Abnormal Psych Anxiety Disorders

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Anxiety:

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A negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future.

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In humans, anxiety can be:

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subjective sense of unease, set of behaviors, a physiological response.

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Anxiety vs. fear vs. panic (anxiety):

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a future-oriented mood state, characterized by apprehension because we can't predict or control upcoming events.

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Anxiety vs. fear vs. panic (fear):

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an immediate emotional reaction to current danger characterized by strong escapist action tendencies and often a surge in the sympathetic branch of the ANS.

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Anxiety vs. fear vs. panic (panic):

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an abrupt experience of intense fear or discomfort accompanied by physical symptoms like heart palpitations, shortness of breath, or dizziness.

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3 types of panic attacks:

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situationally bound (cued) panic (always experience it), unexpected (uncued) panic, situationally predisposed panic (not always, but likely).

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Causes of anxiety disorders:

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Biological, psychological.

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Biological cause of anxiety disorders:

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associated with specific brain circuits and neurotransmitter systems. - limbic system

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(biological cause of anxiety disorders) Behavioral inhibition system (BIS):

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Activated by signals from the brainstem of unexpected events and causes us to freeze, and evaluate the environment-- leads to anxiety.

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Fight/flight system (FFS):

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Separate from the BIS; activates the amygdala and results in immediate alarm and escape response (panic).

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(psychological causes of anxiety disorders)
Controllability:

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A general "sense of uncontrollability" may develop early as a function of upbringing and other environmental factors. (combination of conditioning and cognitive explanations)

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Triple Vulnerability Theory:

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1) generalized biological vulnerability - tendency to be high-strung
2) generalized psychological vulnerability - socialized beliefs that the world is dangerous and out of control; lack of ability to cope.
3) specific psychological vulnerability - learn from life stressors and specific early experiences that some situations or objects are filled with danger.

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Anxiety and panic are closely related - anxiety increases the likelihood of :

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panic

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______ is very common with anxiety and panic disorders.

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Comorbidity

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Different disorders share some common features of anxiety and panic and share same ________.

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vulnerability

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Panic and anxiety differ only in the focus of _________________

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anxiety and patterning of panic attacks.

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Clinical description of Generalized Anxiety Disorder:

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When someone worries indiscriminantly about everything; the worry is unproductive; and they are unable to stop worrying.

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Clinical description criteria for Generalized Anxiety Disorder:

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- at least 6 months of excessive worry
-very difficult to turn off or control worry process
-physical symptoms: muscle tension, irritability, mental agitation, difficulty sleeping, susceptibility to fatigue.

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What is the prevalence of Generalized Anxiety Disorder?

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~ 4% of population has it, it's one of the most common anxiety disorders.

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Causes of Generalized Anxiety Disorder:

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generalized biological vulnerability
- inherit a tendency to become anxious
- highly sensitive to threat in general
- less physiologically responsive

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Medical treatment for Generalized Anxiety Disorder:

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Benzodiazepine drug treatment
- give some relief in short term; some risk.

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Psychological treatment for Generalized Anxiety Disorder:

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Focus on the worry process and avoidance of feelings of anxiety and help them process the information on an emotional level.

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Medical treatment for Generalized Anxiety Disorder:

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Benzodiazepine drug treatment
- give some relief in short term; some risk.

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Psychological treatment for Generalized Anxiety Disorder:

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Focus on the worry process and avoidance of feelings of anxiety and help them process the information on an emotional level.

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To meet criterion of panic disorder, person must:

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-experience unexpected panic attacks
-develop substantial anxiety over the possibility of having another attack or the implications of the attack or its consequences
-alter behavior because of attacks

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Development of Agoraphobia:

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Fear and avoidance of situations in which they would feel unsafe in the event of a panic attack or panic symptoms. - or enduring these symptoms with marked distress, with a "safe" person.

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Interoceptive avoidance:

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Avoidance of internal physical sensations because they are associated with the physiological arousal of a panic attack.

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Most people with panic disorder have some __________ avoidance.

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agoraphobic

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About ___% of people with panic disorder have experienced nocturnal attacks (frequently btn 1:30-3:30a)

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60

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Panic disorder is most common in __ - ___ year olds, and begins at or after _______.

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25-29, puberty.

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Panic Disorder causes:

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Develops after unexpected panic attacks; agoraphobia is more socially and culturally determined.

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Biological cause of Panic Disorder:

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person will be more likely to have an emergency alarm reaction

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Psychological vulnerability to Panic Disorder:

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Must be susceptible to developing anxiety over the possibility of having another panic attack.

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(t/f) panic attacks do not equal panic disorder:

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true

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Panic Disorder medical treatments:

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SSRIs preferred drug, ibenzodiazepines also commonly used.

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About ___% of individuals using medication treatment for panic disorder are panic free.

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60

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Psychological treatment for Panic Disorder:

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arrange conditions where the patient can gradually face the feared situations and learn there is really nothing to fear.

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Panic Control Treatment (PCT):

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exposes patients to the cluster of interoceptive sensations that remind them of their panic attacks.

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Specific Phobia:

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An irrational fear of a specific object or situation that markedly interferes with an individual's ability to function.

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4 major subtypes of phobias:

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blood-injection-injury:responses differ. heart rate + blood pressure drop oftenly.
situational- fear of public/enclosed places
natural environment-situations/events in nature (heights, storms)
animal-

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for about ___% of the population, their fears are at some point severe enough to be classified as disorders.

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11

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Specific phobia disorder is one of the most ______ psychological disorders around the world.

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common

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Once a phobia develops, it tends to _________________.

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last a lifetime without treatment.

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several ways to acquire phobias:

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-direct experience
-experiencing a false alarm(panic attack) on a specific situation
-observing someone else experience severe fear
-(under right conditions)being told about danger or warned repeatedly

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Treatment for specific phobias:

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behaviorally based, structured and consistent exposure- base exercises that increase in difficulty gradually.

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Social Phobia:

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extreme, enduring, irrational fear and avoidance of social or performance situations.

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Subtype of generalized type for social phobia:

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people who are extremely shy in almost all social situations.

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___% of general population suffer from social phobia at some point.

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13.3

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3 pathways to social phobia are possible:

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1) inherit a generalized biological vulnerability to develop anxiety and/or social tendency to be socially inhibited.
2) when under stress, might have unexpected panic attack in a social situation that would be come associated to social cues.
3) might experience a real social trauma resulting in a true alarm, and anxiety would then develop in the same or similar pattern.

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Treatment for Social Phobia:

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-Cognitive behavioral therapy program. group therapy, members rehearse or roleplay their socially phobic situations in front of one another (exposure-based).
-intensive cognitive therapy aimed at uncovering and changing the autonomic or unconscious perceptions of danger.

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Post-Traumatic Stress Disorder:

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setting event is an exposure to a traumatic event, where one feels intense fear, helplessness, or horror.

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Post-traumatic stress disorder causes patients to avoid ____________________

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anything that reminds them of the trauma.

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Post-traumatic stress disorder characteristics:

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-behavioral avoidance
-display a characteristic restriction or numbing of emotional responsiveness.
-sometimes unable to remember certain aspects of event.

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Post-traumatic stress patients are typically chronically over-aroused, __________, and quick to ______.

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easily startled, anger

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Acute post-traumatic stress disorder:

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diagnosed one month after the event occurs

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chronic post traumatic stress disorder:

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when symptoms continue longer than 3 months

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delayed onset of post traumatic stress disorder:

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show few, if any, symptoms immediately after trauma, but later develop full-blown PTSD.

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Acute stress disorder (ASD):

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Basically the same thing as PTSD; occurring within the first month, but emphasizes the very severe reaction that some people have immediately.

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Statistics for PTSD: close exposure to trauma __________________. Combat and ___________ are the most common traumas to develop PTSD.

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seems to be necessary,sexual assault.

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Vulnerabilities of PTSD matter at low levels of stress/trauma, not at _____ levels.

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high

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If an individual has a strong supportive group of people around them, they are less likely to develop _______.

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PTSD

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Treatment for PTSD:

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most clinitions agree that victims of PTSD should face the original trauma to develop effective coping procedures.

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Imaginal exposure treatment for PTSD:

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the content of the trauma and emotions associated with it are worked through systematically.

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Drug treatments for PTSD:

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some have been tried, but research and use is only preliminary. some drugs like SSRIs may be helpful.

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OCD description:

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In OCD, the dangerous event is a thought, image, or impulse that the client attempts to avoid.

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Obsessions:

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

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Most common obsessions:

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contamination, aggressive impulses, need for symmetry, somatic concerns + sexual content.

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Compulsions:

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thoughts or actions used to suppress the obsessions and provide relief. (often are "magical" they have no logical relation to the obsessions)

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Major categories of compulsions:

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checking, ordering, arranging, washing, cleaning.

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Prevalence of OCD

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majority are female, but ratio isn't significantly large. More common in male children than female.

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Once OCD develops, it tends to be

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chronic

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onset range for OCD:

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early adolescence (for female)

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Causes of OCD:

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first, one must develop anxiety focused on the possibility of having additional intrusive thoughts
-repetitive, intrusive, unacceptable thoughts may be regulated by a certain brain circuit.

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Thought-action fusion:

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equating thoughts with specific actions or activity represented by the thoughts.

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with OCD, client often tries to "neutralize thought in their head" with _______. this isn't effective.

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compulsions

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Drug treatment for OCD:

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SSRIs; can benefit up to 60% of patients

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psychological treatment for OCD:

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highly structured treatment work better than drugs, but not readily available.

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Exposure and ritual/response prevention (ERP):

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rituals are actively prevented and the patient is systematically and gradually exposed to the feared thought/situation.

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Somatoform disorders:

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the problem seems, initially, to be physical disorders, but there is usually no identifiable medical condition causing the physical complaints.

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soma

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body

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Somatoform disorder patients are :

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pathologically concerned with the appearance or functioning of their bodies.

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Hypochondriasis:

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Severe anxiety focused on the possibility of having a serious disease.

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__%-__% of medical patients are diagnosed with hypochondriasis. (men-women 50/50)

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1, 4

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Hypochondriasis involves the disorder of cognition or perception with strong __________

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emotional contributors

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Hypochondriasis has fundamental causes similar to those of other _____________.

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anxiety disorders

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Hypochondriasis seems to develop in context of a __________________.

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stressful life event

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(t/f)Hypochondriacs tend to have a large incidence of disease in family.

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true

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Treatment of hypochondriasis:

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focus on identifying and challenging illness-related misinterpretations of physical sensations. showing patients how to create "symptoms" by focusing attention on certain body areas.

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Somatization Disorder:

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Extreme and long-lasting focus on multiple physical symptoms for which no medical cause is evident.

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Somatization vs. hypochondriasis:

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somatization patients tend to worry about the symptom itself, not what it might mean. they also don't feel the urge to take action but feel weak and ill constantly, obsess over symptoms.

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about ___% of general population and ___% of patients in a primary care medical setting have somatization disorder.

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4.4, 20

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treatment for somatization disorder:

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very difficult to treat, concentrate on providing reassurance, reducing stress, and reducing frequency of help-seeking behaviors.

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Conversion Disorder:

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physical malfunctioning without any physical or organic pathology to account for the malfunction.

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most symptoms of conversion disorder suggest that :

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some kind of neurological disease affecting sensory motor systems (paralysis, blindness etc)

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la belle indifference :

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an attitude of indifference to symptoms.

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Conversion disorder is often precipitated by _________

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marked stress.

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although patients with conversion disorder can function normally, they seem truly unaware of this ability or :

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sensory input

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Closely related disorders to conversion disorder:

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Malingering- deliberate faking of a physical or psychological disorder motivated by gain.
Factitious Disorders- symptoms are under voluntary control but there aren't obvious reasons for production of movement.

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conversion disorder often occurs with ____________

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somatization disorder and comorbid mood disorders.

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cause of conversion disorder:

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have often experienced a traumatic event that must be escaped
-avoidance behavior
-detached from consciousness
-behavior continues til underlying problem is resolved.

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treatment for conversion disorder:

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strategy is to identify and attend to the traumatic event if still present and remove the resources of secondary gain.