Anxiety disorders Flashcards
What is anxiety?
Negative emotional reaction out of proportion to whats going on around someone
What is a panic attack?
Sudden and overwhelming sense of fear in the wrong time and situation.
What are phobias?
Persistent, excessive, narrowly defined fears that disrupt functioning
What are obsessions?
Repetitive, unwanted, intrusive thoughts (impulses, images, etc)
What are compulsions?
Repetitive behaviours used to escape anxiety (ex: need for symmetry)
What is excessive worry?
Uncontrollable sequence of negative emotional thoughts. (how you talk to yourself) unable to stop.
What are the 3 categories of anxiety disorders in the DSM-5?
Anxiety disorders (Panic disorder, agoraphobia, specific phobias, social anxiety, GAD)
Obsessive-Compulsive and Related Disorders (OCD and body dysmorphic disorders, hoarding, trichotillomania ,and excoriation)
Trauma and Stressor Related Disorders- (mainly PTSD and acute stress disorder)
What is the main argument with the classification of anxiety disorders?
How do they split? Splitting them is not good for classification but is good for treatment
What are the criteria of panic disorder?
- Recurrent, unexpected attacks
- One attack followed by at least 1 month of worry and avoidance
- Can be with or without agoraphobia (usually go hand in hand)
- Cannot be due to medical condition or drug use
What are the symptoms of panic disorder?
Palpitations, sweating, trembling or shaking, choking sensations, fear of death, derealization or depersonalization etc
How many symptoms are needed to diagnose panic disorder?
4
Why is the fear of dying the most common panic attack symptoms?
Because a lot of times, panic attack symptoms present like a heart attack
How many panic attacks are needed to diagnose?
1
What is one of the upsides to anxiety and panic attacks?
They are time limited-peak after 10 mins and ebb off around 20. HOWEVER they are frequent throughout the day
What percentage of people get nocturnal panic attacks?
44-71
Why would one experience panic attacks while trying to relax (such as in sleep?)
Because the body gets used to anxiety so more panic when you wake OR you think about all you have to do the next day.
What is agoraphobia?
Avoidance of a cluster of situations where fear or panic may have occured-fear of public spaces.
What disorder is agoraphobia usually accompanied by?
95% of the time it’s panic disorder (avoid a place for fear of having another attack there)
What are specific phobias?
Excessive fears related to a specific object or situation.
When do specific phobias become an issue?
When they cause a lot of distress and when it isn’t easy to avoid them
What are some different types of phobias?
Animal, natural environment, situational (clausterphobia), other types
What is the fear of blood almost always accompanied by?
Needles
What is social phobia (Social Anxiety Disorder)
Focus of fear is performance/social interaction. Individual fears he or she will act in a way or show anxiety symptoms that will be negatively evaluated (humiliated, embarrassed, or rejected by others)
What is performance only social anxiety?
Fear of doing things in public-fear of making mistakes in front of others and perfectionism.
What causes performance only social anxiety?
History of public humiliation, parental humiliation, high criticism.
What is Generalized Anxiety Disorder?
Excessive anxiety or worry about a number of distinct situations or events more days than not over at least 6 months.
What are the 3 key features of GAD?
1) Uncontrollable worry-can’t put aside, tendency to catastrophize, trivial worries
2) Intolerance of uncertainty
3) Ineffective problem solving-worry because you can’t solve problems
What must the obsessions and compulsions be in order to have the disorder?
Intrusive, unwanted, and unreasonable (however, some patients find them distressing and some find them neccessary)
What must compulsions be driven by in OCD?
Rigid rules or obsessions aimed at reducing anxiety
What are some of the common O/C’s?
Contamination, pathological doubt (did I do this? check a million times), mental compulsions (counting), need for symettry, somatic obsessions, sexual and aggressive obsessions, scrupulosity (has to do with religion)
What is the Neurobiological model of OCD? (Frontal lobe and basal ganglia)
Interactions between frontal lobe and basal ganglia-there is an overactivity in connection (initiation of behaviour). Frontal lobes sare then unable to take control of obsessions, flow to basal ganglia, reaction.
What is theN Neurobiological model of OCD (memory problems and confidence)
Lose confidence in memory, compensate with obsessions to help with it
What is the Neurobiological model of OCD (serotonin hypothesis)?
Drop in serotonin in parts of the brain having to do with fear and anxiety (evidence for this is not great)
What is the Cognitive Behavioural Model of OCD?
Problematic obsessions are caused by people’s catastrophic reactions to intrusive thoughts (have a fear of own thoughts). Have excessive beliefs about personal responsibility and feelings of guilt. Obsessions persist due to peoples maladaptive attempts to cope (trying not to think about the thought makes it worse)
What is body dysmoprhic disorder?
Characterized by an intense disatisfaction with certain aspects of one’s appearance-only diagnosed if the concern with slight defects is markedly excessive.
What percentage of people with body dysmorphic disorder will attempt suicide?
25%
What is trauma defined as?
The experience of both an event involving actual and/or threatened injury or death and the response of intense fear, helplessness and/or horror in reaction
Why has PTSD been controversial since the beginning?
Because we had to define what constitues a trauma-is the only disorder based on a specific causal factor (Trauma)
What is operational stress injury?
A type of PTSD where individuals gain symptoms after witnessing the trauma of another (excluded from this definition are people who have to watch disturbing media as a job)
What are the symptoms of PTSD?
Re-experiencing trauma in flashbacks
Avoiding circumstances accompanied by trauma
Increased autonomic arousal (vigilence, overreaction tense)
Must last more than 1 month
What is Acute Stress Disorder?
Similar to PTSD in symptoms, however usually occurs within 4 w3eeks of exposure to trauma (usually with an eventual diagnosis of PTSD)
Why was ASD implemented?
So soldiers could get faster treatment
Why were PTSD and ASD invented?
Due to pressure from Vietnam soldiers wanting help for their issues after war
What percentage of people experience PTSD at some point?
8%
What percentage of people exposed to severe trauma develop ASD?
14-33%
What are the common causes of PTSD and ASD?
Assaults and other violent crimes, rape, combat exposure, serious accidents, natural disasters
What is the Innate Alarm System?
Amygdala–> prefrontal cortex. Remains on with trauma
What are some of the pre-event risk factors for PTSD?
Being female, low SES, low education, low intelligence, previous psychiatric history, ACE’s
What are some of the post-event risk factors for PTSD?
Severity of stressful event, lack of support, whether other traumatic events occur after the initial event
What type of trauma tends to provoke PTSD more often?
Interpersonal events
What percentage of diagnosable anxiety sufferers seek treatment?
25% (because it’s easy to deal with some disorders)
Which disorders have the highest comorbidity?
GAD, and panic disorders with agoraphobia
What causes the elderly to experience anxiety?
Partners getting serious illness or passing
What kinds of social factors cause anxiety disorders?
Stressful life events, childhood adversity (can be as minor as parents fighting), anxious attachment, separation anxiety
How do learning processes affect anxiety (psychological theories)?
Classical conditioning of thinhs like fear and disgust (explains animal and germ phobias). More disgust=more anxiety. Mitigated by biological preparedness.
What is Biological Preparedness (Seligman)
Certain situations we fear because we should fear them-evolutionary based
What is one of the issues with the Biological Preparedness model?
We fear some things becaues they seem dangerous, but actually aren’t that bad. Why do we fear spiders and not electrical outlets
What is Mowrer’s 2 Factor Theory (psychological theory)?
Emotions like fear are classically conditioned, but maintenance- occurs with operant conditioning- specifically with avoidance (we get rewarded for avoiding things).
Why doesn’t the 2 factor theory work super well?
Because we are cognisant-avoidance is not enough to get rid of anxiety.
What is the Observational (Social) Learning Theroy (Bandura)
Fears can be learned by hearing other people are afraid. Can also use this to fight anxiety (ex: watch someone be comfortable with public speaking, also become comfortable with it)
What are some of the cognitive factors of anxiety?
- Perception of lack of control
- Disgust sensitivity (phobias)
- Catastrophic Misinterpretation (Panic)
- Attention to threat, shifts in attention
- Thought supression
- Thought action fusion (OCD)
- Intolerance of uncertainty (GAD)
- Dual representation theory; meaning of threat (PTSD)
What is thought-action fusion?
When you believe that thinking something is equivalent to doing (ex: thinking violent thoughts is the same as committing violent acts)
What is dual representation theory?
Traumatic memories are encoded in images (not complete). When people cannot put into words what they saw, they become distressed.
What is meaning of threat?
Tendency to overgeneralize threats-fear stays with you even if it is not too traumatic. Person generalizes event to fear of the world
What are some biological factors in anxiety disorders?
Genetic Biological preparedness (phobias) Neurological factors (Brain structures) Neurochemistry
What is the fear circuit?
Incredibly primitive part of brain that only uses the sensory part of cortex and middle structures (thalamus, amygdala). PFC has the role of interpretation and managing fear requires the neocortex
What is the best treatment for an anxiety disorder?
EXPOSURE-as most of anxiety involves avoidance
What is systematic desensitization (in-vivo) typically used for?
Phobias
What is flooding typically used for?
Phobias
What is interoceptive exposure typically used for?
Panic disorder
What is exposure and ritual prevention typically used for?
OCD
What is worry imagery exposure typically used for?
GAD
What is writing and telling an integrated story of trauma typically used for?
PTSD
What is eye movement desensitization and reprocessing used for?
PTSD
What are relaxation training and breathing retraining typically used for?
Relaxation training-many types of anxiety, especially GAD
Breathing retraining-Panic Disorder
What type of intervention is typically the best for anxiety?
Psychological intervention (are at least as effective and cheaper than medications).
