Chapter Five Flashcards
Anxiety Disorders and Obsessive-Compulsive and Related Disorders
anxiety
a generalized state of apprehension or foreboding characterized by a range of symptoms including physical, behavioral, and cognitive features
Activation of fight and flight etc.
Future oriented mood state
Characterized by marked negative affect
Somatic symptoms of tension
Apprehension about future danger or misfortune
two things to note about anxiety
Usually adaptive
- Anxiety is intended to be a helpful process that contributes to intelligence, creativity, performance, and survival
Serves evolutionary and functionally adaptive purposes
- Helping plan and work towards goals
- Building mastery
- Avoiding harm
fear
Present oriented mood state, marked negative affect
Immediate fight or flight response to danger or threat
Strong avoidance/escapist tendencies
Abrupt activation of the sympathetic nervous system
What makes an anxiety disorder?
Impairment
Pervasive / persistent
Avoidance
anxiety disorder
A class of psychological disorders characterized by excessive or maladaptive anxiety reactions
Was classified as neuroses throughout most of the 19th century
Genetic factors can predispose individuals to develop these
Activation of the amygdala
- Produces fear responses to triggering stimuli without conscious thought
neuroses
Derives from roots that mean “an abnormal or diseased condition of the nervous system”
William Cullen
Anxiety is characterized by a wide range of symptoms that cut across physical, behavioral, cognitive domains:
- Physical features
- Jumpiness, jitteriness, trembling or shaking, tightness in the pit of the stomach or chest, heavy perspiration, sweaty palms, light-headedness or faintness, dryness in the mouth or throat, shortness of breath, pounding or racing heart, cold fingers or limbs, and upset stomach or nausea, etc - Behavioral features
- Avoidance behavior, clinging or dependent behavior, and agitated behavior - Cognitive features
- Worry, a nagging sense of dread or apprehension about the future, preoccupation with or keen awareness of bodily sensations, fear of losing control, thinking the same disturbing thoughts over and over, jumbled or confused thoughts, difficulty concentrating or focusing one’s thoughts, and thinking that things are getting out of hand
Major types of anxiety disorders:
Panic disorder
Generalized anxiety disorder
Phobic disorders
Social anxiety disorder (social phobia)
Agoraphobia
panic disorder
A. Recurrent unexpected panic attacks
- An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
Note: the abrupt surge can occur from a calm state or an anxious state
Palpitations, pounding heart, or accelerated heart rate
Sweating, trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal pain
Feeling dizzy, unsteady, light-headed or faint
Chills or heat sensations
Paresthesias
Derealization or depersonalization
Fear of losing control or “going crazy”
Fear of dying
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”
2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations)
C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders)
D. The disturbance is not better explained by another mental disorder
Panic Disorder: Causal Factors
Unusually sensitive alarm or fear network in the brain
Perceiving bodily sensations as dire threats
Induces anxiety, accompanied by activation of the sympathetic nervous system
- Unrecognized hypoventilation
- Exertion
- Changes in temperature
- Reactions to certain drugs or medications
Panic Disorder: Treatment
Most widely used forms of treatment for panic disorder are drug therapy and cognitive-behavioral therapy
- Antidepressant drugs, also have antianxiety and antipanic effects
- Antidepressants help counter anxiety by normalizing neurotransmitter activity
Cognitive-behavioral therapists provide:
- Training in coping skills
- Breathing retraining
- Relaxation training
Phobic Disorders - Social Anxiety
Social Phobia
Marked fear or anxiety about one or more social situation in which the individual is exposed to possible scrutiny by others
- The individuals fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
- The social situations almost always provoke fear or anxiety
- The social situations almost always provoke fear or anxiety
- The social situations are avoided or endured with intense fear or anxiety
- The fear or anxiety is out of proportion to thee actual threat posed by the social situation and the sociocultural context
Phobic Disorders - Agoraphobia
The essential feature of Agoraphobia is anxiety about being in (or anticipating) situations from which escape might be difficult or ini which help may not be available in the event of having a panic attack (or panic-like symptoms)
- Oftentimes, when in this situation, an individual may have the vague thought that something dreadful may happen. Such concerns must persist for at least 6 months and occur virtually every time an individual encounters the place or situation
Phobic Disorders Psychodynamic Theory
Anxiety is a danger signal.
- Indicates that threatening impulses of a sexual or aggressive (murderous or suicidal) mature are nearing the level of awarness
- Ego mobilizes its defense mechanisms to fend off threatening impulses
- Freudian defense mechanism of projection comes into play
Phobic Disorders Learning Theories
Involve both classical and operant conditioning
Fear component of phobias acquired through classical conditioning
Avoidance component of phobias acquired and maintained through operant conditioning
Observational learning - seeing parents or others model a fearful reaction to a stimulus can lead to the development of a fearful response in the observer
Mowrer’s two factor model
Mowrer’s two factor model
Incorporated roles for both classical and operant conditioning in the development of phobias
The fear component of phobia is believed to be acquired through classical conditioning, as previously neutral objects and situations gain the capacity to evoke fear by being paired with noxious or aversive stimuli
Ex - child frightened by a barking dog may acquire a dog phobia
Phobic Disorders Psychodynamic Treatment
Deepening understanding and past analysis
Phobic Disorders Learning Based Treatment
Systematic desensitization
Gradual Exposure
Flooding
Systematic desensitization
Stimuli are arranged in sequence called fear-stimulus hierarchy
Gradual exposure
Uses a stepwise approach in which phobic individuals gradually confront the objects or situations they fear
Imaginal exposure - (imaging oneself in the fearful situation)
In vivo exposure - actual encounters with phobic stimuli in real life
Flooding
A form of exposure therapy in which clients begin therapy by confronting their most difficult anxiety situations either in the imagination or by imagining real life encounters
Phobic Disorders Cognitive Treatment
Cognitive therapists identity and correct dysfunctional or distorted beliefs
Generalized Anxiety Disorder
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)
B. The individual finds it difficult to control the worry
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months)
Note: Only one item is required in children
- Restlessness or feeling keyed up or on edge
- Benign easily fatigued d
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition
F. The disturbance is not better explained by another mental disorder
Generalized Anxiety Disorder Psychodynamic Theory
‘Free floating’, leaking of impulses of conflicts, unaware of its sources
Generalized Anxiety Disorder Cognitive/learning Theory
Exaggerated or distorted thoughts tied to associates of environments and situations
Generalized Anxiety Disorder Biological Theory
Irregularities in the functioning in the amygdala, impacting prefrontal cortex use
Generalized Anxiety Disorder: Treatment (medication)
Medication
- not meant to cure, only to decrease the symptoms
- antidepressant drugs can relive symptoms:
- sertraline (zoloft)
- paroxetine (paxil)
Generalized Anxiety Disorder: Treatment (Breathing Retraining)
A technique that aims to restore a normal level of CO2 in the blood
Clients breathe slowly and deeply from the abdomen, avoiding the shallow, rapid breathing that leads to breathing out too much carbon dioxide
Generalized Anxiety Disorder: Treatment (CBT)
Produces long lasting results
Helps people acquire skills they can use after treatment ends
Cognitive-behavioral therapists use training in:
- Relaxation skills
- Learning to substitute adaptive for worrisome thoughts
- Decatastrophizing
Obsessive Compulsive Disorder
A. Presence of obsessions, compulsions, or both:
B. The obsessions or compulsions are time-consuming (e.g., take more than one hour per day) or cause clinically significant distress or impairment in social occupational, or other important areas of functioning
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition
D. The disturbance is not better explained by the symptoms of another mental disorder
obsessions
Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
The individual attempts to ignore or suppress such thoughts, urges, or other thought or action (i.e., by performing a compulsion)
compulsions
Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive
specify if OCD
- With good or fair insight:
- The individual recognizes that obsessive- compulsive disorder beliefs are definitely or probably not true or that they may or may not be true
- With poor insight:
- The individual thinks obsessive-compulsive disorder beliefs are probably true
- With absent insight/delusional beliefs:
- The individual is completely convinced that obsessive-compulsive disorder beliefs are true
- Tic related:
- The individual has a current or past history of a tic disorder
Body Dysmorphic Disorder
A. Preoccupation with one or more perceive defects or flaws in physical appearance that are not observable or appear slight to others
B. At some point during the course of the disorder, the individual has performed repetitive behaviors or mental acts in response to the appearance concerns
C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder
specify if BDD
With muscle dysmorphia
- The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. Thisi specifier is used even if the individual is preoccupied with other body areas, which is often the case
Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., “I look ugly” or “I look deformed”)
With good or fair insight
- The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true
With poor insight
- The individual thinks that the body dysmorphic disorder beliefs are probably true
With absent insight/delusional beliefs
- The individual is completely convinced that the body dysmorphic disorder beliefs are true
Hoarding Disorder
A. Persistent difficulty discarding or parting with possessions, regardless of their actual value
B. This difficult is due to a perceived need to save the item sand to distress associated with discarding them
C. The difficulty of discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially comprises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (family members, cleaners, etc)
D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
E. The hoarding is not attributable to another medical condition
F. The hoarding is not better explained by the symptoms of another mental disorder
specify if HD
With excessive acquisition
- If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space
With good or fair insight
- The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic
With poor insight
- The individual is mostly convinced that hoarding related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary
With absent insight/delusional beliefs
- The individual is completely convinced that hoarding related beliefs and behaviors are not problematic despite evidence to the contrary
