Abnormal Behaviour

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Anxiety

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Negative mood state characterized by bodily symptoms of physical tension, and apprehension (farhåga) about the future.
Anxiety is worrying for future events, deep uncertainty about ourselves and our ability to deal with upcoming events. Doesn't have to be aimed or about something that's actually a threat.

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How are anxiety and fear different?

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Anxiety is a future-event oriented state, because there's no control about what will happen. Fear is an immediate emotional reaction (alarm) to current danger characterized by strong escapist action tendencies (fight or flight) that makes us move from danger. Anxiety might also come further later than when a trigger is shown.

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What is a panic attack?

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A panic attack is defined as a cued or uncued abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms that usually include heart palpitations, chest pain, shortness of breath, and, possibly, dizziness.
It has a peak, and lasts for several minutes.
The client often has a fear of losing control, feelings of unreality, detached from oneself.

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When can a panic attack be cued? When is it uncued?

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A cued panic attack might come when you do something you know you're afraid of, like driving on a bridge.
An uncued panic attack is if you don't have a clue when or where the next attack will occur.

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How should a parent treat a child so the child has the best chances not to develop an anxiety disorder?

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Interact with the child in a positive and predictable way by responding to their needs, particularly when the child communicates needs for attention, food, relief from pain and so on. Then the child learns that it has control over the environment, has a "secure home base", but is allowed to explore the world and develop the necessary skills to cope with unexpected occurrences. Healthy sense of control.
If not, the child never learns to cope with adversity and never gets control of its own environment.

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Comorbidity

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When a client has more than one disorder. The most common comorbid disorder within the anxiety branch is major depression.

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What is Specific Phobia Disorder?

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Extreme, irrational fear in the presence of a phobic stimulus that markedly interferes with an individuals ability to function, like for example avoiding going places where one might be exposed to the phobia.
- Might be triggered by a traumatic event, an unexpected panic attack close to the phobic stimulus, informational transmission (from someone one looks up to)
- Typical age of onset is 7-11 years old.

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What are the 4 most common sorts of phobias?

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1) Animal type (insects, snakes)
2) Natural Environment (heights, storms, water etc)
3) Blood-injury-injection type (needles, blood, injury)
4) Situational type (planes, elevators, closed places)
5) Other (things that doesn't fit the 4 first types, like vomiting, costumed characters, choking etc)

It is common with multiple phobias.

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How can you see on a child that it has a phobia for a stimulus?

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Freezing, clinging, crying, tantrums.

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What might cause a phobia?

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- Direct experience: A traumatic event, like getting bitten by a dog. (Fear with true alarm = learned phobia)

- Vicarious experience: Observing someone else experience severe fear. (Fear with true alarm = learned phobia)

- Getting extremely stressed about something that doesn't happen.

- Information transmission: being warned repeatedly about a potential danger (reading about flight crashes in newspapers = dangerous to fly).

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How does one treat a specific phobia?

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- Systematic Desensitization
- Virtual Reality Treatment
- Exposure-Based Therapy (don't try that at home alone, might only make it worse)

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Social Anxiety Disorder (Social Phobia)

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- Extreme, irrational fear or anxiety in social situations.

- Fear of being negatively evaluated by others.

- Avoids social situations or endure them with great distress.

- Typical onset ~13 years.

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Social Anxiety Disorder: Causes

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- Biological vulnerabilities: evolutional (predisposed or prepared to fear angry, critical or rejecting faces that indicates danger), inherited genes, neurotransmitter (serotonin and dopamine) dysfunction.
- Psychological vulnerabilities: anxiety sensitivity, observational learning (from someone one looks up to), self-focused (thinks everyone is judging me), other-focused (making assumptions about what others think), not have control over situations. Experience social drama, like being bullied during childhood (true alarm), or think that no one likes you (false alarm).

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Social Anxiety Disorder: Treatment

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- Medications, like Tricyclic. High rates of relapse when stopped.

- CBT, role play, group therapy. Highly effective.

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Panic Disorder

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- Experience of recurrent, unexpected panic attacks
- Persistent anxiety, worry or fear about having another attack.

- Engage in behaviors that helps not to get anther attack or even the implications.

Associated features:
- Agoraphobia (fear of going out).
- Interoceptive/exteroceptive avoidance (I: not getting physically aroused/E: not go to places where panic attacks might be trigged).
- Nocturnal Panic Attacks (attacks while sleeping).

- High rates of attempted suicide.

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Agoraphobia

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Perceives the environment as unsafe. More intense, persistent fear or anxiety.
In severe forms, individuals may become homebound because they think going out will result in a panic attack. Like on a bus, then everyone would be looking, and that's just too hard for agoraphobics to face.

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Panic Disorder: Causes

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Biological: Inherited genetic predisposition.
Psychological: anxiety sensitivity, negative beliefs and behaviors, learned alarm reactions. Hypervigilance (oversensitivity to detect threats), negative attributions.

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Panic Disorder: Treatment

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Medication: Target serotonergic, noradrenergic, and benzodiazepine-GABA systems. SSRIs currently preferred. High relapse rate when discontinued.
Therapy: CBT is highly effective, learning how to managing anxiety, gradual exposure-based exercises, and anxiety coping techniques (relaxing and breathing). Learning how to cope with cues and cognitive therapy.

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Generalized Anxiety Disorder (GAD)

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- Excessive, uncontrollable apprehension and worry about numerous life events, like job, family, chores etc.

- The client is unable to stop this worrying-cycle.
- The anxiety is very strong and persistent.

- Muscle tension, fatigue, irritability, restlessness (bcs the client can never fully rest)

- Shift from crisis to crisis, it's always something worrying them.

- Chronic course.

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Generalized Anxiety Disorder: Causes

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Biological: Inherited genetic predisposition.

Psychological: Chronic muscle tension (bcs stress), reduced responsiveness on most anxiety measures.

- Intolerance of uncertainty.

- Erroneous beliefs about worry.

- Poor problem orientation. Problems should be avoided, not challenged.

- Cognitive avoidance, they think so much about avoiding the affect associated with the threat so they can't arrive at a solution = chronic worriers.

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Generalized Anxiety Disorder: Treatment

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- Pharmacological: Benzodiazepines gives a short term relief, but they impair both cognitive and motor functioning, you get less alert, impairs driving. You get dependent, so it's hard to stop taking them, so only for 1-2 weeks at a time. Antidepressants.

- Psychological: How to relax deeply to combat tension, cognitive therapy and techniques to cope with the worrying, working on increase toleration of uncertainty. Look at images that might trigger anxiety, and learn how to handle it.

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From where can one get Post-Traumatic Stress Disorder (PTSD)?

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Exposure to actual or threatened death, serious injury or sexual violence, either to oneself, witnessing it or if it happened to a loved one. It's most often developed after war, sexual assault, natural disasters, domestic violence, accidents.

Often experience extreme fear, hopelessness or horror, but it's not required to develop PTSD.

About 10-20 % of people who experience trauma get PTSD:

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Description of PTSD

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- One month after the trauma (before that it's acute stress disorder).

- Re-experiencing the traumatic event, even though you might not remember all of it.

- Avoid places that might trigger the PTSD, which can cause flashbacks that makes you think you're re-experiencing the event.

- Intrusive symptoms.

- Negative cognitions and mood states. Your reality has turned upside down, you can't live normally and don't experience joy in the same things as you used to do.

- Emotional numbing, not able to feel joy/anger/happiness, feeling detached; just watching others live without you.

- Altered physiological arousal and reactivity, you're always on the look-out for danger, always prepared for a new trauma.

Very common after a traumatic experience, but they shouldn't persist.

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Why doesn't everyone develop PTSD?

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- Social support: very important to recover from a traumatic event. If you don't have social support you're more likely to develop PTSD.

- The nature of the threat. Was it something that could have been stopped (by me)? Was it my fault? Natural disasters are a bit more easy to accept and let go of.

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PTSD: Causes

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- Biological and psychological vulnerabilities.

- Genetics: might put yourself in situations where you're more likely to experience trauma.

- Preexisting disorders, like depression or anxiety.

- Previous traumas, if you had PTSD before.

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PTSD: Treatment

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- Medications: SSRI

- Therapy: CBT, must be gradual so you can stop avoiding triggers. Helps to increase positive coping skills, increase the feeling of social support. Is highly effective.

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Within PTSD, there's 4 major types of obsessions

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Checking: the stove, maybe 10 times before I can leave the house.
Arranging: A special way of putting things down that might only seem obvious to the client.

Washing/cleaning: most common. Takes a tremendous amount of time. Nothing seems/feels clean, and you feel like you really have to do it.

Symmetry/ordering: Have a special order on things, like avoiding stepping on the cracks of the sidewalk etc.

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Trichotillomania

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Pulling hair disorder, most common around the eyes. Results in distress.

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Excoriation

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Skin-picking disorder. Causes bleeding, sores, scars.

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Obsessive-Compulsive Disorder (OCD)

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A client who attempts to avoid thoughts, images or impulses as much as someone with snake phobias avoid snakes.

Obsessions: intrusive and mostely nonsensical thoughts, images or urges that the individual tries to resist or eliminate.

Compulsions: thoughts or actions used to suppress the obsessions and provide relief, like hand washing, checking or mental (thinking about certain words in a specific order, counting, praying etc). Are thought to prevent stress or dreaded event. "Magical" and without logic relation to the obsession.

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OCD: Causal Factors

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- Moderate genetic risk, functional abnormalities in the basal ganglia and frontal cortex may be responsible for OCD and abnormalities in the serotonin system.

- Early life experiences might trigger maladaptive beliefs about oneself, that one's thoughts are dangerous and need to be prevented. To prevent them a person might develop coping mechanisms that turns into obsessions. Suppressing thoughts.

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OCD: Treatment

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Medications: SSRI, 50-60 % beneficial, high relapse rate when discontinued.

Therapy: CBT, exposure and ritual prevention (ERP), it's highly effective.

Surgery: if it's an extreme case, Cingulotomy.

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Body Dysmorphic Disorder

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- Thinking you have a trait that is so ugly it's the only thing you and others can see, but no one knows about it.

- Preoccupying the thoughts and all behaviors by constantly looking in the mirror, plastic surgeries, grooming, checking etc. Very time consuming.

- Similar to OCD since one get so obsessed with the trait, might even stay home just so others can't see it.

- Same treatments as OCD, exposure therapy, CBT and Prozac.