ASSIGNMENT

Anxiety and Personality Disorders

Submitted to:
Imran Haider Zaidi

Submitted by:
Rabia Azhar
(1599)

M.Sc.
2nd Semester (Eve)

Department of Applied Psychology

Government College University Faisalabad
 Table of Content

No Title Page No.

1. Anxiety Disorder 1
2. Separation Anxiety Disorder 1
3. Selective Mutism 4
4. Specific Phobia 5
5. Social Anxiety Disorder (Social Phobia) 6
6. Panic Disorder 7
7. Panic Attack Specifier 8
8. Agoraphobia 9
9. Generalized Anxiety Disorder 10
10. Substance/Medication Induced Anxiety Disorders 11
11. Anxiety Disorder Due to Another Medical Condition 12
12. Other Specified Anxiety Disorder 14
13. Unspecified Anxiety Disorder 14
14. Personality Disorders and types 14
15. Q # 03 20
16. Q # 04 21
17. Q # 05 23
18. References 26
Q NO 1. Give a brief description of ANXIRTY DISORDERS with etiology,
prevalence and differential diagnosis.

Anxiety Disorders

Anxiety Disorders include disorders that share features of excessive fear and anxiety and
related behavioral disturbances. Fear is the emotional response to real or perceived imminent
threat, whereas anxiety is anticipation of future threat. Obviously, these two states overlap,
but they also differ, with fear more often associated with surges of autonomic arousal
necessary for fight or flight, thoughts of immediate danger, and escape behaviors, and anxiety
more often associated with muscle tension and vigilance in preparation for future danger and
cautious or avoidant behaviors. Sometimes the level of fear or anxiety is reduced by
pervasive avoidance behaviors. Panic attacks feature prominently within the anxiety disorders
as a particular type of fear response. Panic attacks are not limited to anxiety disorders but
rather can be seen in other mental disorders as well.

1. Separation Anxiety Disorder

Symptoms:
• Clinging to parents
• Extreme and severe crying
• Refusal to do things that require separation
• Physical illness, such as headaches or vomiting
• Violent, emotional temper tantrums
• Refusal to go to school
• Poor school performance
• Failure to interact in a healthy manner with other children
• Refusing to sleep alone
• Nightmares
Etiology:

• A family history of anxiety or depression

• Shy, timid personalities
• Low socioeconomic status
• Overprotective parents

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 • A lack of appropriate parental interaction
• Problems dealing with kids their own age
Differential Diagnosis:
• Child-directed interaction therapy
• Bravery-directed interaction therapy
• Parent-directed interaction therapy
• Medication
Prevalence
The 12-month prevalence of separation anxiety disorder among adults in the United States is
0.9%-1.9%. In children, 6- to 12-month prevalence is estimated to be approximately 4%. In
adolescents in the United States, the 12-month prevalence is 1.6%. Separation anxiety
disorder decreases in prevalence from childhood through adolescence and adulthood and is
the most prevalent anxiety disorder in children younger than 12 years. In clinical samples of
children, the disorder is equally common in males and females. In the community, the
disorder is more frequent in females.
Bio Psychosocial Model Causes
When psychologists use the word "environment," they mean all the things that are happening
around us. Used in this way, environment references our life experiences, particularly social
interactions with other people, especially caregivers, family members, etc. Theoretically,
people develop an anxiety disorder when they possess both biological and psychological
"vulnerabilities," coupled with a social environment that set-off, or trigger these
vulnerabilities.
The biological aspect of the biopsychosocial model refers to the body's physiological,
adaptive responses to fear. It also refers to genetic traits, and the brain functioning that we
"inherit." More specifically, what is passed down is a genetic vulnerability expressed as a
"personality type" (Bourne, 2000). This personality type describes a person who is more
reactive, more sensitive, and/or more easily excitable in the presence of stress.
Although we may be born with a biologically determined, heightened sensitivity to stress,
this fact alone is insufficient to create an anxiety disorder. The psychological factors in the
biopsychosocial model refer to our thoughts, beliefs, and perceptions about our experiences,
our environment, and ourselves. These cognitive patterns affect our perceived sense of
control over our environment. These cognitive patterns also influence how we assess and
interpret events in our environment as either threatening or non-threatening.

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These thoughts (cognitions) about our environment, and ourselves, play a key role in the
formation of an anxiety disorder. For instance, one child's mother makes a correction to her
son's homework. He interprets this as helpful and indicative of his parent's confidence in his
ability to learn. Another child's mother makes a correction to her daughter's homework, and
instead of interpreting this as helpful, the daughter interprets this as an indication of her
limitations, and her parent's lack of confidence in her abilities. This furthers strengthens her
own lack of confidence in herself.
Previously, we mentioned anxiety develops from the perceived gap between one's estimated
ability to cope with a challenge, and the estimated difficulty of the task itself. From the
example of the two children described above, you can imagine how the son might grow up to
become a man who has confidence in his skills when faced with a challenging task. Thus,
when estimating the perceived gap between his abilities and a challenging task, he will be
less likely to experience anxiety. In contrast, the daughter may grow up to be a woman who
lacks this self-confidence. When she is faced with a challenging task, she is more likely to
experience anxiety. This is because she is likely to overestimate the perceived gap between
her abilities and the task itself. Thus, because of these differences in their psychological
make-up, the daughter would be at greater risk for developing an anxiety disorder.
According to Barlow (2002), once the biological and psychological vulnerabilities are in
place, an individual may then "learn," from their social environment (such as their family), to
focus their anxiety on specific objects, or situations in their environment. Thus, the social
component of the model refers to environmental factors that may trigger, shape, and
strengthen the biological and psychological vulnerabilities. Environmental factors can include
stressors that commonly affect everyone, such as the tragic events of 9-11. They can also be
more individualized stressors that may not be experienced by everyone. This might include
financial stress, loss of a loved one, or pet loss.
Our social environment includes different role-models that can have a significant influence
on any preexisting vulnerabilities. To illustrate the influence of role models in the formation
of anxiety disorders, consider adolescent peer groups. These peer groups often contribute
strong opinions about what behaviors will help, or hurt, someone's chances of gaining
entrance into the "in crowd." Subsequently, by observing how their peers behave, adolescents
learn what behaviors and attitudes will help them become accepted, or at least, not rejected
by their peers. Although a certain amount of concern over peers' opinions is developmentally
normal, some teens are particularly sensitive to their peers' opinions. They may have a
tendency to become excessively preoccupied with their peers' evaluations. Ironically, this
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excessive preoccupation interferes with the very relationships and peer approval they are so
desperately trying to obtain. Unfortunately for these youth, this preoccupation often results in
clinical levels of worry, avoidance behavior, and feelings of anxiety.
2. Selective Mutism

Symptoms:

• Excessive shyness
• Social isolation
• Fear of embarrassment in front of a group
• Clinging to caregivers
• Temper tantrums
• Oppositional behaviour
• Compulsive traits
• Negativity

Etiology:

• Temperamental factors
• Environmental issues
• Genetics

Differential Diagnosis:

• Contingency management
• Shaping
• Stimulus fading
• Desensitization
• Cognitive reframing
• Social skills

Prevalence:

Selective mutism is a relatively rare disorder. According to the DSM-5, the occurrence of this
condition ranges between 0.03% and 1%, depending on the setting. Selective mutism is more
likely to appear in children than adults, but does not seem to vary based on gender or

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race/ethnicity. The average age of onset is before five years old, but many children are not
diagnosed until they enter school.

3. Specific Phobia

Symptoms:

• Racing heart
• Difficulty breathing
• Trembling or shaking
• Sweating
• Nausea
• Dry mouth
• Chest pain or tightness

Etiology:

In most cases, specific phobias develop in early childhood between the ages of 7 and 11,
though it is possible for a phobia to develop at any age. Specific phobias can be caused by a
variety of different factors: experiencing a traumatic event (e.g. being attacked by a dog);
observing others going through a traumatic event (e.g. witnessing a car accident); an
unexpected panic attack (e.g. while flying in an airplane); or informational transmission (e.g.
extensive media coverage of a terrorist attack).

Often, those affected by a specific phobia are unable to identify the reason why their phobia
developed. While the cause of a specific phobia may be unknown, it is important to recognize
the symptoms and remember that phobias can be treatable if you seek help from a mental
health professional.

Differential Diagnosis:

• Cognitive Behavioral Therapy (CBT)

• Medication

Prevalence:

In the United States, the 12-month community prevalence estimate for specific phobia is

approximately 7%-9%. Prevalence rates in European countries are largely similar to those

in the United States (e.g., about 6%), but rates are generally lower in Asian, African, and

Latin American countries (2%-4%). Prevalence rates are approximately 5% in children and

are approximately 16% in 13- to 17-year-olds. Prevalence rates are lower in older individuals

(about 3%-5%), possibly reflecting diminishing severity to subclinical levels. Females

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are more frequently affected than males, at a rate of approximately 2:1, although rates vary

across different phobic stimuli. That is, animal, natural environment, and situational specific

phobias are predominantly experienced by females, whereas blood-injection-injury

phobia is experienced nearly equally by both genders.

4. Social Anxiety Disorder (Social Phobia)

Symptoms:
• Marked affective lability such as mood swings
• Blushing
• Fast heartbeat
• Trembling
• Sweating
• Upset stomach or nausea
• Trouble catching your breath
• Dizziness or lightheadedness
• Feeling that your mind has gone blank
• Muscle tension
Etiology:
• Inherited traits
• Brain structure
• Environment

Differential Diagnosis:
• Cognitive behavioural therapy
• Exposure therapy
• Group therapy
• Avoiding caffeine
Prevalence:
The 12-month prevalence estimate of social anxiety disorder for the United States is
approximately7%. Lower 12-month prevalence estimates are seen in much of the world using
the same diagnostic instrument, clustering around 0.5%-2.0%; median prevalence in Europe
is 2.3%. The 12-month prevalence rates in children and adolescents are comparable to those
in adults. Prevalence rates decrease with age. The 12-month prevalence for older adults
ranges from 2% to 5%. In general, higher rates of social anxiety disorder are found in females
than in males in the general population (with odds ratios ranging from 1.5 to 2.2), and the

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gender difference in prevalence is more pronounced in adolescents and young adults. Gender
rates are equivalent or slightly higher for males in clinical samples, and it is assumed that
gender roles and social expectations play a significant role in explaining the heightened help-
seeking behaviour in male patients. Prevalence in the United States is higher in American
Indians and lower in persons of Asian, Latino, African American, and Afro-Caribbean
descent compared with non-Hispanic whites.
5. Panic Disorder
Symptoms:

• Palpitations, pounding heart, or accelerated heart rate

• Sweating
• Trembling or shaking
• Shortness of breath
• Feelings of choking
• Chest pain or discomfort
• Feeling dizzy, unsteady, light-headed, or faint
• Chills or heat sensations
• Fear or losing control or “going crazy”
• Fear of dying

Etiology:

• Sexual or physical abuse

• Smoking
• Interpersonal stressors
Differential Diagnosis:

• Selective serotonin reuptake inhibitors (SSRIs)

• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Benzodiazepines

Prevalence:

In the general population, the 12-month prevalence estimate for panic disorder across the
United States and several European countries is about 2%-3% in adults and adolescents. In
the United States, significantly lower rates of panic disorder are reported among Latinos,
African Americans, Caribbean blacks, and Asian Americans, compared with non-Latino

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whites; American Indians, by contrast, have significantly higher rates. Lower estimates have
been reported for Asian, African, and Latin American countries, ranging from 0.1% to 0.8%.
Females are more frequently affected than males, at a rate of approximately 2:1. The gender
differentiation occurs in adolescence and is already observable before age 14 years. Although
panic attacks occur in children, the overall prevalence of panic disorder is low before age 14
years (<0.4%). The rates of panic disorder show a gradual increase during adolescence,
particularly in females, and possibly following the onset of puberty, and peak during
adulthood. The prevalence rates decline in older individuals (i.e., 0.7% in adults over the age
of 64), possibly reflecting diminishing severity to subclinical levels.

6. Panic Attack Specifier

Symptoms:

• Palpitations, pounding heart, or accelerated heart rate

• Sweating
• Trembling or shaking
• Shortness of breath
• Feelings of choking
• Chest pain or discomfort
• Feeling dizzy, unsteady, light-headed, or faint
• Chills or heat sensations
• Fear or losing control or “going crazy”
• Fear of dying

Etiology:

• Sexual or physical abuse

• Smoking
• Interpersonal stressors

Differential Diagnosis:

• Get treatment for panic attacks

• Stick with your treatment plan
• Get regular physical activity

Prevalence

In the general population, 12-month prevalence estimates for panic attacks in the United
States is 11.2% in adults. Twelve-month prevalence estimates do not appear to differ

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significantly among African Americans, Asian Americans, and Latinos. Lower 12-month
prevalence estimates for European countries appear to range from 2.7% to 3.3%. Females are
more frequently affected than males, although this gender difference is more pronounced for
panic disorder. Panic attacks can occur in children but are relatively rare until the age of
puberty, when the prevalence rates increase. The prevalence rates decline in older
individuals, possibly reflecting diminishing severity to subclinical levels.

7. Agoraphobia

Symptoms:

• Rapid heart rate

• Excessive sweating
• Trouble breathing
• Feeling shaky, numb, or tingling
• Chest pain or pressure
• Lightheadedness or dizziness
• Sudden flushing or chills
• Upset stomach or diarrhea
• Feeling a loss of control
• Fear of dying

Etiology:

Researchers are still working to identify the biologic cause of agoraphobia, but they now
know that it often is associated with panic disorder. Panic disorder is another type of anxiety
disorder. People with panic disorder experience short, intense attacks of extreme fear for no
specific reason. During a panic attack, the heart rate speeds up, the person may sweat, feel
nauseous, and the need to flee or escape. An estimated 1/3 of people who have panic disorder
develop agoraphobia. Agoraphobia also can occur on its own.

Differential Diagnosis:

• Using public transportation, such as a bus or plane

• Being in an open space, such as a parking lot, bridge or large mall
• Being in an enclosed space, such as a movie theater, meeting room or small store
• Waiting in a line or being in a crowd
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 • Being out of the home alone

Prevalence

Every year approximately 1.7% of adolescents and adults have a diagnosis of agoraphobia.
Females are twice as likely as males to experience agoraphobia. Agoraphobia may occur in
childhood, but incidence peaks in late adolescence and early adulthood. Twelve-month
prevalence in individuals older than 65 years is 0.4%. Prevalence rates do not appear to vary
systematically across cultural/racial groups.

8. Generalized Anxiety Disorder

Symptoms:

• Perpetual state of constant worry

• Inability to relax or enjoy quiet time
• Muscle tightness or body aches
• Feeling tense
• Avoidance of stressful situations
• Fatiguing easily
• Heart palpitations – feeling like your heart is racing
• Trembles or shakes
• Sweating and dry mouth
• Having difficulty breathing and/or feeling like you are choking
• Feeling lightheaded or dizzy
• Cold chills or hot flashes
• Numbness or tingling sensations
• Feeling like you have a lump in your throat
• Persistent irritability

Etiology:

• Genetics
• Brain chemistry
• Environmental factors

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Differential Diagnosis:

• Psychotherapy
• Medications
• Daily exercise
• Limiting or stopping the use of caffeine
• Eating a healthy, well-balanced diet

Prevalence

The 12-month prevalence of generalized anxiety disorder is 0.9% among adolescents and
2.9% among adults in the general community of the United States. The 12-month prevalence
for the disorder in other countries ranges from 0.4% to 3.6%. The lifetime morbid risk is
9.0%. Females are twice as likely as males to experience generalized anxiety disorder. The
prevalence of the diagnosis peaks in middle age and declines across the later years of life.
Individuals of European descent tend to experience generalized anxiety disorder more
frequently than do individuals of non-European descent (i.e., Asian, African, Native
American and Pacific Islander). Furthermore, individuals from developed countries are more
likely than individuals from nondeveloped countries to report that they have experienced
symptoms that meet criteria for generalized anxiety disorder in their lifetime.

9. Substance/Medication-Induced Anxiety Disorders

Symptoms:

• Thinking that bad things will happen or that you will never get better
• Having trouble falling asleep or waking up often during the night
• Having trouble concentrating or remembering things
• Fearing that you are losing control of yourself and will go crazy or will die
• Losing weight because you don't feel like eating, or because your stomach hurts or
you have vomiting or diarrhea
• Having chills, hot flashes, sweating, shaking, numbness, or a pounding heartbeat
• Having trouble breathing, trouble swallowing, or chest pain

Etiology:

Your healthcare provider will ask how much and how often you use nonprescription, prescription,
and illegal drugs. Be honest about the medicines and drugs you use. Your provider needs this
information to give you the right treatment. He will also ask about your symptoms, medical history
and give you a physical exam. You may have tests or scans to help make a diagnosis.

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Differential Diagnosis:

• Therapy
• Yoga
• Meditation

Prevalence

The prevalence of substance/medication-induced anxiety disorder is not clear. General

population data suggest that it may be rare, with a 12-month prevalence of approximately
0.002%. However, in clinical populations, the prevalence is likely to be higher.

10. Anxiety Disorder Due to Another Medical Condition

Symptoms:
In anxiety due to another medical condition, the most frequently displayed symptom is
anxiety in some form, even though there is another medical condition present that underlies
and leads to the anxiety. General characteristics of anxiety include muscle tension, heart
palpitations, sweating, dizziness, or difficulty catching the breath. In addition to these
physical symptoms, anxiety in general also leads to restlessness, possibly a fear of something
impending that will be catastrophic, or fear of being embarrassed or humiliated.
Anxiety due to another medical condition may exhibit several symptom pictures. For
example, if the anxiety shows itself as panic disorder, symptoms may include sudden onset of
terror with no specific precipitating event (NIMH, n.d.). Along with the terror, a pounding
heart, sweating, feeling faint, or dizziness may be experienced. The patient with panic may
have physical symptoms that suggest a heart attack, also. These include feeling chilled,
numbness in hands, nausea, chest pain, and feelings of smothering. A sense of loss of touch
with reality, fear of some impending doom, and fear of losing control add to the impact of
panic. Many people who experience panic attacks are convinced they are having a heart
attack and seek medical attention at emergency rooms.
Etiology:
One of the major considerations in diagnosing anxiety due to another medical condition is to
be certain the anxiety doesn’t occur just during the course of delirium. It is appropriate to
make the diagnosis if the anxiety occurs directly due to dementia, however.
Differentiation of anxiety due to the effects of continuing substance use or abuse must be
considered, also (Gagarina, 2011). Withdrawal from a substance or exposure to a toxic
substance would lead to a diagnosis of Substance-Induced Anxiety. Medical examination

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including drug screens would be useful in this situation. It is possible to have a dual diagnosis
of Anxiety Due to Another Medical Condition and Substance-Induced Anxiety disorder if
criteria for both diagnoses are met.
A primary anxiety disorder or an adjustment disorder with anxiety are two other conditions
that must be differentiated from anxiety due to another medical disorder. In the first of these,
there is no direct link to a medical condition that causes the anxiety. In the other, onset of the
anxiety at a later age or a family or personal history of anxiety should suggest an adjustment
disorder.
Differential Diagnosis:
Most of the time, anxiety disorders are treated effectively with medications. Specific types of
psychotherapy are also useful. Many times, these treatment approaches are used together.
Without treatment, anxiety disorders tend to become chronic (Karl, 2013).
In the case of anxiety due to another medical condition, treatment of the anxiety may have to
be postponed until the underlying medical condition is successfully treated. This depends on
the medical condition and whether it is potentially life-threatening. Often, treatment of both
conditions can occur simultaneously. Whether this happens may depend on the treatment
conditions for the medical disorder (NIMH, n.d.).
Medications used in the treatment of anxiety do not cure anxiety, but do keep the symptoms
under control while the patient is undergoing psychotherapy to deal with the root of the
anxiety. Primary medications used in treating anxiety are antidepressants, anti-anxiety
medications, and beta-blockers.
Antidepressants originally developed to help with symptoms of depression also have a
positive effect on anxiety. They frequently require several weeks before getting into the
bloodstream at a sufficient level to reduce symptoms. Thus, it is important they be given a
sufficient trial.
SSRIs such as fluoxetine, sertraline, escitalopram, paroxetine, and citalopram are useful in
treating some anxiety symptoms. Venlafaxine is useful for generalized anxiety disorder
symptoms. Tricyclics such as imipramine and clomipramine are used, as well.
Prevalence:
The prevalence of anxiety disorder due to another medical condition is unclear. There appears
to be an elevated prevalence of anxiety disorders among individuals with a variety of medical
conditions, including asthma, hypertension, ulcers, and arthritis. However, this increased
prevalence may be due to reasons other than the anxiety disorder directly causing the medical
condition.
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 11. Other Specified Anxiety Disorder
This category applies to presentations in which symptoms characteristic of an anxiety
disorder that cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning predominate but do not meet the full criteria for any of
the disorders in the anxiety disorders diagnostic class. The other specified anxiety disorder
category is used in situations in which the clinician chooses to communicate the specific
reason that the presentation does not meet the criteria for any specific anxiety disorder. This
is done by recording "other specified anxiety disorder" followed by the specific reason (e.g.,
"generalized anxiety not occurring more days than not").
12.Unspecified Anxiety Disorder
This category applies to presentations in which symptoms characteristic of an
anxiety disorder that cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning predominate but do not
meet the full criteria for any of the disorders in the anxiety disorders diagnostic
class. The unspecified anxiety disorder category is used in situations in which
the clinician chooses not to specify the reason that the criteria are not met for a
specific anxiety disorder, and includes presentations in which there is
insufficient information to make a more specific diagnosis (e.g., in emergency
room settings).
Q NO 2. Give a brief description of PERSONALITY DISORDERS with
etiology, prevalence and differential diagnosis.

PERSONALITY DISORDERS
A personality disorder is a type of mental disorder in which you have a rigid and unhealthy
pattern of thinking, functioning and behaving. A person with a personality disorder has
trouble perceiving and relating to situations and people. This causes significant problems and
limitations in relationships, social activities, work and school.
In some cases, you may not realize that you have a personality disorder because your way of
thinking and behaving seems natural to you. And you may blame others for the challenges
you face.

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Personality disorders usually begin in the teenage years or early adulthood. There are many
types of personality disorders. Some types may become less obvious throughout middle age.
Symptoms
Types of personality disorders are grouped into three clusters, based on similar characteristics
and symptoms. Many people with one personality disorder also have signs and symptoms of
at least one additional personality disorder. It's not necessary to exhibit all the signs and
symptoms listed for a disorder to be diagnosed.
Cluster A personality disorders
Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They
include paranoid personality disorder, schizoid personality disorder and schizotypal
personality disorder.
Paranoid personality disorder
• Pervasive distrust and suspicion of others and their motives
• Unjustified belief that others are trying to harm or deceive you
• Unjustified suspicion of the loyalty or trustworthiness of others
• Hesitancy to confide in others due to unreasonable fear that others will use the
information against you
• Perception of innocent remarks or nonthreatening situations as personal insults or
attacks
• Angry or hostile reaction to perceived slights or insults
• Tendency to hold grudges
• Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful
Schizoid personality disorder
• Lack of interest in social or personal relationships, preferring to be alone
• Limited range of emotional expression
• Inability to take pleasure in most activities
• Inability to pick up normal social cues
• Appearance of being cold or indifferent to others
• Little or no interest in having sex with another person
Schizotypal personality disorder
• Peculiar dress, thinking, beliefs, speech or behavior
• Odd perceptual experiences, such as hearing a voice whisper your name
• Flat emotions or inappropriate emotional responses

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 • Social anxiety and a lack of or discomfort with close relationships
• Indifferent, inappropriate or suspicious response to others
• "Magical thinking" — believing you can influence people and events with your
thoughts
• Belief that certain casual incidents or events have hidden messages meant only for
you
Cluster B personality disorders
Cluster B personality disorders are characterized by dramatic, overly emotional or
unpredictable thinking or behavior. They include antisocial personality disorder, borderline
personality disorder, histrionic personality disorder and narcissistic personality disorder.
Antisocial personality disorder
• Disregard for others' needs or feelings
• Persistent lying, stealing, using aliases, conning others
• Recurring problems with the law
• Repeated violation of the rights of others
• Aggressive, often violent behavior
• Disregard for the safety of self or others
• Impulsive behavior
• Consistently irresponsible
• Lack of remorse for behavior
Borderline personality disorder
• Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating
• Unstable or fragile self-image
• Unstable and intense relationships
• Up and down moods, often as a reaction to interpersonal stress
• Suicidal behavior or threats of self-injury
• Intense fear of being alone or abandoned
• Ongoing feelings of emptiness
• Frequent, intense displays of anger
• Stress-related paranoia that comes and goes

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Histrionic personality disorder
• Constantly seeking attention
• Excessively emotional, dramatic or sexually provocative to gain attention
• Speaks dramatically with strong opinions, but few facts or details to back them up
• Easily influenced by others
• Shallow, rapidly changing emotions
• Excessive concern with physical appearance
• Thinks relationships with others are closer than they really are
Narcissistic personality disorder
• Belief that you're special and more important than others
• Fantasies about power, success and attractiveness
• Failure to recognize others' needs and feelings
• Exaggeration of achievements or talents
• Expectation of constant praise and admiration
• Arrogance
• Unreasonable expectations of favors and advantages, often taking advantage of others
• Envy of others or belief that others envy you
Cluster C personality disorders
Cluster C personality disorders are characterized by anxious, fearful thinking or behavior.
They include avoidant personality disorder, dependent personality disorder and obsessive-
compulsive personality disorder.
Avoidant personality disorder
• Too sensitive to criticism or rejection
• Feeling inadequate, inferior or unattractive
• Avoidance of work activities that require interpersonal contact
• Socially inhibited, timid and isolated, avoiding new activities or meeting strangers
• Extreme shyness in social situations and personal relationships
• Fear of disapproval, embarrassment or ridicule
Dependent personality disorder
• Excessive dependence on others and feeling the need to be taken care of
• Submissive or clingy behavior toward others
• Fear of having to provide self-care or fend for yourself if left alone

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 • Lack of self-confidence, requiring excessive advice and reassurance from others to
make even small decisions
• Difficulty starting or doing projects on your own due to lack of self-confidence
• Difficulty disagreeing with others, fearing disapproval
• Tolerance of poor or abusive treatment, even when other options are available
• Urgent need to start a new relationship when a close one has ended
Obsessive-compulsive personality disorder
• Preoccupation with details, orderliness and rules
• Extreme perfectionism, resulting in dysfunction and distress when perfection is not
achieved, such as feeling unable to finish a project because you don't meet your own
strict standards
• Desire to be in control of people, tasks and situations, and inability to delegate tasks
• Neglect of friends and enjoyable activities because of excessive commitment to work
or a project
• Inability to discard broken or worthless objects
• Rigid and stubborn
• Inflexible about morality, ethics or values
• Tight, miserly control over budgeting and spending money
Etiology:
• Genes
Certain personality traits may be passed on to you by your parents through inherited
genes. These traits are sometimes called your temperament.
• Environment
This involves the surroundings you grew up in, events that occurred, and relationships
with family members and others.
Differential Diagnosis :
• Physical exam
The doctor may do a physical exam and ask in-depth questions about your health. In some
cases, your symptoms may be linked to an underlying physical health problem. Your
evaluation may include lab tests and a screening test for alcohol and drugs.

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 • Psychiatric evaluation
This includes a discussion about your thoughts, feelings and behavior and may include a
questionnaire to help pinpoint a diagnosis. With your permission, information from family
members or others may be helpful.
• Psychotherapy
During psychotherapy with a mental health professional, you can learn about your condition
and talk about your moods, feelings, thoughts and behaviors. You can learn to cope with
stress and manage your disorder.
Psychotherapy may be provided in individual sessions, group therapy, or sessions that include
family or even friends. There are several types of psychotherapy — your mental health
professional can determine which one is best for you.
• Medications
There are no medications specifically approved by the Food and Drug Administration (FDA)
to treat personality disorders. However, several types of psychiatric medications may help
with various personality disorder symptoms.
Antidepressants. Antidepressants may be useful if you have a depressed mood, anger,
impulsivity, irritability or hopelessness, which may be associated with personality disorders.
Mood stabilizers. As their name suggests, mood stabilizers can help even out mood swings
or reduce irritability, impulsivity and aggression.
Antipsychotic medications. Also called neuroleptics, these may be helpful if your symptoms
include losing touch with reality (psychosis) or in some cases if you have anxiety or anger
problems.
Anti-anxiety medications. These may help if you have anxiety, agitation or insomnia. But in
some cases, they can increase impulsive behavior, so they're avoided in certain types of
personality disorders.
Prevalence:
Epidemiological studies on personality disorders in community samples are rare, whereas
prevalence rates are fairly high and vary substantially depending on samples and methods.
Future studies investigating the epidemiology of personality disorders based on the DSM-5
and ICD-11 and models of personality functioning and traits are needed, and efficient
treatment should be a priority for healthcare systems to reduce disease burden. Declaration of
interest None.

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Q NO 3. Write a note on psychoanalysis as psychotherapy.
Ans:- Psychoanalytic or psychodynamic psychotherapy draws on theories and practices of
analytical psychology and psychoanalysis. It is a therapeutic process which helps patients
understand and resolve their problems by increasing awareness of their inner world and its
influence over relationships both past and present. It differs from most other therapies in
aiming for deep seated change in personality and emotional development.
Psychoanalytic and psychodynamic psychotherapy aim to help people with serious
psychological disorders to understand and change complex, deep-seated and often
unconsciously based emotional and relationship problems thereby reducing symptoms and
alleviating distress. However, their role is not limited only to those with mental health
problems. Many people who experience a loss of meaning in their lives or who are seeking a
greater sense of fulfilment may be helped by psychoanalytic or psychodynamic
psychotherapy.

Sometimes people seek help for specific reasons such as eating disorders, psycho-somatic
conditions, obsessional behavior, or phobic anxieties. At other times help is sought because

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of more general underlying feelings of depression or anxiety, difficulties in concentrating,
dissatisfaction in work or inability to form satisfactory relationships. It may benefit adults,
children, and adolescents. It can help children who have emotional and behavioral difficulties
which are evident at home or school. These can include personality problems, depression,
learning difficulties, school phobias, eating or sleeping disorders.
Psychoanalytic or psychodynamic psychotherapy provides an effective treatment for a range
of psychological disorders, both as a treatment in its own right and as an adjunct to other
forms of treatment. It can contribute significantly to patient's mental and physical health, to
their sense of well-being and to their ability to manage their lives more effectively.
Whether psychoanalytic or psychodynamic psychotherapy is the treatment of choice for a
particular individual depends on a variety of factors. It is often helpful to have one or more
preliminary consultations with an experienced psychotherapist before deciding whether
psychoanalytic psychotherapy is an appropriate treatment for the person concerned.
Occasionally, the treatment might be of short duration but generally speaking psychoanalytic
psychotherapy is best considered as a long-term treatment involving considerable
commitment for both patient and therapist.
The relationship with the therapist is a crucial element in the therapy. The therapist offers a
confidential and private setting which facilitates a process where unconscious patterns of the
patient's inner world become reflected in the patient's relationship with the therapist
(transference). This process helps patients gradually to identify these patterns and, in
becoming conscious of them, to develop the capacity to understand and change them.
Q NO 4. How does cognitive behavior therapy work? Please give a detailed
note.
Ans:-
Cognitive behavioral therapy (CBT) for anxiety
Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders.
Research has shown it to be effective in the treatment of panic disorder, phobias, social
anxiety disorder, and generalized anxiety disorder, among many other conditions.
CBT addresses negative patterns and distortions in the way we look at the world and
ourselves. As the name suggests, this involves two main components:
Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety.
Behavior therapy examines how you behave and react in situations that trigger anxiety.

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The basic premise of CBT is that our thoughts—not external events—affect the way we feel.
In other words, it’s not the situation you’re in that determines how you feel, but your
perception of the situation. For example, imagine that you’ve just been invited to a big party.
Consider three different ways of thinking about the invitation, and how those thoughts would
affect your emotions.
Situation: A friend invites you to a big party
Thought #1: The party sounds like a lot of fun. I love going out and meeting new people!
Emotions: Happy, excited
Thought #2: Parties aren’t my thing. I’d much rather stay in and watch a movie.
Emotions: Neutral
Thought #3: I never know what to say or do at parties. I’ll make a fool of myself if I go.
Emotions: Anxious, sad
As we can see, the same event can lead to completely different emotions in different people.
It all depends on our individual expectations, attitudes, and beliefs. For people with anxiety
disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal
of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts
and beliefs. The idea is that if you change the way you think, you can change the way you
feel.
Thought challenging in CBT for anxiety
Thought challenging (also known as cognitive restructuring) is a process in which you
challenge the negative thinking patterns that contribute to your anxiety, replacing them with
more positive, realistic thoughts. This involves three steps:
• Identifying your negative thoughts.
With anxiety disorders, situations are perceived as more dangerous than they really are.
To someone with a germ phobia, for example, shaking another person’s hand can seem
life threatening. Although you may easily see that this is an irrational fear, identifying
your own irrational, scary thoughts can be very difficult. One strategy is to ask yourself
what you were thinking when you started feeling anxious. Your therapist will help you
with this step.
• Challenging your negative thoughts.
In the second step, your therapist will teach you how to evaluate your anxiety-provoking
thoughts. This involves questioning the evidence for your frightening thoughts, analyzing
unhelpful beliefs, and testing out the reality of negative predictions. Strategies for

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 challenging negative thoughts include conducting experiments, weighing the pros and
cons of worrying or avoiding the thing you fear, and determining the realistic chances that
what you’re anxious about will actually happen.
• Replacing negative thoughts with realistic thoughts.
Once you’ve identified
the irrational predictions and negative distortions in your anxious thoughts, you can
replace them with new thoughts that are more accurate and positive. Your therapist may
also help you come up with realistic, calming statements you can say to yourself when
you’re facing or anticipating a situation that normally sends your anxiety levels soaring.
Q NO 5. Please write different behavior modification techniques of
behavior therapy. Support your answer with suitable examples.
Ans:-
Do you remember being punished as a child? Why do you think your parents did that?
Despite what we thought back then, it wasn't because they hated us and enjoyed watching us
suffer through a week without television. They merely disapproved of our actions and were
hoping to prevent us from repeating them in the future. This is an excellent example of
behavior modification.
Behavior modification refers to the techniques used to try and decrease or increase a
particular type of behavior or reaction. This might sound very technical, but it's used very
frequently by all of us. Parents use this to teach their children right from wrong. Therapists
use it to promote healthy behaviors in their patients. Animal trainers use it to develop
obedience between a pet and its owner. We even use it in our relationships with friends and
significant others. Our responses to them teach them what we like and what we don't.
Origin of the Theory
Behavior modification relies on the concept of conditioning. Conditioning is a form of
learning. There are two major types of conditioning; classical conditioning and operant
conditioning.
Classical conditioning relies on a particular stimulus or signal. An example of this would be
if a family member came to the kitchen every time you baked cookies because of the
delicious smell. The second type is known as operant conditioning, which involves using a
system of rewards and/or punishments. Dog trainers use this technique all the time when they
reward a dog with a special treat after they obey a command.

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Behavior modification was developed from these theories because they supported the idea
that just as behaviors can be learned, they also can be unlearned. As a result, many different
techniques were developed to either assist in eliciting a behavior or stopping it. This is how
behavior modification was formed.
Techniques
The purpose behind behavior modification is not to understand why or how a particular
behavior started. Instead, it only focuses on changing the behavior, and there are various
different methods used to accomplish it. This includes:
• Positive reinforcement
• Negative reinforcement
• Punishment
• Flooding
• Systematic desensitization
• Aversion therapy
• Extinction
Positive reinforcement is pairing a positive stimulus to a behavior. A good example of this
is when teachers reward their students for getting a good grade with stickers. Positive
reinforcement is also often used in training dogs. Pairing a click with a good behavior, then
rewarding with a treat, is positive reinforcement.
Negative reinforcement is the opposite and is the pairing of a behavior to the removal of a
negative stimulus. A child that throws a tantrum because he or she doesn't want to eat
vegetables and has his or her vegetables taken away would be a good example.
Punishment is designed to weaken behaviors by pairing an unpleasant stimulus to a
behavior. Receiving a detention for bad behavior is a good example of a punishment.
Flooding involves exposing people to fear-invoking objects or situations intensely and
rapidly. Forcing someone with a fear of snakes to hold one for 10 minutes would be an
example of flooding.
Systematic desensitization is also used to treat phobias and involves teaching a client to
remain calm while focusing on these fears. For example, someone with an intense fear of
bridges might start by looking at a photo of a bridge, then thinking about standing on a
bridge, and eventually walking over a real bridge
Aversion therapy is the pairing of an unpleasant stimulus to an unwanted behavior in order
to eliminate that behavior. Some people bite their finger nails, and in order to stop this

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behavior, there's a clear substance you can paint on your finger nails that makes them taste
awful. Painting your nails with it helps stop the behavior of biting nails.
Extinction is the removal of all reinforcement that might be associated with a behavior. This
is a powerful tool and works well, especially with young children.

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References
• Ehrenreich JT, et al. (2008). Separation anxiety disorder in youth:
phenomenology, assessment, and treatment.
ncbi.nlm.nih.gov/pmc/articles/PMC2788956
• American Psychiatric Association, Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition, American Psychiatric Publishing, Washington, D.C.,
2013: Pages 195-197.
• Comorbid Personality Disorders in Individuals With an At-Risk Mental State for
Psychosis: A Meta-Analytic Review.
Boldrini T, Tanzilli A, Pontillo M, Chirumbolo A, Vicari S, Lingiardi V.
• https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-
causes/syc-20354463
• https://www.bpc.org.uk/about-psychotherapy/what-psychotherapy
• https://www.helpguide.org/articles/anxiety/therapy-for-anxiety-disorders.htm
Melinda Smith, M.A., Robert Segal, M.A., and Jeanne Segal, Ph.D.
• https://study.com/academy/lesson/what-is-behavior-modification-definition-
techniques-examples.html

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