Module 4 - Anxiety Disorders Flashcards
What is anxiety
is an affective state whereby an individual feels threatened by the potential occurrence of a future negative event
Key diagnostic features of panic disorder
To be considered a true panic attack at least 4 symptoms from a list of 13 must be present
Disturbances in heart rate
Sweating
Trembling
Feelings of choking
Chest Pain
Nausea/abdominal discomfort
Paresthesias (numbing of tingling sensations)
chills or heat sensations
dizziness or light headedness
Sensations of shortness of breath or smothering
Derealization (feelings of unreality) or Depersonalization (being detached from one self)
Fear of losing control or going crazy
Fear of dying
DSM-5-TR the panic attack must also develop suddenly, reaching peak within minutes.
At least two unexpected panic attacks are required for this diagnosis.
Key diagnostic features of agoraphobia
Fear of being in places or situations that may be difficult to escape
When avoidance is persistent and pervasive a diagnosis of agoraphobia is made - it is only made when feared situations are actively avoided, require the presence of a companion, or are endured only with extreme anxiety, and is made irrespective of whether a panic disorder is present.
As is the case with all anxiety disorders, a multi-method assessment includes a clinical interview, behavoural measurement, psychophysiology tests, self report indices
Key diagnostic features of specific phobia
Must be a marked and persistent. fear of an object or situation. Furthermore, exposure to the feared the object or situation must invariably produce an anxiety reaction that is excessive and unreasonable.
A diagnosis is given when the symptoms interfere with everyday functioning of cause considerable distress.
DSM-5-TR outlines 5 specifiers:
Animal
Natural-Environment
Blood injection - Injury
Situational (bridges, public transportation, enclosed spaces)
Other (choking, vomiting, clowns) * this category also includes illness phobia - intense fear of DEVELOPING a disease
Having a phobia of one of these subtypes increase the probability of developing another phobia int he same category
Key diagnostic features of Generalized Anxiety Disorder
Primary criterion in DSM-5-TR-
1) presence of excessive worry which must be present more days than not for a period of at least 6 months
2) individual must find it difficult to control their worrying
3) Three or more symptoms for more days than not over a period of 6 months:
-Feeling restless or keyed up
-tiring easily
-difficulty concentrating
-irritability
-muscle tension
-sleep problems
*Only one of these symptoms in addition to excessive worry and difficulty controlling worry is required for children
4) The worry or its associated symptoms must cause clinically significant distress or impairment
5) Must not be better explained by substance or medical issue
Not diagnostic criteria but elevated levels of anger appear to often be associated
Key diagnostic features of social anxiety disorder
Assessment uses structured or semi-structured interview combined with self reports
Fear of being negatively evaluated or embarrassed in social situations
The individual fears they will act in a way or will show anxiety symptoms that will be negatively evaluated
The social situations almost always provoke fear or anxiety
The social situations are avoids or endured with intense fear and great anxiety
Perceived fear is out of proportion to actual threat
Fear is persistent, lasting 6 months or longer
Cause clinically significant distress or impairment in important areas of functioning
Key diagnostic features of obsessive compulsive disorder
1) Presence of either obsessions or compulsions
- need to distinguish between obsessions and excessive worry (obsessions typically more bizarre and involves imagery)
- to be considered compulsions, the cognitive acts the individual performs but serve the purpose to alleviate anxiety. They must also be considered excessive or have little connection with the thoughts or events they are intended to neutralize or prevent.
2) symptoms cause marked distress or significantly interfere with life.
Spending more than 1 hour per day engaged in obsessions or compulsions time consuming to warrant a diagnosis
Key diagnostic features of body dysmorphic disorder
Similarities to OCD.
Tendency for OCD and body dysmorphia to occur together in families
BDD tend to be more severely disturbed than OCD with higher rates of suicide ideation, delusions, Major depression, substance abuse, social phobia
DSM-5-TR Critera:
1) preoccupied with one or more perceived defeats of flaws in physical appearance
2) At some point during the course of the disorder, the individual has performed repetitive behaviors (checking mirror, excessive grooming, skin picking, reassurance seeking) or mental acts (comparing their appearance to others)
3) clinical distress/impairment
4) cannot be better explained with eating disorder
Key diagnostic features of PTSD
The essential feature of posttraumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to one or more traumatic events.
A. Exposure to actual or threatened death, serious injury, or sexual violence
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
2.Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
Note: In children, there may be frightening dreams without recognizable content.
3.Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)
Note: In children, trauma-specific reenactment may occur in play.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred,
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7.
Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1.Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
2.Reckless or self-destructive behavior.
3.Hypervigilance.
4.Exaggerated startle response.
5.Problems with concentration.
6.Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Key etiological theories and maintenance for PTSD
women approx 2x more likely
Pre-event risk factors:
Low SES, education and tested intelligence
Having previous psychiatric history
Childhood adversity
Post event risk factors:
Severity of event
lack of social support
whether or not another stressful experience occurs after the trauma.
Exposure to interpersonal traumas are more likely to provoke PTSD (physical violence, sexual abuse) than non interpersonal (natural disaster, car accident)
Have dysfunctional neurocircuitry in areas of the brain implicated in processing and responding quickly to threat.
issue with biological component - HPA axis
Less volume in hippocampus
Cognitive-
-dual representation theory differences the way traumatic and non traumatic memories are stored and retrieved
-individuals perception about what the traumatic event means for themselves, others and their environment (forced to integrate conflicting previous beliefs)
Key etiological theories and maintenance for body dysmorphic disorder
Most common onset is ages 12-13. Onset is before age 18.
Associated with high rates of child neglect and abuse
First degree relatives
Key etiological theories and maintenance for obsessive compulsive disorder
No fully accepted model of what causes OCD.
Neurobiological model -
-implicate basal ganglia (more volume) and frontal cortex (less volume). Hyperactivation with cingulo-opercular network (detects error and signals brain for behavioural correction)
-serotonin hypothesis
-poor memory or poor memory confidence
Cognitive-behavioural model-
-persons reaction to intrusive thoughts
-high levels of personal responsibility
-believe their thoughts can influence probability that others will be harmed
Maintenance:
-Obsessions are believed to persist because the person’s maladaptive attempts to cope with them
-Using avoidance behaviour to deal reinforces and they never learn that their beliefs are incorrect
-Compulsions are believed to persist because they tend to lower the severity of anxiety, lower frequency of obsessions, “prevent” obsessions from coming true.
Key etiological theories and maintenance for Generalized Anxiety Disorder
Primarily cognitive based.
-Using anxiety as an avoidance strategy (avoid physiological arousal of anxiety, but this ends up reinforcing and is therefore maintaining the disorder).
^^Cognitive avoidance theory - worry facilitates against negative emotions whereas
Contrast avoidance theory posits that worry facilitates avoidance of significant CHANGES to emotional state.
-Less tolerance to uncertainty
-to avoid future threat (believe worrying is useful - motivation, problem solving, relfects positive personality trait, prevents bad outcomes,etc)
Key etiological theories and maintenance for social anxiety disorder
Genetic-biological - genetic factors appear to account to 40% of risk
Environmental - early psychosocial experiences; bullied/teased during childhood, parental criticism, over-protection or control as a child
Cognitive - structure involving fear recognition and conditioning (amygdala), arousal, and stress (HPA axis), and the regulation and areas of the brain that monitor negative affect play an important role. Increase brain activity in the amygdala when looking at peoples faces, suggesting increased threat monitoring
dysregulation of serotonin, norpinephrine and other neurotransmission systems during stress responses are likely associated
Negative beliefs and judgements about self and others. Abnormal processing about social information
Behavioural inhibition is an early marker for risk
Can be maintained with dishonest self disclosure - constantly telling ppl what you think they want to hear instead of authentic opinion, which further erodes self esteem and self concept. As well as excessive self-focused attention, which may diminish important cognitive resources, interfering with ability to accurately interpret social cues.
Some refer to social anxiety disorder as an interpersonal disorder- calling attention to the self-perpetuating interpersonal cycles in the onset and maintenance of this disorder.
Key etiological theories and maintenance for specific phobia
Classical conditioning of fear -main criticism is that is has equipotentiality premise (presumption that all stimuli have an equal chance of becoming acquired phobias), but it appears that there are only a select number of stimuli consistently related to phobias.
Non associative model - proposes that process of evolution has endowed humans to respond fearfully to a select group of stimuli (water, heights, spiders), and thus no learning is required to develop phobias. (Heights - don’t need to experience it to know that one fall could be deadly, or babies born prewired with fears like stranger danger). *most of us eventually habituate to fears over time.
Biological prepardness - refers to the idea that humans and animals are biologically prepared to fear certain stimuli as opposed to others. That is, evolution has “hard-wired” organisms to easily learn those associations that facilitate species survival
Disgust Sensitivity - refers to the degree which people are susceptible to being disgusted by a variety of stimuli such as certain bugs, types of food, an small animals. (develop phobias because an object is disgusting and possibly contaminated)
