CH 6 Panic, Anxiety, Obsessions, and Their Disorders

Question 1

Anxiety

Answer 1

General feeling of apprehension about possible danger

Future-oriented, diffuse

Question 2

Fear vs. Anxiety
Cognitive/subjective Component

Answer 2

F: “I am in danger!”
A: “I am worried about what might happen.”

Question 3

Fear vs. Anxiety
Physiological Component

Answer 3

F: Increased heart rate, sweating
A: Tension, chronic over-arousal

Question 4

Fear vs. Anxiety
Behavioral Component

Answer 4

F: Desire to escape/run
A: General avoidance

Question 5

What 5 primary types of anxiety disorders are recognized in the DSM-5?

Answer 5

1. Specific Phobia
2. Social Anxiety Disorder (Social Phobia)
3. Panic Disorder
4. Agoraphobia
5. Generalized Anxiety Disorder

Question 6

Biological causes of anxiety disorders

Answer 6

Strong genetic heritability, Limbic system (emotional regulation), Low neurotransmitter levels (Serotonin, GABA, Norepinephrine)

Question 7

GABA

Answer 7

Primary inhibitory neurotransmitter

Question 8

Psychological causes of anxiety disorders

Answer 8

Classical and operant conditioning (associate stimuli with anxiety response), Neuroticism, Perceived lack of control

Question 9

Describe the DSM Criteria for Specific Phobias

Answer 9

A. Marked fear or anxiety about a specific object or situation
B. The phobic object/situation almost always provokes immediate fear/anxiety
C. The phobic object/situation is actively avoided or endured with intense fear or anxiety
D. The fear/anxiety is OUT OF PROPORTION to the actual danger
E. 6 Months or longer
F. Clinically significant distress or impairment in functioning

Question 10

List the 5 Subtypes of Specific Phobias

Answer 10

Animals (snakes, dogs, etc.)
Natural Environment (storms, water, etc.)
Blood injection injury (Needles, fainting, etc.)
Situational (Vomiting, public speaking, etc.)
Other (Mayo, etc.)

Question 11

Psychoanalytic viewpoint: Specific phobias

Answer 11

Repressed impulses from the Id are displaced onto external stimuli

Question 12

Phobias as learned behavior

Answer 12

Learned fear from parents/peers’ reactions to stimuli

Viewing stimuli as inescapable/unavoidable increases fear

Question 13

Phobias explained through Evolutionary preparedness

Answer 13

Evolutionary programming to avoid death leads to fearing stimuli that present these risks (snakes have venom, dogs are like wolves)

Question 14

Treatment for specific phobia

Answer 14

Exposure therapy (in vivo, imaginative)

Participant modeling (learning from others)

Virtual reality exposure

Question 15

What diagnosis is given to someone who almost meets the criteria for a disorder?

Answer 15

Other Specified _________. (name of disorder in the blank)

ex. Other specified social anxiety disorder

Question 16

DSM Criteria for Social Anxiety Disorder

Answer 16

A. Persistent fear of one or more social or performance situations (unfamiliar people, scrutiny from others, embarrassing/humiliating potential)
B. Exposure to the feared situation almost invariably provokes anxiety
C. Person recognizes this fear is unreasonable or excessive
D. Feared situations are avoided/endured with intense anxiety
E. Avoidance, anxious anticipation, or distress interferes significantly with normal routine, occupational functioning, social activities, or relationships, or there is marked distress about having the phobia
F. The fear, anxiety, or avoidance is persistent (6 months or longer)

Question 17

Causal Factors in Social Anxiety Disorder

Psychosocial Causal Factors

Answer 17

Learned behavior (experiencing or witnessing the social defeat of others)

Perceptions of uncontrollability and unpredictability in the world > protect self through isolation

Cognitive biases towards “danger schemas”
1. Self-fulfilling prophecy
2. Interpret ambiguous stimuli as negative

Neuroticism and introversion

Question 18

Treatment for Social Anxiety Disorder

Answer 18

Antidepressants
CBT - Cognitive restructuring
Exposure therapy

Getting involved is key

Question 19

DSM Criteria for Panic Disorder

Answer 19

A. Recurrent unexpected panic attacks with 4+ of the following: Palpitations or pounding heart, sweating, trembling, sensations of shortness of breath/smothering, feelings of choking, chest pain, nausea, dizziness, chills/heat, paresthesias (numbness), derealization, fear of losing control, fear of dying

B. 1 Month or more following 1+ panic attack:
Persistent concern/worry about additional attacks and/or significant maladaptive changes in behavior

Question 20

Paresthesias

Answer 20

Numbness or tingling sensations

Question 21

DSM Criteria for Agoraphobia

Answer 21

Marked fear/anxiety about 2+ of the following: public transportation, open spaces, enclosed spaces, lines or crowds, leaving home alone

Fear that escape might be difficult

Situations consistently produce fear

Avoidance of the situations

Disproportionate fear and anxiety

Question 22

Panic & Agoraphobia

Biological & Psychosocial Causal Factors

Answer 22

Moderate heritability

Amygdala (negative emotional processing)

Biochemical abnormalities: low GABA

Tendency to catastrophize

Reliance on safety behaviors

Overperception of threats

Question 23

The Panic Circle

Answer 23

Perceived threat > Apprehension/worry > Body sensations > Interpretation of sensations as catastrophic > Perceived threat

Question 24

Panic and Agoraphobia Treatments

Answer 24

Exposure Therapy
CBT - Interoceptive Exposure, Panic Control Treatment
Anxiolytics
SSRIs

Question 25

DSM Criteria for GAD (A-C)

Answer 25

A. Excessive anxiety and worry about several events or activities (6 months+)

B. Difficult to control the worry

C. 3+ of the following symptoms:
Restlessness, easily fatigued, difficulty concentrating/blank mind, irritability, muscle tension, sleep disturbance

Question 26

Causal factors for GAD

Answer 26

Perceptions of uncontrollability and unpredictability

Misinterpretation of worry as a good thing (chronic worrying is HARMFUL)

Sense of mastery: a greater sense of mastery is linked to reduced risk of GAD

Low GABA, CRH/ high cortisol

Question 27

Treatment for GAD

Answer 27

Anxiolytic Drugs:
Xanax, Klonopin (highly addictive)
BuSpar
SSRIs

CBT: Behavioral techniques, cognitive restructuring techniques

Question 28

DSM Criteria for OCD

Answer 28

Obsessions: Recurrent and persistent thoughts, urges, or images; intrusive and unwanted; cause marked anxiety or distress; individual attempts to suppress or neutralize them (compulsions)

Compulsions: Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that MUST be applied rigidly; aimed at preventing/reducing anxiety/distress or preventing some dreaded event or situation (though not actually reasonably connected to the situation)

Question 29

Obsessions

Examples

Answer 29

Contamination fears, fear of harming self/others, need for symmetry, sexuality, religion, aggression

Question 30

Compulsions

Answer 30

Cleaning, checking, repeating, ordering/arranging, counting

Question 31

Causal Factors for OCD

Answer 31

Learned behavior (neutral stim. > conditioning > frightened by once neutral stim.)

3-12x more likely with parent who has OCD

Basal ganglia abnormalities

Low serotonin

Question 32

T or F
OCD is more common in women.

Answer 32

FALSE, gender makes no significant difference

Question 33

Mowrer’s 2-process theory of avoidance learning

Answer 33

Phase 1: Classical Conditioning
The individual transforms a neutral and innocuous stimulus (an airplane, a spider, an event at work, a crowded supermarket, etc.) into a painful or traumatic stimulus.

Phase 2: Instrumental Conditioning
The individual isn’t just avoiding the original aversive stimulus but everything that comes close to it.

Question 34

Which condition is most often comorbid with OCD?

Answer 34

Depression

Question 35

Treatment for OCD

Psychological & Biological

Answer 35

Exposure and Response Prevention ERP

Medications that affect serotonin
High dose Prozac (SSRI), relapse high when discontinued

Behavior treatment x Meds = Best

Question 36

Body Dysmorphic Disorder BDD

Define & List treatments

Answer 36

Obsessed with perceived or imagined flaw in appearance, causes clinically significant distress

Treatment: SSRIs, ERP (CBT)

Question 37

Hoarding Disorder

Answer 37

Acquire and fail to discard limited value possessions, disorganization in living space interferes with daily life, poorer prognosis for treatment than OCD both with meds and CBT

Comorbid with agoraphobia and other anxiety disorders

Associated with poor overall health

Question 38

Trichotillomania

Answer 38

Compulsive hair pulling

Urge to pull out hair from any body location, preceded by tension, followed by pleasure, must cause clinically significant distress

Onset can be childhood or later, post-puberty onset followed by MORE SEVERE course

Question 39

Ataque de nervios

Answer 39

Latin American, Peurto Rican

Attack of the nerves

Commonly reported symptoms are trembling, shaking uncontrollably, attacks of crying, feeling of heat rising from chest to head, and becoming physically or verbally aggressive

Question 40

Koro

Answer 40

China and Southeast Asia

The belief that genitals or breasts are retracting into the body, leading to death