Anxiety Disorders, Obsessive-Compulsive, and Related Disorders, and Trauma and Stressor Related Disorders

Question 1

Anxiety vs. Depression

Answer 1

• overlap in symptoms: impaired concentration and memory, irritability, fatigue, insomnia, and a sense of hopelessness
• While box involve negative affect, anxiety is associated with a higher level of positive affect and autonomic arousal

Pure anxiety symptoms: tension, trembling, excessive worry, and nightmares

Pure depressive symptoms: depressed mood, anhedonia, loss of interest in usual activities, suicidal ideation, and decreased libido

Question 2

Separation Anxiety Disorder

Answer 2

involves developmentally inappropriate and excessive fear or anxiety related to separation from home or attachment figures as evidenced by at least three characteristic symptoms (recurrent excessive distress when anticipating or experiencing separation from home or major attachment figures; persistent excessive fear of being alone; related complaints of physical symptoms when separation from an attachment figure); disturbance lasts for at least 4 weeks in children and adolescents or six months in adults

Question 3

School Refusal

Answer 3

involves intense anxiety about going to school and is usually accompanied by a stomachache, headache, nausea, and other physical symptoms

typically occurs at three ages: 5-7, 10-11, and 14-16

onset for younger children is associated with beginning school
onset for middle school children- triggered by a change of schools and may be associated with social phobia
Adolescence- associated with social phobia, depression, or other disorder and has a poorer prognosis

Question 4

Treatment for Separation Anxiety Disorder

Answer 4

ordinarily includes systematic desensitization or other behavioral intervention and, for older children and adolescences, cognitive approaches

when disorder includes school refusal- primary goal of treatment is an immediate return to school to avoid academic failure, social isolation, and other secondary impairments

Question 5

Specific Phobia

Answer 5

characterized by intense fear of or anxiety about a specific object or situation with the individual either avoiding the object or situation or enduring it with marked distress; fear or anxiety is not proportional to the actual danger posed by the object or situation, is persistent (lasting at least 6 months) and causes clinically significant distress

subtypes: animal, natural environment, blood-injection injury, situational, and other

Question 6

Etiology of Specific Phobia

Answer 6

linked to biological factors (abnormal levels of serotonin, norepinephrine, and GABA), cognitive factors, and classical conditoning

Mower’s two-factor theory- attributes phobias to avoidance conditioning– people first learn to fear a neutral (Conditioned) stimulus because of its pairing with an intrinsically fear-arousing (unconditioned) stimulus, and their avoidance of the conditioned stimulus is then negatively reinforced because it keeps them from experiencing anxiety; avoid conditioned stimulus and never extinguish conditioned fear

Question 7

Social Anxiety Disorder

Answer 7

intense fear of or anxiety about one or more social situations in which the individual may be exposed to the scrutiny of others;

Etiology: linked to behavioral inhibition, a temperament trait characterized by social avoidance and fear of unfamiliar people and situations

associated with certain information biases, including the tendency to attend selectively to socially threatening information and overestimate the likelihood for negative outcomes in social situations

Question 8

Social Anxiety Disorder Treatment

Answer 8

Exposure with response prevention; found effective for Social Anxiety Disorder and its benefits may be enhanced when it is combined with social skills training or cognitive restructuring or other cognitive techniques; treatment may also include an SSRI or SNRI or the beta-blocker propranolol

Question 9

Panic Disorder

Answer 9

characterized by recurrent unexpected panic attacks with at least one attack being followed by at least one month of persistent concern about having additional attacks or about their consequences and/or a significant maladaptive change in behavior related to the attack

hyperthyroidism; hypoglycemia, cardiac arrythymia, and other medical conditions

Question 10

Panic Attack

Answer 10

an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes; involves a minimum of four characteristic symptoms: e.g. palpitations or accelerated heart rate; sweating; trembling; feelings of choking; chest pain or discomfort; paresthesias; derealization or depersonalization; fear of losing control

2-3% of adolescents and adults; females twice as likely as males to receive diagnosis; children rarely receive diagnosis because they have cognitive limitations that do not allow them to make catastrophic interpretations of their bodily symptoms

Question 11

Treatment of Panic Attacks

Answer 11

CBT interventions that incorporate exposure

Panic control therapy (PCT) is a brief treatment that incorporates psychoeducation, relaxation training, cognitive restructuring, and interoceptive exposure (exposure to physical sensations associated with panic attacks)

also responsive to imipramine and other TCAS, SSRIs, SNRIs and benzodiazepines; risk for relapse is high when drug treatment is used alone (30-70%)

Question 12

Agoraphobia

Answer 12

requires the presence of marked fear or anxiety about at least two of the following situations: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being part of a crowd, and being outside the home alone

fears of avoids these situations due to concern that escape might be difficult or help will be unavailable in case he or she develops panic-like fear or anxiety and are actively avoided, require the presence of a companion, or are endured with intense feelings of fear or anxiety

in-vivo exposure with response prevention is best treatment

Question 13

Generalized Anxiety Disorder

Answer 13

excessive anxiety and worry about multiple events or activities that are relatively constant for at least 6 months, finds it difficult to control, and cause clinically significant distress or impaired functioning; anxiety and worry include at least three of the following symptoms: restlessness, feeling keyed up or on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance

GAD has highest comorbidity rates; 90% of individuals with lifetime GAD also had another lifetime psychiatric diagnosis; most often MDD and PDD followed by substance use disorder, simple phobia, and social anxiety disorder

Drugs that have been useful for GAD include SSRs or SNRIs or when the individual is nonresponsive to an antidepressant, a benzodiazepine or the anxiolytic buspirone

Question 14

Obsessive Compulsive and Related Disorders

Answer 14

characterized by recurrent obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impaired functioning

1.2% prevalence

occurs equally between males and females; however, because the average age of onset is earlier for males, among children and adolescents, OCD is more prevalent in males than in females

Question 15

Etiology of OCD

Answer 15

caused by low levels of serotonin is supported by the effectiveness of drugs that block the reuptake of serotonin for reducing symptoms

evidence that behavioral and drug treatments for OCD both reduce activity in the right caudate nucleus, which is involved in converting sensory input into cognitions and actions and appears to be over-active in people with OCD; other areas of the brain that have been implicated include the orbitofrontal cortex and the cingulate cortex, which mediate emotional reactions

Question 16

Treatment of OCD

Answer 16

exposure with response prevention and the tricyclic clomipramine or an SSRI is usually the treatment of choice

exposure is often supplemented with thought stopping or other interventions that directly target obsessions

because antidepressants are associated with a high risk for relapse once the drug is discontinued, they are rarely used alone

Question 17

Body Dysmorphic Disorder

Answer 17

characterized by a preoccupation with a defect or flaw in appearance that appears minor or is unobservable to others; person has, at some time during the course of the disorder, performed repetitive behaviors or mental acts because of the defect or flaw; often seek plastic surgery

Question 18

Hoarding Disorder

Answer 18

involves “persistent difficulty discarding or parting with possessions, regardless of their actual value due to a need to save items or to distress associated with parting with them; the inability to discard items causes living areas to be cluttered to the extent that the areas are not usable and the symptoms case clinically significant distress

Question 19

Reactive Attachment Disorder

Answer 19

characterized by a consistent pattern of inhibited and emotionally withdrawn behavior toward adult caregivers as manifested by a lack of seeking or responding to comfort when distressed and a persistent social and emotional disturbance that includes at least two of the following symptoms: minimal social and emotional responsiveness to other people; limited positive affect; episodes of unexplained irritability, sadness, or fearfulness when interacting with adult caregivers

also requires that the child has experienced extreme insufficient care that is believed to be the cause of the disturbed behavior and is evidenced by at least one of the following: basic emotional needs for comfort; stimulation, and affection are not met by adult caregivers; repeated changes in primary caregivers that limit the ability to form a stable attachment; rearing in an unusual environment that limits opportunities to form a stable attachment; rearing in an unusual environment that limits opportunities to form selective attachments; symptoms must be evident before the child is 5 years old and the child must have a developmental age of at least 9 months

Question 20

Disinhibited Social Engagement Disorder

Answer 20

characterized by a pattern of behavior that involves inappropriate interactions with unfamiliar adults as evidenced by at least two of the following: reduced or absence of reticence in approaching or interacting with unfamiliar adults; overly familiar behavior with unfamiliar adults; diminished or absence of checking with an adult caregiver after venturing away from him/her; willingness to accompany an unfamiliar adult with little or not hesitation; for the diagnosis, the child must have a developmental age of at least 9 months and have experienced extreme insufficient care that is believed to be the cause of the disturbed behavior and is evidenced by at least one of the following: basic emotional needs for comfort; stimulation, and affection are not met by adult caregivers; repeated changes in primary caregivers that limit the ability to form a stable attachment; rearing in an unusual environment that limits opportunities to form selective attachments

Question 21

PTSD

Answer 21

exposure to actual or threatened death, serious injury or sexual violence in at least one of the following ways: direct experience of the event; witnessing the event in person as it happened to others; learning that the event occurred to a close family member or friend: repeated or extreme exposure to aversive details of the event (except when the exposure is through the media unless such exposure is work-related)

presence of at least one of the following intrusion symptoms: recurrent, involuntary distressing memories of the event (or in children, repetitive play related to the event); recurrent distressing dreams related to the event (or in children, distressing dreams without recognizable content); dissociative reactions in which the person feels or acts as if the event is recurring (or, in trauma-related reenactment during play); intense or prolonged psychological distress when exposed to reminders of the event; marked physiological reactions to reminders of the event

persistent avoidance of the stimuli associated with the event as evidenced by one or both of the following: avoidance of distressing memories, thoughts, or feelings related to the event; avoidance of external reminders that elicit distressing memories, thoughts, or feelings related to the event

negative changes in cognition or mood associated with the event as evidenced by at least two of the following: inability to remember an important aspect of the event; persistent and exaggerated negative beliefs about oneself, others, or the world; persistently distorted cognitions related to the event’s cause or consequences; markedly diminished interest in significant activities; feelings of detachment from others; persistent inability to experience positive emotions

marked change in arousal and reactivity associated with the event as evidenced by at least two of the following: irritable behavior and angry outbursts, reckless or destructive behavior, hypervigilance, exaggerated startle response; impaired concentration; sleep disturbance

duration: at least one month

Question 22

Treatment of PTSD

Answer 22

treatment of choice is comprehensive CBT intervention that incorporates exposure, cognitive restructuring, and anxiety management or similar technique; an SSRI is often prescribed to reduce comorbid depression or anxiety; relapse is high when stopped

Question 23

Acute Stress Disorder

Answer 23

requires exposure to actual or threatened death, severe injury, or sexual violation in at least one of four ways; direct experience of the event; witnessing the event in person as it happens to others; learning that the event occurred to a close family member or friend; repeated or extreme exposure to aversive details of the event; at least nine symptoms from any one of five categories must be present (intrusion, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms) and symptoms must have a duration of three days to one month and cause clinically significant distress or impaired functioning

Question 24

Adjustment Disorders

Answer 24

involve the development of emotional or behavioral symptoms in response to one or more identifiable psychosocial stressors within three months of the onset of the stressor(s). For the diagnosis, symptoms must be clinically significant as evidenced by the presence of marked distress that is not proportional to the severity of the stressor and/or significant impairment in functioning, and they must remit within six months after termination of the stressor or its consequences; disorder is not diagnosed when symptoms represent normal bereavement