Anxiety Disorders and Obsessive-Compulsive and Related Disorders

Introduction
In this unit, you will learn about the anxiety disorders, including panic disorder, phobias, generalized anxiety, separation anxiety, and social anxiety. You will also review the obsessive-compulsive and related disorders including obsessive-compulsive disorder (OCD), body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation disorder (skin-picking disorder).
Anxiety Disorders
Anxiety can manifest itself in many different types of symptoms. You can find a good list of examples in Table 5.1 on page 110 of the Abnormal Psychology text. People vary in terms of how they experience and describe their feelings of anxiety, and it is important to take a client’s age and sociocultural background into account during your assessment.
A variety of factors can cause a person to have symptoms of anxiety. For example, many medical conditions can lead to similar symptoms, and the use of some drugs or prescription medications can cause anxiety. Factors in a client’s environment—such as living in an unsafe neighborhood, dealing with domestic violence, experiencing harassment and discrimination, living in poverty, or not having access to medical services—can trigger symptoms of fearfulness and apprehension. Taking time to assess a client’s thoughts, behaviors, and emotions as well as understanding how the environment and larger social systems impact these things is important to making an accurate diagnosis.
Obsessive-Compulsive and Related Disorders
Certain obsessive-compulsive and related disorders are characterized by excessive or repetitive behaviors (for example, hand washing, checking, or ordering) while others are categorized by recurrent body-focused repetitive behaviors (for example, hair-pulling or skin-picking). Like anxiety disorders, the etiology of obsessive-compulsive and related disorders may be attributed to biological and environmental factors. Behavioral therapies are very effective for the treatment of these disorders. Starting on page 145, the Abnormal Psychology text describes a common treatment approach called exposure and response prevention.
Psychiatric medications, often called psychotherapeutic or psychotropic medications, are used in a variety of contexts to treat diagnosed mental disorders. Some medications have been found to be effective in the treatment of a wide range of mental disorders, particularly when they are used in combination with counseling or psychotherapy, including anxiety, depression, and OCD. When used as prescribed, they may affect physiological as well as psychological changes that aid clients in feeling a remission of their primary symptomology. While no medication can cure a mental disorder, these medications may be effective in treating the various symptoms associated with the disorder itself.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Nolen-Hoeksema, S. (2014). Abnormal psychology (6th ed.). New York, NY: McGraw-Hill.

Objectives
To successfully complete this learning unit, you will be expected to:
1. Discuss processes used to assess clients with anxiety disorders and obsessive-compulsive and related disorders.
2. Review the diagnostic criteria used to diagnose anxiety disorders and obsessive-compulsive and related disorders.
3. Develop a DSM-5 diagnosis for clients presenting symptoms of anxiety disorders and obsessive-compulsive and related disorders.
4. Discuss the impact of larger social systems on the assessment and diagnostic process for clients diagnosed with anxiety disorders and obsessive-compulsive and related disorders.

Learning Activities
5 Study 1
Studies Readings
Use your Abnormal Psychology text to read pages 106–109 and pages 118–149 of Chapter 5, “Trauma, Anxiety, Obsessive-Compulsive, and Related Disorders.”

Use the library and the Internet to read one of the following articles:
• Benito and Storch’s 2011 article, “Assessment of Obsessive-Compulsive Disorder: Review and Future Directions,” from Expert Review of Neurotherapeutics, volume 11, issue 2, pages 287–298.
• Abramowitz, Baucom, Wheaton, Boeding, Fabricant, Paprocki, and Fischer’s 2013 article, “Enhancing Exposure and Response Prevention for OCD: A Couple-Based Approach,” from Behavior Modification, volume 37, issue 2, pages 189–210.
• Scott’s 2006 article, “The Medicalisation of Shyness: From Social Misfits to Social Fitness,” from Sociology of Health & Illness, volume 28, issue 2, pages 133–153.
• Harmon, Langley, and Ginsburg’s 2006 article, “The Role of Gender and Culture in Treating Youth With Anxiety Disorders,” from Journal of Cognitive Psychotherapy, volume 20, issue 3, pages 301–310.
• Beesdo, Knappe, and Pine’s 2009 article, “Anxiety and Anxiety Disorders in Children and Adolescents: Developmental Issues and Implications for DSM-V,” from Psychiatric Clinics of North America, volume 32, issue 3, pages 483–524.
Use the Internet to complete the following:
• Review “Mental Health Medications” from the National Institute of Mental Health. This publication identifies many types of medications used to treat mental disorders and discusses their efficacy and side effects. Review the medications used to treat the mental disorders discussed in this unit.
• Review the ethical codes for a professional counseling association (for example, ACA, AAMFT, or NAADAC).
DSM-5 Review
Read the following from the chapter “Other Conditions That May Be a Focus of Clinical Attention,” from Section II of the DSM-5:
• “Relational Problems,” pages 715–716.
Review the following chapters from Section II:
• “Anxiety Disorders,” pages 189–233.
• “Obsessive-Compulsive and Related Disorders,” pages 235–264.
Media
• Click Launch Presentation to view Case Studies of a Couple and a Family.
• Click Launch Illustration to view Case Study: Sam and Lisa. You will use one of the cases from this media in this unit’s discussion.

Case Studies of a Couple and a Family
Vignette of a Couple
Robert and Sophia are in their early 30’s and have been married for five years. Robert’s parents moved to the U.S. from Germany when he was 15 years old; he is an only child who felt very isolated during high school and college. Sophia is from a large Italian family that has been living in the U.S. for several generations. Sophia was abused by an uncle as a child, but was too afraid and ashamed to tell anyone.
Both Robert and Sophia work long hours at demanding jobs, and they feel exhausted and stressed at the end of the day. Typically, they drink a bottle or two of wine with dinner, and often argue about the amount of time Sophia spends with her family, Robert’s frequent business trips out of town, or when they should start to have children.
Three weeks ago, Sophia discovered that Robert had an affair with a co-worker the previous summer. Robert refuses to discuss this except to say that it was “a mistake.” Robert admits he has felt unhappy in the marriage and depressed for over two years, but he does not think talking about it will help.
Sophia feels betrayed and furious. For the past week she has been unable to concentrate at work, can’t sleep, and feels irritable much of the time. She pleads with Robert to tell her what he needs, but he is silent and withdrawn. His drinking has increased and he is becoming more depressed.
Sophia has been going through Robert’s computer and mail when he is not at home, and she discovered current messages he had written to another women describing his hopeless feelings about the marriage and thoughts of suicide. Two nights ago Sophia confronted Robert with this correspondence, and she became so angry that she threw a glass at him, which shattered and cut his arm. This incident frightened them both, and they have decided to get marriage counseling.
Vignette of a Family
The Jones family is an African-American family consisting of Harold (42), Shirley (36), and their two children, Ben (13) and Tracy (9). Shirley has been deployed overseas for the past 18 months. During this time Harold’s mother Barbara has been living with the family. Ben has become very withdrawn during his mother’s absence; he is often truant from school and Harold suspects he is using drugs. Tracy is doing well in her school work, but has temper tantrums at home when things do not go her way. Harold was recently laid off from a job he held for over 10 years and is feeling very discouraged. His mother has loaned him money until he can find another job, but he worries about his ability to take care of his family.
Shirley returned home from duty three weeks ago. She was initially very happy to see her family, but is having trouble adjusting to being back home. She does not get along with Harold’s mother and the two women argue constantly. She has been having difficulty sleeping, feels like she is “in a daze” much of the time, refuses to go into town saying it is “too noisy and too crowded,” and doesn’t seem interested in connecting with her old friends. When the children want to spend time with her, Shirley becomes irritable and says she is too tired.
Tracy has been crying frequently since her mother has returned, and Ben disappeared for two days without telling anyone where he was. Harold feels overwhelmed and does not know what to do. When he discovered some marijuana in Ben’s room, he decided the family needed to see a therapist.

Case Study: Sam and Lisa
Sam
Sam R. is a 16-year-old African American high school student. He has recently moved to a new town with his parents and younger sister due to his father’s promotion and job transfer. Sam’s old high school included a mix of students from many racial, ethnic, and economic backgrounds. At his new school, there are few African American students and Sam feels like an outsider.
Sam has always been a quiet and serious person. Although he usually has one or two close friends, he feels awkward trying to start conversations with others and has never mixed easily in large groups. A good deal of activity at this new school takes place around sports and student government; two areas Sam has little interest in.
Sam also feels unprepared for the level of work that is expected of him at this school, particularly the emphasis placed on presenting oral reports and participating in debates in front of the class. He becomes embarrassed and tongue-tied when he has to speak in front of others. Sam often “gets sick” on the day of an oral report so he can stay home from school, and he is worried this will impact his grades.

Lisa
Lia is a 32-year-old Caucasian bank teller. She has been married for five years and has a 3-year-old daughter. Lisa’s job requires her to interact with customers on a daily basis. Her work involves processing routine bank transactions including cashing checks and depositing and exchanging money.
Lisa is constantly fearful of coming into contact with anything that might be contaminated. Concerned about bacteria and viruses from the money she handles, Lisa hurries to the bathroom to wash her hands after each teller transaction. She is convinced the bacteria on her hands will cause an illness, serious or fatal, eventually leading to her inability to take care of her family. Lisa spends up to ten minutes each time in the bathroom. This has caused delays in getting her work done. Despite spending a significant part of her day washing and using hand sanitizer, Lisa constantly doubts her cleanliness. If she accidently touches something she believes is dirty, she immediately washes her hands. This has resulted in bleeding and skin abrasions.
Lisa showers twice daily and systematically washes each body part starting with her head and working down to her feet. This often takes her one hour each time. After showering, Lisa “drip dries” so that her bath towel does not spread germs. To avoid spreading germs at home, she excessively uses Lysol on household objects, sanitizes dishes using several wash cycles, and even uses her elbow to flip light switches. Lisa’s husband often assists with the daily cleaning to reassure her that the house is clean.

Optional – Readings
Refer to Optional Readings for Principles of Psychopathology for a list of additional articles about the mental disorders and current issues regarding assessment, diagnosis, and treatment you are studying in this unit.
Unit 5 – Anxiety Disorders and Obsessive-Compulsive and Related Disorders
Articles
Beidel, D. C., & Turner, S. M. (2007). Assessment of social anxiety disorder. In Shy children, phobic adults: Nature and treatment of social anxiety disorders (2nd ed.) (pp. 121–150). Washington, DC: American Psychological Association.
Cooley, M. R., & Boyce, C. A. (2004). An introduction to assessing anxiety in child and adolescent multiethnic populations: Challenges and opportunities for enhancing knowledge and practice. Journal of Clinical Child and Adolescent Psychology, 33(2), 210–215.
Hamilton, J. M. (2008). Culture bound: Anxiety disorder in adolescence: A case study. Journal of Child and Adolescent Psychiatric Nursing, 21(3), 186–190.
Neal-Barnett, A. M., & Crowther, J. H. (2000). To be female, middle class, anxious, and Black. Psychology of Women Quarterly, 24(2), 129–136.
Scott, S. (2006). The medicalisation of shyness: From social misfits to social fitness. Sociology of Health & Illness, 28(2), 133–153.
Gallagher, S., & Doherty, D. T. (2010). A comparative analysis of users and non-users of prescribed psychotropic medication among individuals who reported mental health problems. The Internet Journal of Mental Health, 6(2).

Discussion 1: 1 page needed with minimum of 250 words and 2 references.
Anxiety or Obsessive-Compulsive Disorder Diagnosis
Review the media Case Study: Sam and Lisa. Select one case to respond to for this discussion.
Based on your reading of the vignette, discuss the possible diagnoses you considered when thinking about the client’s presenting issues.
1. What diagnosis would you make?
2. What is your rationale for how the client meets all of the specific DSM-5 diagnostic criteria for the mental disorder you have selected?
3. What other information would you need if your client does not meet all of the criteria?
4. What are some examples of current medications being used to treat this diagnosis?
o What are the benefits the client might receive from taking medication, and what are the potential side effects?
o What other issues or concerns would you want to address when considering the use of medication with this client?
5. How is the impact of the larger social system (family, school, work, and community) important to consider when assessing and diagnosing the client?
Support your ideas with references to the course texts, articles from this learning unit, articles from the Optional Readings for Principles of Psychopathology list, or articles from peer-reviewed journals that you locate in the library.

 

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