Anxiety Disorders Flashcards
Anxiety Disorders
- related to impaired or highly distressing experiences of anxiety
- can physciologically (heart pounding, sweating) or emotional (fear)
- Result in behavioral changes (avoidance) cognitive rumination (worry) hypervigilence (persistent awareness of fear- inducing stimuli) or heightened arousal (insomnia, muscle tension)
Separation Anxiety : Criterion A
Developmentally inappropriate and excessive anxiety concerning separation from those to whom the individual is attached, 3 symptoms
- recurrent excessive distress when anticipating or experiencing separation from home or major attachment figures
- Persistent and excessive worry about losing major attachment figures or possible harm to them, such as illness, injury, disasters or death
- ”” that an untoward event (getting lost, being kidnapped, having an accident) that causes separation from a major attachment
- ” reluctance or refusal to go out, away from home etc because of fear of separation
- ”” fear of reluctance about being alone or without major attachment figures at home or in other settings.
- Repeated night mares involving the theme of separation theme
- ” refusal or reluctance to sleep away from home or to sleep without being near major attachment figure
- repeated complaints of physical symptoms (headache, stomach aches, nausea, vomiting) when separated from major attachment figures occur or is anticipated
Seperation Anxiety Criterion B, C, D
B. Fear, anxiety or avoidance is persistent, lasting at least 4 weeks in children and adolescence’s typically 6 months or more in adults
C. causes impairment in functioning
D. The disturbance is not better explained by another mental disorder … Autisim Spectrum Disorder, delusions or hallucinations in Psychotic Diosrer, Agoraphobia, GAD or Illness Anxiety Disorder
Selective Mutism
A. Consistent failure to speak in specific social situations despite speaking in other situations
B. interferes with educational or occupational achievement or social communication
C. Duration of disturbance is at least 1 month (not including 1st month of school)
D. Failure to speak is not due to a lack of knowledge of or comfort with the spoken language required or social situation
E. not better explained y Communication Disorder, and does not occur in Autism spectrum disorder, schizophrenia or psychotic disorder
Pantic Attack
- This is a syndrome NOT a disorder
- occur commonly during an anxiety attack
An abrupt surge of intense fear, discomfort that reaches a peak within minutes, and during which time four or more of symptoms:
- palpitations, pounding heart or accelerated heart rate
- 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, lightheaded or faint
- chills or heat sensations
- parathesias (numbness or tingling sensations)
- derealization or depersonalization (looks real but having an out of body experience)
- fear of losing control
- fear of dying
Panic Disorder
A. Recurrent (unexpected) Panic Attacks
B. At least one of the attacks has been followed by 1 month of one (ore more):
1. persistent concern or worry about additional panic attacks or their consequences (e.g. losing control, having a heart attack, going crazy)
2. A signficant maladaptive change in behavior related to attacks (behavior designed to avoid having panic attacks, such as avoidance or exercise or unfamilar situations)
C. R/o physiological effects of a substance (drug abuse medication ) or another medical condition (hyperthyrodism, cardiopulmonary disorder)
D. not better explained by mental disorder (OCD Social Anxiety Disorder, Seperation Anxiety)
Agoraphobia
“fear of the market place”
A. Marked fear or anxiety about two (or more) of the following five
- Using public transportation
- Being in Open spaces
- Being in enclosed places
- standing in line or being in a crowd
- Being outside of the home alone
B. Fears or avoids situations because the thoughts that escaping might be difficult or that help might not be available in the event of developing panic like symptoms
C. agoraphobic situations almost always provoke fear or anxiety
D. Actively avoid situations, require the presence of a companion or endured with intense fear or anxiety
E. Fear or anxiety is out of proportion to actual danger
F. Fear, anxiety, avoidance is persistent, lasts for 6 months +
G. Causes impairment in functioning
H. if another medical condition is present, the fear, avoidance or anxiety is beyond reason.
I. Not better explained by Specfical Phobia, Situation Type, Social Anxiety Disorder, OCD, Body Dysmpophic Disorder, Posttraumatic Stress Disorder or Seperation Anxiety Disorder
Specific Phobias
A. Marked Fear or anxiety about a specific object or situation
- in children this fear is marked by crying, tantrums, freezing or clinging
B. Phobic object or situation almost always provokes immediate fear or anxiety
C. Phobic object or sitaution is actively avoided or endured with intense fear or anxiety
D. Fear or anxiety is out of proportion to the actual danger posed
E. Fear, anxiety avoidance lasts for 6months +
F. causes impairment in functioning
G. Not better explained by other mental disorder including Agoraphobia, OCD, PST, Separation Anxiety Disorder or Social Anxiety Disorder
- can be related to harm from the object
- may also be related to losing control when encountering the feared stimulus
- may also be related to fear of embarrassment by doing something when the feared situation
Types of Phobia
- Animal Type (dogs, spiders, insects) onset often in children
- Natural Enviornment (heights, storms, water) onset often in children
- Blood injection Injury Type - highly familial and related to fainting responses
- Situational Types (airplanes, elevators, enclosed places) onset children and mid 20s
Other Type (phobic avoidance of situations that may lead to choking, vomiting or contracting an illness, in children, avoidance of loud sounds or costumed characters
Specific Etiology (5 types)
Evolutionary: fear response is natural and adaptive as God intended (many animals are dangerous, as walking in hi high places, some indicators of an injury may reflect contagion
Psychodynamics Theories:
- Anxiety Stemming from dynamic conflicts get displaced onto a stimulus that is both feared and avoidable
- feared objects are symbolic of representation
Behavioral Theories:
Conditioning : occurs when a stimulus becomes associated with a negative experience
Vicarious conditioning: occurs when watching another person by watching their distress or through watching their experience
-particularly in the case when unexplained panic attacks become associated with either the environment or whatever stimuli happen to be present at the time.
- maintained by cognitive biases, selective attention to negative aspects or experiences
Cognitive Theories:
- Maladaptive automatic thoughts: about how negative an experience is, about control, about lack of ability/ mastery
- selective attention: instead of focusing on a variety of aspects of the situation, including one’s goals, one’s experiences of anxiety, one’s plan of problem-solving, one focuses on negative aspects of the situation that maintain fear
Social Anxiety Diosrder
A. Marked fear or anxiety about one or more social situations in which indivudal is exposed to possible scruinty by others
- in children, anxiety must occur in peer settings
B. The individual fears he or she will act in a way or show anxiety symptoms that will be negatively evaluated
C. Social situations provoke fear or anxiety
- in children, expressed through crying, tantrums, freezing, clinging, shrinking or failing to speak in social situations
D. social situations are avoided or endured with intense fear
E. Fear, anxiety is out of proportion to actual threat
F. Fear , anxiety avoidance is persistent for 6months +
G. Fear, anxiety avoidance causes impairment in functioning
H. Fear, anxiety or avoidance not attributable to physiological effects of a substance or another medical condition
I. The fear, anxiety or avoidance is not better explained by another mental disorder (panic disorder Body dysmorphic disorder, autism spectrum disorder)
J. If another medical condition is present (Parkinson’s disease, obesity, disfigurement from burns or injury), the fear anxiety is beyond reason
** Specify if:
Performance only: if the fear is restricted to speaking or performing in public
Social Phobia Etiology (2)
Psychodynamics Theories:
- negative interactions with parents are internalized
- self is internalized as helpless and dependent and inferior
- also, parents may view others as threatening and children internalize this from parents
Biological Theories:
Kagan, in styding infacnts, has found some who are highly reactive temparament (easily overstiumlated, longer time to sooth, regarded to have more sensitive sensory system) and likely to develop anxiety spectrum disorder
Anxiety Disorder :
Behavioral Therapy Treatment
- Exposure to the feared stimulus
can be graded
also known as systematic desensitization
- Relaxation Training - used to increase desensitization
Cognitive Thearpy
-Cognitive Restructuring ( replacing maladaptive automatic thoughts)
Helping patients see postive aspects of an expereince, helpig patience perceive control, helping patients see their own gains their ability/ mastery
- selective attention
instead of focusing on the negative aspects of the istuation, focus on the positives or on goals of mastery
