Chapter 5 (Adult) Flashcards
State 9 anxiety disorders
- Separation anxiety
- Selective mutism
- Specific phobias
- Social phobia
- Agoraphobia
- Panic
- Generalized anxiety
- Medical condition induced anxiety
- Substance induced anxiety disorder
State 5 trauma, stress related disorders
- Adjustment disorder
- PTSD
- Disinhibited social engagement
- Acute stress disorder
- Reactive detachment
State 7 Obsessive-compulsive and related disorders
- OCD
- Hoarding
- Trichotillomania
- Excoriation
- Body dysmorphic
- Obsessive compulsive and related disorder due to medical condition
- Substance induced obsessive/related
What common symptomatology do ocd spectrum and trauma related disorders share?
Anxiety
Differentiate between fear and anxiety
Fear is a normal, natural response to threat by humans and animals. From an evolutionary respect
Anxiety is a mood characterized by negative affect and bodily symptoms like tension, in which a person anticipates future danger/ misfortune. Anxiety involves feelings, behaviors and physiological responses.
Why is anxiety a future-oriented feeling state
Because human ability to conceive and plan for the future is connected to the g n a w i n g feeling that things might go wrong and that we have better prepared for them
State five bodily symptoms of anxiety
Muscular tension increased pulse dry mouth altered breathing and fidgeting
If fear can be likened to an alarm what can pathological fear like panic be likened too
False alarm. Or a state of excessive vigilance because this fearful state is experienced in an overexaggerated manner often or good reason at all
What is an archetypal threat
It is a Primal Fear or danger that is deeply rooted in the human site amongst all human. Examples include the Field of death abandonment and the unknown which can trigger and intense emotional response and Influence behavior often manifesting in various forms like anxiety aggression or avoidance
What is the fear-anxiety rule of thumb
It is a simplified way to understand the relationship between fear and anxiety
What is the relationship between an archetypal threat and a pathological response
An archetypal threat is a a Primal Fear the tips into universal human experiences and often relates to Survival Instincts I think examples include fear death fear of abandonment smothering. A pathological response refers to reactive behavior that deviate from normal functioning and cause distress or impairment and life. Please responses can run first a psychological disorders or dysfunctional coping mechanisms
Give five archetypal threats and the corresponding pathological responses
- Smothering- panic attack or panic disorder.
- Animals and environment- specific phobia.
- Social rejection- social anxiety.
- Dirt, disorganization- OCD.
- Future- generalized anxiety disorder
What is the most intense expression of Fear
Panic. It is encountered across a range of normal situations and physical conditions and many mental disorders which one not limited to the panic disorder
What is an immediate emotional reaction to a current threat geared towards averting danger
Fear
What is a future-oriented mood state which is characterized and should because we cannot predict or control upcoming event
Anxiety
What is a panic attack
It is a true expression of Fear immediate and overwhelming
What is a panic attack in psychopathology
an abrupt experience of intense fear or acute discomfort accompanied by physical symptoms like breathing changes, palpitations, chills and flushing
Cued and uncued panic attacks (DSM-5)
Expected and unexpected
Provide examples for acute and uncued panic attack
For example if one knows that there are afraid for high places they might have a panic attack in a situation with it or in a high place but not anywhere else this is a cubed or unexpected panic Clinch. One might experience unexpected panic attacks if attacked by a stranger for no good reason. Unexpected funny attacks are important in panic disorder
In which phobias are expected attacks more common in
Specific phobias or social phobias
Since uh panic attack is not to considered a disorder by the dsm5 what is it recognized as
Recognized as occurring across arrange of conditions including panic disorder which is characterized by recurrent panic attacks
What is the diagnostic criteria for the panic attack in the dsm-5
A panic attack according to the dsm-5 is an abrupt surge of intense fear that reaches a peak within minutes and during which time for or more of the symptoms occur; palpitations ford/pounding heart/accelerated heart rate sweating trembling/shaking sensations of shortness of breath or smothering feeling of choking chest pains/discomfort nausea/abdominal distress feeling dizzy for slash and steady/l/ faint paresthesius( numbness or tinglings sensations) chills or heat do you realization (feelings of unreality) or the personalization (being detached from oneself closed) fear of losing control or going crazy and fear of dying
The difference between panic and a panic attack
Panic is a sudden overwhelming fright or fear
a panic attack is the abrupt experience of intense fear or discomfort accompanied by a number physical symptoms such as dizziness or heart palpitations
Biological contributions to panic and anxiety
Tendencies to feel tension, uptight and anxious may be inherited.
Anxiety and panic tendencies can run in families and have a genetic component.
No single gene causes anxiety or panic- it is influenced by collections of genes on chromosomes. Genetic vulnerability doesn’t directly cause anxiety or panic but it makes individuals more subsceptible to them. Environmental stressors can activate genes associated with anxiety or panic. Anxiety is associated with specific neurosystems in the brain. Various neurotransmitter systems ( gaba noradrenaline dopamine and serotonin) are implicated in the anxiety development
The Corticotropin-releasing factor system (CPF)
CPF activates the hypothalamic pictureary adrenocortinol( HPA) axis, which affects areas of the brain associated with anxiety including the hippocampus, amygdala, brain stem, locus coeruleus and the prefrontal cortex. The CRF system interacts with neurotransmitter systems like gabaergic serotonergic and noradrinergic Systems.
Which system is heavily implicated in anxiety and act as a mediator between the brain stem and cortex
The limbic system articularly the amygdala and hippocampus
Which other systems in the brain that control mood does the CRF also interact with
G a b a e r g i c so serotonergic and Nora denergic systems
Which two parts of the limbic system are important for anxiety and what is their roll
The amygdala and hippocampus which act as Middleman between the brain stem and the cortex
What is the purpose of the brain stem
It is like a Watchdog that notices changes in the body and since dangerous signals through the limbic system to the Cortex which is the thinking part of the brain
What is the behavioral inhibition system(b i s)
a pathway in the limbic system that goes from the septal and the hippocampul areas to the frontal cortex which gets activated by signals from the brain stem when something unexpected happens
BIS-behavioral inhibition system
Brain circuit in the limbic system that responds to threat signals by inhibiting activity and causing anxiety. P i s circuit is distinct from the circuit involved in panic
What is the fight/ flight system( FFS)
It is a brain circuit in animals that when stimulated causes an immediate alarm and escape responds resembling human panic. The circuit originate in the brainstem and travels through several midbrain structures including the amygdala the ventromedial nucleus off the hypothalamus and the central Gray matter
What activates FFS
Partly by abnormalities in serotonin e r g i c transmission
Explain how environmental factors affect anxiety
Environmental factors can influence the sensitivity of neural systems affecting the risk of anxiety disorders
A study followed nearly 700 adolescence into Adulthood finding that teenagers who smoked heavily where it significantly higher risk of developing panic disorder and generized anxiety disorder later on in life confirming the complex relationship between smoking and panic disorder
How are brainstem chemo receptors implicated in panic disorder
Brainstem kimo receptors are implicated in panic disorder because panic attacks can be induced by lactic acid infusion which mimics the biochemical effects of smothering
What triggers panic like responses in the brain
Kimo receptors in the brain stem detect increases in carbon dioxide triggering panic-like responses
What is associated with brainstem abnormalities in terms of anxiety disorders
Agoraphobia often accompanied by mild disequilibrium symptoms
What cardio respiratory conditions can provoke panic attacks
Conditions such as myocardial infarction pulmonary embolism pneumothorax and pneumonia
Infection in patients with AIDS main present with hyperventilation and panic symptoms
Pneumocystis Carini is a fungus that may present with Mark type of ventilation and panic symptoms in patients with AIDS.
What endocrine disorders can precipitate panic attacks
Endocranopathies such as hypothyroidism and pharochromocytoma ( a tumor producing excessive noradrenaline and adrenaline) may precipitate panic attacks
What chronic conditions are associated with anxiety symptoms
Chronic gastrointestinal disease and various arthritides
What movement disorder is often characterized by anxiety
Parkinson’s Disease
What type of seizures may produce symptoms similar to panic attacks
Focal seizures particularly those originating in the medial temporal lobe as well as migraines
What type of medications may cause anxiety symptoms and panic
Beta-agonists used to treat asthma may cause anxiety symptoms and panic
What substances of abuse are implicated in causing anxiety symptoms
Substances of abuse with the during intoxication or with four our implicated in anxio Genesis. Alcohol and sedative-hypnotic withdrawals are noted for the prominence of anxiety
Why is it important to exclude potentially life threatening physical conditions in the management of panic
Because a panic attack is often mistaken for a heart attack until proven otherwise
What are some theories on the psychological causes of anxiety/ psychological contributions to anxiety
Freud foot anxiety was a psychic reaction to danger surrounding the reactivation of an infantile fearful situation the. Behavioral theorists believed that anxiety was the product of early classical conditioning modeling and other forms of learning
What evidence support and integrated model of anxiety
New and accumulating evidence supports an integrated model of anxiety involving a variety of psychological factors
How might upbringing and environmental factors contribute to a sense of uncontrollability
Upbringing and disruptive or traumatic environmental factors can contribute to a sense of uncontrollability ranging from total confidence in control to Deep uncertainty about the dealing with upcoming events
How did the apartheid political system contributes to anxiety?
It created adverse social conditions including extreme poverty HIV infection intimate partner violence and child abuse which contributed to a sense of uncontrollability and anxiety
What parenting Styles Foster a healthy sense of control and children
Parents who interact positively and predictably with their children responding to their needs and allowing exploration while providing secure home base Fosters a healthy sense of control
How do overprotective parenting Styles impact children’s sense of control?
Overprotective parenting styles that shield children from adversity may prevent them from learning to cope leading to a diminished sense of control and an increased vulnerability to anxiety
What psychological factor influences vulnerability to anxiety in later life?
The sense of control (or lack there off) that develops from early experiences influences vulnerability to anxiety in later life
What is the conditioning process in psychological accounts of panic?
The conditioning process involves associating an emotional response with external and internal Cues which leads to a learned or false alarm response to those cues
How do external and internal Cues contribute to panic attacks?
External Cues such as places or situation similar to where panic attacks occurred and internal Cues like the increase is in heart rate can provoke panic attacks even when no actual danger is present
Why might individuals be unaware of Cues or triggers of severe fear?
Individuals may be unaware of Cues or triggers of severe fear because they are unconscious and made bypass the Cortex traveling directly to the amygdala in the emotional brain
How does socioeconomic status relate to anxiety
Decreased socioeconomic status in social capital are associated with non-specific psychological distress in South Africa suggesting that anxiety is more common in groups with low socioeconomic status
How do cultural factors influence the experience and interpretation of anxiety?
Cultural factors strongly influence how anxiety is experienced interpreted and responded to
What is the triple vulnerability theory of anxiety development?
It’s suggests three vulnerabilities that contribute to anxiety development; general biological vulnerability general psychological vulnerability and specific psychological vulnerability
How do the three vulnerabilities interact to predispose individuals to anxiety disorders?
If individuals possess all three vulnerabilities ( biological general psychological and specific psychological) they are more likely to develop and anxiety disorder after experiencing a stressful situation
How does panic relate to stress and genetic factors?
Panic is a characteristic response to stress influenced by genetic components separate from anxiety. Anxiety increase as the likelihood of panic suggesting and evolutionary preparation for reacting to imminent danger
What are the characteristics of each vulnerability in the triple vulnerability Theory?
Biological vulnerability- heritable contribution to negative affect irritability and driven behavior.
Specific psychological vulnerability- anxiety about death and non-clinical panic.
psychological vulnerability-tendency towards select off self-confidence low self-esteem and inability to cope
How does stress perpetuate anxiety in the triple vulnerability model?
Stressors can activate biological and psychological vulnerabilities to anxiety. Once the cycle starts it tends to feed on itself persisting even after the stressor has passed
How does the experience of anxiety prepare individuals for potential threats?
Anxiety as a response to possible future threats prepares individuals to react instantaneously with an alarm response if the danger becomes imminent
Why is it important to note the comorbidity of anxiety and related disorder?
Comorbidity emphasizes how these disorders share common features in vulnerabilities both biological and psychological contributing to their development
Is the most common additional diagnosis for anxiety disorders?
Major depression
How do additional diagnosis of depression or substance abuse affect recovery from anxiety disorders?
Make recovery less likely and increase the likelihood of a relapse
What physical conditions are commonly c o morbid with anxiety disorders
- thyroid disease
- respiratory disease
- Gastrointestinal disease
- Arthritis
- Migraine
- Allergic conditions
How does comorbidity with physical diseases affect quality of life
They cause greater morbidity and a poorer quality of life
What relationship exists between panic disorder and cardiovascular disease
Panic attacks often co-occur with certain medical conditions particularly cardio respiratory gastrointestinal and vestibular disorders
How long does comorbidity with anxiety disorders affect suicide risk?
Having an anxiety or related disorder increases the risk of suicidal thoughts or attempts with a panic disorder and PTSD showing the strongest Association
What disorders are traditionally grouped together as anxiety disorders?
- Generalized anxiety disorder (g a d)
- panic disorder (PD)
- agoraphobia
- specific phobia
- social anxiety disorder
- separation anxiety disorder 7. selective mutism
What distinguishes specific anxiety disorders from other conditions
The other disorders are complicated by panic attacks or other features but are the focus of the anxiety
What is generalized anxiety disorder (g a d)
intense, chronic, uncontrollable and continuous worry about everyday life events accompanied by physical symptoms like tenseness irritability and restlessness
What distinguishes pathological worrying in general anxiety disorder from normal worrying
Pathological worrying in general anxiety disorder is present more days than not for at least six months and it’s difficult to control unlike normal worrying that stops once the challenge is over
What physical symptoms are associated with gad
Muscle tension headaches susceptibility to fatigue and difficulty sleeping
What distinguishes the focus of worry in g A D from other anxiety disorders
People with g a d mostly worry about minor everyday life events although major events can also become the focus of anxiety
What are common worries for children with gad
Health related concerns and difficulty sleeping often exacerbated by insomnia and anxiety
What are the general guidelines for anxiety disorders
Common conditions common comorbidity with other psychological disorders more than one anxiety disorder coexistence with major depression common commonity with physical conditions panic attacks are non-specific and can occur across various conditions panic may be the first presentation of serious physical illness suicide is a serious and common risk
What is the duration requirement for excessive anxiety and worry in g a d according to the dsm-5 criteria
Excessive worry and anxiety must occur on more days than not for at least 6 months
What is the Criterion related to the individuals control over the worry in g a d(dsm5 criteria)
The individual must find it difficult to control the worry
How many of the six listed symptoms must be present in gad for diagnosis and how many are required for children according to the dsm-5
At least three of these six symptoms listed are required for diagnosis in adults with only one symptom required for children.
Restlessness or feeling on edge being easily fatigued difficulty concentrating or mind going blind irritability muscle tension sleep disturbance
What is the diagnostic criteria for gad according to the dsm-5
A. Excessive anxiety and worry about a number of events like school or work performance occurring on more days than not for at least 6 months
B. The individual finds it difficult to control the worry.
C. The anxiety and why we are associated with at least three or more of six symptoms. Only one of the following is required in children:
1. Restlessness
2. Easily fatigued
3. Irritability
4. Muscle tension
5. Sleep disturbance
6. Difficulty concentrating
D. The anxiety worry or physical symptoms cause clinically significant distress or impairment in social occupation and other important areas of functioning.
E. The disturbance is not due to the direct psychological effects of a substance (drug abuse, medication ) or general medical condition such as hyperthyroidism.
F. The disturbance is not better explained by another mental disorder (anxiety/ worry about panicking attacks in PD)
What are the six symptoms associated with g a d according to the dsm-5
- Restlessness or feeling on edge
- being easily fatigued
3.difficulty concentrating or mind going blank - irritability
- muscle tension
- sleep disturbance
What level of distress or impairment is required in gad
Anxiety worry or physical symptoms must cause clinically significant distress or impairment in social occupational and other important areas of functioning
What exclusions are specified in the dsm-5 criteria for gad
The disturbance cannot be due to the direct physiological effects of substances or general medical conditions and it cannot be better explained by another mental disorder
What is the general biological vulnerability associated with g a d
If there is a generalized biological vulnerability reflected in genetics studies showing attendancy to become anxious rather than g8d itself being inherited
How do individuals with g a d differ in physiological responsiveness compared to those with other anxiety disorders
Individuals with g a d showed less physiological responsiveness to stresses often termed” automatic restrictors closed with chronic muscle tension being a key distinguishing Factor
What cognitive processes contribute to the development of gad
Individuals with g a d show high-end sensitivity to threat particularly threat to with personal relevance which leads to intense cognitive processing such as worry without accompanying images
How does intense cognitive processing contributes to autonomic restriction in the g80
Intense cognitive processing particularly worry may consume attentional resources leaving the capacity for creating mental images of potential threats thus leading to autonomic restriction
Why do individuals with g a d show chronic worry and muscle tension
They may avoid processing negative affect and imagery associated with anxiety leading to chronic worry and muscle tension as a result of continuous autonomic arousal
What are the key factors contributing to the development of gad
Generized biological vulnerability (inheritance of a tendency to be tense) and the general psychological vulnerability (early experiences of uncontrollable adverse events) play significant Rose exacerbated by significant stress triggering intense worry and physiological changes
What is the model of development proposed for gad
The development of g a d involves a combination of biological and psychological vulnerabilities leading to intense worry and physiological changes rather than an immediate response to threat
What is the most prudent approach to managing GAD?
It involves excluding physical causes or contributors to anxiety symptoms
What are the 2 separate approaches to pharmacological treatment for GAD?
First approach involves acute symptomatic relief with anxiolytic agents like benzodiazepines.
The second approach concerns long-term management with antidepressants
What are the proffered characteristics of benzodiazepines for acute symptomatic relief in GAD?
Longer-acting, lower-potency agents like diazepam are preferred over short-acting high potency agents to reduce the risk of dependence
What are some limitations of benzodiazepines in GAD treatment?
They have a modest therapeutic effect, they impact cognitive and motor functioning, increase the risk of falls in old people and are recommended only for short term relief during crises
Besides benzodiazepines, what other pharmacological agent is useful for acute symptomatic relief in GAD?
Beta blockers, particularly propranolol which is used for acute symptomatic relief
What type of antidepressants are effective for the long-term management of CAD
Both newer agents like ssri’s and s n r i’s as well as the older agents like tricyclic antidepressants have been shown to be effective
What is the current clinical consensus on the use of benzodiazepines in gad treatment
Benzodiazepines are recommended for short-term relief of anxiety associated with temporary crisis or stressful events such as family problems
What are some recent Innovations in psychological treatment for g80
Recent Innovations include treatments that help patients process threatening information emotionally using images and teaching relaxation techniques to combat tension
What psychological treatment has proven efficacy in the management of gad
Cognitive Behavioral Therapy (CBT)
What did b o r k o v e c and his colleagues find regarding the effectiveness of a particular psychological treatment for gad compared to a placebo
The found that the treatment was significantly better than the placebo not only at post treatment but also at a one-year follow-up
What is a recent psychological treatment for gad that Focuses on acceptance rather than avoidance of distressing thoughts and feelings
A new psychological treatment for gad that incorporates acceptance-based procedures in addition to cognitive therapy
What is the effectiveness of psychological treatments for children with g a d
Psychological treatment particularly CBT have shown effectiveness in children with gad with significant improvements maintain for at least one year
What progress has been made in adapting psychological treatments for older adults with g a d
Adaptations of psychological treatments have shown efficiency for older adults with gat compared to usual care
What does s n r i and SSRI stand for
Selective serotonin reuptake inhibitors and serotonin n o r a d r e n e r g i c reuptake inhibitors s n r i
What characterizes panic disorder
It involves recurrent unexpected panic attacks accompanied by concern about future attacks and/or lifestyle changes to avoid future attacks
Define agoraphobia
It is characterized by anxiety about being in places or situations from which escape might be difficult in the event of panic symptoms or other unpleasant physical symptoms
What is anticipatory anxiety in the context of panic disorder
Refers to the anxiety experienced by individuals with panic disorder about the possibility of experiencing a panic attack leading them to avoid situations that may provoke an attack
What is the relationship between panic disorder and agoraphobia
Many individuals with PD also experience symptoms of agoraphobia particularly fearing experiencing a panic attack in certain situations. Although not all individuals with PD develop agoraphobia
How does agoraphobia relate to panic attacks
It’s often develops as a response to severe unexpected panic attacks leading individuals to avoid situations or places where they fear experiencing a panic attack
What are some common avoidance behaviors associated with agoraphobia
Avoidance behaviors include sitting near exit for rapid escape avoiding certain locations or people perceived as unsafe and enduring situations with intense dread despite anxiety
What is interceptive avoidance and why is it important in panic disorder and agoraphobia
It involves avoiding internal physical sensations that resemble the beginning’s of a panic attack such as avoiding exercise to due to increased cardiovascular activity or faster respiration. It is as important as classical goraphobia avoidance
What is the dsm-5 diagnostic criteria for a panic disorder
A. Recurrent unexpected panic attacks should be present.
B. At least one of the attacks has been followed by one month or more of one or both of the following- persistent concern or worry about additional panic attacks and their consequences like going crazy or have in the heart attack. They significant maladaptive change in behavior related to the attacks for example avoidance of exercise are familiar situations
C. The disturbance is not attributable to the physiological effects of a substance for example drug abuse on medication or another medical condition like hypothyroidism
D. The disturbance is not better explained by another mental disorder( like the panic attacks do not occur only in response to feared situations as in social anxiety disorder)
Are there significant differences in panic disorder rates among different ethnic groups in the USA
Rates are similar among different ethnic groups in the USA including african-americans. Black and white patients with panic disorder shown no significant differences in symptoms
How do some cultures perceive subjective feelings of dread?
Subjective feelings of dread may be foreign to some cultures leading to individuals to focus more on body licensations rather than emotional experiences
How did traditional healers in South Africa respond to a case of panic disorder and agoraphobia?
Traditional healers in South Africa often do not recognize mental illness
What is brain f a g syndrome and where is it commonly described?
It is a reactive form of anxiety including symptoms such as depersonalization, sensory disturbances( itchiness of the scalp) and cognitive limitations( restriction of memory and concentration)
What symptoms are commonly associated with brain f a g syndrome
It is often attributed to an overemphasis on academic achievement and its typically found among individuals involved in scholarly Pursuits
Are nocturnal panic attacks similar to Nightmares?
No research indicates that nocturnal panic attacks occur during delta or slow wave sleep typically several hours into sleep as frustrated by p o l y s o m n o g r a p h y
What is a related phenomenon in children to nocturnal panic attacks?
Sleep terrors
How do individuals experiencing nocturnal panic attacks differ from those experiencing sleep terrors?
Individuals experiencing nocturnal panic attacks do wake up and later remember the event clearly
At which stage of sleep do sleep terrors tend to occur
Latest stage of sleep known as stage 4 which is associated with sleepwalking
What factors contribute to understanding panic disorder?
Biological psychological and social contributing factors
How does agoraphobia typically develop?
It often develops after a person has unexpected panic attacks or panic likes sensations but the severity and development of agoraphobia seem to be socially and culturally determined
What are panic attacks and panic disorder strongly related to?
Biological encyclological factors and their interaction
What is the triple vulnerability model in panic disorder
It explains how biological psychological and social factors may contribute to the development and Maintenance of anxiety and to an initial unexpected panic attack
How do individuals develop specific associations during panic attacks?
Particular situations quickly become associated in an individual’s mind with external and internal causes that were present during the panic attack
How can being in a movie theater during a panic attack lead to future panics?
Being in a movie theater when a panic attack occurs can become an external queue that might lead to future panic attacks as a condition stimulus
What are Cues associated with panic attacks through a learning process
Earned alarm which are Cues that become associated with a number of different internal and external stimuli through a learning process
What is the significance of these learned Cues in relation to panic attacks?
They play a role in the development and maintenance of panic disorder
What factors differentiate individuals who develop anticipatory anxiety from those who do not?
Those with a history of physical disorders and health anxiety were more likely to develop panic disorder than either anxiety disorders suggesting a learned belief that an unexpected bodily sensations are dangerous
What does the tendency to believe unexpected body sensations are dangerous indicate
It reflects a specific psychological vulnerability to develop panic and related disorders
How do individuals who do not develop anticipatory anxiety typically respond to panic attacks?
The attribute the attack to events of the moment such as an argument something they ate or a bad day and go on with their lives perhaps experiencing occasional panic attacks when they are under stress again
What cognitive processes does David Clark’s Theory emphasize in panic disorder?
The specific psychological vulnerability of interpreting normal physical sensations in a catastrophic way
How does the interpretation of normal physical sensations lead to a vicious cycle in panic disorder?
Individuals may interpret normal physical sensations as dangerous leading to anxiety. This anxiety produces more physical sensations perceived as even more dangerous resulting in a panic attack
What hypothesis suggests the development of panic disorder and agoraphobia from psychodynamic causes?
One hypothesis suggests that early object loss/ separation anxiety might predispose someone to develop panic disorder and agoraphobia as an adult
What characterizes individuals with agoraphobia according to the hypothesis of early separation?
Individuals with agoraphobia have dependent personality tendencies which are hypothesized as a possible reaction to early separation
Study diagram on page 67
Is the dsm-5 diagnostic criteria for a graphobia
A. Marked fear or anxiety about two or more of the following five situations the; public transportation open spaces and closed spaces standing in line or being in a crowned being outside the home Alone.
B. The individual fears or avoids these situations due to thoughts that escape might be difficult or help might not be available in the event of developing panic like any embarrassing symptoms like fear of falling by old people.
C. The agoraphobic situations almost always provoke fear or anxiety or stop
D. The agoraphobic situations are actively avoided require the presence of a companion or endured with intense fear or anxiety.
E. With the fear or anxiety is not proportionate to the actual danger posed by the agoraphobic situations or to the social cultural context.
F. The fear anxiety or avoidant is persistent typically lost in for six months or more.
G. The fear anxiety or avoidance causes clinically significant distress or impairment is social occupational or other important areas of functioning.
H. If another medical condition is present( inflammatory bowl disease or Parkinson’s Disease) the fear anxiety or avoidance is clearly excessive.
I. The fear anxiety or avoidance is not better explained by symptoms of another medical disorder and are not related exclusively to obsessions like OCD perceived deficits of flows in physical appearance bdd reminders of traumatic events PTSD or fear of separation(separation anxiety disorders)
What specific treatments can indicate the causes of panic disorder
Response to certain specific treatments where the pharmaceological or psychological me indicate the causes of the disorder
What class of medications is currently preferred for panic disorder?
SSRI (selective serotonin reuptake inhibitors)
What is the focus of psychological treatment for panic disorder?
The focus on reducing agoraphobia avoidance through exposure based strategies
How effective are psychological treatments for panic disorder?
They are quite effective
What is the goal of exposure-based treatments in panic disorder?
The goal is to arrange conditions in which the patient can gradually face feared situations and learn there is nothing to fear
What is the role of panic control treatment(PCT) in managing panic disorder?
PCT Focuses on exposing patients to introceptive sensations that remind them of their panic attacks
How effective are booster sessions in preventing Relapse for panic disorder?
Boosters sessions aimed at reinforcing acute treatment gains have shown to improve long-term outcomes and prevent relapse
What challenges exist in accessing psychological treatments for panic disorder?
Access can be challenging to the requirement of therapists with advanced training
What innovative methods are being explored to disseminate psychological treatments for panic disorder?
Innovations include computer guided Cognitive Behavioral programs for primary care settings such as calm tools for living
What is the goal of the computerized program(calm tools for living)
To enhance the integrity of CBT in the hands of novice and relatively untrained clinicians
What does come tools for living prompt
It prompts clinicians to engage in specific therapeutic tasks such as helping patients to establish a fear hierarchy demonstrating breathing skills or designing exposure assignments
What is Panic control treatment
It is when the therapist attempts to create mini panic attacks in the office by having patience exercise to elevate their heart rates or perhaps by spinning them in a chair to make them dizzy. Basic attitudes and perceptions concerning the dangerousness of the feared but objectively harmless situation are then identified in modified- attitudes and perceptions which are mostly beyond the patients awareness
What is the usual sequence of treatment for panic disorder?
Patience usually commence pharmacotherapy before being referred for psychological treatment
What does long-term treatment with Cognitive Behavioral Therapy(CBT) show in comparison to anti-depressant or combination treatment
Long-term treatment with CBT appears more effective with retention of gains
Clinical setting what early improvement does treatment with antidepressants provide?
Mint with antidepressants provides earlier improvement favoring the combined approach in the clinical setting
What was observed when CBT was added to the medication in the primary care setting?
Adding CBT to the medication for patients already on medications resulted in significant further improvement
What approach may be superior to combining treatments from the beginning?
A stepped care approach where one treatment is initiated first and another is added if necessary
Usually the first step in treating panic disorders especially in primary care settings?
General practitioners typically initiate pharmacotherapy due to the scarcity of psychological treatments in these settings.
How does long-term treatment with Cognitive Behavioral Therapy compared to antidepressant or combination treatment for panic disorders?
Treatment with CBT appears more effective with sustained benefits compared to antidepressants or combination treatment
What advantage does treatment with antidepressants offer in the clinical setting for panic disorders?
Antidepressant provide earlier improvement which may favor a combined approach especially in clinical settings
What treatment approach may be superior in managing panic disorders and agoraphobia?
A stepped care approach starting with one treatment and adding another if needed
Is there any advantage to combining pharmacological agents and CBT initially for panic disorders and agoraphobia?
There is no advantage
Which type of treatment tends to perform better in the long run for panic disorders?
Psychological treatments
What treatment sequence is suggested for panic disorders when psychological treatment is available?
Psychological treatment should be offered initially followed by antidepressant treatment for non-responsive patients or when psychological treatment is not available
specific phobia
It is an unreasonable fear of a specific object or situation that significantly disrupts daily functioning
What is the clinical description of specific phobia?
It involves an irrational fear of a specific object or situation that m a r k e d l y interferes with an individual’s ability to function
What term was used in earlier versions of the DSM to describe specific phobia?
Simple phobia which distinguished it from agoraphobia
How do specific phobias affect individuals
They can be extremely disabling
What is the major characteristic of specific phobias according to the dsm-5?
Marked fear and anxiety about a specific object or situation
What are the four major subtypes for specific phobia?
Blood injection injury phobia situational type natural environment type and animal type
What is blood injection injury phobia
It is an unreasonable fear and avoidance of exposure to blood injury or the possibility of an injection usually accompanied by fainting
What is situational phobia
It involves anxiety related to enclosed spaces (claustrophobia) or public transportation( such as fear of flying)
What is natural environment phobia
It is a fear of situations or events in nature such as Heights storms and water.
Fears also sing to cluster together so if one fears a situation or event such as deep water they are likely to fear another like storms. It is not a phobia if it is a passing fear so it has to be persistent lasting at least 6 months and should substantially interfere with a person’s functioning like the avoidance of boat trips or mountains where they may be storms
What is animal phobia
Is an unreasonable enduring fear of animals are insects often developing early in life normally picking at 7 years of age
-
What is the main difference between situational phobia and panic disorder
People with situational phobia never experience panic attacks outside the context of their phobic object or situation while people with PD in contrast might experience unexpected and uncubed panic attacks at any time
What is the diagnostic criteria for specific phobia according to the dsm-5
A. Marked fear or anxiety about a specific object or situation (flying Heights animals receiving an injection or seeing blood).
B. The phobic object or situation almost always provokes immediate fear or anxiety( which may be expressed in children through crying or tantrums).
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the socio-cultural context.
E. The fear or anxiety or avoidance is persistent typically lasting or more months.
F. The fear anxiety or avoidance causes clinically significant distress or impairment in social occupational and other important areas of functioning.
G. It is not better explained by symptoms of another mental disorder including fear anxiety and avoidance; of situations associated by Panic like symptoms or other encapacitating symptoms ( agoraphobia Close record objects or situations related to obsessions (OCD) reminders of traumatic events (PTSD Close (separation from home or attachment figures (separation anxiety) or social situations( s a d)
What was the traditional belief regarding the onset of specific phobias
It was believed that most specific phobias originated from a dramatic event such as being bitten by a dog
A specific phobia developed in a young child
If they experience stress and uncertainty coupled with encountering a menacing object such as a grasshopper
How do specific phobias affect individuals
They can be extremely disabling interfering significantly with an individual’s ability to lead a normal life.
What are examples of phobias that are acquired through Direct experience
The development of a phobia of choking after experiencing A jogging incident or developing claustrophobia after being trapped in an elevator
What are examples of phobias that are acquired through Direct experience
The development of a phobia of choking after experiencing A jogging incident or developing claustrophobia after being trapped in an elevator
What are the different ways in which a phobia can develop
Phobia can develop through Direct experience false alarms (panic attacks) observing someone else’s severe fear or being informed about danger under the right conditions
How do many patients with phobias initially experience their fear
Let’s say initially experience unexpected panic attacks in specific situations often related to current live stressors which then leads to the development of a specific phobia
What is an example of vicarious learning of phobias
Witnessing an accident or injury happening to someone else may be sufficient to install a phobia in The Witness as emotions are contagious
How can repetitive warnings about a danger leads to the development of a phobia?
through information transmission
What distinguishes a true phobia from a terrifying experience?
A true phobia involves anxiety about the possibility of another traumatic event or false alarm leading to avoidance behaviors
What protected individuals from developing a phobia despite frightening encounters?
Virtuals who did not develop a phobia despite frightening encounter as demonstrated developed anxiety about another encounter with the source of Fear and like those who became phobic
What is traffic phobia
Trauma that may develop as a result of a traumatic experience like a car accident
What are the key factors contributing to the development of a phobia?
A traumatic conditioning experience genetic predisposition and susceptibility to anxiety about the possibility of the event happening again
How does genetic predisposition play a role in the development of phobias?
Genetic factors such as heritability and inherited physiological responses contribute to the vulnerability of phobias. For example blood injection injury phobia is highly heritable with individuals inheriting a strong vasovagal response
How do social and cultural factors influence the development of specific phobias?
Social and cultural factors strongly influence who develops and reports specific phobias with societal expectations often leading to under reporting of phobias among men
What is the observed pattern regarding gender and specific phobias?
In most societies specific phobias are predominantly reported by women possibly due to societal norms discouraging men from expressing fears and seeking treatment
How do men typically respond to fears and phobias
The either work and expose themselves to the feared situations to overcome their fears independently or endure them without seeking treatment or sharing their experiences
What is generalized biological vulnerability in the context of phobias
It includes a heritable tendency to associate fear with objects or situations that have been historically dangerous to humans and a low threshold for specific defensive reactions such as fainting at the site of blood ( vasovagal response)
What is specific psychological vulnerability in relation to phobias
It refers to perceiving a specific object or situation as dangerous
What approach is recommended for managing specific phobias
Structured and consistent exposure based approaches
Why is therapeutic supervision important during exposure-based therapy for phobias
To prevent individuals from attempting too much too soon and to address any unexpected panic attacks
How can separation anxiety be addressed in therapy
Parents are often included in therapy to help structure exercises and address parental reactions to childhood anxiety
What recent development has shown success in treating phobias in young girls?
An intensive 1 Week program including a sleepover at a clinic for girls between the ages 8 to 11
How are exposure based exercises for blood injection injury phobia different?
Individuals must tense various muscle groups during exposure exercises to maintain blood pressure and prevent fainting
How do modern functional neuro imaging techniques support the effectiveness of phobia treatments?
The demonstrate that phobia treatments modify neural circuitry diminishing responsiveness in fear sensitive areas while increasing rational appraisals in prefrontal cortical areas
What role does pharmacotherapy play in managing phobias
The role is unclear but anxiolytic agents may be useful for acute distress containment or as emergency measures. Beta antagonists and d- cycloserin have also shown promise in conjunction with exposure therapy
What is separation anxiety disorder?
Is an excessive enduring fear in some individuals that harm will come to them or their loved ones when they are a part
How is separation anxiety disorder characterized in children
By a child’s unrealistic and persistent worry that something will happen to his parents or other important people or to the child when separated from them for example getting lost to kidnapped peeled or hurt in an accident which leads to them often refusing to go to school or even leave home because they fear separation
What symptoms may accompany separation anxiety disorder in children?
Refusal to sleep alone nightmares involving possible separation and by physical symptoms distress and anxiety
What is the Essential distinction between separation anxiety and school phobia?
In separation anxiety that act of separating from the parent or attachment figure provokes anxiety and fear while in school phobia The Fear is focused on something specific to the school situation and the child can lead the parents to go somewhere other than School
What is the focus of anxiety in adults with separation anxiety disorder?
” harm me before loved ones during separation”
Why was separation anxiety disorder elevated to full status as a diagnostic category in the dsm-5
recognition that separation anxiety disorder a occurs across the lifespan and is characterized by unique sensations
How are parents involved in treating separation anxiety disorder in children?
They are included to help structure the exercises and also to address parental reactions to childhood disorder
What innovative treatment approach has been explored for separation anxiety disorder
The use of real-time coaching of parents using a small microphone in the parents ear to allow therapists to actively instruct them on how best to respond when the child resists separation
What is social anxiety disorder also known as
Social phobia
What is the definition of social anxiety disorder
It is extreme enduring irrational fear and avoidance of social or performance situations
Distinguish social anxiety disorder from exaggerated shyness
Social anxiety disorder negatively influences performance
What is a subtype of social anxiety disorder and what do individuals who suffer from it have difficulty with
Performance anxiety. Individuals with performance anxiety don’t usually have difficulty with social interaction but when they must do something specific in front of people anxiety takes over and they focus on the possibility of Embarrassing themselves
What is the most common type of performance anxiety
Public speaking
What is performance anxiety called among performing artists
Stage freight
What are some anxiety provoking physical reactions associated with social anxiety disorder
Blushing sweating trembling urinating in a public toilet ( for males known as bashful bladder) where males with this problem must wait until everyone else has lift the urinal
How do individuals with social anxiety disorder typically behave in private versus in the presence of others
They have no difficulty eating writing or urinating in private their anxiety arises only when others are watching their behavior
What is the diagnostic criteria for sad according to the DSM 5
A. Marked fear and anxiety about one or more social situations in which the person is exposed to possible script any by others. For example social interactions being observed or performing in front of others. B. The individual fears that they will act in a way or show anxiety symptoms that will be negatively evaluating. C. The social situation almost always provoke fear or anxiety(which may be expressed through crying tantrums freezing by children). D. The social situations are avoided or endured with intense fear or anxiety. E. The fear or anxiety is out of proportion to the actual threat to post by the Social situation and to the social cultural context. F. The fear anxiety or avoidance is persistent typically lost in six or more months. G the fear anxiety or avoidance causes clinically significant distress or impairment in social occupational or other important areas of functioning. H. The fear anxiety avoidance is not attributable to the effects of a substance or other medical conditions. I. The fear anxiety or avoidance is not better explained by the symptoms of another mental disorder such as panic just order or separation anxiety. J. If another medical condition( stuttering Parkinson’s disease of basicity) is present the fear and variety or avoidance this clearly unrelated or is excessive
Can infants exhibit temperamental traits related to social anxiety disorder
Yes some infants are born with a temperamental profile or trade of inhibition or shyness that is evident as early as 4 months of age
How do infants with a temperamental profile of inhibition or shyness typically responds to stimuli
Become agitated and crime more frequently when presented with toys or other age appropriate stimuli then children without the trait
What risk do individuals with excessive behavioral inhibition face
They are at a high risk of developing p h o b i c behavior including social anxiety disorder
What does n it’s your logical model of social anxiety disorder resemble
The models of panic disorder and specific phobia
What are the three pathways to developing social anxiety disorder
- Inheriting a generalized biological vulnerability to develop anxiety or social inhibition.
- Experiencing unexpected panic attacks in social situations which become associated with social cues.
- Enduring real Social traumas that condition anxiety in similar social situations possibly extending back to difficult childhood periods
What additional Factor is required to produce social anxiety disorder after stressful experiences
The vulnerable individual must also Harbor the belief that social evaluation in particular can be dangerous creating a specific psychological vulnerability
What do some people with Sad tend to focus their anxiety on
Events involving social evaluation
How do parents of individuals with Sad differ from parents of individuals with panic disorder
Parents of individuals with social anxiety disorder are significantly more socially fearful and concerned with the opinions of others than the parents of individuals with panic disorder
What is recognized regarding the overlap between sad and avoidant personality disorder
Both conditions are very similar phenomenologically and seem likely to share a common etiology
What are the effective treatments developed for social anxiety disorder
Cognitive therapy (CT) and interpersonal psychotherapy (ipt) which emphasizes real life experiences during therapy to disproof automatic perceptions of danger
One reason why social anxiety disorder may be maintained despite repeated exposure to social cues
Sad individuals engage in avoidance and safety behaviors to reduce the risk of rejection preventing them from critically evaluating their catastrophic beliefs about social interactions
What is the goal of social mishap exposures in treating social anxiety disorder
Say confront patients with the actual consequences of social misaps challenging their catastrophic beliefs about embarrassment and foolishness in social interactions
How do family-based treatment approaches compared to individual treatment approaches for youth with social anxiety disorder
Family based treatment approaches appear to art perform individual treatment when the child’s parents also have an anxiety disorder leaving to significantly higher diagnosis free rates 3 years following treatment
Trauma and stressor related disorders
What does the dsm-5 consolidate under trauma and stress related disorders
It consolidates a group of formally disparate disorders that all develop from a stressful or dramatic life event
Give examples of trauma and stressorrelated disorders
Attachments disorders in childhood adjustment disorders severe reactions to trauma such as PTSD and acute stress disorder
Besides fear and anxiety what other emotions may be implicated in the onset of trauma and stressor related disorders
Horror rage guilt shame especially in PTSD
What is the clinical description of PTSD
Is an enduring distressing emotional disorder that follows exposure to severe helplessness or a fear inducing threat characterized by living the trauma again avoidance numbing of responsiveness and increased vigilance and arousal
What setting event does dsm-5 mandate for the diagnosis of PTSD
Exposure to a dramatic event during which an individual experiences or Witnesses death serious injury or sexual violation
What is the difference between acute stress disorder and PTSD
Acute stress disorder is a severe reaction immediately following a terrifying event often including amnesia emotional numbing and derealization. It is considered PTSD if symptoms persist after 1 month
What is a notable symptom difference between acute stress disorder and PTSD
There are more dissociative symptoms in acute stress disorder compared to PTSD
What is the known cause of PTSD
The cause relates to the precipitating events-when someone personally experiences a trauma and develops a disorder
What factors influence whether a person develops PTSD after a trauma
Biological psychological and social factors
What accounts for differences in developing PTSD among those Who Experience less intense trauma
Persons unique generalized biological and psychological vulnerabilities present during the traumatic event
What does a family history of anxiety suggest in relation to PTSD
It’s suggests a generalized biological vulnerability for PTSD
What model helps explain the development of PTSD in relation to genetic factors
The stress dia thesis model explains that genetic factors predisposed individuals to be easily stressed and anxious increasing the likelihood of developing PTSD after a traumatic experience
How does the presence of the short a l l e l e of the serotonin Transporter g e n e relates to PTSD
It’s presence correlates with an increased risk of developing major depression and acute stress symptoms
What Discovery was made about 6 year old children with externalizing problems
See we’re more likely to encounter trauma assault and later develop PTSD
How does higher intelligence relate to exposure to traumatic events
Higher intelligence predicts decreased exposure to traumatic events
What do studies on reciprocal Gene environment interactions suggest about PTSD
They suggest that existing vulnerabilities some heritable may determine the environment one lives in and the type of psychological disorder one May develop including PTSD
What psychological vulnerability might increase the risk of developing PTSD
A generalized psychological vulnerability based on early experiences with unpredictable or uncontrollable events
How does family instability relates to the risk of developing PTSD
It installs a sense that the world is uncontrollable and dangerous increasing the risk of developing PTSD aftet the trauma
How do social factors influence the development of PTSD
Destroying and supportive social networks decrease the likelihood of developing PTSD after trauma
What effect does social support have on biological and psychological responses to stress
Support from loved ones reduces cortisol secretion and HPA access activity in children during stress
What neurobiological systems are involved in PTSD
CRF responses and heightened HPA a x i s reactivity
What brain changes are associated with PTSD
damaged to the hippo campus
What is the hippo campus role in PTSD
It regulates the HPA a x i s and is Central to encoding explicit memory; it’s pathology in PTSD includes decreased volume correlating with increased and memory deficiency
How is panic attack similar to an alarm reaction in PTSD
Both are adaptive fear responses occurring at inappropriate times but in PTSD the initial alarm is true due to real danger
What pathological mechanism is suspected in PTSD related to dissociation
Dissociation may cause functional lesions of neural networks producing flashbacks dissociative symptoms and a f f e c t i v e restriction
What is the psychological management for PTSD
Victims should face the trauma process intense emotions and develop effective coping procedures to overcome PTSD
What is catharsis in psychology therapy
It’s refers to r e l i v i n g emotional trauma to relieve emotional suffering
How is imaginal exposure used in PTSD therapy
It involves systematically working through the trauma and associated emotions
What role does cognitive therapy play in PTSD therapy
It correct negative assumptions about the trauma such as self-plane and guilt
How might trauma victims repress memory and emotions
Semi unconsciously and automatically reverse the emotional side of their memory or the memory itself
What is the effect of a single debriefing session on trauma victims
It can be harmful if it forces the victim to express feelings prematurely
How can pharmacological treatment be effective for PTSD symptoms
Antidepressants like ssri’s and mood Stabilizers can help with anxiety panic attacks depression and flashbacks in PTSD
What is the role of propranolol
It may reduce the risk or severity of PTSD symptoms
What are adjustment disorders
They describe anxious or depressive reactions to life stress that impair work and Academic performance and erode quality of life
What happens if adjustment disorder symptoms processed for more than 6 months
The adjustment disorder is considered chronic
Why has there been little research on adjustment disorders
Because it has often been used as a residual diagnostic category not meet and criteria for more serious disorders
What are attachment disorder
Say involved disturbed and inappropriate behaviors in children unable or unwilling to form normal attachment relationships due to inadequate more abusive child rearing practices
What can cause attachment disorders in children
Frequent changes in primary caregivers on neglect because they fail to meet the child basic emotional needs
How are attachments disorders considered pathological reactions
They are pathological reactions to early extreme stress resulting from inadequate child rearing practices
How were different presentations of attachment disorders categorized and previous DSM additions
Reactive attachment disorder
What are the two separate disorders described in the dsm-5 related to attachment
The emotionally withdrawn inhibited type and the indiscriminantly social disinhibited type
How does a child with reactive attachment disorder typically behave towards caregivers
They barely sick out caregiver for protection support and nurturing and seldom respond to offers from caregivers to provide this kind of care
What emotional characteristics are generally evidence in reactive attachment disorder
Lack of responsiveness limited positive a ffe City and heightened emotionality such as fearfulness and intense Sadness
What behavior pattern is associated with disinhibited social engagement to disorder
A child shows no inhibitions in approaching adults possibly engaging in inappropriately intimate behavior by showing a willingness to accompany and unfamiliar adult without checking first with a caregiver
Why were the behavior patterns combined into one disorder in the dsm-iv then separated into two different disorders in the dsm-5
Because of the notable different presentations of an adequate detachment behavior
What is reactive attachment disorder
It is an attachment disorder where a child with disturbed behavior neither 6 out a caregiver nor response to offers of Help from one with fearfulness and sadness being evident
What is disinhibited social engagement disorder
That is a condition in which a a child shows no inhibitions whatsoever in approaching adults
What new class of disorders are included in the dsm-5
Obsessive compulsive and related disorders
Which disorders are now included in the obsessive-compulsive and related disorders category in the dsm5
OCD hoarding disorder body dysmorphic disorder trichotillomania and e x c o r i a t i o n disorder
What is obsessive compulsive disorder
It is a disorder involving unwanted persistent intrusive thoughts in impulses as well as repetitive action intended to suppress them
How is the anxiety in OCD characterized
It is a symptom released by the underlying psychopathological processes and not a primary feature of the condition
What are the conditions commonly occur simultaneously with obsessive compulsive symptoms in OCD
Severe generalized anxiety recurrent panic attacks debilitating avoidance and major depression
How does the danger in OCD differ from that in other anxiety disorders
N OCD the Dangerous event is a thought image or impulse that the client attempts to avoid
What are compulsions in OCD
Thoughts or actions released in conjunction with the obsessions
What happens when a person with OCD fails to engage in the compulsion associated with their disorder
Heightened distress and anxiety
What are the four major types of obsessions in OCD
Symmetry forbidden thoughts or actions cleaning and contamination and hoarding
What is symmetry obsession in OCD associated with
Keeping things in perfect order or doing something in a specific way
What type of rituals are associated with pathological dot and certain forbidden thoughts in OCD
Checking rituals to prevent an imagined disorder or catastrophe
What type of compulsions are associated with contamination of sessions and OCD
Washing rituals to restore a sense of safety and control
What is a t i c
It is a semi-purpose for muscular behavior usually a sudden jerk of a limb neck movement premise tight closure of the eye g r u n t other simple vocalization
Is p a n d a s and how is it related to OCD
Pediatric autoimmune disorder associated with streptococcal infection where obsessions and compulsions emerge following the streptococcal infection
Is thought-action fusion in OCD
It is when clients with OCD equate thoughts with the specific actions or activity represented by those thoughts
What pharmacological treatments are most effective OCD
Treatments that inhibit the reuptake of serotonin such as tricyclic antidepressant and ssris like s e r t r a l i n e
What is exposure and ritual prevention treatment (ERP) in OCD
It is a process where rituals are actively prevented and the patient is systematically and gradually exposed to the feared thoughts or situations
What is the role of psychosurgery in treating severe OCD
Psychosurgery such as c i n g u l o t o m y or deep brain stimulation may be considered as a lust resort for very severe or treatment refractory OCD
What are some examples of usually acceptable appearance modifications
Skin lightening nail extensions
What behavior characterizes individuals with body dysmorphic disorder (bdd)
Individuals with bdd think they are so ugly that they refused to interact with others or function normally fearing judgment of their appearance
What is the central preoccupation of someone with body dysmorphic disorder
It is an imagined defect in a parent or an over evaluation of a minor imperfection despite looking reasonably normal to others
With which type of disorders was bdd previously aligned why
somatoform disorders
To which category of disorders has bdd been reclassified
Obsessive compulsive and related orders because of its close relationship to the OCD spectrum
What similarities exist between bdd and OCD
- persistent intrusive thoughts
- compulsive behaviors
- similar age of onset
- run the same course
How many body areas of concern do individuals with DD typically have
5 to 7
What are some common checking or compensating rituals in bdd
Excessive turning excessive grooming and skin picking
Why might skin picking be related to BDT
Because it is considered an OCD spectrum disorder and may share biological substrate with bdd
How do individuals with bdd typically interact with mirrors
They become fixated on mirrors repeatedly checking their features or mirrors almost phobically
What’s the view consequences can bdd lead to
Suicidal ideation suicide attempts and in severe cases suicide
What is meant by” psychotic-like ideas of reference in body dysmorphic disorder
Individuals with bdd may believe that everything happening around them is related to their imagined defect
What was Edd previously known as and why
It was previously known as dysmorphophobia which means fear of ugliness
How do delusional and non- delusional bdd patients response to treatment
They both respond equally well to BD treatment but the delusional group does not respond to treatments for psychotic disorder
Why is it challenging to estimate the prevalence of bdd
The disorder tends to be kept secret
What are Common focuses of concern for men versus women with bdd
Maintenance to focus on bodybuild genitals and thinning hair while women focus on more varied body areas and are more likely to have an eating disorder
What is the typical age of onset for bdd
Early adolescence through the 20s speaking at 16 or 17
How does the severity of bdd compared to other disorders
Pdd patients often experience where psychological distress quality of life and impairment compared to patients with depression diabetes or a recent myocardial infarction
What are some extreme measures bdd patients have taken due to their condition
Self surgery such as using a staple gun on their face or filing down their teeth
What can cultural practices of appearance alteration tell us about bdd
Bdd behaviors may seem strange because they go against to prevailing cultural practices but they can be seen as exaggerations of normal culturally sanctioned behaviors
What psychoanalytic speculation exists about bdd
Is suggest that bdd may involve the defense mechanism of displacement where an underlying conflict is displaced onto a body part
What c o morbid condition is often associated with bdd
OCD
What is the first type of treatment for bdd that shows evidence of effectiveness
Serotonin reuptake inhibiting agents
How effective is clomipromines against pdd
It is more effective than e e s i p r a m i n e given delusional type bdd
What is the second type of treatment that is effective for both OCD and bdd
Exposure and response prevention which is a type of Cognitive Behavioral Therapy (CBT)
What is a challenge associated with CBT for bdd despite its effectiveness
Even though CBT produces better and longer lasting outcomes compared to medication alone it is not really available as pharmacological treatment
What is t a i j i n k y o f u s h o and how is it related to bdd
It is a Japanese variant of social anxiety disorder where individuals may believe that they have horrendous bed breath or body odor avoiding social interaction and it shows characteristics with bdd
How might social anxiety disorder be fundamentally related to bdd
perceived negative evaluation of their appearance by others is as important as self-evaluation of emergent defect in appearance for people with bdd
What are common commorbid conditions found in people with bdd
OCD and social anxiety disorder
What is hoarding disorder and hard did it initially come to attention
It is characterized by the compulsive hoarding of items initially thought to be a variant of OCD but recognized as a major problem itself
What are the three major characteristics of hoarding disorder
Excessive acquisition of things difficulty discarding anything and living with excessive clutter under grossly organized conditions
How does hoarding disorder typically begin and progress over a person’s life
It begins and teenage years and worsens with each passing decade
What Cognitive and emotional abnormalities are associated with hoarding disorder
Strong emotional attachment to possessions exaggerated Desire for control over possessions and deficits in deciding the value of possessions
How do individuals with the hoarding disorder typically respond to intervention
They do not see their hoarding is a problem until intervention is insisted upon by family members or authorities
What is a notable characteristic of animal hoarding compared to object holding
Animal hoarders often fail to care for animals properly leading to unsanitary conditions and health threats
What psychological treatment shows promise for boarding disorder and what does it teach patients
Nutritments teach people to assign different values to object and reduce anxiety about discarding items
What is trichotillomania and what are its social consequences
It is the urge to pull out one’s hair resulting in noticeable hair loss distress and significant social impairments
What is e x c o r i a t i o n disorder and how does it impact individuals
It involves repetitive and compulsive skin-baking leading to tissue damage distress and social and occupational impairment
Why is trichotillomania and exoriation disorder under obsessive compulsive and related disorders
Because the repetitive and compulsive behaviors
What psychological treatment has shown the most successful trichotelomania and xoriation disorder
Habit reversal training which teaches patients to be more aware of their behavior and substitute it with a different and harmless behavior
What pharmacological treatment has proven effective for trichotillomania
SSRI antidepressants such as fluoxetine
How were anxiety disorders classified in the dsm-iv compared to the dsm-5
The anxiety disorders from the dsm-iv are not divided into three separate groupings or classes of disorders with 10 disorders added either by splitting existing disorders relocating this orders from other sections or introducing new disorders for the first time in the DSM
What advantage does the dimensional profile offer over a categorical diagnosis
The dimensional profile provides a more complete picture of the clinical presentation by capturing the relative severity of key features of anxiety and mood disorders which helps Taylor therapy more closely to the individual’s problems
What are the two types of panic attacks and how do they relate to anxiety disorders
Panic attacks can be unexpected without warning on queued or expected occurring in a specific situation queued
What is the most common type of performance anxiety
Public speaking
Which physical reactions provoke anxiety?
Blushing, sweating, trembling, urinating in a public toilet for males
