Chapter 4: Anxiety, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders

The chapter establishes foundational distinctions between anxiety as a future-oriented state of physiological activation and fear as an immediate response to perceived danger, with panic attacks representing intense episodes that may be situationally triggered or occur unexpectedly. The triple vulnerability model provides an integrative framework suggesting that anxiety pathology emerges from the interaction of biological predisposition, generalized psychological vulnerability involving heightened sensitivity to stress, and specific conditioned fears developed through learning experiences. Generalized anxiety disorder is characterized by persistent and uncontrollable worry accompanied by physical tension and agitation, responsive to cognitive-behavioral approaches and selective serotonin reuptake inhibitors. Panic disorder involves recurrent unexpected panic episodes often leading to agoraphobic avoidance of situations where escape feels impossible, treated through panic control techniques and systematic exposure. Specific phobias represent circumscribed irrational fears amenable to exposure-based intervention. Social anxiety disorder involves fear of social scrutiny and negative judgment, addressed through cognitive restructuring and graduated exposure. Posttraumatic stress disorder emerges following traumatic exposure and involves persistent re-experiencing, emotional numbing, and hypervigilance, with prolonged exposure therapy and cognitive processing showing efficacy. Obsessive-compulsive disorder involves intrusive unwanted thoughts paired with ritualistic behaviors serving to reduce distress, treated primarily through exposure and response prevention combined with pharmacotherapy. The chapter also addresses body dysmorphic disorder characterized by preoccupation with perceived bodily flaws, and repetitive body-focused behaviors including trichotillomania and excoriation disorder, which respond to habit reversal training and cognitive-behavioral modification.