Abnormal Psych Chapter 4 Flashcards
What is fear?
Present-oriented
Immediate fight-or-flight response to danger or threat
Strong avoidance/escapist tendencies
Abrupt activation of sympathetic nervous system
How is anxiety different from fear?
Future-oriented
Worry about future danger or misfortune
Expectations of negative events, or that positive events won’t happen
Bodily tension
What are the areas of the brain that regulate the fear system?
Prefrontal cortex - cognitions
Amygdala - emotional reactivity, also fear conditioning
Hippocampus - memory
Anxiety disorders
Pervasive and persistent symptoms of anxiety and fear
Excessive avoidance and escapist tendencies
Symptoms and avoidance cause clinically significant distress and impairment
What is the pattern of activity of different brain networks in anxiety disorders?
Overactivity in salience, underactivity in executive control and intrinsic networks
Generalized Anxiety Disorder (GAD)
Excessive anxiety and worry
Difficulty in controlling the worry
Restlessness or feeling keyed-up or on edge
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension and sleep distrubance
What percent of the general population meet diagnostic criteria for GAD?
4%
What is the gender distribution of GAD?
Females outnumber males approximately 2:1
Psychodynamic GAD Theory
Neurotic anxiety - id based
Realistic anxiety - ego based
Moral anxiety - superego based
Humanistic GAD Theory
Conditions of worth
Lack of authenticity, incongruence
Existential GAD Theory
Realities of the human condition: freedom, responsibility, loneliness, certainty of death
Existential angst
Cognitive GAD Theory
Focus on threat, lack of control
Metacognitive theory (or “metaworry”, when you worry about worrying)
Avoidance theory: worrying reduces bodily arousal
Biological GAD Theory
Reduced GABA activity
Less inhibition of areas involved in fear response
Variety of mechanisms
GABA receptors dense in PFC, amygdala, hippocampus
Antianxiety drugs increase GABA; serotonin also involved
Treatments for GAD
Cognitive-behavioral approaches often most effective
Traditional cognitive approaches
Newer approaches e.g., mindfulness
Biological treatments: anti-anxiety drugs (focus on increasing GABA), relaxation training, biofeedback
What is a panic attack?
Abrupt experience of intense fear or discomfort
Accompanied by several physical symptoms (e.g., breathlessness, chest pain)
Often presents as heart attack
Panic disorder
Experience of unexpected panic attack
Develop anxiety, worry, or fear about having another attack or its implications
Symptoms and concern about another attack persists for 1 month or more
Could also experience agoraphobia
Agoraphobia
Fear or avoidance of situations/events associated with panic
Biological component of panic disorder
Neurotransmitters:
Fight-or-flight response poorly regulated
Dysregulation of norepinephrine, especially in locus ceruleus (part of pons in brainstem)
Affects limbic system, stress response
What percent of the general population meet diagnostic criteria for panic disorder?
3.5%
What is the gender distribution of panic disorder?
2/3 are female
Onset of panic disorder
Onset is often acute, beginning betwen 25 and 29 years of age
Onset of GAD
Onset is often insidious, beginning in early adulthood
Tendency to be anxious runs in families
How does genetics relate to panic disorder?
Runs in families to some extent
Parent/child and twin studies
Agoraphobia also has genetic component
Biological treatments for panic disorder
Tricyclic antidepressants: increase levels of norepinephrine, serotonin, and other neurotransmitters; imipramine preferred
Selective serotonin reuptake inhibitors: increase levels of serotonin; prozac and paxil currently preferred treatment
Benzodiazephines (e.g., valium, xanax): suppress the central nervous system and influence functioning in the GABA, norepinephrine, and serotonin neurotransmitter systems; high relapse rate when drug treatments are discontinued
Cognitive aspects of panic disorder
Extra-sensitive to body sensations
Negative misinterpretation
Catastrophizing
Cognitive-behavioral therapy for panic disorder
Identifying the catastrophizing cognitions about changes in bodily sensations
Challenge catastrophizing thoughts about bodily sensations
Cognitive-behavioral therapy techniques for panic disorder
Relaxation and breathing exercises
Systematic desensitization (with or without relaxation and breathing techniques)
Using “biological challenge” in therapy: using relaxation and breathing exercises while experiencing panic symptoms in the therapy session
Psychological and combined treatments of panic disorder
Cognitive-behavior therapies are highly effective
Combined treatments (CBT and drugs) do well in the short term
Best long-term outcome is with cognitive-behavior therapy alone
Phobias
Persistent and unreasonable fears of particular objects, activities, or situations
Sufferers know it’s out of proportion, but their response is out of control
What percent of the general population meet diagnostic criteria for specific phobia?
11%
What is the gender distribution of phobias?
Females are over-represented
Phobia onset
Phobias run a chronic course, with onset beginning between 15 and 20 years of age
Specific phobias
Fear of specific objects, places, or situations
Animal type, natural environment type, situational type, blood-injection-injury type, etc.
Social anxiety disorder
Fear of being judged or embarrassed by others
Blood-injury-injection phobia
Vasovagal response to blood, injury, or injection
Situational phobia
Public transportation or enclosed places (e.g., planes)
Natural environment phobia
Events occurring in nature (e.g., heights, storms)
Animal phobia
Animals and insects
Other phobias
Do not fit into the other categories (e.g., fear of choking, vomiting)
Causes of phobias
Direct conditioning - classical or operant
Observational/social learning (modeling)
Biological and evolutionary vulnerability
Information transmission
Direct conditioning
Traumatic event, e.g.: classically conditioned fear response
Anxiety about recurrence
Avoidance and escape relieve anxiety (i.e. negative reinforcement): operant conditioning maintains phobia
Observational learning
Seeing someone else have a traumatic experience
Beliefs derived in/directly
Being warned repeatedly about someting
Cognitive theories focus on beliefs (e.g., social phobia, “must be perfect”, afraid to embarass oneself, bias in attention and evaluation of social situations)
Psychodynamic approach to phobias
Unconscious anxiety displaced onto phobic object, often symbolic
Treatment: developing insight into the hidden conflicts
Behavioral treatment of phobias
Systematic desensitization
Modeling
Flooding
Cognitive-behavioral treatment of phobias
Helps clients identify and challenge negative, catastrophizing thoughts about feared situations
Biological treatment of phobias
Reduce symptoms of anxiety generally so that they do not arise in the feared situation
Fear
The central nervous system’s physiological and emotional response to a serious threat to one’s well-being
Anxiety
The central nervous system’s physiological and emotional response to a vague sense of threat or danger
What are the most common mental disorders in the US?
Anxiety disorders
In any given year, what percent of the adult population suffer from one of the anxiety disorders identified by DSM-5-TR?
19%
What percent of all people develop an anxiety disorder at some point in their lives?
31%
What percent of people with anxiety disorders receive treatment?
37%
Which race is most likely to develop an anxiety disorder?
non-Hispanic white americans
What do people with generalized anxiety disorder experience?
Excessive anxiety under most circumstances and worry about practically anything
What is generalized anxiety disorder sometimes called?
Free-floating anxiety
How long do symptoms of GAD last?
At least 6 months
Altogether, around what percent of all people develop GAD sometime during their lives?
6%
What percent of people who have GAD receive treatment for it?
43%
According to sociocultural theorists, who is most likely to develop GAD?
People who are faced with ongoing societal conditions that are dangerous
How could poverty affect the development of GAD?
Poverty is one of the most powerful forms of societal stress
People without financial means are likely to live in rundown communities with high crime rates, have fewer educational and job opportunities, experience housing and food insecurity, and run a greater risk for health problems
Correlation between wages and GAD?
As wages decrease, the rate of GAD steadily increases
What is the correlation between anxiety disorders and widespread contagious diseases?
Studies have found increases in the prevalence of anxiety disorders in communities and nations overrun by epidemics
What did Sigmund Freud believe regarding anxiety?
That all children experience some degree of anxiety as part of growing up and that all use ego defense mechanisms to help control such anxiety
Some children have particularly high levels of anxiety, or their defense mechanisms are particularly inadequate, and these individuals may develop GAD
How did Freud think early developmental experiences could contribute to GAD?
A child may come to believe that their various id impulses are very dangerous, and they may feel overwhelming anxiety whenever they have such impulses, setting the stage for GAD
How did Freud think weak ego defense mechanisms could contribute to anxiety?
Overprotected children, shielded by their parents from all frustrations and threats, have little opportunity to develop effective defense mechanisms. When they face the pressures of adult life, their defense mechanisms may be too weak to cope with the resulting anxieties.
What do today’s psychodynamic theorists believe regarding GAD?
That the disorder can be traced to inadequacies in the early relationships between children and their parents
What general techniques to psychodynamic therapists use?
Free association and the therapist’s interpretations of transference, resistance, and dreams
How do Freudian psychodynamic therapists use psychodynamic techniques?
They use them to help clients with GAD become less afraid of their id impulses and more successful in controlling them
How do object relations therapists use psychodynamic techniques?
They use them to help anxious patients identify and settle the childhood relationship problems that continue to produce anxiety in adulthood
What do humanistic theorists propose regarding GAD?
That GAD arises when people stop looking at themselves honestly and acceptingly
What do practitioners of client-centered therapy do?
Try to show unconditional positive regard for their clients and to empathize with them
The therapists hope that an atmosphere of genuine acceptance and caring will help clients feel secure enough to recognize their true needs, thoughts, and emotions
When clients eventually are honest and comfortable with themselves, their anxiety or other symptoms will theoretically subside
What do followers of the cognitive-behavioral model suggest?
That psychological disorders are often caused by problematic behaviors and dysfunctional ways of thinking
Which aspect of the cognitive behavioral model do proponents of the model mostly focus on with regard to GAD?
The cognitive dimension
What did cognitive-behavioral theorists initially suggest GAD is caused by?
Maladaptive assumptions
Basic irrational assumptions
The inaccurate and inappropriate beliefs held by people with various psychological problems, according to Albert Ellis
Metacognitive theory
Suggests that people with generalized anxiety disorder implicitly hold both positive and negative beliefs about worrying
Positive: Believe that worrying is a useful way of appraising and coping with threats in life
Negative: Believe that their repeated worrying is in fact harmful (mentally and physically) and uncontrollable
People further worry about the fact that they always seem to be worrying (meta-worries)
Intolerance of uncertainty theory
Certain individuals cannot tolerate the knowledge that negative events may occur, even if the possibility of occurrence is very small
Since life is filled with uncertain events, these individuals worry constantly that such events are about to occur
People with GAD keep worrying and worrying in their efforts to find “correct” solutions for various situations in their lives and to restore certainty to the situations. However, because they can never really be sure that a given solution is a correct one, they are always left to grapple with intolerable levels of uncertainty, triggering new rounds of worrying and new efforts to find correct solutions
Avoidance theory
Suggests that people with GAD have greater bodily arousal (higher heart rate, perspiration, respiration) than other people and that worrying actually serves to reduce this arousal, perhaps by distracting the individuals from their unpleasant physical feelings
What are the two kinds of cognitive-behavioral approaches used in cases of generalized anxiety disorder?
- Therapists help clients change the maladaptive assumptions that characterize their disorder
- New-wave cognitive-behavioral therapists help clients understand the special role that worrying may play in their disorder, modify their views about worrying, and change their behavioral reactions to such unnerving concerns
Rational-emotive therapy
Therapists point out the irrational assumptions held by clients, suggest more appropriate assumptions, and assign homework that gives the clients practice at challenging old assumptions and applying new ones
How do new-wave cognitive-behavioral therapists treat clients with GAD?
Specifically guide them to recognize and change their dysfunctional use of worrying
Educate the clients about the role of worrying in their disorder and have them observe their bodily arousal and cognitive responses across various life situations
In turn, the clients come to appreciate the triggers of their worrying, their misconceptions about worrying, and their misguided efforts to control their lives by worrying
Acceptance and commitment therapy
Therapists help clients to become aware of their streams of thoughts, including their worries, as they are occurring and to accept such thoughts as mere events of the mind
What is the biological perspective of GAD supported by?
Family pedigree studies, in which researchers determine how many and which relatives of a person with a disorder have he same disorder
What have studies found regarding the biological relatives of people with GAD?
The relatives are more likely than nonrelatives to have the disorder
Approximately 15% of the relatives of people with the disorder display it themselves
The closer the relative, the greater the likelihood that relative will also have the disorder
Benzodiapines
Drugs such as xanax, ativan, and valium that provide relief from anxiety
Interact with receptors that ordinarily receive GABA
How does GABA work?
Carries inhibitory messages: when GABA is received at a receptor, it causes the neuron to stop firing
What are our everyday fear reactions tied to?
Brain circuits: networks of brain structures that work together, triggering each other into action
What brain structures does the fear brain circuit include?
The prefrontal cortex, anterior cingulate cortex, insula, and amygdala
What do studies reveal about the brain’s fear circuit in people with GAD?
It is hyperactive, producing experiences of fear and worry that are excessive in number and duration
After their discovery in the 1950s, what were benzodiazepines marketed as?
Sedative-hypnotic drugs - drugs that calm people in low doses and help them fall asleep in higher doses
How do benzodiazepines work?
They travel to receptor sites in the brain’s fear circuit - particularly in the amygdala - that ordinarily receive the neurotransmitter GABA
When they bind to these neuron receptor sites, they increase the ability of GABA to bind to the sites and stop neurons from firing, thus helping to improve the overall functioning of the fear circuit and, in turn, reducing an individuals excessive levels of anxiety
What percent of people with GAD experience at least some improvement when they take benzodiazepines?
60%
What are the problems with benzodiazepines in treating GAD?
- the effects are short-lived - when they are stopped, anxiety returns as strong as ever
- people who take benzodiazepines in large doses for an extended time can become physically dependent on them
- The drugs can produce undesirable effects such as drowsiness, lack of coordination, memory loss, depression, and aggressive behavior
- The drugs mix badly with certain other drugs or substances
What is the treatment of choice for people with GAD now?
Antidepressants
How do antidepressants work to help GAD?
They increase the activity of serotonin and norepinephrine
These are prominent in certain parts of the brain’s fear circuit
What is a phobia?
A persistent and unreasonable fear of a particular object, activity, or situation
How do phobias differ from common fears?
DSM-5-TR indicates that a phobia is more intense and persistent and the desire to avoid the object or situation is stronger
People with phobias often feel so much distress that their fears may interfere dramatically with their lives
Specific phobias
An intense and persistent fear of a specific object or situation
Each year, what percent of all people in the US have the symptoms of a specific phobia?
as many as 9%
What percent of individuals develop phobias at some point during their lives?
13%
What is the gender distribution of phobias?
Women outnumber men by at least 2 to 1
What percent of people with a specific phobia seek treatment?
32%
Agoraphobia
Fear of being in pubic places or situations in which escape might be difficult or help unavailable, should they experience panic or become incapacitated
What percent of the population experience agoraphobia in any given year?
1%
What percent of the population display agoraphobia at some point in their lives?
1.3%
What percent of people with agoraphobia receive treatment for it?
46%
Gender distribution of agoraphobia
More common among women
What do cognitive-behavioral theorists believe about the reason for phobias?
People with phobias first lean to fear certain objects, situations, or events through conditioning
Once the fears are acquired, the individuals avoid the dreaded object or situation, permitting the fears to become all the more entrenched
Classical conditioning
Two events that occur close together in time become strongly associated in a person’s mind, and the person then reacts similarly to both of them
Modeling
Observation and imitation
Little Albert experiment
For weeks baby Albert was allowed to play with a white rat and appeared to enjoy doing so
Once, when Albert reached for the rat, the experimenter struck a steel bar with a hammer, making a very loud noise that frightened Albert
The next several times that Albert reached for the rat, the experimenter again made the loud noise
Albert acquired a fear and avoidance response to the rat
Preparedness
A predisposition to develop certain fears, such as animals, heights, and darkness
Where could predispositions to fear come from?
Some theorists suggest they could have been transmitted genetically through an evolutionary process, as our ancestors who more readily acquired fears of animals, darkness, and heights were more likely to survive long enough to reproduce and pass on their fear inclinations to their offspring
What is the major cognitive-behavioral approach to treating phobias?
Exposure treatment: an approach in which people are exposed to the objects or situations they dread
Systematic desensitization
An exposure technique developed by Joseph Wolpe in which people learn to relax while gradually facing the objects or situations they fear
Relaxation training
Teaching clients how to bring on a state of deep muscle relaxation at will
Fear hierarchy
A list of feared objects or situations, ordered from mildly to extremely upsetting
In vivo desensitization
An actual confrontation with an object/situation one fears
Covert desensitization
A person imagines the frightening event while the therapist describes it and pairs relaxation responses with each feared item
Flooding
An exposure treatment for phobias in which clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless
Can be either in vivo or covert
Modeling
The therapist confronts the feared object or situation while the fearful person observes, demonstrating that the person’s fear is groundless
Participant modeling
The participant is actively encouraged to join in with the therapist in confronting the feared object or situation
What percent of phobic patients show significant improvement after receiving exposure treatment?
70%
Which is more effective: in vivo or covert exposure?
In vivo
Exposure treatment for agoraphobia
Therapists help clients venture farther and farther from their homes and gradually enter outside places, one step at a time
Support group approach for agoraphobia
A small number of people with agoraphobia go out together for exposure sessions that last for several hours
What percent of agoraphobic clients who receive exposure treatment find it easier to enter public places?
70%
Social anxiety disorder
Severe, persistent, and irrational anxiety about social or performance situations in which they may face scrutiny by others and possibly feel embarassment
What percent of people in the US and other Western countries experience social anxiety disorder in any given year?
7%
What percent of people in the US and other Western countries who experience social anxiety disorder in any given year are female?
60%
What percent of people in the US and other Western countries experience social anxiety disorder at some point in their lives?
12%
What percent of individuals with social anxiety disorder are currently in treatment?
40%
What do cognitive-behavioral theorists propose as an explanation for social anxiety disorder?
People hold a group of dysfunctional beliefs and expectations regarding the social realm
Because of these beliefs, people with social anxiety disorder keep anticipating that social disasters will occur, overestimate how poorly things go in their social interactions, and dread most social situations
They learn to perform “avoidance” and “safety” behaviors to help prevent or reduce such disasters
How do clinicians now treat social anxiety disorder?
By trying to reduce social fears, by providing training in social skills, or both
How do medications like benzodiazepines and antidepressants work to reduce social fears?
They improve functioning in the brain’s fear circuit, which tends to be hyperactive for people with social anxiety disorder
What do cognitive-behavioral therapists use on the behavioral side to help clients with social anxiety disorder?
Exposure therapy, encouraging clients to expose themselves to their dreaded social situations and to remain in these situations as their fears subside
What do cognitive-behavioral therapists use on the cognitive side to help clients with social anxiety disorder?
Systematic therapy discussions in which the clients are guided to reexamine and challenge their maladaptive beliefs and expectations, given the less-than-dire outcomes of their social exposures
Social skills training
The therapists model appropriate social behaviors for clients and encourage the individuals to try them out
The clients role-play with the therapists, rehearsing their new behaviors until they become more effective
Throughout the process, therapists provide frank feedback and reinforce the clients for effective performances
Social skills training groups and assertiveness training groups
Members try out and rehearse new social behaviors with other group members
Panic attacks
Periodic, short bouts of panic that occur suddenly, reach a peak within minutes, and gradually pass
What are the symptoms of panic?
Heart palpitations, tingling in hands or feet, shortness of breath, sweating, hot and cold flashes, trembling, chest pains, choking sensations, faintness, dizziness, a feeling of unreality
How many symptoms of panic do panic attacks feature?
At least 4
What fraction of all people have one or more panic attacks at some point in their lives?
1/3
Panic disorder
An anxiety disorder marked by recurrent and unpredictable panic attacks
What percent of all people in the US suffer from panic disorder in a given year?
3%
What percent of people in the US develop panic disorder at some point in their lives?
5%
What percent of people with panic disorder are currently in treatment?
59%
What is panic disorder often accompanied by?
Agoraphobia
What types of antidepressant drugs work to alleviate panic disorder?
Those that increase the activity of norepinephrine throughout the brain
What did researchers initially suspect that panic disorder might be caused by?
Abnormal activity of norepinephrine and of a brain structure called the locus coeruleus - an area rich in neurons that use norepinephrine
What are panic reactions produced by?
A brain circuit consisting of structures such as the amygdala, hippocampus, ventromedial nucleus of the hypothalamus, central gray matter, and locus coeruleus
What happens in the brain when a person confronts a frightening object or situation?
The amygdala is stimulated
In turn, the amygdala stimulates the other structures in the brain circuit, temporarily setting into motion an “alarm and escape” response that is very similar to a panic reaction
What is one possibility for why some people have hyperactive panic circuits and are prone to the development of panic disorder?
A predisposition to develop such abnormalities is inherited
What is the likelihood that if one identical twin has panic disorder, the other does too?
31%
What is the likelihood that if one fraternal twin has panic disorder, the other does too?
11%
How do antidepressants prevent or reduce panic attacks?
By increasing the activity of serotonin and norepinephrine in the locus coeruleus and other parts of the brain’s panic circuit, thus helping to correct the circuit’s tendency to be hyperactive
According to cognitive-behavioral theorists, only what people experience full panic reactions?
People who misinterpret the physiological events that are taking place within their bodies
Biological challenge tests
Researchers produce hyperventilation or other biological sensations by administering drugs or by instructing clinical research participants to breathe, exercise, or simply think in certain ways
Participants with panic disorder experience greater upset during these tests than participants without the disorder, particularly when they believe that their bodily sensations are dangerous or out of control
Why might some people be prone to misinterpreting bodily reactions to panic?
Panic-prone individuals experience more frequent, confusing, or intense bodily sensations than other people do
Alternatively, panic-prone people have had more trauma-filled events over the course of their lives than other persons, leading to higher expectations of catastrophe
Anxiety sensitivity
A tendency to focus on one’s bodily sensations, assess them illogically, and interpret them as harmful
Correlation between anxiety sensitivity and panic disorder
People who score high on anxiety-sensitivity surveys are much more likely than other people to develop panic disorder
Individuals with panic disorder typically ear higher anxiety-sensitivity scores than other persons
How do cognitive-behavioral therapists correct people’s misinterpretations of their bodily sensations?
First, they educate clients about the general nature of panic attacks, the actual causes of bodily sensations, and the tendency of clients to misinterpret their sensations
Next, they teach the clients to apply more accurate interpretations during stressful situations, thus short-circuiting the panic sequence at an early point
The therapists may also teach the clients ways to cope better with anxiety and to distract themselves from their sensations
Biological challenge procedures
Technique used by cognitive-behavioral therapists to induce panic sensations so that clients can apply their new interpretations and skills under watchful supervision
Obsessions
Persistent intrusive thoughts, images, ideas, impulses that cause distress
Compulsions
Repetitive behaviors or mental acts the person feels they must perform
Anxiety if unable to perform behaviors
What percent of people will develop OCD at some point?
Between 1 and 3%
Are there gender or ethnic differences with OCD?
No
Common obsessions
Contamination, aggressive impulses, sexual content, somatic concerns, religious concerns, need for order
Common compulsions
To reduce anxiety, gain control, resist unwanted thoughts
Checking, repetitive actions, handwashing, counting
Biological treatments for OCD
Anti-anxiety drugs not so effective
SSRIs more effective, target serotonin
Only help about 50%, have side effects, relapse if discontinued, need to learn different behaviors
Biological theories of OCD
Dysfunction in the circuit in the brain regulating primitive impulses (e.g. aggression, sexuality, body functions)
Impulses arise in the frontal cortex, are filtered in the caudate nucleus, we think and act if the impulses reach the thalamus (often in stereotyped ways). The impulses may not “turn off” in OCD.
Evidence of deficiencies in serotonin. Possibly glutamate, GABA and dopamine involved too.
Psychodynamic theories of OCD
Obsessions and compulsions symbolize unconscious conflicts e.g. Lady MacBeth
Conflicts create anxiety, id impulses and ego defense mechanisms acted out
Deal with conflicts indirectly by symptoms
Psychodynamic treatment of OCD
Insight therapy, leading to appropriate expression of impulses
Not generally as effective as other treatments
Cognitive-Behavioral theories of OCD
Most people have intrusive thoughts and rigid, ritualistic behavior when distressed
OCD when can’t turn off thoughts
May be generally anxious or depressed, tend to rigid, moralistic thinking, and believe they should be able to turn off intrusive thoughts.
OCD maintained by operant conditioning
Compulsive behaviors reduce anxiety
Cognitive-behavioral treatments for OCD
Exposure therapies: expose to obsessive thoughts, prevent compulsive behavior (exposure and response prevention)
Modeling may be included
Homework assignments
Used together with drug therapies
OCD-Related Disorders in the DSM-5
Hoarding
Hair Pulling (trichotillamania)
Skin Picking (excoriation)
Body Dysmorphic Disorder (BDD)
Obsessive-compulsive disorder
When obsessions or compulsions feel excessive or unreasonable, cause great distress, take up much time, and interfere with daily functions
How is anxiety involved in OCD?
The obsessions cause intense anxiety, while the compulsions are aimed at preventing or reducing anxiety
Anxiety rises if the individuals try to resist their obsessions or compulsions
What percent of people with OCD seek treatment?
40%
What are some common themes of obsessions?
Dirt/contamination, violence/aggression, orderliness, religion, sexuality
What are some common compulsions?
Cleaning compulsions, checking compulsions, seeking order or balance, touching, verbal, and counting compulsions
What do compulsions often represent?
A yielding to obsessive doubts, ideas, or urges
How do psychodynamic theorists view OCD?
The battle between anxiety-provoking id impulses and anxiety-reducing defense mechanisms is not buried in the unconscious but is played out in overt thoughts and actions
The id impulses usually take the form of obsessive thoughts, and the ego defenses appear as counterthoughts or compulsive actions
What did Freud trace OCD to?
The anal stage of development (2 years old)
During this stage some children experience intense rage and shame as a result of negative oilet-training experiences
Psychodynamic therapy for OCD
Uncover and overcome underlying conflicts and defenses using free association and therapist interpretation
Neutralize
A person’s attempt to eliminate unwanted thoughts by thinking or behaving in ways that put matters right internally, making up for the unacceptable thoughts
Why do individuals with OCD find normal thoughts os disturbing?
They
1) Have exceptionally high standards of conduct and morality
2) Believe that intrusive negative thoughts are equivalent to actions and capable of causing harm (thought-action fusion)
3) Believe that they should have perfect control over all of their thoughts and behaviors in life
How do cognitive-behavioral therapists treat OCD?
Educate the clients, pointing out how misinterpretations of unwanted thoughts, an excessive sense of responsibility, and neutralizing acts have helped to produce and maintain their symptoms
Guide the clients to identify and challenge their distorted cognitions
Exposure and response prevention
Clients are repeatedly exposed to objects or situations that produce anxiety, obsessive fears, and compulsive behaviors, but they are told to resist performing the behaviors they usually feel so bound to perform
What is the brain circuit that helps regulate our primitive impulses?
The cortico-striato-thalamo-cortical circuit: Orbitofrontal cortex, cingulate cortex, striatum, thalamus, and amygdala, with the neurotransmitters serotonin, glutamate, and dopamine
What is the most widely used biological treatment for OCD?
Antidepressant drugs, particularly ones that increase activity of serotonin
How do antidepressants work to improve OCD?
They increase the activity of serotonin within the cortico-striato-thalamo-cortical circuit, helping to correct the brain circuit’s hyperactivity
Hoarding disorder
A disorder in which individuals feel compelled to save items and become very distressed if they try to discard them, resulting in an excessive accumulation of items
Trichotillomania
A disorder in which people repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of the body
Excoriation
A disorder in which people repeatedly pick at their skin, resulting in significant sores or wounds
Body dysmorphic disorder
A disorder in which individuals become preoccupied with the belief that they have certain defects or flaws in their physical appearance
Such defects or flaws are imagined or greatly exaggerated
How do developmental psychopathology theorists view anxiety-related disorders?
Examine how key factors emerge and intersect at points throughout an individual’s life span
The factors of interest to them include genetic factors, a hyperactive fear circuit in the brain, an inhibited temperament, overprotective parenting style, maladaptive thinking, avoidance behaviors, life stress, and negative social factors
