Lecture 6: Everyday life

Question 1

Define fear
Define anxiety
How do they interact?

Answer 1

A state of tension or alarm in response to a serious threat
A response to an unspecified threat
They both prepare one for a fight or flight response and they have the same clinical features.

Question 2

When does anxiety become a disorder?

Answer 2

When it’s continuous, disabling, too severe, too frequent, too long lasting and too easily triggered. 15% of people have one of the six anxiety disorders.

Question 3

What are the six types of anxiety disorder?

Describe each

Answer 3

Specific phobia; Fears of objects or situations that are out of proportion to any real danger. Social phobia involves a fear of unfamiliar people or public scrutiny.
Panic disorder; Anxiety about recurrent panic attacks, this is sometimes accompanied with agoraphobia which is a fear of being in places where this panic could occur.
Generalised anxiety disorder; Uncontrollable worry for at least 6 months
Obsessive compulsive disorder; Obsessions involve uncontrollable thoughts, impulses or images. Compulsions are repetitive behaviours or mental acts.
PTSD; When a person re-experiences a traumatic event, avoids stimuli associated with it and experiences increased arousal.
Acute stress disorder; Similar to PTSD but lasts for less than 4 weeks.

Question 4

What are the six types of anxiety disorder?

Describe each

Answer 4

Specific phobia; Fears of objects or situations that are out of proportion to any real danger. Social phobia involves a fear of unfamiliar people or public scrutiny.
Panic disorder; Anxiety about recurrent panic attacks, this is sometimes accompanied with agoraphobia which is a fear of being in places where this panic could occur.
Generalised anxiety disorder; Uncontrollable worry for at least 6 months
Obsessive compulsive disorder; Obsessions involve uncontrollable thoughts, impulses or images. Compulsions are repetitive behaviours or mental acts.
PTSD; When a person re-experiences a traumatic event, avoids stimuli associated with it and experiences increased arousal.
Acute stress disorder; Similar to PTSD but lasts for less than 4 weeks.

Question 5

Describe the historical background of anxiety disorders

Answer 5

They were originally called neuroses, which Freud believed was caused by the inability of ego defence mechanisms to prevent anxiety aroused by unconscious conflicts. It was obvious that anxiety was involved in phobic, anxiety and OCD disorders. However, this anxiety was hidden in hysterical, neurasthenic, depersonalisation, depressive and hypochondriacal neuroses.

Question 6

Describe the historical background of anxiety disorders

Answer 6

They were originally called neuroses, which Freud believed was caused by the inability of ego defence mechanisms to prevent anxiety aroused by unconscious conflicts. It was obvious that anxiety was involved in phobic, anxiety and OCD disorders. However, this anxiety was hidden in hysterical, neurasthenic, depersonalisation, depressive and hypochondriacal neuroses. The DSM now defines anxiety by it’s symptoms rather than its causes.
Anxiety is the main symptom of these disorders, other symptoms lead to mood disorders, somatoform disorders or dissociative disorders.

Question 7

List the basic characteristics of anxiety disorders

Answer 7

Faster breathing, tense muscles, rapid heart rate, nausea, inability to concentrate and distorted world perceptions.

Question 8

Describe the autonomic nervous system in terms of anxiety disorders

Answer 8

Sympathetic involves the fight or flight system
Parasympathetic involves the rest and digest system
Both systems are complementary to each other.

Question 9

What is trait anxiety?

What about state anxiety?

Answer 9

Anxiety that is on your general level, long lasting

This is anxiety that changes depending on your situation, kind of like a mood.

Question 10

Describe phobic disorders

Give 3 examples of phobias

Answer 10

A persistent unreasonable fear of an object or situation. The coping strategy is to avoid the object and not think about it. They vary with age; old people mainly fear crowds or injury, young adults mainly fear snakes, heights and storms.
Agoraphobia; Fear of public places
Social phobia; Fear of scrutiny
Simple phobia; Fear of objects or discrete events.

Question 11

Describe phobic disorders

Give 3 examples of phobias

Answer 11

A persistent unreasonable fear of an object or situation. The coping strategy is to avoid the object and not think about it. They vary with age; old people mainly fear crowds or injury, young adults mainly fear snakes, heights and storms.
Agoraphobia; Fear of public places
Social phobia; Fear of scrutiny
Simple phobia; Fear of objects or discrete events.

Question 12

How do phobic disorders develop?

Answer 12

Vulnerability; genes, cognitions
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Classical conditioning
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Observational learning; seeing other people react fearfully to something

Question 13

Describe GAD (generalised anxiety)

Answer 13

It’s free floating anxiety or chronic, persistent anxiety. At mainly appears in childhood and it’s symptoms include: muscular tension, autonomic hyperactivity, vigilance and scanning. People usually develop other disorders as a result, mainly depression. It’s frustrating for family and friends as well as the sufferer.

Question 14

Describe the explanations for phobias and GAD

Answer 14

Sociocultural/societal pressures.
Psychoanalytical: Ego defence mechanisms
Humanism: Harsh self standards
Behavioural: Classical conditioning, operant for avoidance
Biological: Genetic basis. benzodiazepines reduces anxiety. GAD is associated with the feedback system that involves GABA and its receptors. The arousal styles run in families.

Question 15

Describe the explanations for phobias and GAD

Answer 15

Sociocultural/societal pressures.
Psychoanalytical: Ego defence mechanisms
Humanism: Harsh self standards
Behavioural: Classical conditioning, operant for avoidance
Biological: Genetic basis. benzodiazepines reduces anxiety. GAD is associated with the feedback system that involves GABA and its receptors. The arousal styles run in families.

Question 16

Describe panic disorders

Answer 16

They are periodic discrete bouts of panic that occur abruptly and peak at 10 minutes. Symptoms involve: palpitations, tingling in extremities, shortness of breath, sweating, temperature change, trembling, chest pains, choking, faintness, dizziness and a sense of unreality. It occurs frequently, unpredictably and without apparent cause. It requires a certain level of cognitive and physical maturity.

Question 17

Describe the explanations of panic disorders

Answer 17

Biological: They have high norepinephrine levels and drugs reduce these levels and reduce the symptoms. Norepinephrine activity in the locus coerulus is irregular for these people. Yohimbine, which alters this activity, can trigger a panic attack in anyone.

Question 18

Describe the explanations of panic disorders

Answer 18

Biological: They have high norepinephrine levels and drugs reduce these levels and reduce the symptoms. Norepinephrine activity in the locus coerulus is irregular for these people. Yohimbine, which alters this activity, can trigger a panic attack in anyone. Blood pressure medicine, like clonidine, alters the activity and reduces panic symptoms.
Cognitive biological: They’re sensitive to physical sensations and worry about losing control as a result. They fear the worst and hyperventilate, inducing a panic attack. People with medical disorders can be incorrectly diagnosed with having a panic attack.

Question 19

Describe the prevalence of OCD

Answer 19

2% of people have it, it usually begins in adolescence and early adulthood. There are no sex differences. Comorbidity: Depression and alcoholism most likely.

Question 20

Describe obsessions

Answer 20

Thoughts or wishes that can involve the past or future. Cross cultural obsessions: Dirt, contamination, violence, aggression, orderliness, religion and sexuality.

Question 21

Describe compulsions

Answer 21

When one is compelled to perform behaviours. The rituals are detailed and elaborate. Common compulsions: Cleaning, checking, symmetry, order, balance, touching, counting, eating etc.

Question 22

How are obsessions and compulsions related?

Answer 22

70% of people have both. Compulsions usually yield to obsessive doubts. It’s less common for compulsions to be used to control obsessions.

Question 23

How are obsessions and compulsions related?

Answer 23

70% of people have both. Compulsions usually yield to obsessive doubts. It’s less common for compulsions to be used to control obsessions.

Question 24

List the explanations of OCD

Answer 24

These aren’t very well understood
Psychoanalytic: Anal stage
Cognitive-behavioural: Repetitive behaviours develop via operant conditioning and they help reduce anxiety.
Biological: Antidepressants help reduce symptoms. Clomipramine increases serotonin activity, this reduces OCD symptoms. Abnormal functioning in the orbital region of the frontal cortex and caudate nuclei may be involved, these areas control the conversion of sensory input into cognitions/actions. When these areas are damaged, symptoms can increase or decrease. PET scans reveal rapid glucose metabolism in these areas and serotonin is active.

Question 25

List the explanations of OCD

Answer 25

These aren’t very well understood
Psychoanalytic: Anal stage
Cognitive-behavioural: Repetitive behaviours develop via operant conditioning and they help reduce anxiety.
Biological: Antidepressants help reduce symptoms. Clomipramine increases serotonin activity, this reduces OCD symptoms. Abnormal functioning in the orbital region of the frontal cortex and caudate nuclei may be involved, these areas control the conversion of sensory input into cognitions/actions. When these areas are damaged, symptoms can increase or decrease. PET scans reveal rapid glucose metabolism in these areas and serotonin is active.

Question 26

What can increase your risk of developing more than one anxiety disorder?

Answer 26

Genetic vulnerability, increased activity in the fear circuit, decreased functioning of GABA and serotonin, increased norepinephrine activity, negative life events, behaviour inhibition, neuroticism, cognitive factors like low perception of control.

Question 27

What factors can cause stress?

Answer 27

Stressors: A situation or event that sets demands, constraints and opportunities.
Appraisal of the stressor: Perceiving the degree of demand
Appraisal of the ability to cope: Perceiving one’s ability to handle demand

Question 28

What can make you more vulnerable or resistant to stress?

Answer 28

Your temperament, confidence, coping skills, e.g. task orientated or emotion focused, social support.

Question 29

What can make you more vulnerable or resistant to stress?

Answer 29

Your temperament, confidence, coping skills, e.g. task orientated or emotion focused, social support.

Question 30

Finish the sentence

People who can cope with stress have the ability to…

Answer 30

… seek pertinent information, share concerns, find consolation, redefine a situation to make it more solvable, consider alternatives, examine consequences, use humour to defuse a situation.

Question 31

Define stress

Answer 31

An experience that occurs when one appraises the stressor as exceeding one’s ability.

Question 32

Describe the physical reactions to stress

Answer 32

The reticular activating system (focuses attention) focuses your attention on the potential danger so a feedback loop can be created. The hypothalamic-pituitary-adrenal axis connect the nervous system to the endocrine system, allowing the reaction to occur. In response to a threat, the adrenal glands release adrenaline which diverts energy to muscles and away from long-term maintenance. Adrenaline interferes with judgement resulting in you seeing everything as a threat rather than a challenge to be solved, this is narrow focus. Adrenaline is quick but after prolonged stress, cortisol is released which can depress immunity for up to 8 hours. Sustained cortisol release can damage learning and memory. DHEA, aka dehydroepiandosterone, slows ageing and prevents chronic health conditions, it decreases after 30 years, as cortisol increases, DHEA decreases and the ratio indicates health or illness.

Question 33

Describe the physical reactions to stress

Answer 33

The reticular activating system (focuses attention) focuses your attention on the potential danger so a feedback loop can be created. The hypothalamic-pituitary-adrenal axis connect the nervous system to the endocrine system, allowing the reaction to occur. In response to a threat, the adrenal glands release adrenaline which diverts energy to muscles and away from long-term maintenance. Adrenaline interferes with judgement resulting in you seeing everything as a threat rather than a challenge to be solved, this is narrow focus. Adrenaline is quick but after prolonged stress, cortisol is released which can depress immunity for up to 8 hours. Sustained cortisol release can damage learning and memory. DHEA, aka dehydroepiandosterone, slows ageing and prevents chronic health conditions, it decreases after 30 years, as cortisol increases, DHEA decreases and the ratio indicates health or illness.

Question 34

Describe adjustment disorder

Answer 34

Excess distress due to one or more stressors in the previous 3 months. It doesn’t include bereavement. When the stressors dissipate, so does the distress because they learn to live with the circumstances. Symptoms usually last less than 6 months. There isn’t bizarre behaviour, there’s just depression, anxiety, sleep disturbances, deterioration on performance, social withdrawal and conduct disturbances.

Question 35

Describe adjustment disorder

Answer 35

Excess distress due to one or more stressors in the previous 3 months. It doesn’t include bereavement. When the stressors dissipate, so does the distress because they learn to live with the circumstances. Symptoms usually last less than 6 months. There isn’t bizarre behaviour, there’s just depression, anxiety, sleep disturbances, deterioration on performance, social withdrawal and conduct disturbances.

Question 36

What is PTSD?

Answer 36

A stress reaction in response to an intensely traumatic event more disturbing than most common human experiences. It occurs within 3 months of the event (acute) or within 6 months (delayed).

Question 37

List the symptoms of PTSD

Answer 37

A tendency to re-experience events, painful or intrusive recollections like dreams, excessive autonomic arousal like hyperalertness, difficulty concentrating, depression, anxiety, restlessness, irritability, impulsiveness, alcohol and drug abuse, social deterioration, denial.

Question 38

What makes you more vulnerable to getting PTSD?

Answer 38

Pre-existing emotional and behavioural difficulties (alcoholism), your stage of development/sense of identity, dissociation during trauma leading to you ignoring the reality of the danger, lack of control, vulnerability, new emotional and behavioural discoveries of self, the trauma itself whether causal or victim and the severity, duration and proximity to the trauma.

Question 39

What makes you more vulnerable to getting PTSD?

Answer 39

Pre-existing emotional and behavioural difficulties (alcoholism), your stage of development/sense of identity, dissociation during trauma leading to you ignoring the reality of the danger, lack of control, vulnerability, new emotional and behavioural discoveries of self, the trauma itself whether causal or victim and the severity, duration and proximity to the trauma.

Question 40

Name an event when PTSD rose dramtically

Answer 40

9/11

Question 41

Describe prolonged duress disorder

Answer 41

Similar to PTSD except there is a number of events that accumulate and have the chronic nature of stressors that constitute a trauma.

Question 42

Describe dissociative disorder

Answer 42

Disturbance in the function of identity, memory and consciousness. Compartmentalisation (used to avoid anxiety) of the above occurs.

Question 43

What is dissociation

Answer 43

You can severe your connection between ideas and emotions, it occurs when: attention is divided between multiple tasks, in a fantasy, in imagination. It becomes pathological when one loses control of this in the face of a trauma. Individuals differ in their ability to dissociate. It’s common and accepted in various cultural rituals and religious experiences.

Question 44

What is dissociation

Answer 44

You can severe your connection between ideas and emotions, it occurs when: attention is divided between multiple tasks, in a fantasy, in imagination. It becomes pathological when one loses control of this in the face of a trauma. Individuals differ in their ability to dissociate. It’s common and accepted in various cultural rituals and religious experiences.

Question 45

What is dissociative amnesia

Answer 45

Extensive but selective memory loss in the absence of organic change so it’s not forgetfulness. It’s usually precipitated by accidents or trauma.

Question 46

Describe the types of dissociative amnesia

Answer 46

Localised amnesia; fail to recall events that occurred during a particular period of time
Selective amnesia; recall some events that occurred during a particular period of time
Generalised amnesia; Recall failure that encompasses one’s whole life, this is rare
Continuous amnesia; Unable to recall events after a specific time up until present
Systematised amnesia; The loss of memories for categories of information

Question 47

Describe the types of dissociative amnesia

Answer 47

Localised amnesia; fail to recall events that occurred during a particular period of time
Selective amnesia; recall some events that occurred during a particular period of time
Generalised amnesia; Recall failure that encompasses one’s whole life, this is rare
Continuous amnesia; Unable to recall events after a specific time up until present
Systematised amnesia; The loss of memories for categories of information

Question 48

What is dissociative fugue?

Answer 48

Unexpected travel away from home or work and assuming a new identity. You forget your previous one. It’s purposeful but usually brief with complete recovery. Likely to re-occur. No recollection of events on recovery. There is usually no psychopathology and it’s often precipitated by intolerable stress.

Question 49

What is dissociative identity disorder?

Answer 49

Alternate personalities, each one has memories, values, behaviours etc. There is usually one-sided awareness or each personality is aware of the other. Can spontaneously go into a trance. New personalities usually begin in childhood as a response to abuse, it’s a mechanism to protect oneself from the abuse. They try to hide their personalities until they become aware of them in later life. After the publication of Sybil, the amount of cases dramatically increased. A hillside strangler claimed to have MPD to get a reduced sentence but students were able to replicate this MPD proving it was false.

Question 50

What is dissociative identity disorder?

Answer 50

Alternate personalities, each one has memories, values, behaviours etc. There is usually one-sided awareness or each personality is aware of the other. Can spontaneously go into a trance. New personalities usually begin in childhood as a response to abuse, it’s a mechanism to protect oneself from the abuse. They try to hide their personalities until they become aware of them in later life. After the publication of Sybil, the amount of cases dramatically increased. A hillside strangler claimed to have MPD to get a reduced sentence but students were able to replicate this MPD proving it was false.

Question 51

What is depersonalisation?

Answer 51

It’s a change of self perception where the sense of reality is temporarily lost. Not in control of of what you’re doing, saying or feeling. It has a rapid onset and causes an impairment of social and occupational functioning. There is a persistent sense of depersonalisation and gradual cessation.