Anxiety Disorders Flashcards
Separation Anxiety Criteria
A: Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached as evidence by 3 of the following:
- recurrent excessive distress
-persistent and excessive worry about losing attachment figure
- persistent worry about an upturn event (kidnapping) that would separate you from the attachment figure
-persistent reluctance or refusal to go out or be away from home
-fear of being along
-repeated nightmares about separation
-refusal to sleep away from home
-physical symptoms
B: 4 weeks in kids, 6 months in adults
Panic Disorder Criteria
A. Recurrent, unexpected panic attacks including 4+ of the following symptoms:
▪ Palpitations, pounding heart, accelerated HR
▪ Sweating
▪ Trembling or shaking
▪ Sensations of shortness of breath or smothering
▪ Feelings of choking
▪ Chest pain or discomfort
▪ Nausea or abdominal distress
▪ Feeling dizzy, unsteady, light-headed or faint
▪ Chills/Heat sensation
▪ Paresthesias (numbness/tingling)
▪ Derealization or depersonalization
▪ Fear of losing control or going crazy
▪ Fear of dying
▪ Culture specific stuff like tinnitus, neck soreness, headache, screaming, DO NOT COUNT
B. At least one attack has been followed by 1+month s of one or both of the following
▪ Persistent concern/worry about future panic attacks or their consequences
▪ A significant maladaptive change in behavior related to the attacks (avoidance of activities or places)
C. Disturbance not attributable to effects of a substance or medical condition
D. Not explained by another mental disorder
Key Concerns of Panic Disorder
o There is a panic attack specifier for other disorders – any disorder can be accompanied by a panic attack
o Specific to panic disorder is the fear of the panic attack itself
o Social anxiety and specific phobias are often accompanied by panic attacks
o Strong familial component
o Often presents in ER (thinking it’s a heart attack)
o More common in women
o Late adolescence to mid-30s
o Panic attacks indicate worse prognosis
Methods to Assess for Panic Disorder
o Unstructured clinical interview
o SCID-5: Anxiety Disorders – good for ruling out other anxiety disorders
o MMPI-2-RF – specifically EID (Emotional/Internalizing), RCd (demoralization), RC7 (dysfunctional negative emotions), STW (stress/worry), AXY (anxiety, but be careful bc this is often PTSD related), BRF (behavior restricting fears), NEG-r (Neuroticism)
o PAI
o BASC-3 (for children)
o Conners CBRS (for children)
o Multidimensional Anxiety Scale for Children (MASC-2)
o Self-report measures such as the Beck Anxiety Inventory
o Behavioral observation
o Mental status exam
Panic Disorder Treatment
o Medical consult for anxiolytics/antidepressants
o Cognitive-Behavioral therapy incorporating psychoeducation, interoceptive and in vivo exposures, and cognitive restructuring has shown high efficacy.
o Combo with meds most effective
o Individual therapy
o Exposure therapy
GAD Diagnostic Criteria
A. Excessive anxiety and worry (apprehensive expectation), more days than not for at least 6 months about a number of things
B. Difficulty controlling worry
C. Anxiety associated with 3+ (1+ for children) of the following (present for more days than not in past 6 months)
▪ Restlessness/keyed up/on edge
▪ Easily fatigued
▪ Difficulty concentrating/mind blanking
▪ Irritability
▪ Muscle Tension
▪ Sleep disturbance
D. Anxiety/Worry/Physical symptoms cause clinically significant distress or impairment
E. Not attributable to effects of a substance
F. Not better explained by another disorder
GAD Key Concerns
o GAD is often difficult to parse out from MDD, as the two disorders have very similar features, and they have a very high comorbidity rate
o The key difference between the two disorders is that people with GAD have Negative Emotionality AND Positive Affectivity while people with MDD have Negative Emotionality and LACK Positive Affectivity
o More common in women, genetic risk factors worsened by stress, onset in childhood/adolescence
o Often resistant to treatment
GAD Assessment Measures
o SCID-5: Anxiety Disorders section (Mood Disorders too – need to rule out other explanations)
o MMPI-2-RF- look at the EID (Emotional/Internalizing Dysfunction), RCd (Demoralization), RC7 (Dysfunctional Negative Emotions), COG (Cognitive Complaints), possibly HLP (helplessness), possible SFD (self-doubt), NFC (inefficacy), STW (stress and worry), AXY (anxiety – but this is usually PTSD type), NEGE-r (Neuroticism)
o PAI
o Self-report measures: Beck Anxiety Inventory, State-Trait Anxiety Inventory (really good for parsing out whether it’s general or situational)
o BASC-3 or Conners CBRS for children
o Multidimensional Anxiety Scale for children (MASC-2)
GAD Treatment
o Relaxation training and mindfulness
o CBT to address negative automatic thoughts that are a source of worry
o Combo of meds and psychotherapy
Phobia Criteria
A. Marked fear of anxiety about a specific object or situation (note: in children it may be expressed by crying, tantrums, freezing, clinging)
B. The phobic object or situation almost always provokes immediate fear or anxiety
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety
D. The fear/anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
E. Fear/anxiety/avoidance I persistent, typically 6+ months
F. Fear/anxiety/avoidance causes clinically significant distress or impairment
G. Not better explained by another mental disorder
Specify if
▪ Animal
▪ Natural environment – heights, storms, water
▪ Blood-injection-injury – needles, invasive medical procedures
▪ Situational – flying, elevators, enclosed places
▪ Other
Key Concerns of Phobias
o Really rooted in learning theory (classical conditioning); person associates a stimulus with a negative feeling(fear). Avoiding that stimulus reinforces this association because the person does not feel fear when avoiding the object
o Heightened suicide risk
o Onset usually in childhood or early adolescence
o Often comorbid with something else
o More common in women
o Can be very distressful for a person, but is relatively easy to treat
o Very few seek treatment unless comorbid
Phobia Assessment
o SCID-5 for Anxiety Disorders
o Beck Anxiety Inventory
o BASC-3 or Conners CBRS for kids
o MMPI-2-RF – specifically scales EID, (emotional/internalizing dysfunction), RC7 (dysfunctional negative emotions), COG (cognitive complaints), AXY (anxiety, maybe due to fear and dread), BRF (behavior restricting fears), MSF (multiple specific fears), NEGE-r (negative emotionality)
o PAI
Phobia Treatment
o CBT Treatment involving exposure to feared stimuli – in the absence of avoidance responses, exposures allow a person to habituate to fear and disconfirm the expected catastrophes associated with coming into contact with the feared stimuli; shown to be effective with good maintenance
o Flooding is probably the most quick and effective exposure type, however this can damage the therapeutic relationship and it could also be impossible, impractical, or cruel depending on the feared stimuli
o Systematic desensitization – creating a hierarchy of interaction with feared stimulus and gradually working up that hierarchy
o Need to teach relaxation techniques to cope with distress during the exposures
o Important to rate distress level
o CBT Treatment involving exposure to feared stimuli – in the absence of avoidance responses, exposures allow a person to habituate to fear and disconfirm the expected catastrophes associated with coming into contact with the feared stimuli; shown to be effective with good maintenance
o Flooding is probably the most quick and effective exposure type, however this can damage the therapeutic relationship and it could also be impossible, impractical, or cruel depending on the feared stimuli
o Systematic desensitization – creating a hierarchy of interaction with feared stimulus and gradually working up that hierarchy
o Need to teach relaxation techniques to cope with distress during the exposures
o Important to rate distress level
Selective Mutism
A: consistent failure to speak in specific social situations
B: interferes with educational or occupational achievement
C: a least a month
Social Anxiety
- lasting 6 months or more
-fear or anxiety around social situations
-avoidance
Performance only specifier: if the fear is restricted to speaking or performing in public
