Week 7 Chapter 6 Anxiety Disorders CF

Question 1

Give a basic definition of Anxiety

Answer 1

Anxiety is defined as apprehension over an anticipated problem.

Question 2

Give a basic definition of Fear

Answer 2

Fear is defined as a reaction to immediate danger

Question 3

What are the similarities between Anxiety and Fear?

Answer 3

• Both anxiety & fear can involve arousal, or sympathetic nervous system activity
• Both Anxiety & Fear are adaptive, therefore neither is necessarily “bad”

Question 4

How do Anxiety and Fear differ?

Answer 4

• Anxiety often involves moderate arousal, whereas fear involves higher arousal:
• A person experiencing anxiety may feel no more than restless energy & physiological tension (at the low end)
• A person experiencing fear may sweat profusely, breathe rapidly, & feel an overpowering urge to run.

Question 5

In what way is Fear adaptive?

Answer 5

• Fear is fundamentally a “fight-or-flight(-or-freeze)” reaction.
• Fear causes rapid changes in the sympathetic nervous system that prepare the body for escape or fighting.
• In the right circumstance, fear saves lives.

Question 6

In what way is Anxiety adaptive?

Answer 6

• Anxiety is adaptive in helping us notice & plan for future threats.
• Anxiety increases our preparedness,
• helps us avoid potentially dangerous situations,
• helps us to think through potential problems before they happen

Question 7

What is thought to happen to the sympathetic nervous system in some anxiety disorders?

Answer 7

The fear system seems to misfire, so that a person experiences fear at a time when there is no danger in the environment.

Question 8

In what way is Anxiety Performance viewed as a U-shaped curve?

Answer 8

• A small degree of anxiety has been found to improve performance however, too much anxiety interferes with performance.
• An absence of anxiety is a problem, a little anxiety is adaptive, and a lot of anxiety is detrimental

Question 9

Anxiety disorders as a group are the most common type of psychiatric diagnosis. What’s the prevalence in the US?

Answer 9

28% of adults in America have reported symptoms at some point during their life that have met the DSM-IV-TR criteria for a diagnosis of an Anxiety Disorder

Question 10

In what ways are anxiety disorders very costly to society, and to the people with the disorder?

Answer 10

Anxiety disorders are associated with:

• twice the average rate of medical costs
• higher risk of cardiovascular disease & other medical conditions
• difficulties in employment
• serious interpersonal concerns

All of the anxiety disorders, are associated with substantial decrements in the quality of life

Question 11

There is a lot of overlap in the way various anxiety disorders are defined. What are the characteristics common to all?

Answer 11

All share excessively high or frequent anxiety.

With the exception of Generalised Anxiety Disorder (GAD) the anxiety disorders also involve tendencies to experience intense fear

Question 12

There is a lot of overlap in the way various anxiety disorders are defined. What are the DSM criteria common to all, and, essential for diagnosis?

Answer 12

• Symptoms must interfere with important areas of functioning or cause marked distress
• Symptoms are not caused by a drug or a medical condition
• The fears and anxieties are distinct from the symptoms of another anxiety disorder

Question 13

What is the DSM-5 Criteria for “Specific Phobia”?

Answer 13

A. Marked fear or anxiety about a specific object or situation (e.g. flying, heights). Note: in children, the fear may be expressed by crying, tantrums, freezing or clinging
B. The phobic object or situation almost always provokes immediate fear or anxiety
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation & to the sociocultural context
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, & avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (i.e. agoraphobia); objects or situations related to obsessions (i.e. OCD); reminders of traumatic events (i.e. PTSD); separation from home or attachment figures (i.e. separation anxiety disorder); or social situations (i.e. social anxiety disorder)

Question 14

What is the DSM-5 Criteria for “Social Anxiety Disorder”?

Answer 14

A. Marked fear or anxiety about one or more social situation in which the individual is exposed to possible scrutiny by others. Examples include social interactions, being observed, & performing in front of others. Note: In children, the anxiety must occur in peer settings & not just during interactions with adults
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (e.g. embarrassed, humiliated, rejection or offend others)
C. The social situation almost always provokes fear or anxiety. Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations
D. The social situations are avoided or endured with intense fear or anxiety
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation & to the sociocultural context
F. The fear, anxiety, or avoidance is persistent, lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g. drug, medication) or another medical condition
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another medical disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder
J. If another medical condition (e.g. Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated.
Specify if: Performance only: If the fear is restricted to speaking or performing in public.

Question 15

What is the DSM-5 Criteria for “Panic Disorder”?

Answer 15

A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, & during which time 4 (or more) of the following symptoms occur:
Note: the abrupt surge can occur from a calm state or an anxious state
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breathe or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed, or faint
9. Chills or heat sensations
10. Numbness or tingling sensations (paresthesias)
11. Derealisation (feelings of unreality) or depersonalisation (being detached from oneself)
12. Fear of losing control or “going crazy”
13. Fear of dying
Note: culture-specific symptoms (e.g. tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Should symptoms should not count as 1 of the 4 required
B. At least 1 of the attacks has been followed by 1 month (or more) of both of the following:
1. Persistent concern or worry about additional panic attacks or their consequences (e.g. losing control, ‘going crazy’, have a heart attack)
2. A significant maladaptive change in behaviour related to the attacks (e.g. behaviours designed to avoid having panic attacks, i.e. avoiding exercise or unfamiliar situations)
C. The disturbance is not attributable to the physiological effects of a substance or another medical condition (e.g. hyperthyroidism, cardiopulmonary disease).
D. The disturbance is not better diagnosed by another medical disorder (e.g. the panic attack does not occur only in response to feared social situations, or circumscribed phobic, in response to obsessions or trauma, or separation from an attachment figure

Question 16

What is the DSM-5 Criteria for “Agoraphobia”?

Answer 16

A. Marked fear or anxiety about 2 (or more) of the following 5 situations:
1. Use of public transportation
2. Being in open spaces (e.g. bridges, car parks)
3. Being in enclosed spaces (e.g. shops)
4. Standing in line or being in a crowd
5. Being outside or home alone
B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (fear of falling or of incontinence)
C. The agoraphobic situation almost always provokes fear or anxiety
D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety
E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations & to the sociocultural context
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
H. If another medical condition (e.g. inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety or avoidance, is clearly excessive.
I. The fear, anxiety, or avoidance disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, & avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (i.e. agoraphobia); objects or situations related to obsessions (i.e. OCD); reminders of traumatic events (i.e. PTSD); separation from home or attachment figures (i.e. separation anxiety disorder); or social situations (i.e. social anxiety disorder)
Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual’s presentation meets criteria for panic disorder & agoraphobia, both diagnoses should be assigned.

Question 17

What is the DSM-5 Criteria for “Generalised Anxiety Disorder”?

Answer 17

A. Excessive anxiety & worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number if events or activities (such as work or school performance)
B. The individual finds it difficult to control worry
C. The anxiety & worry are associated with 3 (or more) of the following 6 symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Note: Only 1 item is required in children
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep Disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
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 (e.g. hyperthyroidism)
F. The disturbance is not better explained by another mental disorder (e.g. anxiety about having panic attacks or panic disorder, social anxiety disorder, OCD, PTSD, eating disorder, BDD, schizophrenia or delusional disorder)

Question 18

What is a “Specific Phobia”?

Answer 18

A specific phobia is a disproportionate fear caused by a specific object or situation, such as fear of flying, fear of heights, fear of snakes
The person recognises the fear is excessive, but still goes to great lengths to avoid the feared object or situation

Question 19

What is “Social Anxiety Disorder”?

Answer 19

• Social Anxiety Disorder is a persistent, unrealistically intense fear of social situations that might involve being scrutinised by, or even just exposed to, unfamiliar people.
• People with social anxiety disorder try to avoid situations in which they might evaluated, show signs of anxiety, or behave in embarrassing ways.
• The most common fears include public speaking, speaking in meetings or classes, meeting new people, talking with authority figures.

Question 20

What are some of the characteristics of Social Anxiety Disorder?

Answer 20

• Social Anxiety Disorder is distinct from shyness, in that people feel discomfort socially and avoid more social situations, & the symptoms last longer, than people who are shy
• At least 1/3 of those diagnosed with Social Anxiety Disorder also meet criteria for Avoidant Personality Disorder (Cath :-) has been one)
• Social Anxiety Disorder generally begins in adolescence when social interactions become more important
• Social Anxiety Disorder can range in severity from a relatively few specific fears to a more generalised host of fears.
• The number of fears experienced is related to more comorbidity with other disorders, i.e. depression, alcohol abuse, & more negative effects on the person’s social & occupational activities

Question 21

What is “Panic Disorder”?

Answer 21

Panic Disorder is characterised by frequent panic attacks that are unrelated to specific situations & by worry about having more panic attacks.

Question 22

What is a panic attack?

Answer 22

• A Panic Attack is a sudden attack of intense apprehension, terror, & feelings of impending doom, accompanied by at least 4 other symptoms.
• Physical symptoms may include laboured breathing, heart palpitations, nausea, upset stomach, chest pain, feelings of choking & smothering, dizziness, lightheadedness, sweating, chills, heat sensations, & trembling
• Other symptoms may include depersonalisation (a feeling of being outside one’s body); derealisation (a feeling that the world is not real); and fears of losing control, of going crazy, or even dying.

Question 23

How do the symptoms of Panic attack, as experienced in Panic Disorder, manifest?

Answer 23

• The symptoms tend to come on rapidly & reach a peak of intensity within 10 minutes
• People often report an urge to flee whatever situation they are in
• We can think about a panic attack as a misfire of the fear system as the level of arousal of the sympathetic nervous system matching what most people would experience when faced with an immediate threat to life
• more than 25% of US adults have experienced at least one panic attack in their lifetime (not sufficient for diagnosis
• Panic Disorder usually develops in adolescence

Question 24

There are 2 types of Panic Attack, what are they and how do they manifest?

Answer 24

*Uncued attacks
these occur unexpectedly

*Cued Panic Attacks
these are cued by a specific situation (e.g. seeing a snake)

Question 25

What is “Agoraphobia”?

Answer 25

Agoraphobia is defined by anxiety about situations in which it would be embarrassing or difficult to escape if anxiety symptoms occurred.

• Commonly feared situations include crowds, & crowded places
• Many people with Agoraphobia are unable to leave their homes
• Less is known about agoraphobia because it was only seen as a subtype of panic disorder.

Question 26

What is “Generalised Anxiety Disorder”?

Answer 26

The central feature of Generalised Anxiety Disorder (GAD) is worry.

• People with GAD worry persistently and often worry about minor issues
• Worry is the cognitive tendency to chew on a problem, unable to let it go. Worry can continue because a person cannot settle on a solution.
• Worry for people with GAD is excessive, uncontrollable, & long-lasting
• GAD typically begins in adolescence but some people report a tendency to worry all their lives
• GAD is often chronic lasting more than 5 years in about 50% of people studied

Question 27

What is the comorbidity of Anxiety Disorders with other anxiety disorders?

Answer 27

More than 50% of people with 1 anxiety disorder meet the criteria for another during their lifetime.

• More than 80% of people with GAD will develop another anxiety disorder compared to rates in the general population
• It is also common for people with 1 anxiety disorder to have subthreshold symptoms for another disorder as the symptoms often overlap, & some etiological factors (neurobiological or personality characteristics) may increase risk for more than 1 anxiety disorder

Question 28

What is the comorbidity of Anxiety Disorders with other psychological disorders?

Answer 28

*75% of people with an anxiety disorder meet the criteria for at least 1 other psychological disorder
*about 60% meet the criteria for major depression
*other conditions include substance abuse
Also comorbid with other medical disorders, such as coronary heart disease

Question 29

What part does Gender play in Anxiety Disorders?

Answer 29

• Women are more vulnerable to anxiety disorders with twice as many women diagnosed compared to men
• Women may be more likely to report symptoms
• Men may be raised to believe they have greater personal control than women
• Gender roles are likely to influence anxiety
• Men may experience more social pressure to face fears
• Women are more likely to be sexually assaulted than men
• Women appear to show more biological reactivity to stress than do men

Question 30

What influence do Sociocultural factors play in Anxiety Disorders?

Answer 30

• People in every culture seem to experience problems with anxiety disorders
• The prevalence of anxiety disorders varies across cultures:
• as cultures differ with regard the factors known to play a role in the occurrence of reporting anxiety disorder, such as, attitudes towards mental illness, stress levels, the nature of family relationships, and prevalence of poverty