3 anxiety disorders Flashcards
How does the DSM 5 classify categories of anxiety disorders?
Anxiety disorders
- Social Anxiety Disorder
- Panic Disorder
- Agoraphobia
- Generalised Anxiety Disorder
Obsessive compulsive disorders & related disorders
OCD
Trauma and stressor related disorders
PTSD
How does attention work?
attentional spotlight - limited capacity for processing information
voluntarily direct our attention to the portion of the environment that we deem important
→ prioritisation
What are attentional biases?
a tendency to pay attention to some type of information while simultaneously ignoring other information
What tests are used to test attention?
Dot Probe Task
1. fixation point on the screen for a short period of time
2. two stimuli appear simultaneously on the screen
3. position is counterbalanced
4. a probe appears in the location previously occupied by one of the two stimuli
5. identifying the probe as quickly as possible
Modified Stroop Task
Why are attentional biases relevant for mental disorders?
negative attentional bias - tendency to disproportionally allocate attention towards negative information over neutral or positive information
→ excessive bias have a crucial role in the etiology and maintenance of different mental health disorders
What is the history of classification of SAD?
“social phobia” Pierre Janet, 1903
1960s Isaac Marks - distinct category separate from other phobias
DSM-III in 1980 - social phobia and avoidant personality disorder
in DSM-I and DSM-II: social fears were viewed as projections of underlying conflicts onto social situations reflecting the prominence of psychodynamic thinking at the time
DSM-III: “speaking or performing in public, using public lavatories, eating in public, and writing in the presence of others” (APA, 1980, p. 324).
Theodore Millon’s biosocial learning theory (1969, 1981), avoidant personality disorder described a behaviour pattern resulting from an anxious child being subjected to persistent experiences of depreciation, which in turn resulted in an
active-detached coping style.
the publication of DSM-IV (APA, 1994, 2000), further revised the criteria for generalised social anxiety in a manner that suggested even greater overlap with avoidant personality disorder
underlying and enduring personality factors (negative self-image, …)
1994 - SAD was introduced
According to DSM-5, SAD is characterised by “a marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others” (APA, 2013, p. 202)
When is a diagnosis of SAD given?
diagnosis of SAD is given when these fears significantly and consistently hinder a persons social or occupational functioning
→ restricted social circle
→ career and romantic opportunities are negatively affected
→ avoiding normal social events (family gatherings, malls, gardening,
weddings, …)
What is the primary manifestation of SAD?
overly concerned they will act in a socially inept way or exhibit inappropriate symptoms
→ negative evaluation → rejection
Feared situations included being observed (e.g. writing or eating), formal social situations (e.g. public speaking) and informal social interations (e.g. small talk with acquaintances)
How does the ICD-10 classify SAD?
ICD-10: social phobia rather than SAD
- fear of being focus of attention
- fear of behaving in a way thats embarrassing or humiliating
- marked avoidance of situation in which both things could occur
What are possible subtypes of SAD?
- fear of performance or public speaking situations
- fear of social interaction situations
- fear of observation situation (being watched while writing or eating)
(- fear of displaying visible signs of anxiety)
What are common treatment options for SAD?
treatment: focus exclusively on regulation of distressing symptoms is inadequate
→ adress underlying issues of vulnerability, insecurity, self-concsiousness, self-image, social competence
in vivo exposure, applied relaxation, social skills training, cognitive restructuring, cognitive bias modification, cognitive behavioural therapy, cognitive therapy, interpersonal psychotherapy, short-term psychodynamic psychotherapy, mindfulness training, facilitated self-help and unsupported self-help (NICE, 2013)
CBT
CBT-based self help
short-term psychodynamic psychotherapy
(MCT??)
What is the current epidemiology of SAD?
relatively common in the west
3.5 to 24% (variation bc of methodological factors)
lifetime prevalence of 12.1%
→ third most common mental health difficulty
early age of onset and risk factor for subsequent depressive and substance use disorders
50% of cases develop SAD by age 11
80% before age 20
50% ever seek treatment
15-20 years after onset
slightly more women suffer
Collaborative Psychiatric Epidemiology Studies, which included over 20,000 participants, McLean et al. (2011) found that the lifetime prevalence of SAD was 10.3% for women and 8.7% for men.
geographic variation - cultural factors
0.4% in rural Taiwan and 0.82% in Iran to 16% in Basel, Switzerland, and 24% in Poland
SAD is unrecognised in primary care and specialist mental health settings
What are common consequences of SAD?
serious social, occupational and educational impairments such as increased rates of school and college dropout, reduced educational attainments and lower employment levels
social isolation
more likely to be single, unmarried or divorced
What are common comorbidities with SAD?
52 - 80% have lifetime diagnoses of at least one other psychiatric disorder
mood disorders (35-70%) for MDD and (3-21%) for BD
risk factor for suicidal ideation and suicide attempts
14.6% for specific phobia, 9.3% for obsessive compulsive disorder, 6.1% for panic disorder, 4% for post-traumatic stress disorder and 0.8% for general
anxiety disorder
alcohol and substance use disorders!
Fang and Hofmann (2010) found that that 4.8–12% of individuals with SAD have a diagnosis of body dysmorphic disorder (BDD), and 68.8% of individuals
with BDD have a diagnosis of SAD
What are the diagnostic criteria for SAD in the DSM-5?
- fear or anxiety about one or more social situations (social interactions, unfamiliar ppl, being observed)
- fear of negative evaluation or embarrassment
- social situation must always provoke fear or anxiety
- fear of anxiety is out of proportion to the actual threat of the social situation
- persistent for 6 months or more
- clinically significant distress or impairment
- fear is not attributable to substance use or medical condition
- not better explained by other disorder
- if another medical condition is present …
and performance only fear
