Anxiety and OCD Flashcards
Anxiety (fear + worry)
Combination of fear and excessive worry.
Be careful about how you define. Misconceptions of anxiety definition
Fear: emotional response to real or perceived threat. Usually automatic Flight or fight, escape behaviors
Anxiety: anticipation of future threat. Muscle tension and vigilance in preparation of future dangers. Also cautious and avoidant behaviors
Worry: mental distress about something that might happen
Different parts of the brain are active for fear and for anxiety, but other parts similar
Intensity, duration, and focus of anxiety become the discriminating factors for types of Anxiety Disorders One of the most common categories of disorders in general population
Brain Components
Amygdala: Emotion, activated when recalling emotion memories
Thalamus: Sensory info and relays to cortex
Hippocampus: processing long term memory and recollection
Separation anxiety disorder
Separation Anxiety Disorder. Now classified as an anxiety disorder due to growing number of adults experiencing similar symptoms.
Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached.
Persistent worry or distress about losing loved one to death, getting lost or kidnapped, refusal to go away from home, nightmares, can’t sleep away from home or attachment figure
Duration criterion—at least 4 weeks for kids and 6 months of adults.
This is most common in children: going ballistic when left alone, chronic worries about going to school or leaving attachment, clinging to attachment, creating somatic complaints to stay near, excuses to stay awake
In adults: overconcerned with children or spouse leaving, dying, kidnapped; can’t leave home, go to college, move away from attachment figure. All of these cause significant impairment with social and work related area
GAD
The mind never rests, always alert for the perceived danger or threat. These are often typical life challenges (family, money, health, school, relationships). Occurring most days for at least 6 months.
Anxiety (or also known as worry wart) have both cognitive symptoms (poor concentration, catastrophizing, indecision) and physical symptoms (nausea, diarrhea, headaches, sweating, tense muscles, sleeplessness).
Everyone encounters anxiety or worry on a daily basis, what makes it pathological is significant impairment in life.
GAD is also not specific like the other anxiety disorders. The person could have many “things” in life that give them worry or a small number that are always present.
Panic disorder
The experience of terror in a given situation. The terror gives way to physical symptoms; this increases terror; which then causes further physical symptoms.
Panic attacks come on suddenly and leave suddenly, but a person may have escalated to point of medical intervention.
Don’t usually begin with environment triggers (unexpected panic attack), but soon classical conditioning takes hold and settings represent more than they did before (expected panic attack)Panic attacks involve short periods of intense anxiety symptoms, which peak within 10 minutes. Panic attack symptoms can include: chest pain or discomfort, choking, dizziness or faintness, fear of being out of control, fear of dying, fear of “going crazy”, hot flashes or chills, nausea or other stomach distress, numbness or tingling, racing heart, shortness of breath, sweating, trembling
Must have 4 symptoms (some noted above) that occur, with a following period (1 month) of persistent concern or maladaptive changes in behavior
Panic disorder diagnostic tips
Rare that panic attacks will occur alone. Often associated with other disorders. Particularly, anxiety (agoraphobia) major depression, bipolar, and substance use. Panic attacks can be assigned as specifier to other disorder, but panic disorder (which includes panic attacks) could be alone
Rule out real life dangers (rape, car accident, war) as it is normal to have excessive physical reactions to these events
Substances, supplements, medical conditions (hyperthyroid), medications can all have side-effects
Panic disorder is not specifics to phobias, trauma, OCD, separation. These represent other disorders, which could have panic attack specifiers. However, if both multiple criteria are met then rank order by prominence.
Agoraphobia (social phobia unspecified)
Agoraphobia is considered to be present when places or situations are being avoided (transportation, open spaces, closed spaces, being in crowds, being alone). People with agoraphobia generally do not feel safe in public places. Their fear is worse when the place is crowded. Avoidance morphs to include a growing list of places and becomes a central theme of life. Significant impairment: massive energy used to avoid or plan escapes once in space.
Symptoms of agoraphobia include: Becoming housebound for prolonged periods of time; Dependence on others; Fear of being alone, being in places where escape might be difficult, losing control in a public place; Feelings of detachment or estrangement from others; Feelings of helplessness, that the body is unreal; Unusual temper or agitation
Agoraphobia diagnostic tips
Social anxiety similar, but focuses on specific social situationsPhobias can have many specific focal points
PTSD or Acute Stress have specific trauma events
Panic Disorder would be chosen unless 2 or more situations still actively avoided.
Agoraphobia is usually a secondary complication arising as a consequence of repeated panic attacks
Consider where the client is at. Meaning how confined have they become. The more confined and more places avoided the deeper the issue
Obsessive compulsive disorder
Obsessions: recurrent and persist thoughts or urges that are intrusive and unwanted
*Compulsions: repetitive behaviors/mental acts that one feels compelled to do in response to obsessions.
*There are many types of obsessions and compulsions.▫excessive hand washing, ordering, checking.
*The person usually recognizes that the behavior is excessive or unreasonable, but can’t stop. There are specifiers regarding insight level (good or fair insight; poor insight; absent or delusional beliefs)
*These rituals take up more than 1 hour per day and cause significant impairment or distress in areas of life
OCD theories of causation
- Biology. OCD may be a result of changes in your body’s own natural chemistry or brain functions. OCD also may have a genetic component, but specific genes have yet to be identified.
*Environment. OCD may stem from behavior-related habits that you learned over time.
*Insufficient serotonin. An insufficient level of serotonin, one of your brain’s chemical messengers, may contribute to obsessive-compulsive disorder. In addition, people with obsessive-compulsive disorder who take medications that improve the action of serotonin often have fewer OCD symptoms.
We now know that higher metabolic activity occurs on a “circuit” or pathway between the frontal cortext (i.e. decision making), thalamus (sensory perception), basal ganglia (learning), and anterior cingulate cortex (motivation) when OCD actions are present
*Therapy and medication can decrease the activity in this area, subsequently, reducing the OCD symptoms
Clinical features of OCD
Overestimate threatsIntolerance of uncertainty
*Perfectionistic
*Cleanliness
*Obsessions and compulsions must be time consuming (more than 1 hour a day)
*Some have good insight to their disorder while others have poor insight
*Fewest group (4%) is those that have no insight or are delusional
*Highly likely to avoid situations that trigger O/C
*Average onset is 19-20 years old with most symptoms starting by age 14
*Males more likely to have in childhood, but females more likely in adulthood
*30% of OCD individuals develop a tic disorder
*Suicidal ideation a 50/50 chance at some point; 25% attempt
OCD diagnostic tips
*Anxiety disorders are a boundary land. However, the obsession are related to real-life and rarely considered odd. Plus no clear links to compulsions
*OC personality disorder represent rigid, perfectionistic all encompassing way to engage life
*Don’t diagnosis if rituals are harmless or part of cultural expectations
*Usually more useful to target compulsions in therapy as they are more behaviorally based
*If significantly odd delusional qualities are involved stronger treatment with medication is needed
Body dysmorphic disorder
- Perceived defects in appearances that are not or barely noticed by others. Often nose or breasts, but muscle dysmorphia possible
*Ashamed of their appearance; impact social engagement; work performance or restrictive choices
*Cosmetic treatment high
*Behaviors turn to excessive mirror checking, comparisons, negative self descriptions (I look hideous). Hours spent engage in review
BDD diagnostic tips
*Anorexia Nervosa is more concerned with feeling fat
*Social phobia is not related to sole focus on appearance
*It’s normal for people to be disappointed in appearances
*Think Clinical Significance: avoiding situations, persistent checking and evaluating, repeated corrective surgeries, attempts to conceal deficits constantly
*Don’t argue or say “your nose if fine.” The client has heard all of that thousands of time
*More about being curious what they see, how they want to live in spite of the “deformity”
*Catalogue concealment plans, surgeries, various body parts that are problematic. Building a summary or picture of disorder course can assist with insight development.
Hoarding disorder
*Persistent difficulty discarding with things (animals).
*Nearly all things hold value or meaning (utility or aesthetic)
*Indecisiveness, perfectionism, low organization/planning, isolation.
*Specify insight levels and if associated with excessive acquisition *Hoarding can be related to compulsive buying (such as never passing up a bargain), the compulsive acquisition of free items (such as collecting flyers), or the compulsive search for perfect or unique items (which may not appear to others as unique, such as an old container
Hoarding diagnostic tips
*OCD if the hoarding results from an obsession noted in OCD (contamination)
*Schizophrenia if hoarding is related to bizarre delusions
*Not related to Age related Neurocognitive Disorder (previously dementia, brain injury)
*Normal “pack rat” behaviors may be annoying to client and others, but clinical impairment is not present
*Family or primary reported of hoarding vital to treatment
*Hoarding may be present on its own or as a symptom of another disorder. Most often associated with OCPD, OCD, ADHD, and depression.
*Although less often, hoarding may be associated with an eating disorder, pica (eating non-food materials), Prader-Willi syndrome (a genetic disorder), psychosis, or dementia
