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PYB306 Psychopathology > 5. Anxiety disorders and OCD > Flashcards

5. Anxiety disorders and OCD Flashcards

1
Q

Historical perspectives of anxiety disorders

A

Concepts related to the Anxiety Disorders (as we now know them) were discussed/explored in 19th & 20th centuries
• by Freud / the psychanalysts (the concept of “anxiety neuroses”)
• by Pavlov and Skinner (“fear conditioning”).
• In pharmaceutical development studies (from 1980’s)

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2
Q

DSM’s historical view of anxiety disorders

A
  • DSM-I (1952) & DSM-II (1968): Anxiety categorised under “Neuroses”
  • DSM-III (1980): “Anxiety” becomes a new disorder category
  • DSM-III-R to DSM-IV-TR (2000): Disorder criteria refined.
  • DSM-5 (2013): major changes…
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3
Q

fear

A

the emotional resonse to real (or perceived) immediate danger threat; builds quickly; facilitates behavioural response to threat

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4
Q

anxiety

A

anticipation of future threat; a more general or diffuse emotional state

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5
Q

worry

A

a relatively uncontrollable sequence of negative emotional thoughts, that are concerned with possible future threats or danger

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6
Q

panic attacks

A

sudden, overwhelming experiences of terror or fright, can be distinguished from anxiety in four major ways: more focused, less diffuse, more intense, and sudden onset; physiological symptoms dominant

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7
Q

anxiety versus Anxiety

A

anxiety: the feeling of intense apprehension & worry that is
• in response to a realistic source of danger, and;
• is of “appropriate” intensity

Anxiety with a capital A
A clinical disorder; a generalised/diffuse negative emotional reaction that is
• Maladaptive
• Irrational
• Uncontrollable
• Disruptive
• Disproportionate
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8
Q

phobias

A

Narrowly defined fears – associated with a specific object or situation. Focused anxiety or fear that is “out of proportion” to the actual or perceived threat or danger, after taking into account all the factors of the environment and situation. Associated with panic, terror and avoidance

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9
Q

Phobias distinguished from fear

A

In phobias the pattern of fear/avoidance is “persistent” (present
for at least 6 months).

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10
Q

DSM-5 categories of phobias

A

specific phobia
social phobia
agoraphobia

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11
Q

Specific phobia

A
  • Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
  • almost always provokes immediate fear or anxiety.
  • actively avoided or endured with intense fear or anxiety.
  • out of proportion to the actual danger
  • lasting for 6 months or more.
  • significant distress or impairment in social, occupational, or other important areas of functioning.
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12
Q

Social phobia

A

or social anxiety disorder
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.

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13
Q

Examples of social phobia

A

– social interactions (e.g., having a conversation, meeting unfamiliar people),
– being observed (e.g., eating or drinking),
– performing in front of others (e.g., giving a speech)

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14
Q

what is it that a person fears if they have social anxiety disorder?

A

The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

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15
Q

Agoraphobia

A

Marked fear or anxiety about two (or more) of the following five situations:

  1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
  2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
  3. Being in enclosed places (e.g., shops, theaters, cinemas).
  4. Standing in line or being in a crowd.
  5. Being outside of the home alone.
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16
Q

what causes the fear or avoidance on agoraphobia?

A

Fear or avoidance is due to concern that escape might be difficult or help
might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence)

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17
Q

Generalised anxiety disorder

A

Persistent & excessive anxiety & worry (apprehensive
expectation) that is:
• generalised [about several events or activities],
• difficult to control

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18
Q

Symptoms of GAD

A 
3 or more of these symptoms
•restlessness, feeling keyed-up/on edge
•fatiguing easily
•difficulty concentrating / mind blanks
•irritability
•muscle tension
•sleep disturbance
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19
Q

GAD compared to normal worry

A

Not a fleeting nor rare sensation: occurs almost daily, for at least 6 months

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20
Q

Panic Attacks

A

A sudden unexpected & overwhelming (but short-lived) period of intense fear or discomfort; surges abruptly, peaks within minutes.
Panic attacks may:
• be understood as a normal incorrectly triggered fear response – a false alarm
• May have situational cues or triggers
• Or can be unexpected – no clear reason

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21
Q

Panic Attacks compared to anxiety

A 
Distinct from anxiety in two ways:
– Greater intensity
– More rapid onset.
Not a disorder in itself
Can occur as a part of any of the anxiety disorders
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22
Q

Symptoms of panic attacks

A

4 or more symptoms:
– Palpitations, pounding, racing heart rate
– Sweating
– Trembling, shaking
– Feeling short of breath, difficulty breathing
– Chills or hot flushes
– Feelings of derealisation or depersonalisation
– Fear of dying;
– parethesias (numbness or tingling),
– fear of losing control or going crazy,
– feeling dizzy, unsteady, lightheaded or faint,
– chest pain or discomfort.
Reaching a peak within minutes

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23
Q

Panic disorder

A

Recurrent panic attacks PLUS one attack that had “lasting” effects
i.e., it led to one month of

  • Persistent concerns about attacks and/or
  • A significant, maladaptive, behaviour change (e.g. avoidance)

Not occurring in relation to a specific stimulus as in phobias

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24
Q

Distinctions of anxiety disorders

A

There are some strong similarities between the disorders in this group.
• Two keys to distinguishing amongst them:
– Duration (of episode and the “disorder”)
– Scope of fear/avoidance (one or many objects; a relatively narrowly defined fear (as for phobias) or a generalised fear (as for GAD))

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25
Q

Course of anxiety disorders

A

Often chronic conditions – long term evidence of anxiety, worry and avoidance
“General conclusion is that the long term outcome
for anxiety disorders is mixed and somewhat
unpredictable”

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26
Q

treat-ability of anxiety disorders

A

highly treatable – often good response to intervention

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27
Q

causes of poor treatment outcomes of anxiety disorders

A

Poorer outcomes associated with earlier age of onset and lack of treatment

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28
Q

Cross-cultural affects of anxiety disorder symptoms

A

People in non-Western cultures are more likely to present with somatic symptoms
• Focus of anxiety differs across cultures
– Western cultures – work performance
– Nigeria – family or religious experience

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29
Q

Prevalence of anxiety disorders

A

Anxiety is the most common mental health condition
• Lifetime prevalence
– 1 in 4 people
– 1 in 3 women and 1 in 5 men
• Prevalence is highest in younger adults
• But there is also a peak in the aged (70+) – w

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30
Q

Comorbidity of anxiety disorders and substance abuse

A

45% of people with an anxiety disorder also have an affective disorder or substance abuse (ABS, 1998)

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31
Q

Comorbidity of anxiety disorders and depression

A

50% of individuals with an anxiety disorder also meet the criteria of at least one other anxiety disorder or depression (Brown & Barlow, 1992)

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32
Q

three theories of anxiety disorder causes (etiology)

A

biological
conditioning and learning
cognitive

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33
Q

Biological theories of anxiety disorder etiology

A
  • Genetic predisposition, anxiety sensitivity
  • an “Evolved” / selected genotype
  • Neurochemical changes
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34
Q

Conditioning and learning theories of anxiety disorder etiology

A
  • Acquired through classical conditioning or observational learning
  • Maintained through operant conditioning
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35
Q

Cognitive theories of anxiety disorder etiology

A

Cognitive theories emphasise the cognitive overlay applied to bodily sensations (cognitive bias/interpretive error, e.g., “catastrophic” misinterpretation) and the interpretation of events

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36
Q

Bioligical factors contribution to anxiety disorders

A

• Twin studies suggest modest heritability for anxiety disorders
– Concordance rates for MZ significantly higher than DZ twins for anxiety disorders suggesting some genetic component
– Heritability estimates are 20–30 percent for GAD
• Greatest genetic influence found for agoraphobia; least for specific phobias

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37
Q

Neurochemistry of anxiety disorders

A
  • Serotonin and GABA are inhibitory neurotransmitters that serve to dampen stress responses
  • when these neurotransmitter levels are reduced, increased fear and anxiety may result.
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38
Q

Biological Fear response process

A
  • The amygdala stores unconscious, emotional memories
  • When a threat is perceived, the limbic systems triggers the threat response activating the adrenal system and mobilizing physical resources to fight, flee or freeze
  • Automatic, non-rational, non-cognitive process
  • Sensitivity of pathways is influenced by genetics, hormone levels, stress, childhood experiences, social & psychological factors
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39
Q

learning as a cause of phobias

A

Specific fears might be learned through classical conditioning

40
Q

classical conditioning of fears

A

• A neutral stimulus paired with an intense fear reaction may
lead to a learned fear
• Many (but not all) specific phobias seem to develop this way
• Human beings seem to be prepared to develop intense, persistent fears only to a select set of objects or situations (see over)

41
Q

observational learning as a cause of fears

A

vicarious learning of fear through

seeing others respond fearfully to certain situations

42
Q

Operant principles of anxiety

A

Operant principles can also help to make sense of maintenance of anxiety
• Avoidance of feared stimuli — reduction in anxiety (negative reinforcement)

43
Q

Evolution as an explanation for fears

A

The process by which fears are learned suggests that the process is guided by a module, or specialized circuit (Ohman & Mineka, 2001).
We have an inbuilt tendency to more easily acquire phobias about things that would have posed a threat to our ancestors, (e.g., snakes, spiders, heights) than to modern threats (e.g., electrical outlets)
• Conditioned responses to fear relevant stimuli (snakes) are more resistant to extinction that fear-irrelevant stimuli (e.g. flowers)

44
Q

Fear as an adaptive survival technique

A

Emotional fear responses can be adaptive - Mobilize responses that help the person survive in the face of both immediate danger and long-range threats

45
Q

Fear as a maladaptive function

A

If triggered at inappropriate times or places, these responses may become maladaptive

46
Q

Survival and evolution as an explanation for anxiety disorders

A
  • Generalised anxiety prepared humans for unidentified threats
  • Specific anxiety prepared humans to respond effectively to certain types of danger, e.g., freezing when at a great height
47
Q

Childhood adversity as a social factor of anxiety

A

higher levels of adversity, more likely to develop an anxiety disorder (Moffitt et al., 2007; Phillips et al., 2005)

48
Q

Insecure/disorganised attachment as a social factor of anxiety

A

Several studies have found that people with anxiety disorders are more likely to have had insecure or disorganised attachment as children (Cassidy & Mohr, 2001; Dozier et al., 2008; Lewinsohn et al., 2008).

49
Q

what do frequent experiences of unsolvable fear shape?

A
  • Emotion regulation
  • Information processing
  • Sensitization of threat pathways
50
Q

stressful life events as a social factor of anxiety

A

environmental stress increases risk of anxiety disorders

51
Q

Why do some negative life events lead to depression while others lead to anxiety?

A

– The nature of the event may be an important factor in determining the type of mental disorder that appears (McLaughlin & Hatsenbuehler, 2009; Updegraff & Taylor, 2000).
– For anxiety, an event involving danger is more likely to have occurred (e.g. exposure to DV)
– For depression, an event involving severe loss (lack of hope) is more likely to have occurred.

52
Q

Cognitive factors of anxiety

A

Three main cognitive processes highlighted by cognitive theory
– Perception of controllability
– Catastrophic misinterpretation
– Attention to Threat and Biased Information Processing

53
Q

PERCEPTION OF CONTROLLABILITY as a cognitive factor of anxiety

A
  • Sense of helplessness, low control, low efficacy

* Underestimate protective factors and personal resources

54
Q

CATASTROPHIC MISINTERPRETATION as a cognitive factor of anxiety

A
  • Misreading benign experiences as threatening

* Predicting worse outcome than is probable and realistic

55
Q

ATTENTION TO THREAT AND BIASED INFORMATION PROCESSIING as a cognitive factor of anxiety

A
  • Hypervigilance and attentional narrowing
  • Overidentification of threat cues
  • Fleeting danger triggers off a cascade of worry (what if”?) that increases anxiety and further vigilance
56
Q

Types of Biological therapies for anxiety

A
  • Antianxiety medications (anxiolytics)

* Antidepressants often used – preferred treatment

57
Q

Antianxiety medications (anxiolytics)

A
  • A class of drugs known as the benzodiazepines;
  • Examples: Diazepam (Valium) - relatively long half life and Lorazepam (Ativan)
  • Enhance GABA activity
  • Provide short term relief
  • Side effects, withdrawal problems, & addictiveness
58
Q

Antidepressants often used – preferred treatment

A
  • SSRIs – first line medication for Panic Disorder and Social Anxiety
  • Good evidence for effectiveness
  • Fewer side effects than anxiolytics
59
Q

Types of behavioural therapies for anxiety

A

• Relaxation training – progressive muscle relaxation
• Breathing retraining – slow, diaphragmatic
breathing;
• Physical exercise
• Attention to dietary factors (e.g., caffeine)
• Behavioural experiments – testing predictions
• Exposure therapy

60
Q

Exposure therapies for anxiety

A

Grounded in learning theory – conditioning a new response
• Education: Understanding the ‘fight-flight’ cycle; new cognitive interpretations of “bodily” symptoms.
• Exposure can be imagined, in vivo, or virtual

61
Q

Types of exposure therapies

A
  • systematic de-sensitistaion
  • Interoceptive exposure
  • flooding
62
Q

Systematic de-sensitisation

A

work through a hierarchy of feared situations whilst practicing relaxation

63
Q

Interoceptive exposure

A

deliberate inducement of panic symptoms to reduce fear of inner sensations

64
Q

Flooding

A

exposure until response subsides

65
Q

Types of cognitive therapies for anxiety

A
  • Psychoeducation – recognizing anxiety
  • Cognitive restructuring
  • Distraction
  • Practice & homework are important
66
Q

Cognitive restructuring

A
  • Increase awareness of irrational, negative, catastrophic, predictive, or otherwise unhelpful cognitions (self-talk)
  • Differentiating productive and unproductive worry
  • Decatastrophising
  • Examine & challenge faulty logic
67
Q

OCD as an anxiety disorder?

A

OCD no longer an “Anxiety” disorder

A “new” disorder category (Obsessive Compulsive and Related Disorders)

68
Q

prevalence of OCD compared to Anxiety disorders

A

A relatively “low” prevalence disorder compared to the Anxiety Disorders (ABS data)

69
Q

Classes of OC and related disoders

A 
• This chapter includes
– OCD
– Body Dysmorphic Disorder
– Hoarding Disorder
– Trichotillomania 
– Excoriation Disorder
70
Q

Body Dysmorphic Disorder

A

preoccupation with perceived deficits in personal appearance

71
Q

Hoarding Disorder

A

– persistent difficulties in getting rid of possessions, regardless off real value

72
Q

Trichotillomania

A

Recurrent pulling out own hair despite attempts to stop

73
Q

Excoriation Disorder

A

– persistent picking of one’s skin despite attempts to stop

74
Q

Criteria A of OCD

A

Presence of obsession, compulsions or both

75
Q

Obsessions

A

repetitive, uncontrollable, intrusive, unwanted thoughts/urges/images that usually provoke “marked anxiety”
• Intrude suddenly into consciousness
• The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action

76
Q

Compulsions

A

a repetitive behaviour or mental act or ritual that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
• that is undertaken with the intent to reduce anxiety or distress or to prevent some dreaded situation (but is unlikely to do so) or is “clearly excessive

77
Q

Criterion B of OCD

A

• The obsessions or compulsions (or both) occupy a considerable amount of time (>1 hour per
day).
OR
• Cause clinically significant impairment in functioning

78
Q

Examples of obsessions

A
  • Contamination obsession
  • Symmetry obsession
  • Aggressive obsessions – fear of harming someone, self, fear of stealing something
  • Superstitious obsessions – fear of saying particular words, passing/touching particular items
  • Sexual obsessions
79
Q

examples of compulsions

A 
• Checking compulsions
• Cleaning compulsions
• Repeating compulsions – completing something over and over, perhaps a certain number of times
• Counting compulsions
• Tapping/touching compulsions
• Ordering/arranging compulsions
• Other mental rituals – repetitive
prayers, mantras
• Avoiding objects
• Ritualised behaviours- using particular hands for things, eating in a particular order
80
Q

Diagnostic specifiers of OCD

A

With good or fair insight
With poor insight
with absent insight/delusional belieffs

81
Q

OCD With good or fair insight

A

The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

82
Q

OCD With poor insight

A

The individual thinks obsessive-compulsive

disorder beliefs are probably true.

83
Q

OCD with absent insight/delusional beliefs

A

The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

84
Q

Course of OCD

A

Typically follows a pattern of some improvement along with some persistent symptoms

85
Q

onset of OCD

A

Onset tends to be gradual but can be acute

86
Q

Age of onset for OCD

A

• In the United States, the mean age at onset of OCD is 19.5 years,
and 25% of cases start by age 14 years (Kessler et al. 2005; Ruscio et al. 2010).
• Onset after age 35 years is unusual but does occur
• Males have an earlier age at onset than females: nearly 25% of males have onset before age 10 years (Ruscio et al. 2010).
• Earlier onset appears to be associated with a longer course

87
Q

Functional consequences of OCD

A

• OCD can be highly debilitating
• Impairment may result from
– Time spent engaging in compulsions
– Avoidance of particular contexts – e.g. family/friends, hospitals/GPs
– Reduced work output – e.g. Need for symmetry/rigid expectations with projects/writing
– Physical complications – e.g. dermatological problems from hand washing

88
Q

Prevalence of OCD in Ausralia

A

– 3% lifetime prevalence
– 2% in a 12 month period
• Higher rates in females in adulthood, higher rates in males in childhood
• Occurs at similar rates across cultures
• Nature of obsessions and compulsions tends to be similar cross culturally

89
Q

Cognitive model of the aertiology of OCD

A

Many individuals with OCD have ‘dysfunctional beliefs’
– inflated sense of responsibility
– the tendency to overestimate threat
– perfectionism and intolerance of uncertainty
– over-importance of thoughts (e.g., believing that having a forbidden thought is as bad as acting on it) and the need to control thoughts

Rebound from thought suppression
– Attempt to suppress unwanted/threatening thoughts
– Rebound tends to occur – resurge with greater intensity and
frequency

90
Q

Learning theories of OCD

A

• “Maladaptive learning/associations”
– Intrusive thought/image is relieved by compulsive behaviour
– Creates an erroneous connection between behaviour and reduction in anxiety (i.e. negative reinforcement of compulsion)

91
Q

biological factors of OCD

A
  • Higher rates in first degree relatives
  • Higher concordance for MZ twins than DZ twins
  • Multiple brain regions associated with OCD
92
Q

Brain regions associated with OCD

A

– Basal ganglia
– Orbital prefrontal cortex
– Anterior cingulate cortex
• in those with OCD, heightened activity is observed in these regions in response to stimuli associated with obsessions

93
Q

Treatment for OCD

A

• Medication is often utilised
• Exposure + response prevention
• Combination therapies – medication and
psychotherapy often used together

94
Q

Exposure and response prevention as a treatment for OCD

A

– Exposure to situations that evoke distress
– Prevention of compulsive response
– Typically hierarchical exposure

95
Q

medication as a treatment for OCD

A

Typically an antidepressant, such as SSRIs, TCAs

PYB306 Psychopathology (13 decks)

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