Anxiety, obsessions and compulsions

Question 1

What is the APA definition of anxiety?

Answer 1

According to the APA, anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.
often accompanied by worry, fears, uneasiness, and dread.

Question 2

What is the difference between anxiety and fear?

Answer 2

Fear is a basic emotion that is a response to a concurrent threat and is accompanied by distinct physiological reactions such as fight or flight. It is universal and automatic, brief, and not future-oriented.
Anxiety, on the other hand, is a common emotion that is not brief (but usually time-limited), not a response to a concurrent threat, and involves possible future negative outcomes that are dreaded. It involves future-oriented thoughts and escape and avoidance behaviors, and cognitive appraisals of the situation and the future. It is not universal and has cognitive, behavioral, and somatic manifestations.

Question 3

What are obsessions and compulsions?

Answer 3

Obsessions are persistent thoughts, images, or urges that are hard to stop thinking about
compulsions are behaviors or mental actions that the person feels driven to perform, often in response to delusions.
Common examples include checking the stove, checking things repeatedly, and going back to check something again.

Question 4

What are the different types of anxiety disorders?

Answer 4

According to the DSM and ICD perspectives, the types of anxiety disorders include specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, separation anxiety disorder, and selective mutism.
Obsessive-compulsive and related disorders are also considered anxiety disorders according to the ICD

Question 5

What is specific phobia?

Answer 5

Specific phobia is a fear associated with a given object or situation, such as heights, spiders, germs, injections, or dentists.
It is associated with active avoidance of the situation, and the person has physiological reactions such as immediate anxiety when the phobic object or situation is present.
When the person is not near the phobic object/situation, anxiety is not present.

Question 6

What is specific phobia according to DSM and ICD criteria, and what are its prevalence rates?

Answer 6

According to DSM and ICD criteria, specific phobia is characterized by a disproportionate fear and avoidance of a specific object or situation that occurs upon exposure to it and persists for at least 6 months (several months in ICD).
Prevalence rates vary across regions, with 6-9% in the US and Europe and 2-4% in Asia, Africa, and Latin America.
Teens have the highest prevalence (16%), while older people have the lowest (3-5%), and women have a higher prevalence than men.

Question 7

What is social anxiety disorder (social phobia), and what are its prevalence rates?

Answer 7

Social anxiety disorder (social phobia) is characterized by a disproportionate fear and avoidance of social situations where the person might be scrutinized (observed) and is overly concerned about behaving anxiously and being evaluated negatively for it.
It lasts at least 6 months (several months in ICD-11) and can be comorbid with depression, substance use, and other anxiety disorders.
Prevalence rates are 7% in the US and 2.3% in Europe.

Question 8

What is panic disorder, and what are the symptoms of a panic attack according to DSM and ICD criteria?

Answer 8

Panic disorder is characterized by recurrent and unexpected panic attacks, which are intense anxiety reactions that come abruptly and involve severe and terrifying anxiety attacks.
People may feel like they are dying, which can lead to it being mistaken for a heart attack.
To be considered a panic attack, the episode must be accompanied by 4 or more of the following symptoms: palpitations, sweating, trembling, shortness of breath, choking sensations, chest pain, nausea, dizziness, derealization, depersonalization, fear of losing control, fear of dying, and paresthesias.
Panic disorder also involves at least one month of worrying about further panic attacks or dysfunctional alteration of behaviors in response to the attacks.

Question 9

What is agoraphobia, and what are its prevalence rates and comorbidities?

Answer 9

Agoraphobia is characterized by the dread of having an embarrassing fear reaction in public and a fear of situations or places where escape might be difficult, such as public transportation, movies, and crowds.
It is generally diagnosed simultaneously with panic disorder, but this is not a must.
DSM and ICD criteria define agoraphobia as a disproportionate fear and avoidance of two or more of the following: public transportation, open spaces like parking lots and bridges, enclosed spaces like theaters and stores, crowds or lines, and being away from home by oneself. The situations are feared and avoided because escape might not be possible and panic or other embarrassing anxiety symptoms might ensue.
Agoraphobia lasts at least 6 months (several months in ICD) and has a 1.7% prevalence rate. Females are twice as likely to be diagnosed than males, and it is generally comorbid with other anxiety disorders, depression, PTSD, and alcohol use problems.

Question 10

What are the diagnostic criteria for Generalized Anxiety Disorder according to DSM and ICD?

Answer 10

Excessive and consistent worry that is global
Continually anxious in general
Undue, hard to control, and ongoing anxiety and worry that occurs almost every day
Presence of 3 or more symptoms such as restlessness, easily tired, trouble concentrating, irritability, muscle tension, and sleep difficulties
Lasts at least 6 months (several months in ICD)
Prevalent in 2.9% of adults
More common in females

Question 11

What is Separation Anxiety Disorder according to DSM and ICD?

Answer 11

Disproportionate worry about being separated from or losing important attachment figures
More prevalent in childhood (4%) but can also be seen in adulthood (0.9-1.9%)
Generally comorbid with specific phobia or generalized anxiety disorder
Lasts at least 1 month in children, and at least 6 months in adults (several months in ICD)

Question 12

What is Selective Mutism and its characteristics?

Answer 12

Failing to speak in social situations where speaking is expected
Generally comorbid with Social Anxiety Disorder
Generally starts in childhood
Relatively rare (0.03-1% in children)
Not speaking when socially expected, even though speaks in other situations
Failure to speak is not due to inability or lack of comfort speaking the language required
Interferes with achievement at school or work
Lasts at least for one month (excluding the first month of school) (same duration in ICD)

Question 13

What are Obsessive-Compulsive Disorders and its diagnostic criteria according to DSM and ICD?

Answer 13

The person has obsessions and compulsions
Obsessions are persistent, distressing, invasive, and unwelcome thoughts, impulses or images that are difficult to ignore or eliminate
Compulsions are recurring behaviors or mental acts that the person feels compelled to engage in to decrease anxiety associated with obsessions (even though doing so has no effect)
Obsessions and compulsions take up enormous amounts of time
Possible obsessions include germs, order/symmetry, fear of forgetting, and thoughts about losing control and harming others
Possible compulsions include washing, cleaning, checking, counting, orderliness/symmetry, and following a strict routine
Prevalent in 1.1-1.8% of OCD diagnosis
More prevalent in females, but the childhood onset is higher in males
Mostly comorbid with other anxiety, mood, & eating disorders
30% qualify for tic disorder
DSM-5 TR no longer recognizes OCD as a part of anxiety disorders, they now have their own category.

Question 14

What is Body Dysmorphic Disorder and what are some of its symptoms?

Answer 14

Body Dysmorphic Disorder is an obsessional preoccupation with one or more parts of the body that are perceived as a physical flaw in appearance.
Symptoms can include repetitive behaviors in checking appearance and mental acts like comparing appearance to others.

Question 15

What is Hoarding Disorder and what are some of its symptoms?

Answer 15

Hoarding Disorder is characterized by anxiety and worry about disposing possessions even if they are not used anymore, resulting in an accumulation of possessions and cluttered living space.

Question 16

What is Trichotillomania and what are some of its symptoms?

Answer 16

Trichotillomania is a hair-pulling disorder that results in hair loss due to ongoing efforts to stop.

Question 17

What is Excoriation and what are some of its symptoms?

Answer 17

Excoriation is a skin-picking disorder that involves constant and recurrent picking at the skin, resulting in skin lesions.

Question 18

What are some biological (chemistry) perspectives for treating anxiety disorders?

Answer 18

Biological perspectives (chemistry) for treating anxiety disorders include the use of drugs to relieve anxiety, such as anxiolytics and antidepressants.
Benzodiazepines are one well-known anxiolytic that works by enhancing GABA activity in the brain. However, they pose a risk for addiction and have negative side effects, so they are generally used for short periods.
Antidepressants, such as SSRIs and SRNIs, are primary anti-anxiety and OCD drugs now.
SSRIs are better than placebos
But some studies show that they are effective in half of the patients

Question 19

What are some biological (structural) perspectives for treating anxiety disorders?

Answer 19

Amygdala (important for emotions) and insula (important for basic emotions, sense of self, awareness of bodily states) are highly active
But they are not differentially active in different anxiety disorders making it questionable to discuss whether they are indeed different disorders that are reflected differently in brain structure
Activation and structure of different parts of the brain might be implicated
But the results are not consistent
🡪 maybe there is no specific and consistent structural abnormality
🡪 Maybe OCD is not only one disorder and has different subdimensions with distinct neural substrates for different subdimensions 🡪 OCD related to Symmetry/Ordering vs Contamination/Washing
vs Harm/Checking

Question 20

What are some biological (evolution/ genetics) perspectives for treating anxiety disorders?

Answer 20

Genetic Perspectives
Heritability estimates of anxiety disorders are relatively high
30-65%
But still room for environment
Evolutionary Perspectives- Anxiety
Fear and anxiety are adaptive responses that alert people to dangers and allow them to anticipate possible dangers (so person eludes danger)
Prepared conditioning: We have a predisposition to be conditioned to develop phobias to certain things/situations (e.g., spiders, heights) more easily–which had generally been dangerous for our ancestors
Group selection theory of OCD
Not everyone shall display OCD behaviors since they are time consuming
BUT Behaviors that people with OCD display can be beneficial for the survival of the group

Question 21

What are some biological (immune) perspectives for treating anxiety disorders?

Answer 21

Inflammation🡪 not widely confirmed but can be related
Gut 🡪 has bacteria necessary for digestion and health Is related to the release of cytokines – immune-system- produced proteins that aid healing but is related inflammation in large amounts
Modest evidence
Multifinality: inflammation can cause many things and can cause anxiety and all kinds of disorders (cant pin point role of inflammation to predict anxiety disorders)

Question 22

Overall, evaluate the biological perspective on anxiety and OCD

Answer 22

Same set of drugs (antidepressants) are related to anxiety and depression
Are they similar/ biologically non-differentiable disorders
OR
Do we have limited knowledge?
CBT is found to be more effective for OCD than drugs
Drug treatment will be less likely to be solely influential

Question 23

What are the origins of anxiety according to the psychodynamic perspective? How do people with anxiety disorders control their anxiety according to the psychodynamic perspective?

Answer 23

The origins of anxiety are believed to be unconscious conflicts related to intolerable feelings, desires, and fantasies.
These conflicts may arise from inconsistent or overprotective parenting in early life, which can lead to insecure attachment and difficulty developing effective defense mechanisms to cope with anxiety.
People with anxiety disorders control their anxiety by using ego defense mechanisms to manage their fear of their own id impulses (i.e., unconscious desires and impulses).
The goal of treatment from a psychodynamic perspective is to help the person become more aware of their id impulses and develop healthier ways of managing them.

Question 24

What are some potential causes of OCD according to the psychodynamic perspective?

Answer 24

According to the psychodynamic perspective, problematic attachment relationships are at the core of OCD.
Individuals with OCD may have had parents who were emotionally ambivalent or superficially supportive but subtly rejecting, which can lead to feelings of self-doubt, negative self-worth, and compulsive behaviors used to compensate for these feelings.

Question 25

What is stress conditioning and how does it relate to anxiety and phobias?

Answer 25

Stress conditioning is a form of environmental conditioning in which anxiety and phobias are first created through classical conditioning and then sustained and strengthened through operant conditioning.
This means that anxiety and phobias may develop when a person experiences a stressful or anxiety-provoking event and then learns to associate that event with fear or discomfort.

Question 26

What are some cognitive explanations for anxiety?

Answer 26

Cognitive explanations for anxiety suggest that irrational thinking can play a role in the development and maintenance of anxiety.
For example, some people with anxiety may hold beliefs like “It is always best to assume the worst” or “You can only be worthy of love if you are thoroughly competent, adequate, and achieving in all possible respects.”
Additionally, several different models have been suggested to explain the relationship between worry and anxiety, including the avoidance model of worry, the intolerance of uncertainty model, and the emotional dysregulation model.

Question 27

What are some CBT treatment examples for anxiety and OCD?

Answer 27

CBT treatment examples for anxiety and OCD include
exposure plus response prevention (which involves gradually exposing the person to anxiety-provoking situations and preventing them from engaging in compulsive behaviors),
systematic desensitization (which involves gradually exposing the person to feared stimuli while they practice relaxation techniques),
modeling (which involves the therapist modeling an aversive behavior to help the person confront their fear),
mindfulness and acceptance cognitive therapies (which involve learning to accept and observe upsetting thoughts and feelings without trying to eliminate them)
rational-emotive therapy is another example of a cognitive therapy that can be used to treat anxiety and OCD. Therapist points out the irrational assumptions and suggests more appropriate assumptions

Question 28

What is the cause of anxiety in Person Centered Therapy? What is the aim of Person Centered Therapy?

Answer 28

Anxiety is caused by incongruence. If a person can only receive positive regard from others when they behave in self-inconsistent ways, they will display anxiety.
The aim of Person Centered Therapy is to help the client understand their actual self and display behaviors that are congruent with that, which will help alleviate anxiety.

Question 29

What is the cause of anxiety in Emotion Focused Therapy? What is the aim of Emotion Focused Therapy?

Answer 29

Anxiety is a consequence of difficult or painful past experiences in Emotion Focused Therapy.
The aim of Emotion Focused Therapy is to help clients gain awareness of the emotional conflicts that make them avoid certain situations and provide therapeutic support to accept difficult feelings and reduce avoidant behaviors, ultimately helping the client face and resolve emotional conflicts.

Question 30

What are some sociocultural perspectives on anxiety?

Answer 30

Different cultures might express anxiety differently, low SES is an important factor exacerbating psychological disorders including anxiety, and women are diagnosed more with anxiety but they also receive more drugs for anxiety.

Question 31

What is the systems perspective on anxiety?

Answer 31

The systems perspective on anxiety is that how others in different relationships respond to a person’s anxiety is influential in treatment. Having a family member with anxiety disorder is difficult and generally related to relationship dysfunctions, which can further increase anxiety. When family members try to be accommodating, they can make the problem worse.