Anxiety and OCD Flashcards
What is the origin of the term “anxiety,” and how is it related to fear and worry?
“Anxiety” is derived from the German root “Angh” and “Angst,” meaning a feeling of “pressure, tightness, and constriction.” While anxiety, fear, and worry are common everyday experiences, when symptoms become clinically significant and impair functioning, they may indicate psychopathology.
What are the key factors that differentiate Fear, Anxiety, and Worry (AFW)?
Differentiating AFW involves considering the timing of the threat (present vs. future), the specificity of the source (clearly identifiable vs. vague or general), and the degree of cognitive, behavioral, and physiological involvement. Fear typically involves immediate reactions, while anxiety involves building responses to potential future threats.
How are the cognitive, physiological, and behavioral responses different for Fear, Anxiety, and Worry?
Fear: Rapid onset, difficult to control physiological responses (e.g., racing heart), with urgent behavioral avoidance to save life.
Anxiety: Less immediate, with intense physical changes (e.g., elevated heart rate), and avoidance to reduce unpleasantness or anxiousness.
Worry: Low-level, cognitively driven anticipation of future events, typically with behavioral avoidance challenged by everyday stimuli.
How were anxiety disorders viewed in the 19th and 20th centuries?
Freud’s psychoanalysis introduced “anxiety neuroses,” Pavlov and Skinner focused on “fear conditioning,” and in the 1980s, biological framing led to pharmacological interventions.
What changed in the DSM-5 for anxiety disorders?
PTSD and OCD were removed from the anxiety group. DSM-5 includes specific phobia, social phobia, GAD, separation anxiety, and selective mutism (newly re-categorized). Panic disorder and agoraphobia are no longer linked to anxiety disorders.
What are the key characteristics of phobias
Phobias involve focused, persistent fear/avoidance (6+ months) that is “out of proportion” to actual/perceived threats. They cause maladaptive behaviors, distress, and dysfunction. Examples include specific, social, and agoraphobia.
What are the key features of Generalized Anxiety Disorder (GAD)
GAD involves persistent, excessive worry about several events or activities, difficult to control. Symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. Occurs almost daily for at least 6 months.
What defines Panic Disorder?
Recurrent, unexpected panic attacks—intense fear peaking within minutes. Panic attacks may have situational triggers or specific symptoms. One attack must lead to a month of persistent concern or maladaptive behavior change.
What are the key symptoms of a panic attack
Panic attacks require 4+ symptoms, such as palpitations, sweating, trembling, shortness of breath, chills/hot flushes, derealization, or depersonalization. The DSM uses a polythetic approach—4 symptoms meet part of the diagnosis.
How are anxiety disorders distinguished in the DSM?
Key distinctions include the duration of episodes, the scope of fear/avoidance (specific phobias vs. generalized fear), and the intensity of symptoms (e.g., pounding heart in panic attacks vs. restlessness in GAD).
What does the ABS report say about anxiety disorder prevalence?
Australian data shows that anxiety disorders are more common in females than males. The report uses older DSM categorizations and indicates anxiety as a gendered condition.
What is the nature of triggers in specific phobia?
Specific phobia is the most common anxiety disorder, and its trigger involves a clearly identifiable feared stimulus, which is the source of intense anxiety.
What are the subtypes of triggers that are common in specific phobia?
Specific phobia is the most common anxiety disorder. Triggers can be divided into 5 subtypes:
1. Animals (e.g., snakes, bats)
2. Natural environment (e.g., heights, water)
3. Situations (e.g., closed spaces)
4. Blood-injection-injury (e.g., needles)
5. Other (e.g., vomiting)
Critical focus: Are these triggers stable across cultures and time? Some may have evolutionary roots (e.g., fear of snakes).
Anxiety Disorders: prevalence by age
Prevalence is highest in younger adults.
Another peak occurs in the aged (70+) – why?
Exception to the general rule that new anxiety disorders don’t typically manifest in the elderly: “late life onset agoraphobia”.
What is the debate around the 6-month criterion and naming of GAD?
There is debate over whether 6 months is the best time frame for GAD diagnosis.
The name “Generalised Anxiety Disorder” is also debated; alternatives like “Generalised Worry Disorder” or “Pathological Worry Disorder” were proposed.
Some proposed renaming it Panophobia (anxiety about everything).
How does GAD overlap with mood disorders?
GAD shares similarities with mood disorders, particularly Major Depressive Disorder (MDD).
A radical proposal suggested merging GAD with nonbipolar depression into a spectrum of mood/anxiety disorders due to high comorbidity.
What are the proposed sub-classes for emotional disorders in DSM-5?
The proposal for DSM-5 suggested three sub-classes of emotional disorders:
1. Bipolar disorders
2. Distress disorders (MDD, dysthymic disorder, GAD, PTSD)
3. Fear disorders (PD, agoraphobia, social phobias, specific phobias)
What cognitive deficits are linked to different anxiety disorders?
The DSM-IV vs DSM-5 debate also examined cognitive dimensions in anxiety disorders.
Cognitive deficits across anxiety disorders can include:
Working memory and attentional bias
(strong in GAD, PD, SAD, PTSD)
Cognitive flexibility and response
inhibition (limited effect in some
disorders)
Increased baseline startle and disgust;
sensitivity seen in specific cases.
What critique did Allen Frances offer about DSM-5’s changes to GAD?
Worst Change #9: Frances argues that DSM-5 blurs the boundary between GAD and normal worries, potentially over-pathologizing everyday concerns.
Small definitional changes risk creating millions of new ‘patients’.
Concern over expanding inappropriate prescribing of anti-anxiety medications for less severe worries, such as school-related stress.
What are the key points about the prevalence and and overlapping features of anxiety disorders?
Prevalence: Anxiety disorders are common, with women more likely to be diagnosed than men, and younger people more likely than older people (with some exceptions)
Overlapping features: Disorders share feelings of intense fear but differ in temporal aspects and the nature (scope) of feared stimuli.
What are the core features of Obsessive Compulsive and Related Disorders (OCD as an exemplar)?
Unwanted and intrusive thoughts
Intrusive or habitual responses
How did the DSM-5 redefine Obsessive Compulsive & Related Disorders?
Redefinition of obsessions: Emphasizes the role of avoidance and thought-stopping strategies beyond compulsions.
New groupings: Includes OCD along with:
o Trichotillomania (hair pulling disorder)
o Hoarding Disorder
o Excoriation (skin picking disorder)
o Body Dysmorphic Disorder
What changes were made to OCD’s classification in the DSM-5?
OCD is no longer an anxiety disorder.
New disorder category created, moving these conditions from various DSM sections.
OCD has a relatively low prevalence compared to anxiety disorders (ABS data).
Critical focus: Does OCD have more in common with its new group than with anxiety disorders? What evidence justifies the change?
What are the key features of OCD?
Obsessions: Repetitive, uncontrollable, intrusive, unwanted thoughts/urges/images that provoke marked anxiety.
Compulsions:
Repetitive behaviours or mental
acts/rituals intended to reduce
anxiety (though unlikely to succeed)
or are clearly excessive.
Examples: Hand washing, counting.
Time occupied: Obsessions or compulsions (or both) take up over 1 hour per day.
Relief: People feel compelled to perform the act for temporary relief from anxiety.
