Anxiety Disorders: GAD and OCD Flashcards
Generalized Anxiety Disorder
A. excessive anxiety and worry occurring more days than not for >6 months about a number of events/activities
B. individual finds it difficult to control the worry
C. 3 or more of following
1. restlessness, keyed up, on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance
D. cause clinically significant impairment/distress in important settings
E. ruled out physiological cause
F. ruled out other mental disorder
Resulting Behaviors of GAD
=reassurance seeking behavior
=subtle avoidance behaviors
-procrastination, checking, calling loved ones
=difficulty making decisions
-worry that they made the wrong decision after it’s made
- Prevalence of GAD
- level of impairment
- comorbidity
- one year: 3%, lifetime 5.7%
twice as common in women than men - functioning is not as impaired as with some other disorders
frequent medical complaints –> vague, persistent somatic complaints - other anxiety disorders
depression - lots of overlap
-someone with depression and GAD will have worse impairment than someone with only GAD
Tripartite model of depression and anxiety
- anxious arousal: keyed up, restless, muscle tension
- high negative affect: anger, fear, distress
- low positive affect: inability to find pleasure in things
1 + 2 –> anxiety
-still able to find joy, brighten to good news, and then go back to worrying
2 + 3 –> depression
-psychomotor retardation, lethargic, not keyed up
Etiology according to Psychodynamic Theory of GAD
- largely discounted
- unconscious conflict between ego and id, not adequately dealt with bc of poor defense mechanisms
Etiology of GAD
=numerous uncontrollable unpredictable life events
-abuse, sick sibling, insecure job
-lack of control
=low tolerance for uncertainty
=intrusive over controlling parenting style
=biased attention toward threatening stimuli
=biased interpretation of ambiguous stimuli
=modest genetic heritability
=deficiency in GABA, excess CRH
-GABA inhibits anxiety
-CRH leads to excess cortisol
What people with GAD thinks worrying does
=helps avoid catastrophe -gives control, superstitious quality =helps avoid deeper emotional topics -distract yourself --> worry about financial health because you are unhappy with job =helps cope and prepare
What worrying actually does
- greater sense of danger and anxiety
- more negative intrusive thoughts
- paradoxical increase in thoughts that you are trying to avoid
Treatment for GAD
=medication
=Cognitive Behavioral Therapy
GAD medication
=medication tends not to be too effective
=Benzodiazepine
-sedating
-interact with other drugs, ex alcohol - makes you drunker
-addicting, tolerance
-rebound –> return to same level when you get off them
=SSRIs
-antidepressants can be effective
-delayed effect, 4-6 weeks
-rebound
-sexual side effects
CBT for GAD
=aimed at reducing distorted cognition and information processing
=cognitive restructuring
=minimizing catastrophizing over minor events
=muscle relaxation
Obsessive Compulsive Disorder
A. presence of obsessions which the individual attempts to neutralize with compulsions that reduce anxiety
B. they are time consuming and cause clinically significant impairment
C. ruled out physiological cause
D. ruled out other mental disorder
Obsessions
- recurrent unwanted disturbing thoughts
- feel intrusive, foreign
- attempts to avoid them lead to to anxiety
Compulsions
- repeated, ritualistic behaviors or mental acts that people feel they must perform to reduce distress caused by obsessions
- obsessions and compulsions are not always clearly linked - ex touching an object repeatedly because it is associated with calming down violent thoughts
OCD in the media / actual level of impairment
- used for comic relief
- in reality one of the most impairing because of the time it takes up
Common OCD Themes across cultures and ages
=dirt - handwashing, contamination
=acting out - violent, aggressive, sexual
-mental rituals - counting, repeating
-orderliness, symmetry, arranging
-pathological doubt –> forgetting something, stove off, door locked
-compulsion is checking
- Prevalence of OCD
- age of onset
- comorbidity
- -one year: 1.2%
- lifetime: 2.3%
- little or no sex differences - -onset in children or early adulthood
- more common in boys when onset is in childhood
- early onset is worse prognosis, will have worse symptoms - highly comorbid
- phobias, GAD, depression
Etiology (not biological) of OCD
=Learned Behavior =evolutionary preparedness -germs are bad, you want to avoid them =effort to suppress =inflated sense of responsibility =biased attention toward disturbing material
OCD as Learned Behavior
internal/external stimulus –> obsession distress and anxiety –> ritualized behavior temporary relief from anxiety (reinforces behavior)
-continue going back to ritual because anxiety relief is only temporary
OCD efforts to suppress
-people who ruminate on weird thoughts instead of letting them go
OCD inflated sense of responsibility
- people who equate having a thought with acting on it, think having a bad thought is the moral equivalent of doing it
- most people recognize that everyone has weird thoughts
Etiology (biological) of OCD
=most genetic of any disorder
=structural abnormalities in the brain
-overactivation of orbital frontal cortex - area responsible for primitive urges
-dysfunction in communication with other brain parts
-urges that should stay in orbital frontal cortex leak through to consciousness
=NT abnormalities
-serotonin - increased levels and sensitivity
-GABA, glutamate, dopamine - a little related
Treatment of OCD
=exposure and response prevention - gold standard
=medication
=neurosurgery
-destroy brain tissues in implicated areas
-used only for very severe untreatable cases
OCD: exposure and response prevention
- develop hierarchy - start with easier tasks
- evoke obsession (anxiety) and then prevent compulsion –> eventually anxiety subsides and association is broken
Medication OCD
- mild to moderately effective
- ocd does not respond to a wide range of medication like other disorders
- respond best to those which affect serotonin system
- relapse rates are high after medication is stopped
