Anxiety and OCD

Question 1

What is the origin of the term “anxiety,” and how is it related to fear and worry?

Answer 1

“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.

Question 2

What are the key factors that differentiate Fear, Anxiety, and Worry (AFW)?

Answer 2

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.

Question 3

How are the cognitive, physiological, and behavioral responses different for Fear, Anxiety, and Worry?

Answer 3

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.

Question 4

How were anxiety disorders viewed in the 19th and 20th centuries?

Answer 4

Freud’s psychoanalysis introduced “anxiety neuroses,” Pavlov and Skinner focused on “fear conditioning,” and in the 1980s, biological framing led to pharmacological interventions.

Question 5

What changed in the DSM-5 for anxiety disorders?

Answer 5

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.

Question 6

What are the key characteristics of phobias

Answer 6

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.

Question 7

What are the key features of Generalized Anxiety Disorder (GAD)

Answer 7

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.

Question 8

What defines Panic Disorder?

Answer 8

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.

Question 9

What are the key symptoms of a panic attack

Answer 9

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.

Question 10

How are anxiety disorders distinguished in the DSM?

Answer 10

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).

Question 11

What does the ABS report say about anxiety disorder prevalence?

Answer 11

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.

Question 12

What is the nature of triggers in specific phobia?

Answer 12

Specific phobia is the most common anxiety disorder, and its trigger involves a clearly identifiable feared stimulus, which is the source of intense anxiety.

Question 13

What are the subtypes of triggers that are common in specific phobia?

Answer 13

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).

Question 14

Anxiety Disorders: prevalence by age

Answer 14

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”.

Question 15

What is the debate around the 6-month criterion and naming of GAD?

Answer 15

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).

Question 16

How does GAD overlap with mood disorders?

Answer 16

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.

Question 17

What are the proposed sub-classes for emotional disorders in DSM-5?

Answer 17

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)

Question 18

What cognitive deficits are linked to different anxiety disorders?

Answer 18

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.

Question 19

What critique did Allen Frances offer about DSM-5’s changes to GAD?

Answer 19

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.

Question 20

What are the key points about the prevalence and and overlapping features of anxiety disorders?

Answer 20

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.

Question 21

What are the core features of Obsessive Compulsive and Related Disorders (OCD as an exemplar)?

Answer 21

Unwanted and intrusive thoughts
Intrusive or habitual responses

Question 22

How did the DSM-5 redefine Obsessive Compulsive & Related Disorders?

Answer 22

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

Question 23

What changes were made to OCD’s classification in the DSM-5?

Answer 23

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?

Question 24

What are the key features of OCD?

Answer 24

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.

Question 25

What themes are common in OCD?

Answer 25

Contamination obsessions: Linked with cleaning compulsions.

Symmetry obsessions: Linked with ordering or counting compulsions

Question 26

How can you differentiate OCD from other disorders?

Answer 26

Generalized Anxiety Disorder (GAD): If the focus is on generalised, excessive worry.

Body Dysmorphic Disorder (BDD): If the obsession is primarily about bodily appearance.

Hoarding Disorder: If compulsions involve storing objects to alleviate unwanted thoughts.

Question 27

What are the main theories behind the Aetiology of Anxiety Disorders?

Answer 27

Biological Factors: Genetic predisposition, neurochemical imbalances, and anxiety sensitivity.

Conditioning and Learning: Acquired through classical conditioning, maintained through operant conditioning.

Cognitive Theories: Cognitive biases or errors (e.g., “catastrophic” misinterpretations of bodily sensations).

Question 28

What is Anxiety Sensitivity (AS) and how is it assessed?

Answer 28

Anxiety Sensitivity (AS) refers to the cognitive predisposition to fear anxiety-related sensations, interpreting them as harmful or dangerous. It assesses fear in relation to:

1. Symptoms of cognitive dyscontrol (CD)
2. Publicly observable symptoms
3. Symptoms of cardiovascular illness/stroke
4. Symptoms of respiratory illness

Fear of CD is most strongly related to anxiety.

Question 29

What does the Preparedness Model (AKA Prepared Learning) suggest about our tendency to develop phobias?

Answer 29

It suggests that we have a biological predisposition to develop phobias for ancestral dangers (e.g., snakes, spiders) when paired with an aversive cue, and that fear responses can be adaptive but may become maladaptive when triggered inappropriately.

Question 30

What are the key elements of spontaneous remission and biological therapies for anxiety disorders?

Answer 30

Spontaneous Remission: Some individuals recover from anxiety without treatment, especially with social anxiety disorder, possibly due to coping strategies or diminished social concerns.

Biological Therapies:
Benzodiazepines (e.g.,
Diazepam, Lorazepam):
Enhance GABA activity to
reduce anxiety but pose
risks of withdrawal and
addiction.
Antidepressants: Often used
due to overlap between
anxiety and depressive
disorders.

Question 31

What are the different types of exposure therapies for treating anxiety disorders?

Answer 31

Exposure: Involves imagined, in vivo (real-world), or virtual exposure to feared stimuli.

Systematic Desensitization: Gradual exposure to fear while practicing relaxation.

Interoceptive Exposure: Inducing panic symptoms to help individuals develop coping mechanisms.

Flooding: Prolonged exposure to feared stimuli until the anxiety response diminishes.

Question 32

What are common behavioural therapies used to treat anxiety disorders?

Answer 32

Relaxation Training: Progressive muscle relaxation techniques.

Breathing Retraining: Slow, diaphragmatic breathing to manage hyperventilation.

Dietary Considerations: Reducing caffeine and stimulants to manage anxiety.

Physical Exercise: Regular exercise to help reduce anxiety symptoms.

Question 33

How can exercise be used in the treatment and prevention of depression and anxiety disorders?

Answer 33

Exercise can serve as a mood enhancer and may be used as an adjunctive or preventative approach in the treatment of depression and anxiety. It can be added to other therapies or promote coping mechanisms, especially once recovery has begun, to create sustainability in the treatment plan.

Question 34

What are some cognitive therapy techniques used to treat anxiety disorders?

Answer 34

Cognitive therapies for anxiety include cognitive restructuring (increasing awareness of irrational, negative, or unhelpful thoughts), challenging faulty logic, distraction, and thought-stopping. Patients are often assigned practice and homework to reinforce these skills. The ABC model (Activating event → Belief → Consequence) is used to identify and change thought patterns linked to emotional consequences, improving well-being.

Question 35

What did research conclude about the effectiveness of pharmacological vs psychological therapies for anxiety disorders?

Answer 35

A study reviewing 230 RCTs on treatments for panic, GAD, and social phobia found that medications offered a larger benefit compared to psychological therapies pre and post-treatment. However, psychological therapies also delivered significant benefits. The choice between psychotherapy, medications, or a combination should be left to the patient, as drugs can have side effects and contraindications.

Question 36

How does the cognitive model explain and address obsessive thoughts in OCD?

Answer 36

A cognitive (attentional) error leads to mental preoccupation in OCD. Thought suppression and physical cues (e.g., using a rubber band to flick when an intrusive thought arises) can help redirect attention and manage anxiety.

Question 37

How does the learning model explain the treatment for OCD?

Answer 37

The learning model suggests that OCD is due to maladaptive learning or associations. Treatment focuses on exposure and response prevention to break the cycle of compulsions and anxiety.

Question 38

What biological findings influenced the DSM-5 reclassification of OCD from an anxiety disorder?

Answer 38

Neuroanatomical findings (structural and functional) showed specific changes in the brain, leading to the reclassification of OCD. Medications like SSRIs and TCAs are used to address these changes.

Question 40

Can complete recovery from OCD happen, and how long might it take?

Answer 40

Yes, complete recovery can happen, but it may take a long time. Some degree of symptomology may persist even as improvement occurs.

Question 41

What did a long-term study on OCD recovery reveal?

Answer 41

The study tracked individuals over 40 years, showing that improvement can still happen decades later. Some had complete recovery, others had subclinical or clinical symptoms, and some deteriorated. The study’s inter-rater reliability was high as the same psychiatrist conducted both evaluations.

Question 42

What is the distinction between fear and anxiety in anxiety disorders?

Answer 42

Fear is a specific response to a present threat, while anxiety is a generalized “anticipatory fear” about future events that is disproportionate to the threat. Anxiety disorders often involve intense distress and dysfunction, although they are generally treatable, unlike OCD which can be more challenging.

Question 43

How do we differentiate ‘anxiety’ and ‘Anxiety’ (capital A)?

Answer 43

‘anxiety’ (lowercase) refers to an intense, appropriate worry in response to a real danger, while ‘Anxiety’ (capital A) is a clinical disorder characterized by a generalized negative emotional reaction that is maladaptive, irrational, uncontrollable, disruptive, and disproportionate.

Question 44

What is the difference between fear and anxiety, and how does this relate to excessive vs. normal worry?

Answer 44

Fear is a response to a present threat, while anxiety is usually a diffuse, disproportionate response to a future threat. Excessive worry is more intense, less controllable, verbally mediated, and future-oriented compared to normal worry.