Test 2: Anxiety, Stress, Trauma, and Obsessive Compulsive Related Disorders Flashcards
Define fear:
An immediate, present-oriented response caused by activation of the sympathetic nervous system
Define Anxiety:
An apprehensive, future-oriented emotion with somatic symptoms of muscle tension, restlessness, and elevated heart rate
Define panic attack. What are the two types?
An abrupt experience of intense fear with
- physical symptoms of heart palpitations, chest pain, dizziness, sweating, chills or heat sensations, etc
- cognitive symptoms of fear of losing control, dying, or going crazy
Types:
- Expected/Cued (specific stimulus)
- Unexpected (panic disorder)
Read Through DSM 5 for each disorder
In the textbook
What are the general biological contributions to anxiety?
- Polygenetic influences: corticotropin releasing factor (CRF) and its affects of the HPA axis (hypothalamic-pituitary-adrenocortical)
- Brain circuits and neurotransmitters
- Limbic system
How do brain circuits and neurotransmitters affect anxiety?
- Brain circuits are shaped by environment: ie smoking that has an interactive relationship with the somatic symptoms
- Neurotransmitters:
– decreased GABA,
– noradrenergic system: decreased
norepinephrine
– serotonergic system: decreased serotonin
How does the limbic system affect anxiety?
- Behavioral Inhibition System: BIS
(receives danger signals from brain stem and septal-hippocampal system) - Fight/flight system: FFS
(panic circuit, alarm/escape response)
What are Freud and the Behaviorist’s suggestions as to the psychological contributions of anxiety?
- Freud:
– anxiety is a psychic reaction to danger
– and a reactivation of infantile fear situation - Behaviorists:
– Classical and operant conditioning: symptoms are result of learned associations
– Modeling: anxious behavior
What are the social contributions to anxiety?
Biological vulnerabilities are triggered by stressful life events
- Family
- Interpersonal
- Occupational
- Educational
What is triple vulnerability?
- Generalized biological vulnerability (Diathesis)
- Generalized psychological vulnerability (beliefs/perceptions)
- Specific psychological vulnerability (learning/modeling)
What are the rates, commonalities, and linked physical disorders of anxiety comorbidities?
- Rates: 55-76%
- Commonalities: Features & vulnerabilities
- Physical disorders: GI, migraines, arthritis, and allergies
- Suicide: similar to major depression
What disorder is described as
- shift from possible crisis to crisis
- worry about minor, everyday concerns (job, family, chores, appointments)
- accompanied by symptoms such as sleep disturbance and irritability
- leads to behaviors like procrastination, overpreparation
Generalized Anxiety Disorder (GAD)
How is Generalized Anxiety Disorder different in children and the elderly?
- Children: need only one physical symptom, worry about academic, social, and athletic performance
- Elderly: worry about health, use minor tranquilizer: for medical or sleep problems, increase risk of falls and cognitive impairments
What causes GAD?
- inherited tendency to become anxious
- neuroticism (tendency for more intense negative affect w/ avoidant coping)
- less responsiveness: autonomic restrictors
- threat sensitivity
- Frontal lobe activation
What are the pharmacological treatments for GAD?
Benzodiazepines (most often)
- Ativan
- fast-acting, short-term
- cognitive & motor impairment
- physical & psychological dependance
Antidepressants (SSRI)
- Paxil, Effexor
What are the psychological treatments for GAD?
- Cognitive-behavioral treatments
– exposure to worry processes
– confronting anxiety-provoking images
– coping strategies - Acceptance
- Meditation
*Similar benefits to drugs and better long-term results
What disorder is described as
- Unexpected panic attacks
- Anxiety, worry, or fear of another attack
- Persists for 1 month or more
Panic Disorder
Female:Male 2:1
What disorder is described as
- Fear or avoidance of situations/events
- Concern about being unable to escape or get help in the event of panic symptoms or other unpleasant physical symptoms (incontinence, vomiting, falling)
- Avoidance can be persistent
- Use and abuse of drugs and alcohol
- Interoceptive avoidance (physical sensations)
Agoraphobia
Female:Male 2:1
What is unique about children and elderly for PD and agoraphobia?
Children:
- Hyperventilation is a common symptoms
- Earlier cognitive development means fewer cognitive symptoms
Elderly:
- Health focus is more common
- Changes in prevalence - decreases with age
What is the Latin American disorder similar to PD characterized by sweating, increased heart-rate and insomnia but not anxiety or fear, even though severe fright is the cause
Susto
What is the Hispanic American disorder similar to PD characterized by panic attack-like symptoms with shouting
Ataque de nervios
What is the Cambodian (Khmer) and Vietnamese refugees disorder similar to PD and characterized by a
- panic attack with orthostatic dizziness and sore neck
0 Khmer concept - “wind overload” - too much wind or gas in the body which may cause blood vessels to burst
Kyol goeu
What are the aspects of nocturnal panic?
- Nocturnal attacks:
– occur in non-REM sleep, during delta/slow wave sleep
– deep relaxation (letting go) - Sleep terrors; kids, blood curdling scream remembering nothing next morning
- Isolated sleep paralysis: unable to move from sleep to wakes accompanied by surge of terror and occasional hallucination
What are the causes of PD and agoraphobia?
- Generalized biological vulnerability: alarm reactions to stress
- Cues get associated with situations: conditioning occurs
- Generalized psychological vulnerability: anxiety about future attacks, hypervigilance, increase interoceptive awareness
What are the medications for PD and agoraphobia? Affects, result and use?
- Benzodiazepines (Ativan)
- SSRIs (Prozac and Paxil)
- Affects: serotonergic, noradrenergic, GABA
- Results: high relapse rates after discontinuation
- Use: Can be very necessary and helpful for many people
What is the psychological treatment for PD and agoraphobia?
- Exposure based
- Reality testing: testing their hypothesis that they cannot handle an anxiety-provoking situation by entering the situation and discovering that it is survivable
- Relaxation and breathing skills
Ex: Panic control treatment (PCT)
- exposure to interoceptive cues, cognitive therapy, relaxation/breathing
*High degree of efficacy - better than drugs long term, combination no better
What is the disorder described as
- Extreme and irrational fear of a specific object or situation
- Feared situation almost always provokes anxiety
- Significant impairment or distress
Specific phobias
Female:Male 4:1
What is unique about blood-injection-injury phobia?
- Decreased heart rate and blood pressure when seeing blood, injection or injury
- Fainting
- Inherited vasovagal response
- Onset = usually in childhood
What is unique about situational phobia?
- Fear of specific situations (Flying/driving)
- No uncued panic attacks
- Fear centers around the risks of the situation, not having a panic attack
- Onset = early to mid 20s
What is unique about natural environment phobias?
- Heights, storms, water
- May cluster together
- Associated with real danger
- Onset = usually in childhood
What is unique about animal phobia?
- Dogs, snakes, mice, insects
- May be associated with real dangers
- Onset = usually in childhood
What can cause a specific phobia?
- Direct experience
- Vicarious experience - seeing someone else encounter a feared object
- Information transmission - learning about a situation/object being dangerous
- “Preparedness” - theory that says through natural selection we are prepared to fear certain things more than others
What are the treatments for specific phobias?
Cognitive-behavior therapy
- Exposure: graduated/structured
- Relaxation - used to be practived more, now often not a part of empirically supported treatment
What disorder is characterized by unrealistic and persistent worry that something will happen to self or loved ones when apart (kidnapping, accident) as well as anxiety about leaving loved ones
Separation Anxiety Disorder
(4.1% children, 6.6% adults)
What disorder is characterized by
- extreme/irrational concern about being negatively evaluated by other people
- sometimes (not always) manifests as shyness
- leads to significant impairment and/or distress
- avoidance of feared situation, or endurance with extreme distress
What is the subtype?
Social phobia/ social anxiety disorder
- Subtype: performance only: anxiety only in performance situations
What are statistics about social anxiety disorder?
- Men = Women
- Onset: adolescence
- more common when young, undereducated, single, low socioeconomic class
What is the disorder characterized by
- fear of offending others or making them uncomfortable
- concern about aspects of personal appearance (stuttering, blushing, body odor)
Taijin Kyofusho
(Japan)
- more common in males
What are the causes of social anxiety disorder?
- Generalized psychological vulnerability (believe threatening events are uncontrollable)
- Generalized biological vulnerability (propensity toward anxiety)
What is the medication treatment for social anxiety disorder?
- Beta blockers (stage fright)
- Benzodiazepines (performance only)
- SSRI (Paxil, Zoloft, Effexor - Generalized)
- D-cycloserine (antibiotic) - cognitive enhancer when someone is engaged in extinction learning with exposure therapy
What is the psychological treatment for social anxiety disorder?
CBT:
- challenging of anxious thoughts about the consequences of social judgement
- exposure to anxiety-provoking situations
- rehearsal
- role-play
Highly effective!
What is the comparison of Agoraphobics and Social Phobics?
***
Agoraphobics
- Fear of actual symptoms of anxiety
- Seek others for comfort
Social Phobics
- Fear of the social context
- Avoid others for comfort
What is the disorder described as
- rare childhood disorder characterized by a lack of speech
- must occur for more than one month and cannot be limited to the first month of school
What is the comorbidity and treatment?
Selective Mutism
- HIGH comorbidity with SAD
- Treatment: CBT most efficacious, similar to treatment for SAD
What disorder is described as
- Trauma exposure
- Continued re-experiencing (memories, nightmares, flashbacks)
- Avoidance (situation, talking about it)
- Emotional numbing
- Reckless or self-destructive behavior
- Interpersonal problems
- Refers to problems that persists for more than one month after the trauma
Posttraumatic stress disorder
What disorder is described as post-traumatic stress symptoms lasting less than one month?
Acute stress disorder
What made the Vietnam War particularly problematic for PTSD?
- no group identity - shipped as massive recruits
- soldiers felt there was no purpose because Americans were in opposition to the war
- lack of an all-out attempt to win the war
- removal from combat was abrupt
What are aspects that causes the prevalence of PTSD to vary?
- Most people who undergo traumatic events do not develop PTSD
- Type of Trauma
- Proximity: more likely if closer
What are factors that affect the likelihood of PTSD: Trauma
***
Features of the Trauma
1) Intensity of exposure to the trauma
2) Duration of exposure to trauma
3) Extent of threat posed by trauma
4) Nature of the trauma
- humans
- natural disaster
What are factors that affect the likelihood of PTSD: Person
***
Features of the Person
1) Pre-trauma psychological adjustment
2) Family history of psychopathology
3) Cognitive and coping styles
4) Feeling of guilt
What causes PTSD?
- Trauma intensity: PTSD more likely with severe trauma
- Generalized biological vulnerability (twin studies, gene-environment interactions)
- Generalized psychological vulnerability (beliefs about uncontrollability and unpredictability of threatening situations)
- Poor social support
- Neurobiological model
What is the neurobiological model of causes of PTSD?
- Threatening cues activate CRF system
- CRF system activates fear and anxiety areas (amygdala)
- Increased HPA axis activation –> cortisol and CRF
What is the psychological treatment of PTSD?
CBT
- Imaginal exposure to memories of event
- Graduated or massed
- Increase positive coping skills
- increase social support
- Highly effective !
Psychoanalytic therapy: catharsis = reliving emotional trauma to relieve suffering
What is the medication treatment of PTSD?
SSRIs can be helpful - relieve heightened anxiety and panic attacks
What disorder is characterized as
- anxious or depressive reactions to life stress
- milder than PTSD/acute stress disorder
- occur in reaction to life stressors like moving, new job, divorce, etc
- clinically significant distress or impairment
Adjustment disorder
What disorder is characterized as
- disturbed and developmentally inappropriate behaviors in children
- child is unable or unwilling to form normal attachment relationships with caregiving adults
- occurs as a result of inadequate or neglectful care in early childhood
Attachment disorder
What disorder is characterized by
- abnormally withdrawn and inhibited behavior
- less receptive to support from caregivers
- the child will very seldom seek out a caregiver for protection, support, and nurturance and will seldom respond to offers from caregivers to provide this kind of care
Reactive attachment disorder
What disorder is characterized by
- A pattern of abnormally low inhibition in children
Disinhibited social engagement disorder
(approaching unfamiliar adults without fear)
What are obsessions? What are the four types?
- intrusive & nonsensical
- thoughts, images, or urges
- attempts to resist or eliminate
Types
1) symmetry
2) forbidden thoughts or actions
3) cleaning and contamination
4) hording
What are compulsions? What are the four major categories?
- thoughts or actions
- provide relief from obsessive thoughts
Categories:
1) Checking
2) Ordering
3) Arranging
4) Washing/cleanings
What is characterized by
- involuntary movements
Tic disorder
- Often co-occurs in patients with OCD
- Sometimes used as compulsions
What is Tourette syndrome?
- Two or more motor tics
- One vocal tic
- More than one year
(either or is just tic disorder)
What are statistics on OCD?
- Female = male
- chronic
- Onset: childhood - 30s
What causes OCD?
- Generalized biological vulnerability: similar to general anxiety
- Specific psychological vulnerability:
– Early life experiences
— learning Thoughts are dangerous/unacceptable
– Thought-action fusion - Distraction temporarily reduces anxiety
What are medication treatments for OCD?
- SSRIS: 60% benefit, high relapse when discontinued
- Psychosurgery: cingulotomy, 35% benefit
What are psychological treatments for OCD?
CBT
- Exposure and Ritual Prevention: exposure to cues that trigger obsessions, with prevention of compensatory compulsions
- Highly effective: 86%
- No added benefit from combined treatment with drugs
What disorder is characterized by
- Preoccupation with some imagined defect in appearance
- OR actual defect is slight to others
What is the comorbidity, course, onset, and treatments?
Body Dysmorphia Disorder
- Comorbid: OCD 10%
- Course: lifelong
- Onset: early adolescent - 20a
- Treatments: SSRIs, exposure and response prevention
– Plastic surgery: 76.4% sought this, 66% received
(8-25% patients requesting plastic surgery may have BDD)
What disorder is characterized by
Excessively collecting and keeping items with minimal value, leading to cluttering and disruption of living space
Statistics?
Hoarding disorder
- 2-5% population
- men = women
-
What is the difference between hoarding disorder and OCD?
OCD tends to wax and wane
Hoarding behavior can begin early in life and get worse with each passing decade
What is the disorder characterized by
- the urge to pull out one’s own hair from anywhere on the body
- leads to noticeable hair loss on scalp, eyebrows, arms etc
Trichotillomania
What is the disorder characterized by
- repetitive and compulsive picking of the skin leading to tissue damage
Treatment?
Excoriation
- Often face
1-5% prevalence rate
- behavioral habit reversal treatment is most effective treatment
