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HLT-PSYC90-02 · Lesson 4 · 10 clock hours · theory

Anxiety Disorders, OCD, and Trauma-Related Disorders

Objective. Students will describe the distinguishing behavioral and physiological features of generalized anxiety disorder, panic disorder, OCD, PTSD, and acute stress disorder, and identify technician actions that reduce re-traumatization.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

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Anxiety Disorders, OCD, and Trauma-Related Disorders

Why This Matters for Psychiatric Technicians

Anxiety-based and trauma-related conditions are among the most common reasons people seek behavioral health services. As a psychiatric technician, you will observe patients experiencing panic attacks, compulsive rituals, and flashbacks on a daily basis. Your ability to recognize these presentations, respond safely, and avoid actions that cause further harm is essential to patient safety and your scope of practice.

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Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder is characterized by excessive, difficult-to-control worry about multiple everyday topics — work, health, finances, relationships — occurring more days than not for an extended period. The worry is out of proportion to the actual likelihood of harm.

Observable behavioral signs: restlessness, irritability, difficulty concentrating, muscle tension, and fatigue. Patients may ask repetitive reassurance-seeking questions.

Physiological signs: elevated heart rate, headaches, gastrointestinal complaints, and disturbed sleep.

Technician response: Maintain a calm, predictable environment. Offer structured activities. Avoid dismissing worries with phrases like "just relax" — this rarely helps and can damage therapeutic rapport. Consistent routines reduce uncertainty, which is a key trigger.

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Panic Disorder

Panic Disorder involves recurrent, unexpected panic attacks — sudden surges of intense fear that peak within minutes — along with persistent concern about future attacks or significant behavior changes to avoid them.

Observable behavioral signs during an attack: the patient may grip surfaces, hyperventilate, pace, seek exits, or appear frozen with fear.

Physiological signs: rapid heartbeat (palpitations), shortness of breath, chest pain, dizziness, sweating, trembling, and numbness or tingling. Patients often believe they are having a heart attack or dying. Always report new chest pain or breathing distress to licensed nursing or medical staff immediately — medical causes must be ruled out first.

Technician response: Stay with the patient. Speak calmly and slowly. Guide the patient to a quieter space if safe to do so. Encourage slow, controlled breathing without forcing it. Document the episode's duration, observable behaviors, and any triggering event you observed.

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Obsessive-Compulsive Disorder (OCD)

OCD is characterized by obsessions (intrusive, unwanted thoughts, images, or urges that cause distress) and compulsions (repetitive behaviors or mental acts the person feels driven to perform to reduce that distress or prevent a feared outcome). Note: OCD is classified separately from anxiety disorders in the DSM-5, though it shares features.

Observable behavioral signs: repeated handwashing, checking behaviors, ordering or arranging objects, counting, seeking reassurance, or prolonged time spent on everyday tasks.

Key distinction: compulsions temporarily reduce anxiety but do not provide pleasure, and the person often recognizes the behavior as excessive.

Technician response: Do not assist or participate in rituals, as this reinforces the cycle. Do not forcibly interrupt rituals in a way that escalates distress. Report significant interference with daily functioning to the treatment team. Use matter-of-fact, non-judgmental communication.

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Trauma- and Stressor-Related Disorders

The DSM-5 groups PTSD and Acute Stress Disorder together because both require exposure to a traumatic event as a diagnostic criterion — distinguishing them from anxiety disorders.

#### Post-Traumatic Stress Disorder (PTSD)

PTSD develops after exposure to actual or threatened death, serious injury, or sexual violence (directly experienced, witnessed, or learned about happening to a close person). Symptoms persist for more than one month.

Four symptom clusters:

1. Intrusion: flashbacks, nightmares, intrusive memories

2. Avoidance: avoiding thoughts, feelings, or reminders of the trauma

3. Negative cognitions and mood: distorted blame, persistent negative emotions, feeling detached

4. Hyperarousal and reactivity: exaggerated startle response, hypervigilance, irritability, sleep disturbance, reckless behavior

During a flashback, the patient is psychologically re-experiencing the trauma and may not be oriented to current surroundings. Safety first: remove potential hazards from the immediate environment and ensure the patient cannot harm themselves or others. Use grounding techniques: speak the patient's name calmly, describe the current safe environment, encourage the patient to notice five things they can see or feel.

#### Acute Stress Disorder (ASD)

ASD presents with similar symptom clusters as PTSD but occurs within three days to one month after the traumatic event. It is an important early indicator: patients with ASD have an elevated risk of developing PTSD without appropriate support.

Technician role: Provide safety, predictability, and compassionate presence. Avoid pressing the patient to discuss the trauma in detail — this is outside the technician's scope and can cause re-traumatization.

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Trauma-Informed Care (TIC)

SAMHSA's Trauma-Informed Care framework establishes six key principles: Safety; Trustworthiness and Transparency; Peer Support; Collaboration and Mutuality; Empowerment, Voice, and Choice; and Cultural, Historical, and Gender Issues.

As a technician, trauma-informed care means:

Avoiding Re-Traumatization

Re-traumatization occurs when a patient's current experience triggers the emotional and physiological response of a past trauma. Common technician actions that unintentionally cause re-traumatization include: unexpected physical touch, raising the voice, blocking exits, using authoritative commands, or asking invasive questions without consent. Awareness of these triggers and consistent use of TIC principles are your primary tools for prevention.

Documentation Reminder

Always document observable behaviors — not diagnoses. Write what you see and hear, not what you interpret. Diagnostic language (e.g., "patient is having a PTSD flashback") belongs in a clinician's assessment, not a technician's observation note.

Key terms10

Generalized Anxiety Disorder (GAD)A condition marked by excessive, hard-to-control worry about multiple topics occurring more days than not, accompanied by physical symptoms such as muscle tension and sleep disturbance.
Panic AttackA sudden surge of intense fear or discomfort that peaks within minutes and includes physical symptoms such as palpitations, shortness of breath, dizziness, and a sense of impending doom.
ObsessionAn intrusive, unwanted, and distressing thought, image, or urge that the person struggles to control, characteristic of OCD.
CompulsionA repetitive behavior or mental act performed to reduce the distress caused by an obsession; provides temporary relief but reinforces the OCD cycle.
FlashbackA dissociative re-experiencing of a traumatic event in which the person feels as though the trauma is happening again in the present moment; a core intrusion symptom of PTSD.
HypervigilanceA state of heightened alertness and sensitivity to potential threat, commonly seen in PTSD and Acute Stress Disorder; the person may startle easily and seem constantly on guard.
Acute Stress Disorder (ASD)A trauma- and stressor-related disorder with PTSD-like symptoms beginning within three days and lasting no more than one month after traumatic exposure; a risk factor for developing PTSD.
Re-traumatizationThe unintentional triggering of a trauma response in a patient by a current experience, interaction, or environment that resembles elements of the original trauma.
Trauma-Informed Care (TIC)A framework (described by SAMHSA) that recognizes the widespread impact of trauma, integrates knowledge about trauma into policies and practices, and actively seeks to avoid re-traumatization.
Grounding TechniqueAn intervention that helps a patient re-orient to the present moment and physical environment, used to interrupt dissociation or flashback states; examples include naming sensory details in the current surroundings.
In class: Lecture comparing the fear/anxiety-based disorders and the trauma/stressor-related disorders; students complete a comparison grid for each condition covering triggers, observable signs, and technician response dos and don'ts. · Trauma-informed care principles worksheet: students read a brief trauma-informed care overview (SAMHSA framework) and list five specific technician behaviors that support or violate each principle. · Case vignette practice: three short written scenarios (panic attack, OCD ritual, PTSD flashback); students write a one-paragraph observation note and one de-escalation action for each, then share with class for feedback.
Materials: SAMHSA 'Trauma-Informed Care in Behavioral Health Services' TIP 57 excerpts, NIMH anxiety disorder fact sheets, comparison grid worksheet, vignette handouts
Check: Comparison grid reviewed by instructor: at least 80% of cells correctly completed; observation notes contain no diagnostic language and at least one appropriate technician action per scenario.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Mental Health Concepts and Patient Care
1. A patient with generalized anxiety disorder repeatedly asks staff whether the unit door is locked and whether they are safe. Which technician response is most appropriate?
Patient Safety and Scope of Practice
2. During your shift, a patient suddenly grabs the wall, begins hyperventilating, reports chest pain, and says, 'I think I'm dying.' What is the technician's first priority?
Mental Health Conditions and Psychopathology
3. Which statement best describes the relationship between obsessions and compulsions in OCD?
De-escalation and Crisis Intervention
4. A patient on the inpatient unit is found in the hallway staring blankly, breathing rapidly, and does not respond when you say their name. They have a documented history of PTSD. Which action should the technician take first?
Therapeutic Communication and Trauma-Informed Care
5. According to the SAMHSA Trauma-Informed Care framework, which of the following technician behaviors supports the principle of 'Empowerment, Voice, and Choice'?
Mental Health Conditions and Psychopathology
6. What is the key criterion that distinguishes Acute Stress Disorder from PTSD?
Scope of Practice and Documentation
7. A psychiatric technician witnesses a patient performing a lengthy hand-washing ritual. Which response best reflects appropriate scope of practice?
Scope of Practice and Documentation
8. A student technician writes in an observation note: 'Patient had a PTSD flashback at 1400 and was triggered by a male staff member's voice.' Which part of this note is outside the technician's documentation scope?
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