2-Ch 5: Anxiety, OCD Flashcards
Anxiety
sometimes vague, always UNPLEASANT feeling of FEAR & APPREHENSION
-accompanied by physical symptoms
Fear vs Anxiety
Fear: more focused/specific
Anxiety: more diffused and generalized
Anxiety = fear + apprehension
Generalized Anxiety Disorder
Chronic, prolonged, “free-floating” anxiety & dread
-no specific stimulus, but can become attached to events/stimuli–>increases likelihood of an extreme response
GAD DSM requirements
Symptoms must be reported for at least 6 months
GAD symptoms
- Motor Tension (muscular tension)
- Autonomic Reactivity (arousal response)
- Apprehension about the future (worry)
- Hypervigilance (super aware of everything in the environment)
GAD prevalence
Most commonly diagnosed in medical settings
lifetime prevalence: 4-7%
Females 2x as likely
GAD Onset
most commonly before 30
-half diagnosed in childhood/adolescence
Panic Disorder
sudden intense arousal-symptoms may resemble heart attack
Panic disorder: cued or uncued
must experience some uncued episodes (not triggered by any specific stimulus)
Panic Disorder vs GAD
Panic Disorder:
- onset more abrubt
- onset typically later
- more heredity evident
- more alcoholism seen
- higher rates for depression
PD co-occurance
often co-occurs with agoraphobia (up to half with PD also have agoraphobia)
Phobia
Irrational, unrealistic fear of an object, event, situation
Phobia onset
may begin with real trauma-conditioned to fear
-may also begin with GAD
Phobia & avoidance
when you avoid a feared stimulus–>negatively reinforces fear & avoidance behavior
Treatment: exposure to the feared
Animal Type phobia
Animals/Insects
e.g., spiders, snakes, dogs, cats, etc.
Natural Environment Type Phobia
Objects in the natural environment
e.g., storms, bodies of water, heights, etc.
Blood-Injection-Injury Type Phobia
cued by seeing blood/injury, injection, medical procedure
*may include fainting
Situational Type Phobia
Such as elevators, tunnels, bridges, flying, driving, enclosed spaces
Other Type Phobia
Cued by other stimuli
-fear of situations that could lead to choking, vomiting, illness
Social Phobias
Fear/embarrassment around others
Basis: fear of being observed/evaluated negatively
Most common social phobias
Public speaking
Meeting new people
Taijin Kyofusho
Japanese Social Anxiety Disorder
fear of offending/embarrassing other people
must have 1+ of the following:
- Fear of blushing
- fear of emitting odors/flatulence
- Fear of staring inappropriately
- Fear of making inappropriate facial expressions
- fear of having a physical deformity
*Anxiety same, source is different
Agoraphobia
Now has own category in DSM-5
- fear of open spaces
- fear of novel situations
- fear of “the marketplace”
- fear of losing control/being vulnerable in public
Agoraphobia Onset
20s-40s
more common in females
Obsessions
Intrusive, unwanted, repeated thoughts
Compulsions
Repetitive acts/behaviors-performed to reduce anxiety
“Magical Thinking”
Thinking that defies logic
patient believes performing compulsion will enable them to control outcomes in some way
Common forms of compulsions
- counting
- ordering/organizing
- checking
- touching
- washing/cleaning
*can be combos
Hoarding
Now has own category in DSM 5
Hoarding onset & prevalence
Onset: typically late adolescence/early adulthood
Prevalence: equally male/female
More common:
- higher income
- higher intellectual functioning
Less common:
- African American
- Hispanic American
- Asian American
OCD Spectrum disorders
covary with rates of OCD
-Co-morbid with OCD and/or run in OCD families
OCD spectrum disorder examples
Trichotillomania: compelled to pull hair out from body
Motor Tics
Tourrettes
Eating Disorders
Body Dysmorphic Disorder
Obsessive-compulsive & related disorders
Preoccupation with a perceived defect in appearance
DSM-must cause significant distress/impairment of functioning
- most often cite face & head
- exaggerated/imagined flaws
BDD males vs females
Males: body build, genitals, hair, height
Females: breasts, hips, thighs, weight
BDD prevalence & onset
5-15%
Onset: early adolescence to early adulthood
BDD comorbidity
- 1/3 with BDD also have OCD
- Social Anxiety
- Avoidant Personality
- Major depression/suicidality
- substance abuse
BDD study: America vs Taiwan
Americans men express significant more body dissatisfaction than Taiwanese men
BDD study: Germany vs US
Germany: 5.3% symptoms of BDD
US: 13% symptoms of BDD
Behavioral Treatment of Anxiety & OCD
Anxiety is learned from the environment
Anxiety–>learned (conditioned)
Avoidance–>negatively reinforces behaviors
Anxiety–>can be extinguishes
Systematic Exposure Treatment
Step-by-step desensitization-gradual exposure to source of anxiety
- establish fear hierarchy
- train in relaxation
- “walk through” the hierarchy using imagination
-reciprocal inhibition
Reciprocal Inhibition
underlying principle of systematic exposure
-2 incompatible responses cannot co-exist. they inhibit one another (anxiety & relaxation)
Flooding Treatment
Sudden, INTENSE exposure to the feared
*must remain in presence of the fear until anxiety subsides
so not to negatively reinforce avoidance
Virtual Reality Exposure
- exposure to virtual stimuli
- works via classical conditioning
Exposure Response Prevention Therapy (ERP)
Primarily treatment for OCD
-expose client to object of their obsession, AND prevent associated compulsive behavior
Modeling Treatment
Observe someone engage in the desired behavior
Most effective: participant modeling-watch someone else, then eventually client also does desired behavior
Cognitive Treatment Anxiety & OCD
address thoughts associated with anxiety
Cognitive restructuring
learn to ‘construct’ situations differently
Thought-stopping
stop maladaptive thoughts
Cognitive Rehearsal
in anticipation of anxiety-provoking situation
Acceptance Commitment Therapy (ACT)
- Acceptance: accept & NOT AVOID thoughts/feelings
* Know that they are only thoughts/feelings - Mindfulness: Be present in the moment
- increased awareness of what is current - Commitment: commit to pursue life values
ACT effectiveness
effective for mild-moderate anxiety problems
As Effective as: CBT for OCD, social anxieties, GAD
Biological Treatment of anxiety & OCD
drug treatments
Anxiolytics
Anti-anxiety
-enhance GABA (inhibitory)
commonly used for: GAD, Panic Disorder, Phobias
Antidepressents
SSRI
More common for: -OCD (decreases frequency of compulsive behaviors)
-Panic Disorder
-Agoraphobia
Comorbidity issues of Anxiety/OCD
- if have 1 anxiety disorder, increases risk for another
- Anxiety disorders “run in families”
- People with anxiety disorders more likely to be depressed, but not vice versa
