CH 6 Panic, Anxiety, Obsessions, and Their Disorders Flashcards
Anxiety
General feeling of apprehension about possible danger
Future-oriented, diffuse
Fear vs. Anxiety
Cognitive/subjective Component
F: “I am in danger!”
A: “I am worried about what might happen.”
Fear vs. Anxiety
Physiological Component
F: Increased heart rate, sweating
A: Tension, chronic over-arousal
Fear vs. Anxiety
Behavioral Component
F: Desire to escape/run
A: General avoidance
What 5 primary types of anxiety disorders are recognized in the DSM-5?
- Specific Phobia
- Social Anxiety Disorder (Social Phobia)
- Panic Disorder
- Agoraphobia
- Generalized Anxiety Disorder
Biological causes of anxiety disorders
Strong genetic heritability, Limbic system (emotional regulation), Low neurotransmitter levels (Serotonin, GABA, Norepinephrine)
GABA
Primary inhibitory neurotransmitter
Psychological causes of anxiety disorders
Classical and operant conditioning (associate stimuli with anxiety response), Neuroticism, Perceived lack of control
Describe the DSM Criteria for Specific Phobias
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
List the 5 Subtypes of Specific Phobias
Animals (snakes, dogs, etc.)
Natural Environment (storms, water, etc.)
Blood injection injury (Needles, fainting, etc.)
Situational (Vomiting, public speaking, etc.)
Other (Mayo, etc.)
Psychoanalytic viewpoint: Specific phobias
Repressed impulses from the Id are displaced onto external stimuli
Phobias as learned behavior
Learned fear from parents/peers’ reactions to stimuli
Viewing stimuli as inescapable/unavoidable increases fear
Phobias explained through Evolutionary preparedness
Evolutionary programming to avoid death leads to fearing stimuli that present these risks (snakes have venom, dogs are like wolves)
Treatment for specific phobia
Exposure therapy (in vivo, imaginative)
Participant modeling (learning from others)
Virtual reality exposure
What diagnosis is given to someone who almost meets the criteria for a disorder?
Other Specified _________. (name of disorder in the blank)
ex. Other specified social anxiety disorder
DSM Criteria for Social Anxiety Disorder
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)
Causal Factors in Social Anxiety Disorder
Psychosocial Causal Factors
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
Treatment for Social Anxiety Disorder
Antidepressants
CBT - Cognitive restructuring
Exposure therapy
Getting involved is key
DSM Criteria for Panic Disorder
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
Paresthesias
Numbness or tingling sensations
DSM Criteria for Agoraphobia
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
Panic & Agoraphobia
Biological & Psychosocial Causal Factors
Moderate heritability
Amygdala (negative emotional processing)
Biochemical abnormalities: low GABA
Tendency to catastrophize
Reliance on safety behaviors
Overperception of threats
The Panic Circle
Perceived threat > Apprehension/worry > Body sensations > Interpretation of sensations as catastrophic > Perceived threat
Panic and Agoraphobia Treatments
Exposure Therapy
CBT - Interoceptive Exposure, Panic Control Treatment
Anxiolytics
SSRIs
DSM Criteria for GAD (A-C)
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
Causal factors for GAD
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
Treatment for GAD
Anxiolytic Drugs:
Xanax, Klonopin (highly addictive)
BuSpar
SSRIs
CBT: Behavioral techniques, cognitive restructuring techniques
DSM Criteria for OCD
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)
Obsessions
Examples
Contamination fears, fear of harming self/others, need for symmetry, sexuality, religion, aggression
Compulsions
Cleaning, checking, repeating, ordering/arranging, counting
Causal Factors for OCD
Learned behavior (neutral stim. > conditioning > frightened by once neutral stim.)
3-12x more likely with parent who has OCD
Basal ganglia abnormalities
Low serotonin
T or F
OCD is more common in women.
FALSE, gender makes no significant difference
Mowrer’s 2-process theory of avoidance learning
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.
Which condition is most often comorbid with OCD?
Depression
Treatment for OCD
Psychological & Biological
Exposure and Response Prevention ERP
Medications that affect serotonin
High dose Prozac (SSRI), relapse high when discontinued
Behavior treatment x Meds = Best
Body Dysmorphic Disorder BDD
Define & List treatments
Obsessed with perceived or imagined flaw in appearance, causes clinically significant distress
Treatment: SSRIs, ERP (CBT)
Hoarding Disorder
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
Trichotillomania
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
Ataque de nervios
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
Koro
China and Southeast Asia
The belief that genitals or breasts are retracting into the body, leading to death
