Anxiety Disorders and Obsessive-Compulsive Disorder Flashcards
Separation Anxiety Disorder criteria
- Fear of separation from attachment figures
- 3+ symptoms (distress related to separation, school avoidance, physical symptoms related to separation)
- Symptoms 4+ weeks (children) or 6+ months (adults)
- Distress or impairment
Separation Anxiety Disorder etiology
Often develops after stressful event (divorce, death, etc.)
Separation Anxiety Disorder treatment
- CBT combined with parent training
- Getting child back to school is primary focus if applicable
Specific Phobia criteria
- Fear of specific object or situation
- Avoidance or endurance with distress
- Symptoms 6+ months
- Distress or impairment
Specific Phobia types
- Animal
- Natural environment (lightning, heights)
- Blood-injection-injury
- Situational (elevators, bridges)
- Other (vomiting, choking)
Specific Phobia prevalence
Rates are 2x higher in girls than boys (depending on type)
Specific Phobia onset
Usually in childhood (mean age = 10 yo)
Mowrer’s two-factor theory and Specific Phobia
Combination of classical and operant conditioning:
1. Classical = onset, neutral stimuli becomes anxiety-provoking
2. Operant = maintenance, avoidance is reinforcing
Specific Phobia treatment
ERP
ERP
- Can be in vivo* or in imagination
- Can be therapist-led* or self-guided
- Flooding or graded/graduated
- Lower attrition with graded exposure
Virtual reality and ERP
- Some evidence that VR is similar to in vivo
- Especially useful for heights and flying
Treatment for blood-injection-injury phobia
Best when ERP is paired with tensing/relaxing muscles to prevent fainting
Social Anxiety Disorder criteria
- Fear of 1+ social situations involving exposure to scrutiny (mostly due to symptoms)
- Avoidance or endurance with distress
- Out of proportion
- Symptoms 6+ months
- Distress or impairment
Social Anxiety Disorder treatment
Children:
1. CBT*
2. School-based CBT
Adults:
1. CBT and antidepressants* (SSRIs and SNRIs)
2. Evidence that guided internet-based CBT is similar to in-person CBT
Panic Disorder criteria
- Unexpected panic attacks
- 1+ month of concern about additional attacks or effects of attack
- Not due to medical condition
Panic attack criteria
- Intense fear or discomfort
- Reaches peak within minutes
- 4+ symptoms (heart palpitations, sweating, nausea, dizziness, fear of death, paresthesia)
Panic Disorder medical condition rule-outs
- Hyperthyroidism
- Cardiac arrhythmia
Panic Disorder treatment
- Cognitive-behavioral* (interoceptive exposure with relaxation)
- Antidepressants (imipramine) or benzodiazepines, with high relapse rates at discontinuation
Agoraphobia criteria
- Fear in 2+ situations
- Fear or avoidance related to escape when symptomatic
- Out of proportion
- Fear/avoidance, need for companion, or endurance with distress almost always
- Symptoms 6+ months
- Distress or impairment
Agoraphobic situations
- Public transportation
- Open spaces
- Enclosed spaces
- Crowds or lines
- Being alone outside the home
Agoraphobia treatment
- In vivo ERP*
- Usually graded, some evidence that flooding has better long-term outcomes
- Some evidence that pairing ERP with relaxation is not more effective (key is tolerating distress)
Generalized Anxiety Disorder criteria
- Excessive worry about multiple stimuli
- Difficult to control
- 3+ symptoms (adults) or 1+ symptoms (children)
- Symptoms most days for 6+ months
- Distress or impairment
Generalized Anxiety Disorder symptoms
- Restlessness
- Fatigue
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
Generalized Anxiety Disorder v. non-pathological anxiety
- Uncontrollable
- Larger number of stimuli
- More likely to report somatic symptoms
Generalized Anxiety Disorder worry stimuli (age)
Children:
1. Catastrophic events
2. Competence in sports, school
Adults:
1. Health
2. Safety
Generalized Anxiety Disorder co-morbidities
- MDD*
- Social anxiety disorder
- Specific phobia
- PTSD
Generalized Anxiety Disorder etiology
- Family history
- Temperament (inhibition, neuroticism, harm avoidance)
- Childhood trauma or chronic stress
- Brain abnormalities
Brain abnormalities linked to Generalized Anxiety Disorder
- vlPFC and dlPFC
- Anterior cingulate cortex
- Posterior parietal cortex
- Amygdala
- Hippocampus
- Reduced connectivity between PFC and anterior cingulate cortex/amygdala (weak control of amygdala response)
Generalized Anxiety Disorder treatment
- CBT*
- Medications (SSRIs and SNRIs*, buspirone, benzodiazepine)
- Some evidence for combined CBT and MI
Obsessive-Compulsive Disorder criteria
- Recurring obsessions and/or compulsions
- Time-consuming (1+ hours per day), distress, or impairment
Obsessions definition
- Repetitive thoughts, urges, or images that are experienced as intrusive/unwanted
- Attempts to ignore or suppress
- Anxiety or distress
Compulsions definition
- Repetitive behaviors or mental acts
- Response to obsession or rigid rule
- Goal is to reduce anxiety or distress or prevent bad outcome
- Excessive or not realistically connected to goal
Obsessive-Compulsive Disorder specifiers
- Level of insight
- Presence of tics
Obsessive-Compulsive Disorder prevalence (gender)
Males:
1. Earlier age of onset
2. Higher rates in childhood
Females:
1. Slightly higher rates in adulthood
Obsessive-Compulsive Disorder co-morbidities
- Anxiety disorder*
- Depressive or bipolar disorder
- Impulse control disorder
- Substance use disorder
90% have co-morbidities
Neurotransmitter abnormality linked to Obsessive-Compulsive Disorder
Low serotonin
Brain abnormalities linked to Obsessive-Compulsive Disorder
Hyperactive:
1. Caudate nucleus
2. Orbitofrontal cortex
3. Cingulate gyrus
4. Thalamus
Obsessive-Compulsive Disorder treatment
- ERP and medication*
- Some evidence for CBT for OCD
- Some evidence for ACT for OCD
Obsessive-Compulsive Disorder medications
- SSRI
- Clomipramine
Ineffective as standalone for severe symptoms
Body Dysmorphic Disorder criteria
- Preoccupation with flaw in appearance
- Flaw not observable or minor to others
- Compulsions related to flaw
- Distress or impairment
Body Dysmorphic Disorder associated symptoms
- Seek to correct flaw medically
- Ideas/delusions of reference (others are mocking them, others are noticing the flaw)
