Anxiety Disorders (Week 4) Flashcards
ANXIETY BECOMES A DISORDER WHEN
• Out of proportion and control • Causes distress • Impairment in functioning and wellbeing • Symptoms severe and long-lasting
S Y M P TO M S A N D S I G N S : P H YS I O L O G I C A L
>. Palpitations >. Sweating >. Trembling/shaking >. Nausea or abdominal distress >. Shortness of breath >. Feeling of choking >. Chest pain or pounding heart >. Feeling dizzy >. Numbness >. Chills or hot flushes >. Muscle tension >. Dry mouth
S I G N S A N D S Y M P TO M S : THOUGHTS
> . Worry about being anxious in future
. Worry about what other people may think about you
. Worry of losing control or going crazy
. Fear of dying
. Rumination and poor concentration
SIGNS AND SYMPTOMS: FEELINGS
> . Feelings of unreality
. Feeling detached from oneself
. Irritability
. Distress
S I G N S A N D S Y M P TO M S : B E HAV IO U RA L
>. Fight or flight (freeze) >. Avoiding situations or things that cause anxiety >. Restlessness >. Tearfulness >. Hypersensitivity to comments >. Freezing up
Side Effects: Part 1
Panic attacks:• Abrupt experience of intense fear in absence of something to fear
• Symptoms: palpitations, chest
pain, dizziness
Duration, intensity, dysfunction and impairment
Side Effects: Part 2
Anxiety = • Apprehensive, future-oriented
• Somatic symptoms = tension
• A response to something that may be intangible, imprecise
Fear = • Immediate, present-oriented
• Sympathetic nervous system activation
• Can be protective
• A response to something real or definite
Both: Negative affect
C ATEGORIES OF ANXIETY DISORDERS
- Generalized Anxiety Disorder - Worry that cannot be
switched off about daily events, tension - Panic Disorder and Agoraphobia - recurrent panic attacks,
may be accompanied by fear/avoidance of situations - Specific Phobias - Intense fears
- Social Anxiety Disorder - anxiety about social situations,
intense shyness, interferes with functioning - Separation Anxiety Disorder – kids; fear that something
will happen to parents when separated - Selective Mutism – kids; lack of speech
GENERAL CAUSES OF ANXIETY: Part 1
Genetic
- Tendency to be tense, uptight, anxious
- Stress or environmental factors may trigger this vulnerability
Biological
• Medical conditions
• Stimulants and recreational drugs (even nicotine!)
• Imbalance of neurotransmitters?
Neuroendocrinal?
• Neurological studies support some involvement of the frontal lobes of the brain
GENERAL CAUSES OF ANXIETY: Part 2
Environmental
• Cumulative stress over time
• Significant personal loss
• Perceived loss of control
• Traumatic incidents e.g. abuse/ accidents
• Family difficulties e.g. conflict between
parents, parents responding in hypercritical or overly cautious ways
• Parenting significant – need to foster control, provide secure home base (but not be overprotective, over
intrusive, ‘clearing the way’)
• Biological vulnerabilities triggered by stressful life events
• Family, Interpersonal, Occupational, Educational
GENERAL CAUSES OF ANXIETY: Part 3
Epidemiological factors: • Age (older; kids also (no longer a separate category) – 2 specific in DSM5 • Gender (F:M) • Socio-economic group
1 . GENERLISED ANXIETY DISORDER
( G A D )
Description
• Shift from possible crisis to crisis
• Worry about ‘minor’, everyday concerns e.g. Job, family, chores, appointments
• Cannot ‘switch off’ the worry
• Problems sleeping, muscle tension, agitation, fatigue
• Perfectionism
> . GAD in children
• Need only one physical symptom
• Worry = academic, social, athletic
performance
GAD E P I D E M I O L O G Y A N D C O U R S E
• Often onset in adulthood after stressor but most report some symptoms from childhood or adolescence
• GAD in elderly – up to 10%,
prescriptions; increasing sense of lack of control?
• More common in women
• Often occurs in relatives of affected persons.
• Lifetime prevalence - 5.7%
• Condition tends to be chronic with periods of exacerbation and remission.
C AUSES: GAD
•Inherit a tendency to be tense or anxiety sensitivity; high sensitivity to threat (biological vulnerability)
•Develop early sense that events in life are uncontrollable and potentially dangerous, and may not cope (generalized
psychological vulnerability)
2 . PA N I C D I S O R D E R: Part 1
Recurrent unexpected panic attacks -Abrupt surge of intense fear or intense discomfort that reaches a peak within a few minutes; includes at least 4 of the following: pounding heart, sweating, shaking, shortness of breath, feeling of choking, chest pain, nausea, dizziness, fear of losing control, numbness or tingling, chills or heat sensations, derealisation or depersonalisation, fear of losing control or going crazy, fear of dying (NB: panic attacks can occur independently of PD – 8-12% of population)
Panic Disorder: Part 2
- Persistent concern about additional attacks, worry about consequences of attack, or changes in behaviour because of attack
- Not due to drugs, medical condition, medication
- Persists for 1 month or more
- (Nocturnal common)
3 . AG O R A P H O B I A
• Often with panic attacks, but not all cases;
panic DO can occur independently
• Fear or avoidance of situations/events where
feel unsafe or unable to get home
•‘agora’ = marketplace (busy, bustling area)
•Agoraphobia develops because not know when symptoms might occur; want to stay in safe place – agoraphobic avoidance or intense dread
• Avoidance can be persistent, interoceptive
avoidance (avoidance of internal situations)
• Use and abuse of drugs and alcohol common
E P I D E M I O L O G Y / S O C I O -C U LT U R A L
4.7% (life)
Female: male = 2:1
Acute onset, ages 20-24yrs
•Social/gender roles: ~75% of those with agoraphobia are female
– more ‘acceptable’ for women to report fear? Men – tough it out?? Substance abuse?
•Common across cultures –more somatic complaints
•Culture-bound syndromes
•e.g. Ataque de nervois
•Suicide risk
C AUSES –PANIC DISORDER
Generalized biological vulnerability
• Neurobiological over-reactivity to daily life events,
• Alarm reaction to stress
Stressful event (but not all go on to develop PD)
• attribution
Cues get associated with situations
• Conditioning occurs e.g. movie theater 1st panic attack
Generalized psychological vulnerability
• Anxiety about future attacks
• Hypervigilance + Increased interoceptive awareness
Specific vulnerability
• Childhood learning that unexpected bodily sensations are dangerous
- PHOBIAS
Marked fear or anxiety about specific object or situation >. Out of proportion/irrational >. Actively avoided, or endured with intense fear >. Impairment Subtypes: Animal Natural environment (heights, storms) Blood-injection-injury Situational (planes, elevators)
Phobia Facts
Statistics 12.5% (life); 8.7% (year) Female : Male = 4:1 Chronic course Onset = ~ 7 Causes: •Direct experience •False alarm – e.g. Panic, related to stress •Vicarious experience •Information transmission •“Prepared” – inherited tendency
5 . S E PA R AT I O N A N X I E T Y: Part 1
Characterized by children’s unrealistic and persistent worry that something will happen to their parents or other important people in their life or that something will happen to the children themselves that will separate them from their parents (for example, they will be lost, kidnapped, killed, or hurt in an accident)
•School refusal common
•Some degree separation anxiety ‘normal’; check developmental age/stage
•4.1% meet criteria for children, 6.6%
for adults (Can develop as adult)
6 . S O C I A L A N X I E T Y D I S O R D E R
> . Clinical description
•Extreme and irrational fear/shyness
•Social/performance situations –exposed to scrutiny by others; fears will act in a way that is negatively evaluated
•Significant impairment
•Avoidance or distressed endurance
. Statistics
•12.1% (life); 6.8% (year)
•Female : Male = 1:1
•Onset = adolescence (can be earlier – biological tendency
towards social inhibition)
•Peak age of 13; young adults (18–29 years)
- SELECTIVE MUTISM
Initially classified as Childhood Disorder Clinical description • Rare disorder characterized by a lack of speech in settings where expected • Driven by anxiety (not failure to speak or part of other DO e.g. autism) • Usually in some but not other settings • Must occur for more than one month and cannot be limited to the first month of school • Comorbidity with SAD
C L A S S I F I C AT I O N I S S U E S: Selective Mutism
>. High rates of comorbidity 55% to 76% >. Commonalities Features >. Vulnerabilities >. Links with physical disorders e.g. thyroid, respiratory, migraine, allergic conditions (cause or effect?) >. Comorbidity with depression
TREATMENT: Selective Mutism
Behavioural: • Systematic desensitization • Flooding/ exposure • Relaxation exercises, breathing exercises, guided imagery, acceptance.
Cognitive/ CBT:
• Identifying/challenging distorted thinking
Cognitive/ CBT
