Anxiety, OCD, Trauma, and Stress Disorders Flashcards
Anxiety is a…
Normal, universal emotion and not a bad thing in and of itself. It involves anticipation accompanied by nervousness or worry about “what’s going to happen
Fear is…
Slightly different than anxiety; An immediate/alarming, and usually more intense, reaction to a perceived threat or danger
An anxiety disorder is diagnosed when an individual:
Experiences abnormally high anxiety/fear that becomes clinically significant and experiences recurrent anxiety/fear when no danger is present
Anticipation
Low lying DREAD
The “Basic/General” Anxiety Disorders
Separation Anxiety Disorder and Selective Mutism (Common in childhood), Social Anxiety Disorder (Social Phobia), Specific Phobias, Agoraphobia, Panic Disorder, Generalized Anxiety Disorder
Separation Anxiety Disorder and Selective Mutism
90% of cases in children, diagnosable in adults but not as often
Separation Anxiety Disorder
Not wanting to be separated from care giver/ important person
Selective Mutism
Prolonged periods of refusal to speak
Social Anxiety Disorder
An intense worry or fear of being scrutinized or being embarrassed/ humiliated in the presence of others (worry about what people think about you becomes clinically significant); AVOIDANCE
Social Anxiety Disorder involves…
Hypersensivity to social cues, as well as significant attempts to avoid drawing attention to oneself, or social avoidance all together (related to Looks or Behaviors)
Types of Social Anxiety Disorder
Generalized or Performance Type
Generalized Social Anxiety Disorder
Social anxiety occurs in every situation with anyone
Performance Social Anxiety Disorder
Specific situations trigger social acuity (Bathroom in public, Meeting new people, Public speaking, Eating around others)
Social Anxiety Disorder is comorbid with…
Other anxiety conditions and other types of disorders (Panic Disorder/Substance Abuse)
Specific Phobias
Extreme and irrational fear of a specific object or situation that produces significant distress or panic (A fear is not the same thing as a phobia!); Person goes to great lengths to avoid the object or situation, or endures it with extreme distress (effects everyday life); Most can recognize that the fear and avoidance are unreasonable, but “can’t help it”; Must markedly interfere with one’s ability to function
Specific Phobias are often comorbid with…
Panic Attacks
Animal SP Subtype
All types, including insects (Most common: Snakes, Bats, Bees)
Natural/Environmental SP Subtype
Things found in “nature”/ outdoors (e.g., heights, storms, water)
Blood-injection-injury SP Subtype
Covers most medical situations (Doctor/Dentist/ Equipment); unusual vasovagal response involved (Fainting, sudden heart rate and blood pressure drop)
Situational SP Subtype
Certain occurrences only, might not be situations that happen often but when it does you’re screwed! (Planes, the dark, enclosed spaces, bridges)
“Other” SP Subtype
Anything not reflected above (Costumes, Clowns)
Agoraphobia
Involves fear and avoidance of situations where escaping or getting help easily is unlikely in the event that something incapacitating or embarrassing happens (Open or public places)
Most commonly, with Agoraphobia the person fears…
Having a panic attack in these situations and thus avoids them markedly; DSM provides a list of possible “situations” and at least 2 of those are required (Many due to past occurrences)
Some with agoraphobia may even become
“housebound” (Avoid public transportation, restaurants, etc.)
Agoraphobia is commonly comorbid with…
Panic disorder
Etiology of Phobias (where does it come from?)
Biological dimension, Psychological Dimension, Social Dimension, Sociocultural Dimension
Biological Dimension (etigology of phobias)
Genetics, exaggerated anxiety/fear response in brain (Higher risk for those who have a disorder in family)
Psychological Dimension (etigology of phobias)
Classical conditioning, “negative information” received, catastrophic thoughts (associate situations)
Social Dimension (etigology of phobias)
High stress or negative emotions within family system
Sociocultural Dimension (etigology of phobias)
Women more likely, certain culture-bound fears
Panic Disorder
Recurrent, unexpected panic attacks (frightening attacks of fear and bodily symptoms); Also apprehension about future panic attacks, or significant changes in behavior to avoid attacks (Must be present for a month or longer) Many avoid situations to avoid attacks and working out bc it feels like an attack
Generalized Anxiety Disorder
Excessive and uncontrollable apprehension and worry about virtually everything; The anxiety is present on the majority of days for at least 6 months; Also accompanied by certain physical symptoms (e.g., restlessness or muscle tension); Most frequently diagnosed anxiety disorder (Disruptive to everyday life)
Treatment of Anxiety Disorders
Some medications are effective; benzodiazepines and SSRI’s are most common but Cognitive-behavioral therapy has strong research support in terms of efficacy
Benzodiazepines (treatment of anxiety disorders)
Significant caution applied to prescribing these (RISKY), Easily form dependence; Combining then with other GABA stimulators (alcohol) can cause problems such as death (ex. Xanax) (GABA’s are calming, used to unwind)
SSRI’s (treatment of anxiety disorders)
Can’t have too much but can have too little with risks emotional stability (Cannot get addicted to these!)
Cognitive-Behavioral Therapy (treatment of anxiety disorders)
Cognitive = restructuring thoughts to be more rational and healthy/calm; Behavioral = modifying behavior (most commonly with EXPOSURE and relaxation for anxiety disorders)
The cognitive element involves…
Recognizing and changing catastrophic thoughts (e.g., “this is just a panic attack; it’s uncomfortable, but it will pass. I’m in control, and I’m not dying.”
Behavioral exposure happens many ways…
Phobias, Panic d/o, GAD
Phobias (behavioral exposure)
Systematic desensitization or flooding
Panic D/O (behavioral exposure)
Exposure to and coping with panic symptoms
GAD (behavioral exposure)
Exposure to worrisome thoughts while restructuring and relaxing
3 Steps of Systematic Desensitization
1) Teach relaxation to client, 2)Develop fear hierarchy, 3) Expose and pair with relaxation as needed
Example of progression/ hierarchy (Claustrophobia)
1) Small Room, Pitch Black> Progressively gets Bigger and Lighter> 20) Big room, Very Bright
Obsessive-Compulsive and Related Disorders
A new category in DSM-5, as we have significant evidence that all these disorders share common tendencies; Obsessive-compulsive disorder, Body dysmorphic disorder, Hair-pulling and skin-picking disorders, Hoarding disorder (Anxiety plays a role in these)
Obsessive-Compulsive Disorder (OCD)
Vicious cycle of Obsessions and Compulsions
Most common themes of OCD
Contamination (germs, bacteria, viruses), Errors/Uncertainty, Unwanted Impulses, and Orderliness
OCD is an interesting spectrum with lots of…
“Gray Area”, Many people report some form of obsessive thinking or compulsive behavior that’s “subclinical”…
OCD Thoughts
“Need to do this”; Thoughts of hurting someone (Urges/Images)
OCD Behaviors
Repetitive or Ritualistic Behaviors; Doubting Actions (opening/closing doors)
Body Dysmorphic Disorder
A preoccupation with perceived physical defects in a normal-appearing person, or Excessive (unwarranted) distress over an actual slight bodily defect; “Perceived ugliness”
The “compulsive” part of Body Dysmorphic Disorder involves the…
Associated repetitive behaviors (e.g., mirror-checking, over-use of make-up)
Body Dysmorphic Disorder is often associated with a desire for…
Cosmetic surgery
which is UNHELPFUL…because BDD is a problem of the mind and not the body, by definition!
Hair-Pulling and Skin-Picking Disorders
Trichotillomania and excoriation, respectively; Vicious cycles that involve constant obsessions about the behavior in question, as well as the compulsive act
With trichotillomania…
Hair loss is visible and significant
More common in women, typically young onset ( < 17)
With excoriation…
The picking results in visible lesions/scabs/scars (and infection can be a risk)
Also more common in women, onset more variable
Hoarding Disorder
Now classified as a form of OCD, but this is questioned by some…;Persistent difficulty in parting with possessions, regardless of value, such that living areas are substantially cluttered and dysfunctional as a result; Typically see obsessions over the “need” for items and a compulsion to acquire more and more; Can be quite serious to the point that the person has no insight re: the dirtiness or danger of living that way
Treatment of Obsessive-Compulsive Disorders
Again, medications can help and SSRI’s are most often recommended; Exposure also plays a central role here
Exposure to treat OCD’s
“Exposure and response prevention” for OCD involves actual or imagined exposure to the relevant situation, while preventing the compulsive response; Quite effective, but there is a high drop-out rate and many clients have to make several attempts or re-visit therapy
Trauma & Stress-Related Disorders
Involve exposure to a stressor (usually something quite traumatic) and subsequent anxiety/avoidance that causes significant distress or impairment (Acute Stress Disorder, Post-Traumatic Stress Disorder (PTSD))
Acute Stress Disorder and PTSD
Both require either witnessing or experiencing a significant stressor/trauma; What “counts” as a trauma = tough question
Acute Stress Disorder and PTSD Require 4 categories of “aftermath” symptoms:
Persistent intrusion (or “re-experiencing”) symptoms such as memories, nightmares, or flashbacks; Significant avoidance of trauma-related triggers; Problems with cognition and mood; Changes in reactivity/physiological arousal
Acute Stress Disorder and PTSD Differences
The MAGNITUDE of what’s involved; The DURATION of the response
MAGNITUDE difference btw Acute Stress Disorder and PTSD Differences
PTSD usually involves worse trauma, requires more symptoms, and symptoms are more severe
DURATION difference btw Acute Stress Disorder and PTSD Differences
Acute stress disorder is diagnosed when the symptoms persist for at least 3 days, but less than a month
PTSD is diagnosed when symptoms last at least a month
Many people experience trauma, so: why do only some of them develop one of these disorders?
One factor is the type/severity of trauma and It also has to do with the person’s underlying vulnerability
Type/Severity of Trauma Example
Injuries involving burns tend to produce a ASD/PTSD response more than other kinds of injuries
Vulnerability of Individual who Experiences Trauma Example
Some people are “biologically predisposed” to develop a pathological/anxious response to trauma and others are not; Psychological, social, and cultural factors also affect vulnerability
Obsessions
Intrusive (frequent/intense) cognitions: thoughts, images, or urges that won’t go away
Compulsions
Behaviors to reduce the anxiety brought on by obsessions
