Exam 2 Flashcards
GAD Symptoms
Excessive, uncontrollable “free-floating” anxiety over everyday issues, muscle tension, trouble concentrating, restless, easily discouraged, sensitive, worrying, indecisive
Specific Phobia Symptoms
Persistent, excessive, or unreasonable fear. Exposure to object of fear -> anxiety response, so avoidance interferes with basic functions
Social Anxiety Symptoms
Fear of social/performance situation for fear of possible scrutiny
Agoraphobia Symptoms
2 of 5 Fears: Public transport, open spaces, close spaces, crowds/lines, can’t leave house. BASICALLY fear of inescapable/unsafe/outside places
Panic Disorder Symptoms
Sudden surge of fear / intense discomfort, resulting in increased heartrate, dizziness. 13 symptoms in DSM, 4 required for diagnosis; symptoms can change with each attack
OCD Symtpoms
Obsessions: Intrusive, uncontrollable thoughts (ego alien).
Compulsions: repetitive behavior/act meant to decrease anxiety/ prevent impending danger. Diagnosis only required one, but 90% have both. Common obsessions: contamination, doubt, symmetry, taboo thoughts.
Common compulsions: cleaning, checking, counting, order.
Symptoms: anxiety, panic, disgust, avoidance. Behavior is often recognized as abnormal.
PTSD Intrusive Symptoms
(unwanted memories/dreams/flashbacks, intense distress with exposure to cues
PTSD Avoidance Symptoms
(Avoid memories, feelings, thoughts about stressors
PTSD Negative Change Symptoms
dissociative amnesia, negative mindset, apathy, detachment, persistent neg. thoughts. Diag needs 2+
PTSD Arousal Symptoms
hypervigilance, exagerrated startle response, recklessness, aggression, irritability, outbursts, insomnia, difficulty concentration
Separation Anxiety Symptoms
Fear/Anxiety about seeparation from home/attachment figures. Excessive distress, headaches, nausea, nightmares. In children: 4+ weeks. In adults: 6+ months
Selective Mutism Symptoms
Failure to speak in specific social situations. >1 month (1st month of school n/a)
Body Dysmorphic Symptoms
Preoccupation w/ 1+ “defect” in appearance (typically face). Leads to repetitive grooming behavior
Trichotillomania Symptoms
Hair pulling
Excorciation Symptoms
Recurrent skin picking, resulting in skin lesions, despite repeated attempts to decrease or stop.
Hoarding Symptoms
Persistent difficulty discarding or parting with possessions, regardless of their actual value that results in accumulation that congests and clutters active living areas and compromises their intended use.
GAD Lifetime Prevalence
5-6% (female 60%)
Specific Phobia Lifetime Prevalence
12% (more female, but equal in blood/injury/injection fears)
Social Anxiety Lifetime Prevalence
12% (female 3:2)
Agoraphobia Lifetime Prevalence
1.7% (Female 2:1)
Panic Disorder Lifetime Prevalence
4.7% (Female 60%)
25% have 1/lifetime; 12% occasionally
OCD Lifetime Prevalence
3% (Equal)
PTSD Lifetime Prevalence
8.7% (normal population, not war) (F>M)
Separation Anxiety Lifetime Prevalence
0.9-1.9%
Body Dysmorphic Lifetime Prevalence
2.4% (equal)
Trichotillomania Lifetime Prevalence
1-2%
Excorciation Lifetime Prevalence
1.4%
Hoarding Lifetime Prevalence
2-6%
GAD Demographic
Higher in African Americans and low income groups
Specific Phobia Demographic
Higher among non-immigrant Hispanics and African Americans
Panic Disorder Demographic
Higher in low income groups
PTSD Demographic
Hispanics are at a higher risk
Selective Mutism Demographic
Children
GAD Age of Onset
Any, but primarily late adolescence/early adulthood
Specific Phobia Age of Onset
Bimodal: Childhood, Mid-20s
Social Anxiety Age of Onset
Median age 13, but variable
Agoraphobia Age of Onset
Late adolescence/early adulthood, 40’s
Panic Disorder Age of Onset
Any, median 20-24
OCD Age of Onset
Median: 19.5, gradual onset
25% by 13
Not common past 35
PTSD Age of Onset
Any
Separation Anxiety Age of Onset
Often after trauma, major choice/loss
Selective Mutism Age of Onset
Childhood
Body Dysmorphic Age of Onset
Teens
GAD Comorbidity
Depression, other anxiety disorders
Specific Phobia Comorbidity
75% have more than one phobia
Social Anxiety Comorbidity
GAD, panic disorder, specific phobias, separation anxiety, low stress tolerance, adults 7x depression likelihood, 13x suicide likelihood, 2x alcohol dependence likelihood
Agoraphobia Comorbidity
Depression, Alcohol abuse, specific phobias, panic, etc.
Panic Disorder Comorbidity
Phobias, depression, substance abuse
OCD Comorbidity
Other anxiety disorders (76%), mood disorder (63%), tic disorder (>30%)
PTSD Comorbidity
80% fulfill criteria for 2+ other disorders
Depression, substance abuse, anxiety disorders, conduct disorders
Separation Anxiety
Other anxiety disorders
Body Dysmorphic Comorbidity
Depression, Social Anxiety, Substance-related disorders
GAD Biological Theory
Moderate genetic influence. 15% have another relative with GAD. Differences in physiological reactivity (muscle tension). GABA deficiency -> less inhibited anxiety
Specific Phobia Biological Theory
Possible genetic susceptibility
Social Anxiety Biological Theory
Inherited temperament (infants: had more stress responses to strangers)
Agoraphobia Biological Theory
Some genetic predisposition. Evolutionary preparedness. Emotional reactivity definitely inherited
Panic Disorder Biological Theory
Overactivity of noradrenic symptoms from lack of 5HT (fight/flight); especially in the pons, or disturbance in the amygdala/parts of hypothalamus. Some genetic predisposition (MZ .31 DZ .11)
OCD Biological Theory
High genetic component (MZ .53 DZ .23)
2x higher anxiety disorder frequency in 1st degree family than controls; 10x more in early onset
High incidence of OCD with Tourette’s (basal ganglia)
Possible serotonin and DA component
OCD Loop Theory: miscommunication between orbitofrontal cortex (pleasure anticipation), caudate nuclei in BG (voluntary movement, DA cells, spatial info, social behavior) and anterior cingulate cortex (connection between emotion and logic)
PTSD Biological Theory
Changes in cortisol and norepinephrine (increased cortisol receptor sensitivity), alterations to hippocampus/amygdala, change in regulation of stress hormones, possible genetic influence on response to trauma
Separation Anxiety Biological Theory
Possible heritability
GAD Behavioral Theory
no such thing as free floating anxiety
Specific Phobia Behavioral Theory
conditioning loop: fear established by classical conditioning, and maintained by operant conditioning
Agoraphobia Behavioral Theory
2 Factor (Avoidance Conditioning) Model: fear established by classical conditioning, maintained by operant conditioning
OCD Behavioral Theory
Learned behavior is reinforced by consequences; does not help explain obsessions
GAD Cognitive Theory
Beck/Ellis: mislabeling of automatic thoughts as anxiety-producing
People with GAD attend more to threats, have an external locus of control, and misperceive ambiguous stimuli as threats
Agoraphobia Cognitive Theory
Phobia = attention to stimuli, have vulnerability schemas
Panic Disorder Cognitive Theory
Misinterpretation of physiological sensations
OCD Cognitive Theory
Cognitive set: having the belief that something will go wrong make it more likely to happen
Salkovski’s Model (Feedback Loop): intrusive thoughts are common and normal to let go, OCD patients cannot dismiss, then blame self and expect worst. Efforts to subdue thoughts increase frequency, reinforced by rituals
GAD Other Theories/Risk Factors
Metacognitive Theory: GAD client has both positive (worrying helps with coping) and negative (worrying about worrying) beliefs about worry
Intolerance of Uncertainty: GAD client cannot tolerate uncertainty, yet life is full of it
Avoidance Theory: worrying serves positive function as it reduces physiological arousal
Sociocultural: there are cultural/social/environmental factors that make people more susceptible
Specific Phobia Other Theories/Risk Factors
Risk factors: negative encounters with the stimulus (possibly vicarious), panic attack in situation, parental overprotection/loss/separation, abuse
Social Anxiety Other Theories/Risk Factors
Overprotective parents, emotionally unsupportive parents, parents who prevented socializing
Agoraphobia Other Theories/Risk Factors
often comes after previously developed anxiety disorders
Panic Disorder Other Theories/Risk Factors
Fear of fear hypothesis: being afraid of panic attacks makes the more anxious, fear loss of control
Poor coping skills/lack of social support/many unpredictable events in childhood
OCD Other Theories/Risk Factors
Chronic disorder, but waxes and wanes. 40% of children remiss by adulthood.
Psychoanalytic: exaggerated defense mechanisms against anxiety
PTSD Other Theories/Risk Factors
Symptoms follow traumatic exposure to actual/threatened death/serious injury/sexual assault (direct or indirect)
Symptoms more severe if stressor is human designed
Traumatic brain injury is possible contributor, particularly with vets
Civilian trauma: 10x more common, often rape (1/6 women)
Prior personality, anxiety, psychological problems, or coping strategies have an effect
GAD Medication
Benzodizapines (anti-anxiety), buspirone, atypical anti-psychotics, anti-depressants (SSRIs SNRIs)
Specific Phobia Medication
Benzos
Social Anxiety Medication
SSRIs, SNRIs, Triglycerides, MAOIs
Panic Disorder Medication
SSRIs, SNRIs, Benzos, Atypical anti-psychotics
OCD Medication
SSRIs
PTSD Medication
SSRIs
GAD Psychotherapies
Short-term psychodynamic therapies (especially with relationship/depression problems)
Cognitive: a) Change automatic thoughts (Beck/Ellis)
b) Evoke worry - counteract/control.
c) cognitive-based mindfulness therapy.
d) acceptance and commitment therapy: accepts anxiety as a normal point of life
Behavioral: relaxation training, biofeedback (control anxiety by being conscious of body processes and attempting to control them)
Specific Phobia Psychotherapies
Exposure Therapy (systematic desensitization, hierarchy, flooding, modeling) In vivo exposure is most effective
Social Anxiety Psychotherapies
Behavioral: exposure, social skills training
Cognitive: CBT (reduces fear/anxiety, but does not improve social skills)
Agoraphobia Psychotherapies
Cognitive: CBT, exposure, relaxation training
Short-term psychodynamic
Family dynamic restructuring
Panic Psychotherapies
Cognitive: CBT (misinterpretation of body responses)
Panic Control Therapy (CBT + Relaxation + Exposure) 70-80% success
Biological: relaxation/breathing techniques
OCD Psychotherapies
Behavioral: Exposure and Response Prevention (55-75% improve considerably, 25% little help); helps more with compulsions than obsessions
Short-term psychodynamic
Cognitive: challenges beliefs on what will happen if rituals are not performed
PTSD Psychotherapies
1) Face Trauma (Exposure therapy: imaginal, virtual reality, EMDR)
2) Process Emotions (CBT to reduce self-blame and guilt, insight)
3) Develop coping strategies
Support Groups
Eye Movement Desensitization and Reprocessing: desensitize trauma/memory by thinking about it while paying attention to a physical stimulus at hand (moving hands/lights)
