chapter 4 Anxiety Disorders

Question 1

Anxiety disorders

Answer 1

–Generalized anxiety disorder –Panic Disorder and agoraphobia –Specific phobias –Social anxiety disorder

Question 2

Anxiety –a future-oriented mood state

Answer 2

–Apprehension about future danger or misfortune
–Physical symptoms of tension
–Characterized by marked negative affect
–May lead to avoidance of situations likely to
provoke fear

Question 3

Fear – a present-oriented mood state

Answer 3

–Immediate fight or flight response to danger or threat
–Involves abrupt activation of the sympathetic nervous system
–Strong avoidance/escapist tendencies –Marked negative affect

Question 4

Panic attack: abrupt experience of intense fear

Answer 4

–Physical symptoms: heart palpitations, chest pain, dizziness, sweating, chills or heat sensations, etc.
–Cognitive symptoms: Fear of losing control, dying,
or going crazy

Question 5

Two types of panic attacks

Answer 5

-Expected

–Unexpected

Question 6

Comorbidity

Answer 6

Having more than one diagnosis at once
–Common across the anxiety disorders
–Major depression is the most common secondary diagnosis
–About half of patients have two or more secondary diagnoses
–Implications:
•Common factors create and maintain disorders •A relation between anxiety and depression

Question 7

Generalized Anxiety Disorder: Chronic Worry

Answer 7

•Overview and defining features
–Excessive uncontrollable anxious apprehension and worry about multiple areas of life (e.g., work, relationships, health)
–Persists for six months or more
–Accompanied by associated symptoms (e.g., muscle tension, restlessness, fatigue, irritability, concentration difficulties, sleep disturbance)

Question 8

Treatment of GAD

Answer 8

Treatment of GAD: Generally weak
–Psychological interventions – cognitive-behavioral therapy
–Pharmacotherapy
•Benzodiazapines – often prescribed •Antidepressants
–Meditation therapy
–Combined treatments – acute vs. long-term outcomes

Question 9

Panic Disorder

Answer 9

Experience of unexpected panic attacks (i.e., a false alarm)
–Develop anxiety, worry, or fear about another attack
–Many develop agoraphobia

Question 10

Agoraphobia

Answer 10

fear of being in places in which it would be difficult to escape or get help in the event of unpleasant physical symptoms (e.g., panic attack, dizziness, vomiting, incontinence)

• Panic and agoraphobia often occur together
• Coupled together in previous editions of the DSM,
  e. g., “Panic disorder with agoraphobia,” “Agoraphobia without a history of panic disorder”
• May occur independently

Question 11

Risk Factors for developing panic disorder

Answer 11

• Generally higher emotional reactivity to stressors
• Higher likelihood of having physical alarm reaction in response to stress
• Tendency to believe that bodily sensations are dangerous or associated with catastrophic outcomes

Question 12

Panic Disorder Treatment

Answer 12

–Example of CBT for panic
–Cognitive therapy combined with purposefully triggering panic sensations to build tolerance
•Psychological and combined treatments
–Cognitive-behavioral therapies are highly effective
–No evidence that combined treatment produces better outcome
–Best long-term outcome is with cognitive-behavioral therapy alone

Question 13

Specific Phobias

Answer 13

–Extreme irrational fear of a specific object or situation
–Persons will go to great lengths to avoid phobic objects
–Most recognize that the fear and avoidance are unreasonable
–Markedly interferes with one’s ability to function

Question 14

Social Anxiety Disorder

Answer 14

Extreme fear or discomfort in social or performance situations
–Markedly interferes with one’s ability to function
–Often avoid social situations or endure them with great distress
–Performance-only subtype: Anxiety only occurs in performance situations (e.g., public speaking) without anxiety in everyday interactions

Question 15

Social Anxiety: Causes

Answer 15

–Biological and evolutionary vulnerability
•Adaptive to fear rejection
–Similar learning pathways as specific phobias

Question 16

Social Anxiety Treatment

Answer 16

•Psychological treatment
–Cognitive-behavioral treatment (CBT) –Cognitive-behavioral group treatment (CBGT) –Cognitive-behavioral therapies are highly effective

Question 17

PTSD terms

Answer 17

Acute – may be diagnosed one to three months post trauma
•Chronic – diagnosed after three months post trauma
•Delayed onset – onset six months or more post trauma
•Acute stress disorder – PTSD immediately post-trauma (up to one month

Question 18

PTSD Casuses

Answer 18

Intensity of the trauma and one’s reaction to it (i.e., true alarm, fear for one’s safety)
–Learn alarms – direct conditioning and observational learning
–Biological vulnerability –Uncontrollability and unpredictability –Social support post-trauma reduces risk

Question 19

PTSD: Psychological Treatment

Answer 19

Psychological treatments
–Cognitive-behavioral therapies (CBT) are highly effective
–CBT may include:
• graduated or massed (e.g., flooding) imaginal exposure
•develop narrative of traumatic event to process understanding
•Challenge maladaptive beliefs about the world (e.g., that interpersonal relationships are unsafe)

Question 20

PTSD Medication Treatment

Answer 20

–Generally use medications effective against anxiety and panic
–Most common: SSRIs

Question 21

Adjustment disorders

Answer 21

•Anxious or depressive reactions to life stress
•Milder than PTSD/acute stress disorder •Occur in reaction to life stressors like moving,
new job, divorce, etc
•Clinically significant distress or impairment

Question 22

Attachment Disorders

Answer 22

• Disturbed and developmentally inappropriate behaviors in children
• Child is unable or unwilling to form normal attachment relationships with caregiving adults
• Occurs as a result of inadequate or neglectful care in early childhood

Question 23

Obsessive-Compulsive Disorder (OCD)

Answer 23

–Obsessions – intrusive and nonsensical thoughts, images, or urges
–Compulsions – thoughts or actions to neutralize anxious thoughts
–Vicious cycle of obsessions and compulsions
–Cleaning and washing or checking rituals are common

Question 24

Causes of OCD

Answer 24

–Parallels the other anxiety disorders 
–Early life experiences 
–Learning that some thoughts are
dangerous/unacceptable
–Thought-action fusion 
– the thought is similar to the action; thinking something will make it more likely to happen

Question 25

OCD Treatment: Psychological

Answer 25

–Cognitive-behavioral therapy is most effective
–CBT involves exposure to anxious cues and prevention of ritualized response
•E.g., touching door handles and not washing hands
afterward
•E.g., saying blasphemous phrase and not engaging in ritualized prayer afterward
–Combining CBT with medication – no better than CBT alone

Question 26

Hoarding

Answer 26

Previously considered a type of OCD
•Characterized by excessively collecting or keeping items regardless of their value and difficulty discarding items, usually due to a fear that one will need them later
•Causes clinically significant distress or impairment (e.g. house too cluttered to live in, arguments with family members)

Question 27

Trichotillomania (Hair pulling Disorder)

Answer 27

The urge to pull out one’s own hair from anywhere on the body
–Leads to noticeable hair loss on scalp, eyebrows,
arms, pubic region, etc.

Question 28

Excoriation (Skin Picking Disorder)

Answer 28

repetitive and compulsive picking of the skin, leading to tissue damage
–1-5% prevalence rate
•Behavioral habit reversal treatment is most effective treatment

Question 29

Body Dysmorphic Disorder (BDD)

Answer 29

•A preoccupation with some imagined defect in appearance
–E.g., ears too big, muscles too small, skin uneven
•Actual defect, if present, appears slight to others
•Leads to clinically significant distress/impairment
•Often leads to compulsive behaviors (e.g., repeated mirror checking)

Question 30

Body Dysmorphic Disorder: Cause

Answer 30

–Little is known – disorder tends to run in families

–Shares similarities with obsessive-compulsive disorder

Question 31

Body Dysmorphic Disorder: Treatment

Answer 31

Treatment parallels that for OCD
–Cognitive behavioral therapy
–Exposure to anxiety (e.g., not wearing makeup) & preventing compulsions (e.g., no mirror available)
•Medications (i.e., SSRIs) that work for OCD provide some relief
•Cultural example – Taijin Kyofusho

Question 32

Anxiety Disorders include

Answer 32

Panic disorder 
–Agoraphobia 
–Generalized anxiety disorder 
–Social anxiety disorder 
–Specific phobia 
–Selective mutism
 –Separation anxiety disorder

Question 33

Trauma and Stressor related disorders include

Answer 33

–PTSD 
–Acute stress disorder
 –Adjustment disorders
 –Reactive attachment disorder 
–Disinhibited social engagement disorder

Question 34

Obsessive compulsive related disorders include

Answer 34

•Obsessive-compulsive and related disorders share common features: compulsive behaviors and, sometimes, obsessive thoughts

–OCD –Hoarding disorder
–Trichotillomania –Excoriation
–Body dysmorphic disorder

Question 35

What is the most effective treatment

Answer 35

Cognitive Behavioral Therapy (CBT)

Medications may also be helpful in treatment