Anxiety Disorders Flashcards
DSM-5 Anxiety Disorders
- Separation Anxiety Disorder
- Selective Mutism
- Specific Phobia
- Social Anxiety Disorder
- Panic Disorder
- Panic Attack Specifier
- Agoraphobia
- Generalized Anxiety Disorder
- Substance/Medication-Induced Anxiety Disorder
- Anxiety Disorder Due to Another Medical Condition
- Other Specified Anxiety Disorder
- Unspecified Anxiety Disorder
- OCD & PTSD in their own sections now for DSM-5
Specific Phobia DSM-5 Diagnostic Criteria
- Fear or anxiety about a specific object/situation
- Object creates immediate fear response
- Avoidance of object/situation (or endured with intense fear)
- The fear/anxiety is out of proportion to the danger posed
- Present for at least 6 months
Specific Phobia Specifiers
- Specify stimulus: Animal, natural environment (e.g., heights, storms), blood-injection-injury, situational (e.g., airplanes, elevators), other
Social Anxiety Disorder DSM-5 Diagnostic Criteria
- Fear of social situations in which individual is exposed to possible scrutiny from others
- Fear of negative evaluation
- Social situations persistently provoke fear and are avoided (or endured with intense fear)
- Fear is out of proportion to actual threat
- 6+ months
Social Anxiety Disorder Specifiers
- Performance only (only for speaking/performing)
Panic Disorder DSM-5 Diagnostic Criteria
- Recurrent unexpected panic attacks
- Panic attack: an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) occur:
1) Palpitations, accelerated HR
2) Sweating
3) Trembling or shaking
4) Sensations of shortness of breath/smothering
5) Feelings of choking
6) Chest pain or discomfort
7) Nausea or abdominal distress
8) Feeling dizzy or light-headed
9) Chills/heat sensations
10) Paresthesias (numbness or tingling sensation)
11) Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12) Fear of losing control or “going crazy”
13) Fear of dying - At least one attack is followed by 1 month of persistent worry about another attack and maladaptive change in bx related to attack
Panic Attacks versus Panic Disorder
Panic attack is not a mental disorder and can occur in the context of any anxiety disorder; can be noted as a specifier
Panic Disorder Symptoms Domains
- Cognitive: focus on immediate threats, interpret ambiguous stimuli as dangerous
- Somatic: respiratory and cardiovascular primarily, but also nausea, loss of bodily control, sweating, dissociation
- Behavioral: mostly avoidance
Initial Panic Attack
- Fear = natural response to a threatening stimulus
- First panic attack like a false alarm; don’t know why it happened
- First attack usually occurs away from home, in public, and while active
- Bodily sensations perceived as threatening
Interoceptive Conditioning
- Somatic arousal related to anxiety becomes conditioned stimulus (i.e., associate somatic arousal with the bad situation the person was in)
Catastrophic misappraisals of bodily sensations
- Sensations interpreted as signs of imminent death or loss of control (e.g., person climbs a flight of stairs & their hear rate changes; person attributes this to early signs of a panic attack and works themselves up)
Maintenance of Panic Attacks
Distress over bodily sensations (fear of fear) ongoing:
1) Cycle of fear about bodily sensations considered a positive feedback loop, triggered by autonomic arousal
2) Seems to start out of the blue; perceived as uncontrollable, which adds to anxiety (When is it going to happen again?)
Increased apprehension = increased availability of/alertness to bodily sensations related to panic
Initiation and Maintenance of Panic Disorder Model
Unknown stimulus –> first attack –> fear of fear –> increased arousal –> sensations as stimuli/catastrophic misinterpretations –> panic attack –> heightened apprehension –> back around the loop (increased arousal) OR avoidance behavior leading to agoraphobia
Agoraphobia DSM-5 Diagnostic Criteria
- Marked fear of 2 or more:
1) Public transportation
2) Open spaces
3) Enclosed spaces
4) Standing in line or being in a crowd
5) Being outside of home alone - Fears driven by thoughts that escape would be difficult or help would not arrive
- Situations are persistently fear provoking and are actively avoided (or require presence of companion/are endured with intense fear)
- Fear out of proportion to actual danger posed by situation
- 6+ months
Generalized Anxiety Disorder DSM-5 Diagnostic Criteria
- Excessive anxiety/worry (apprehensive expectation, or feeling that something bad is going to happen) about a lot of things for at least 6 months
- Worry is difficult to control
- Worry is associated with 3+ of following:
1) Restlessness
2) Fatigue
3) Concentration difficulties
4) Irritability
5) Muscle tension
6) Sleep disturbance
Specific Phobia Epidemiology & Etiology
- Point estimate: 7-9%
- More common females 2:1
- Age of onset can differ by type of phobia
- Preparedness: why afraid of some things but not others? Possibly evolutionary?
- Classical conditioning
Social Anxiety Disorder Epidemiology & Etiology
- Very common (lifetime 12%, point 7%)
- More common in women
- Onset: ages 13-20
- Genetic: moderately heritable; gender differences in twin studies (50% variance in females, 25% men)
- Temperament
- Parents may model anxious behavior; overprotectiveness or parents low in emotional support
- Biological: serotonin involved but role unclear; dopamine involved (MAOIs reduce symptoms)
Social Anxiety Disorder Symptom Domains
- Somatic: panic attack-like symptoms, but only in social situations
- Cognitive/Psychological: thoughts of social inadequacy, concerned others are aware of own distress, fear of embarrassment, biased to attend to indicators of negative eval
- Behavioral: avoid social situations, some have specified fears of eating/drinking in public, often interfere with performance, excessive alcohol use common
Epidemiology of Panic Disorder
- Point prevalence 2-3% (5% lifetime)
- More common females (2:1)
- Onset tends to be sudden, early 20s
Etiology of Panic Disorder
- Genetics: family/twin studies show genetic influence (30-40% of variance)
- Environmental: stressors often associated with initial panic attacks
- Classical conditioning: How much does an event affect you and do you make associations to the event?
- Diathesis-stress approach
- Psychological factors: fear of fear; usually more sensitive to bodily sensations (scan bodies)
- Biological factors: amygdala dysfunction, low GABA (inhibitory) levels, dysregulation of autonomic nervous system and HPA axis (don’t have balance sympathetic and parasympathetic nervous systems), serotonergic systems implicated
Epidemiology of Generalized Anxiety Disorder
- Point prevalence 1-2%, lifetime 4-6%
- Age of onset typically in early adulthood: often describe lifelong difficulties but don’t realize problematic; onset slow and gradual
- Twice as common in women than men
GAD: Biological Perspective
- Genetic factors: increased risk in blood relatives (could be modeling?)
- Neurotransmitters: GABA (inhibitory) low, serotonin low?, norepinephrine elevated?
- Autonomic inflexibility: low autonomic reactivity, higher, unstable heart rate and state of heightened arousal
- HPA Axis: cortisol over-production
- Prefrontal Cortex: cognitive inhibition –> worry/rumination
GAD: Cognitive Perspective
- Theory: GAD is caused by maladaptive assumptions
- Ellis: basic irrational assumptions applied to everyday life
- Beck: GAD as unrealistic, silent assumptions that imply imminent danger
Probability Overestimation
- Worries themselves not necessarily unreasonable
- Overestimate likelihood of negative consequences (interpret ambiguous events as threat, overestimate likelihood of bad events)
Problem Solving & GAD
- Worry in small portions may be adaptive
- Excessive worry associated with poor problem-solving or low confidence
Information Processing & GAD
- “Pay greater attention to threatening stimuli, preferentially encode this info, have biases in memory for threatening events”
- Interpretation of ambiguous stimuli as dangerous/negative
Avoidance Theory
- T. Borkovec
- Worry is attempt at cognitive avoidance –> prevents full emotional experience of anxiety (distracting)
- Reduces distress and fear in short-term
- Worry is employed to prolong and maintain a negative emotional state thereby avoiding an unexpected negative emotional shift
Intolerance of Uncertainty & GAD
They would rather know what is going to happen, even if it’s bad; anxiety about uncertainty
GAD: Sociocultural Perspective
- Negative social conditions: stressful life events that are unexpected, negative, and very important –> increased risk
- One of the most powerful forms of societal stress is poverty; high rates of GAD in low SES & among ethnic minority groups
Common Age-Appropriate Fears in Children
- Infants: loss of support, loud noises, height, strangers, sudden & unexpected objects
- 1-2: separation from parent, strangers, toilet injury, loud noises, large animals
- Preschool: animals, the dark, masks, being left alone, insects, separation from parent
- Elementary School: animals, the dark, thunder & lightening, supernatural beings, current events
- Middle School: academic, social, and health-related fears (e.g., tests, medical procedures)
When is a child too fearful?
- Intensity: fear more intense than expected given the child’s age, gender, etc.
- Duration: continues beyond what is considered normal age
- Impairment: fear interferes with child’s normal activities
