrowed brows, twitching eyelids,
trembling, perspiration, fidgeting
 Concentration is difficult (worrying all the time)
 2/3 of the sufferers are women
Panic Disorder

 An anxiety disorder marked by minutes-long

episodes of intense dread in which a person
experiences terror and accompanying chest
pain, choking, or other frightening sensations
 The fear of having a panic attack becomes a
problem itself, possibly leading to agoraphobia
(fear or avoidance of situations in which escape
might be difficult or help unavailable when panic
strikes)
Panic Disorder
 Smokers have 2 to 4 times more risk of a first-time panic attack
Phobia
 An anxiety disorder marked by a persistent, irrational fear and
avoidance of a specific object or situation
 specific phobia: fears that are selective, persistent, out of
proportion (e.g. heights, seeing blood)
 social phobia: an intense fear of being scrutinized by others
 person avoids potentially
embarrassing social
situations
Phobias
Just the ‘A’s.
 Ablutophobia- fear of washing or bathing.
 Acousticophobia- fear of noise.
 Alektorophobia- fear of chickens.
 Alliumphobia- fear of garlic.
 Allodoxaphobia- fear of opinions.
 Amathophobia- fear of dust.
 Ambulophobia- fear of walking.
 Anthrophobia or Anthophobia- fear of flowers.
 Anuptaphobia- fear of staying single.
 Arachibutyrophobia- fear of peanut butter sticking to
the roof of the mouth.
 Arithmophobia- fear of numbers.
Explaining Anxiety
Disorders
 Freud’s psychoanalytic perspective assumed
that, starting in childhood, people repress
intolerable impulses, ideas, and feelings and that
this submerged mental energy sometimes
produced symptoms like anxiety
 Today’s psychologists have turned away from
Freud to two contemporary perspectives:
Learning
 Biological
Explaining Anxiety Disorder:
Learning Perspective
 Fear conditioning:
 General anxiety is linked with classical
conditioning of fear
 Inthe laboratory, when rats were given
unpredictable electric shocks, they later
became anxious and apprehensive in their lab
environment
 58% of those with social phobia experienced
their disorder after a traumatic event
Explaining Anxiety Disorder
Learning Perspective
• Stimulus generalization:
– Remember that generalization is the tendency
(once a response has been conditioned) for
stimuli similar to the conditioned stimulus to bring
out similar responses
– ex. A person who is afraid of heights after falling
might later generalize that fear to planes
Explaining Anxiety Disorder
Learning Perspective
 Reinforcement:
 After phobias & compulsions develop,
reinforcements help maintain them
 Avoiding or escaping the feared
situation reduces anxiety thus
reinforcing the phobic behavior
 Compulsive behaviors similarly reduce
anxiety
 Observational learning:
 Learn fear by observing others’ fears
Explaining Anxiety Disorder
Biological Perspective
 Natural Selection:
 We are biologically prepared to fear
threats that had been faced by our
ancestors
 Therefore phobias focus on dangers
faced by our ancestors (e.g. snakes,
closed spaces, heights, storms,
darkness)
 Compulsive acts typically exaggerate
behaviors that help our survival
Explaining Anxiety Disorder
Biological Perspective
 Genes:
 Some people seem more genetically
predisposed to particular fears & high
anxiety
 Identicaltwins often develop similar
phobias, sometimes even when raised
separately
 Explaining Anxiety Disorder
Biological Perspective
• Physiology:
– Anxiety disorders are biologically measurable as
an overarousal of brain areas involved in impulse
control and habitual behaviors
– PET scans of people with obsessive-compulsive
disorder reveal unusually high activity in the frontal
lobes
– Fear learning experiences can traumatize the
brain, by affecting the amygdala
General Romeo Dallaire
 I am still suffering from my experience in Rwanda, I
never know when I'm going to drive my car off a
bridge, or just decide to take my life.
 PTSD – Post-Traumatic
Stress Disorder
 PTSD is a disorder that can develop after going
through a severely threatening, uncontrollable event
that included a sense of helplessness and fear
 e.g.war, assault, road accident, natural disaster,
rape
 Post-Traumatic Stress Disorder
 Symptoms include:
Haunting memories (flashbacks)
Nightmares
Social withdrawal
Jumpy anxiety
Insomnia
 Suffered by about 15% of war veterans (higher
among those who experienced heavy
combat), 50% of people kidnapped, tortured, or
raped, and 4% of people who experienced a
natural disaster
Post-Traumatic Stress Disorder

 Note that for many victims of post-traumatic

stress disorder (PTSD), anxiety increases with any
reminder of the trauma

 Some psychologists believe that PTSD is over-

diagnosed, and most people are quite resilient
to traumatic experiences
Obsessive-Compulsive
Disorder
 A disorder characterized by
 unwanted repetitive thoughts
(obsessions)
 and/or actions (compulsions)
 Obsessive thoughts and compulsive behaviors can be
called a disorder when they are so persistent that they
interfere with the way we live or when they cause distress
 For some people with the disorder, obsessions &
compulsions lessen over time
 Common Obsessions & Compulsions
Among Children & Adolescents with Obsessive-Compulsive
Disorder
Thought or Behavior % Reporting
Symptom
Obsessions (repetitive thoughts)
Concern with dirt, germs, or toxins 40%
Something terrible happening (fire, death, illness) 24
Symmetry, order, or exactness 17

Compulsions (repetitive behaviors)

Excessive hand washing, bathing, tooth brushing, 85
or grooming
Repeating rituals (in/out of a door, up/down from 51
a chair)
Checking doors, locks, appliances, car brake, 46
Howard Hughes, a
billionaire, developed
obsessive-compulsive
disorder. He was afraid of
germs, and so avoided
contact with possible
sources of dirt (including
other people) and
constantly washed his
hands.
He was obsessed with the
size of peas, and used a
special fork to sort them by
size. Also, he compulsively
said the same phrases over
and over again.