Chapter 5 - Anxiety and Obsessive Compulsive Related Disorders

Question 1

Fear vs. Anxiety

Answer 1

Fear: more focused and specific
Anxiety: more diffuse and generalized, both fear and apprehension

Question 2

What are the anxiety disorders?

Answer 2

• Generalized Anxiety Disorder (GAD)

* Panic Disorder

Question 3

Characteristics of GAD?

Answer 3

Chronic, prolonged, “free-floating” anxiety and dread

Question 4

According to DSM, what are the criteria for diagnosis of GAD?

Answer 4

Must report symptoms for at least 6 months

Question 5

GAD types of symptoms

Answer 5

1) Motor Tension - muscular tension
2) Autonomic Reactivity - increased heart rate, BP, arousal
3) Apprehension about the future - sense of impending doom
4) Hypervigilance

Question 6

GAD onset

Answer 6

50% of those diagnosed are diagnosed during childhood/adolescence

Question 7

Panic Disorder characteristics

Answer 7

• Can be cued or un-cued
• Sudden intense arousal - symptoms may resemble heart attack
• Must experience some un-cued episodes

Question 8

GAD vs. PD

Answer 8

• Onset more abrupt for PD
• Onset typically later for PD (avg 20-24 yrs old)
• More heredity evidence for PD
• Higher rates of alcoholism and depression for PD

Question 9

What is PD comorbid with?

Answer 9

Comorbid with agorophobia

Question 10

Characteristics of phobias

Answer 10

Irrational unrealistic fear of an object, event, or situation

Question 11

How can phobias be acquired?

Answer 11

May begin with real trauma, GAD, or be vicariously acquired (like being around mother who has phobia)

Question 12

What is the effect of avoidance in a phobia?

Answer 12

When you avoid a feared stimulus, it negatively reinforces the fear and avoidance. Treatment for this is exposure treatment

Question 13

Phobia subtypes

Answer 13

• Animal type - spiders, snakes, dogs, cats
• Natural environment type - storms, wind, bodies of water, heights
• Blood-injection-injury type - seeing blood/injury, injection, medical procedure, may induce fainting
• Situational type - elevators, tunnels, bridges, flying, driving, enclosed spaces
• Other type - cued by other stimuli, fear of situations that could lead to choking, vomiting, or illness

Question 14

What is a social phobia? What is the basis?

Answer 14

• Fear and embarrassment (extreme discomfort) around other people
• Basis: fear of being observed and evaluated negatively in our culture
• Most common manifestation: public speaking and meeting new people

Question 15

What is Taijin Kyofusho?

Answer 15

Japanese social anxiety disorder about offending or embarrassing other people

Question 16

Diagnosis requirements for Taijin Kyofusho?

Answer 16

• Fear of blushing
• Fear of emitting odors or being flatulent
• Fear of staring inappropriately
• Fear of making inappropriate facial expressions
• Fear of having physical deformity

Question 17

What is agoraphobia?

Answer 17

Fear of open spaces, the marketplace, novel situations, losing control in public

• Onset: 20-40s, more common among females
• Co-morbid with PTSD and GAD

Question 18

What is the difference between compulsions and obsessions?

Answer 18

Obsessions: Intrusive, unwanted, related thoughts
Compulsions: repetitive acts/behaviors

Question 19

What is “magical thinking”?

Answer 19

Thoughts during OCD that defy logic - patient believes performing the compulsion will enable them to control their outcomes, reduces anxiety

Question 20

Common forms of compulsions?

Answer 20

Counting, ordering/organizing, checking (locks at front door), touching, washing/cleaning

Question 21

What is hoarding? How is it categorized?

Answer 21

Collecting and keeping a large amount of things

*Now is its own category in DSM-5 as an OCD-related disorder, used to just be a compulsion

Question 22

OCD Onset

Answer 22

Late adolescence to early adulthood

Question 23

OCD Prevalence

Answer 23

Equal among males and females, more common with higher income and intellectual functioning

Question 24

What are OCD spectrum disorders?

Answer 24

Disorders that co-vary with rates of OCD - co-morbid with OCD or run in OCD families (trichotillomania, motor tics) - characterized by problems with impulse control

Question 25

What is body dysmorphic disorder?

Answer 25

Preoccupation with perceived defect in appearance - exaggerated or imagined flaws

Question 26

When is BDD diagnosed?

Answer 26

When it causes significant distress or impairment of functioning

Question 27

Gender differences in BDD?

Answer 27

Equal prevalence between genders, but differ by sites:

• Males: body build, genitalia, hair, height
• Females: breasts, hips, thighs, weight

Question 28

BDD Onset

Answer 28

Early adolescence to early adulthood

Question 29

What is the course of BDD?

Answer 29

Will continue without treatment

Question 30

Comorbidity with BDD

Answer 30

• ~1/3 with BDD also have OCD
• Social anxiety disorders
• Avoidant personality disorders
• Major depression and suicidality
• Substance abuse

Question 31

How does BDD differ with culture?

Answer 31

• American men vs Taiwanese men - Americans express significantly more body dissatisfaction than Taiwanese men
• College students in Germany vs. US - Germany: 5.3%, US: 13% with BDD symptoms

Question 32

Basis of behavioral treatment of anxiety/OCD?

Answer 32

If anxiety is learned and avoidance negatively reinforces these behaviors, anxiety can also be extinguished by removing this reinforcement

Question 33

What are exposure treatments?

Answer 33

• Systematic desensitization: gradual exposure to source of anxiety - establish fear hierarchy, train in relaxation, “walk-through” hierarchy
• Reciprocal inhibition - underlying principle is that two incompatible responses cannot coexist and that they would reciprocally inhibit one another

Question 34

What is flooding?

Answer 34

Sudden, intense exposure to fear. Person must remain with stimulus until anxiety subsides, so that avoidance is not negatively reinforced

Question 35

What is virtual reality exposure?

Answer 35

Virtual stimulus exposure - seems to work by classical conditioning

Question 36

What is exposure response prevention therapy (ERP)?

Answer 36

For OCD treatment - expose patient to anxiety of obsession and prevent compulsive behavior

Question 37

What is modeling?

Answer 37

Observing someone engaging in desired behavior - most effective in participant modeling where they watch a model, then work up to a point when participant can do the behavior

Question 38

What is cognitive restructuring?

Answer 38

Learning to “construct” situations differently

Question 39

What is thought-stopping?

Answer 39

1) Train participant to recognize maladaptive thoughts

2) Teach to tell self “stop” when they come up

Question 40

What is cognitive rehearsal?

Answer 40

Anticipates anxiety-provoking situation and rehearses thought process to do when situation occurs

Question 41

What is acceptance commitment therapy?

Answer 41

“3rd gen” cog therapy

• Acceptance: accept and not avoid thoughts/feelings
• Mindfulness: be present in the moment, increased awareness of what is current
• Studies: ACT is effective for mild to moderate anxiety problems

Question 42

Biological treatments for anxiety and OCD

Answer 42

• Drug treatments
• Anxiolytics (GAD, panic, phobias)
• Antidepressants like SSRIs (most commonly for OCD, panic)