Anxiety Disorders Flashcards
Anxiety
Universal, functional & normal emotional state everyone experiences
Disorders are diagnosed when the anxiety has a significant impact on a persons day to day functioning
On a continuum, both normal emotion & diagnosable disorder
Anxiety vs Fear
Anxiety; -ve mood state, bodily symptoms of physical tension & apprehension about future
Can be good in small amounts
Fear; immediate alarm reaction to danger
Can protect us
Evidence that anxiety & fear differ in psychological & physiological processes
Panic attack
Fear occurring at inappropriate time
Surge of intense fear of discomfort that reaches a peak within minutes
Physical symptoms
Precipitants (causes) of anxiety disorders
External & internal triggers PTSD; life-threatening Adjustment disorder; stressful life change Phobia; feared situation/object GAD; the world, chronic apprehension PD; intense autonomic symptoms OCD; intrusive thoughts, imagined harm
Co-morbidity
Very high rates of co-occurring anxiety disorders
All share same features of anxiety, fear & panic
Share same biological & psychological vulnerabilities
Differ in terms of trigger & in some cases pattern of attacks
Shared vulnerabilities
Biological; heritable contribution to negative affect
Specific psychological; e.g. physical sensations are potentially dangerous
Generalised psychological; sense that events are uncontrollable/unpredictable
Genetic contribution
heritability of tendency to panic or be tense/uptight/anxious, complex trait, combination with stress= vulnerability
Neurochemical contribution
Reduced GABA activity produces anxiety in animal models
Drugs with increase GABA function are anxiolytic
Noradrenaline in Locus Coereleus may be important in panic disorder
Antidepressants with affect noradrenaline are helpful
OCD may involve serotonin imbalance
SSRI antidepressants may help patients
Behavioural Inhibition System
Anti-anxiety drugs
Conflict generation; signals of punishment, signals of non-reward, novel stimuli & inmate fear stimuli
Conflict resolution; behavioural inhibition, increased arousal & increased attention
Threat system
Fight or flight
Psychological factors
Anxiety: sense of control or uncontrollability, role of early childhood & parental style
Panic; conditioning, external & internal cues
Lifetime prevelance of anxiety & OCD related disorders
Any anxiety disorder; 28.8% Panic disorder; 4.7% Agoraphobia w/o panic; 1.4% Specific phobia; 12.5% Social phobia; 12.1% GAD; 5.7% PTSD; 6.8% OCD; 1.6% Separation anxiety disorder; 5.2%
Generalised Anxiety Disorder symptoms
Physical; over-awareness of autonomic activity, gastrointestinal, respiratory, cardiovascular, genito-urinary, CNS changes, muscle tension
Psychological; fearful anticipation, irritability, lack of concentration, sensitivity to noise, restlessness, insomnia & loss of libido
Diagnosis of GAD
Excessive anxiety & worry occurring more days than not for atleast 6 months
Atleast 3 other symptoms
Clinically significant distress or impairment in social, occupational or other important areas of functioning
Disturbance not due to direct physiological effects of substance/condition or other disorder
Integrative model of GAD
Generalised psychological/biological vulnerability -> stress -> anxious apprehension -> worry process -> GAD
Worry process; avoidance of imagery -> restricted autonomic response OR intense cognitive processing -> inadequate problem-solving skills
GAD CBT treatment
Reinterpret ambiguous stimuli
Likelihood of negative event
Exposure
What is Panic Disorder?
Recurrent episodes of sudden, inexplicable & overwhelming apprehension
Sudden onset of attacks lasting approximately 10 minutes
Shortness & severity distinguish it from other anxiety disorders
Unexpected; spontaneous
Expected (cued); can identify trigger event
Symptoms of panic disorder
Emotion: extreme terror, sense of impending doom
Physical: swearing, palpitations, dizziness
Cognitive; catastrophic misinterpretation
Prevelance of Panic disorder
Lifetime incidence; 4.7%
Higher concordance for MZ twins
30% of close relatives of individuals with PD also experience it
Panic Disorder diagnosis
Recurrent unexpected panic attacks
Absence of agoraphobia
Not due to substance, medication or other disorder e.g. social phobia
Atleast one attack has been following by 1 month of; persistent concern about additional attacks, worry about implications of attack or significant change in behaviour related to attacks
Agoraphobia
Fear of entering unfamiliar situations
Anxious when away from home, in crowds & situations they cannot leave easily
Generally same symptoms as other anxiety disorder
Other symptoms e.g. depression, de-personalisation & obsessive thoughts more common than with other disorders
Agoraphobia prevelance
Most common phobia (50-80% of phobic cases)
Women 2x as likely to suffer
Diagnosing agoraphobia
Marked fear or anxiety about 2 or more agoraphobic stimuli
Due to thoughts they may start to panic or not escape
Fear out of proportion to actual danger
Lasts 6 months or more
Significant distress or impairment in important areas of functioning
Not better explaining by other disorder
Nocturnal panic
60% who have panic attacks have nocturnal ones
EEG shows they occur in deepest stage of sleep, link to anxiety around letting go
Isolated sleep paralysis; occurs just before waking or going to sleep, more prevalent in African Americans, link to PTSD
Model of panic disorder w or w/o agoraphobia
1) Generalised psychological/biological vulnerability
2) Stress
3) False or learned alarm
4) Specific psychological vulnerability
5) Anxious apprehension
6) Panic disorder
Cognitive model of panic
1) trigger (external or internal)
2) threat perceived
3) anxiety symptoms (catastrophic misinterpretation) & body or mental symptoms
Panic disorder CBT treatment
Reinterpret bodily symptoms
Exposure
Phobia
Irrational fear
Same core symptoms of GAD but only occur in specific situations or in response to specific stimuli
Typically a persistent & disproportionate fear of something that presents little or no danger
Individual avoids circumstances that provoke anxiety
Experience anticipatory anxiety prior to situation
Specific phobia diagnosis
Marked fear/anxiety about specific object/stimuli
Lasting at least 6 months
Phobic stimulus almost always provokes immediate fear/anxiety & is avoided or endured with intense fear/anxiety
Fear/anxiety out of proportion to danger
Clinically significant distress or impairment in important areas of functioning
Not better explained by another disorder
Types of phobia
4 major subtypes; blood-injection, situational, natural environment & animal type
Differences in response to feared stimuli
People often have several phobias
Never have panic attack outside of context of their phobic object
Phobia prevelance
4:1 Female;male ratio
Around 30% of first degree relatives have same or similar phobias
Social phobia/social anxiety disorder
Fear of situations in which one is exposed to the scrutiny of others
Fear that one may do something that will cause humiliation or embarrassment
High levels of social withdrawal, isolation & depression
Fear of public speaking is a form of SAD
Most prevelant next to specific phobia
Social anxiety disorder model
1) generalised psychological/biological vulnerability
2) stressor
3) no alarm (but perceived poor social skills), false alarm (associated with social-evaluative situations) or true alarm (due to direct experience)
4) false & true alarm become learned alarms
5) anxious apprehension (& increased self-focused attention)
6) specific psychological vulnerability
7) social anxiety disorder
Phobia CBT treatment
1) dispute beliefs about phobic stimuli
2) behavioural experiments
3) exposure
OCD & related disorders
OCD previously classed as anxiety disorder
In its own class along with; hoarding, trichotillomania, body dysmorphia & excoriation (skin picking) disorder
Distressing intrusive thoughts (obsessions) about potential for harm to self or others & unwanted repetitive safety behaviours to prevent something bad happening
In OCD behaviour leads to distress
I’m OC personality individuals enjoy behaviours
No external cues; urges arise from within person
OCD & related disorders cognitive & motor patterns
Obsessions Ruminations Cognitive rituals Compulsive motor rituals Compulsive avoidances 4 main compulsion categories; counting, checking, cleaning & avoidance
OCD & related disorders prevelance
1-3% incidence
No gender differences
Genetic predisposition; incidence of 5-7% in people who’s parents had OCD
OCD diagnosis
Presence of obsessions and/or compulsions
Time-consuming (>1hr a day) or cause clinically significant distress or impairment in important areas of functioning
Disturbance not due to substance, medication or another mental disorder
OCD model
1) generalised psychological/biological vulnerability
2) stress due to life events
3) intrusive thoughts, images or impulses
4) specific psychological vulnerability
5) anxious apprehension OR false alarm (associated with unacceptable thoughts) becoming a learned alarm & resulting in anxious apprehension
6) cognitive or behavioural rituals to neutralise or suppress thoughts
7) OCD
Treatment for anxiety disorders
Drug treatments often no more effective than placebo
CBT; aims to change the misperceptions or irrational beliefs
If moderate or severe depression is present, just treat the depression
