Chapter 6

Question 1

Anxiety Disorders –

Answer 1

share symptoms of clinically significant anxiety or fear

29% lifetime prevalence; most common disorders for women, 2nd most common for men

Question 2

Fear –

Answer 2

alarm reaction in response to immediate danger; fight/flight response of ANS
adaptive response

Question 3

◦ Adaptive response –

Answer 3

allows us to fight enemies or escape danger

Question 4

◦ Panic attack – components

Answer 4

◦ Cognitive – “I’m going to die”
◦ Physiological – increased heart rate, dizziness, etc
◦ Behavioral – urge to escape/flee

Question 5

Anxiety/Worry

Answer 5

– apprehension about possible future danger
◦ Cognitive – worry about future threats
◦ Physiological – tension/chronic overarousal
◦ Behavioral – avoidance
◦ Adaptive response – prepare for threat; enhance learning/performance (mild/moderate)

Question 6

DSM 5 Anxiety Disorders –

Answer 6

characterized by unrealistic/irrational fears or anxieties that cause
significant distress and/or impairments in functioning
includes
◦ Specific Phobia
◦ Social Anxiety Disorder (Social Phobia)
◦ Panic Disorder
◦ Agoraphobia
◦ Generalized Anxiety Disorder

Question 7

Causal Similarities btwn anxiety disorders

Answer 7

◦ Genetic vulnerability – may be nonspecific, shared across disorders
◦ Neuroticism – personality trait; proneness to experience negative mood states
◦ Limbic system and parts of cortex
◦ GABA, norepinephrine, serotonin
◦ Classical Conditioning
◦ Perceived lack of control over environment

Question 8

specific phobia criteria

Answer 8

A. Marked fear or anxiety about specific object or situation. (In children, the fear may be expressed as crying, tantrums, freezing, clinging).
B. The phobic object/situation almost always provokes immediate fear or anxiety
C. The phobic object/situation is avoided or endured with intense fear or anxiety
D. The fear is out of proportion to the actual danger
E. The fear, anxiety, or avoidance lasts more than 6 months
F. The fear, anxiety, or avoidance causes clinically significant distress/impairment in social, occupational, or other important areas of function

Question 9

specific phobias, causal factors

Answer 9

12% lifetime prevalence rate; more common in men than women
◦ Psychological Causal Factors
◦ Behavioral Viewpoint – classical conditioning and/or vicarious learning
◦ Evolutionary preparedness – humans rapidly/easily associate certain objects (snakes, spiders) with fear
◦ Biologi cal Causal Factors
◦ Individuals w/gene variants – superior fear conditioning or resistance to extinction
◦ Research suggests modest genetic contribution to development of specific phobias

Question 10

◦ Treatments – specific phobias

Answer 10

Exposure therapy most effective; virtual reality and D-cycloserine can enhance
exposures

Question 11

social phobias criteria

Answer 11

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to
possible scrutiny by others. Examples: social interactions, being observed, performing.
B. The individual fears they will act in a way or show anxiety symptoms that will be negatively
evaluated.
C. The social situations almost always provoke fear or anxiety (In kids, expressed by crying, tantrums,
freezing, clinging, shrinking, failing to speak in social situations).
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 posed by the situation and to the
sociocultural context.
F. Fear is persistent, lasting > 6 months.

Question 12

social phobia stats, causal factors

Answer 12

12% Lifetime prevalence rate; more common in women vs. men, typically emerges in
adolescence/early adulthood; associated with alcohol use; persistent disorder
◦ Psychological Causal Factors
◦ Behavioral: Direct or vicarious classical conditioning
◦ Perceptions of uncontrollability/unpredictability in response to triggering event
◦ Cognitive factors – expect others will reject them; interpret ambiguous info in negative way
◦ Biological Causal Factors
◦ Temperament: Behavioral inhibition (aspects of neuroticism and introversion) – shy/avoidant
◦ Moderate genetic effect

Question 13

social phobia treatments

Answer 13

◦ Treatments – Cognitive and Behavioral Therapies
◦ Cognitive Restructuring; Behavioral Experiments; Exercises to focus attention outward
◦ Medications: antidepressants (MAOIs, SSRIs)

Question 14

panic attack

Answer 14

A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, in which 4+ of the following symptoms occur

1) Palpitations, pounding heart, accelerated HR
2) Sweating
3) Trembling or shaking
4) Sensations of shortness of breath or smothering
5) Feelings of choking
6) Chest pain or discomfort
7) Nausea or abdominal distress
8) Feeling dizzy, unsteady, lightheaded or faint
9) Chills or heat sensations
10) Paresthesias (numbing or tingling sensations)
11) Derealization or depersonalization
12) Fear of losing control or going crazy
13) Fear of dying

Question 15

panic disorder

Answer 15

A. Recurrent unexpected panic attacks.
B. At least one of the attacks has been followed by 1 month of one or both (1) and (2):
(1) Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control).
(2) A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic
attacks, like avoidance or exercise).
C – D. Panic attacks not due to: physiological effects of a substance or another medical condition and it’s not better
explained by another mental disorder
Panic attacks are often uncued/unexpected; however, some are “situationally predisposed” (only occur when person is in specific situations

Question 16

agoraphobia

Answer 16

A. Marked fear or anxiety about two (or more) of the following five situations:
1. Using public transportation
2. Being in open spaces
3. Being in enclosed places
4. Standing in line or being in a crowd
5. Being outside of the home alone.
(B) The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms.
(C) The agoraphobic situations almost always provoke fear/anxiety.
(D) The agoraphobic situations are actively avoided, required the presence of a companion, or are endured with intense fear or anxiety.
(E) The fear is out of proportion to actual danger posed.

Question 17

panic disorder/agoraphobia causal factors info and comorbidities

Answer 17

◦ 4.7% lifetime prevalence; typically develops in early to mid adulthood; typically chronic course;
twice as prevalent in women vs men
◦ Comorbidity: Over 80% people with panic disorder have atleast one comorbid disorder (GAD,
social phobia, specific phobia, PTSD, depression, substance use disorders)
◦ Panic disorder – increased risk suicide
◦ First panic attack often occurs after negative life event

Question 18

panic disorder causal factors

Answer 18

◦ Biological Causal Factors
◦ Moderate genetic vulnerability – may be manifested at psychological level as neuroticism
◦ Brain activity – increased amygdala activity – part of abnormally sensitive fear network
◦ Hippocampus/higher cortical areas – involved in cognitive appraisal associated with panic attacks
◦ Noradrenergic system – stimulates cardiovascular symptoms
◦ Seratonergic system – SSRIs treat PD by increasing serotonin; this also decreases noradrenergic
◦ GABA – associated with anticipatory anxiety in PD

Psychological Causal Factors
◦ Classical Conditioning– conditioned response to external and/or internal triggers
◦ Cognitive Theory – catastrophic interpretation of bodily sensations
◦ Cognitive Biases – pay attention to threats in environment; interpret ambiguous situations as threatening
◦ Lack of Perceived Control over Situation
◦ Attribute lack of catastrophe to safety behavior (e.g., carrying meds)

Question 19

◦ Treatments for panic disorders

Answer 19

◦ Behavioral/CBT – exposure (interoceptive and feared situations) + cognitive restructuring
◦ Medication – benzodiazepine; antidepressants (SSRIs)

Question 20

GAD

Answer 20

A. Excessive anxiety and worry (apprehensive expectation), more days than not for at least 6 months, about a number of events or activities
B. The individual finds it difficult to control the worry
C. Anxiety and worry are associated with 3 or more of the following symptoms (with at least some present more days than not for > 6 mos): Note: Only one item is required in children.
 Restlessness, keyed up or on edge
 Being easily fatigued
 Difficulty concentrating, mind going blank
 Irritability
 Muscle tension
 Sleep disturbance

Question 21

treatments GAD

Answer 21

◦ Treatments
◦ Medication – antidepressants, benzodiazepines
◦ CBT – includes muscle relaxation, cognitive restructuring

Question 22

OCD

Answer 22

◦ Presence of obsessions, compulsions or both

◦ Obsessions/compulsions are time consuming or cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning

Question 23

Obsessions defined by:

Answer 23

◦ Recurrent/persistent thoughts, urges, images that are experienced as intrusive/unwanted and cause
marked anxiety or distress
◦ Individual attempts to ignore/suppress thoughts, urges, images or neutralized them with thought or
action (compulsion)

Question 24

Compulsions defined by:

Answer 24

◦ Repetitive behaviors (e.g., hand washing, ordering, checking) or meal acts (e.g., praying, counting) that
individual feels driven to perform in response to obsession or rules that must be applied rigidly
◦ Behaviors/mental acts are aimed at preventing or reducing anxiety or distress, or preventing dreaded
event or situation; however, behaviors/mental acts not connected in realistic way with what they are
designed to neutralize/prevent or are clearly excessive

Question 25

OCD prevalence and causal factors

Answer 25

◦ 2-3% lifetime prevalence; greater prevalence in males in childhood; equivalent gender rates in
adulthood; commonly comorbid with other anxiety disorders and MDD
◦ Psychological Causal Factors
◦ Learned Behavior –– classical conditioning of stimuli + avoidance
◦ Cognitive: Suppressing Obsessive thoughts – increases frequency of thoughts
◦ Biological Causal Factors – stronger causal role than other anxiety disorders
◦ Genetic – high concordance rate for monozygotic twins; lower for dizygotic twins
◦ Brain abnormalities – basal ganglia; cortico – basal – ganglionic-thalamic circuit dysfunction
◦ NT abnormalities – SSRI dysfunction

Question 26

OCD treatment

Answer 26

Treatments
◦ Behavioral/CBT: Exposure and Response Prevention; D-cycloserine enhances efficacy
◦ Medications – Prozac, Anafranil; high relapse rates when discontinued;
◦ neurosurgery for severe, treatment resistant cases

Question 27

body dysmorphic disorder

Answer 27

◦ Preoccupation with one or more perceived defects/flaws in physical appearance that are not
observable or appear slight to others
◦ At some point, individual has performed repetitive behaviors (e.g., mirror checking, excessive
grooming, skin picking) or mental acts (e.g., comparing appearance to others) in response to
appearance concerns
◦ Preoccupation causes clinically significant distress/impairment
◦ Appearance/preoccupation not better explained by concerns with body fat/weight in individual
whose symptoms meet criteria for an eating disorder

Question 28

body dysmorphia prevalence, causal factors, treatment

Answer 28

◦ 1-2% prevalence rate (difficult to calculate due to secrecy of disorder); commonly adolescent
onset; 80% history of suicidal ideation, 28% history of suicide attempt; common comorbidities
are social phobia and OCD
◦ Causal Factors: Biopsychosocial Model
◦ Moderate genetic heritability; sociocultural value placed on attractiveness/beauty; biased
attention/interpretation of information relating to attractiveness
◦ Treatment – SSRIs, CBT

Question 29

Hoarding Disorder

Answer 29

◦ Occurs in 3-5% adult population; 10-40% of individuals with OCD
◦ Acquire and fail to discard many positions that seem useless due to emotional attachment to
possessions; living spaces cluttered/disorganized and interfere with normal activities in these spaces,
such as cleaning, cooking and walking through hose
◦ SSRIs/behavioral treatments may have some efficacy, but less effective than for OCD

Question 30

Trichotillomania

Answer 30

◦ Compulsive hair pulling from anywhere in body, leading to noticeable hair loss
◦ Hair pulling typically preceded by sense of tension, followed by pleasure/gratification/relief
◦ After pulling hair – person often examines root, twirls it off, can put strand between teeth/eat it

Question 31

cultural perspectives

Answer 31

◦ Anxiety is universal emotion; differences in prevalence/form in different cultures
◦ ataque de nervios
◦ Higher rates of anxiety disorders – US, Columbia, France, Lebanon
◦ Lower rates of anxiety disorders – China, Japan, Nigeria, Spain
◦ Social phobia/GAD/Panic – lower among ethnic minorities vs non-Hispanic whites

Question 32

Ataque de nervios –

Answer 32

variant of panic disorder, includes additional symptoms such as bursting into tears, anger, uncontrollable shouting
◦ Can include shakiness, verbal/physical aggression, dissociation, seizure-like/fainting episodes
◦ More common in Latin Americans from Caribbean/other people from Caribbean

Question 33

why was OCD removed from anxiety disorders section in DSM and given its own?

Answer 33

◦ OCD removed from Anxiety Disorders Section in DSM5 because
◦ Anxiety not indicator of OCD severity (level of ritualizing, etc. used instead)
◦ Stereotyped, driven, repetitive, nonfunctional quality of compulsive behaviors different from other anxiety
disorders
◦ Unique neurobiological underpinnings
◦ Responds to specific SSRIs whereas other anxiety disorders respond to broad range of SSRIs