Anxiety And Ocd Disorders

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Anxiety: biological dimension

Back 1

-overactive fear circuitry in brain

-5HTTLPR genotype variations

-Abnormalities in neurotransmitters

-Reduced serotonin activity

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Anxiety: Psychological dimensions

Back 2

-negative cognitive appraisal

-anxiety sensitivity

-conditioning experiences

-limited sense of control

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Anxiety: Social dimension

Back 3

Daily environmental stress

Lack of social support

Stressful relationships

Childhood maltreatment

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Anxiety: Sociocultural dimension

Back 4

Gender differences.

Cultural factors.

Acculturation conflicts.

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Anxiety prevalence

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18% have anxiety disorder.

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Amygdala

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Emotions, especially anger and fear. HPA axis affected, inducing fight or flight.

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Hippocampus

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Memory

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Prefrontal cortex

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Complex cognition.

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Serotonin

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Associated with sleep, mood, appetite, impulsive behaviour.

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5HTTLPR genotype

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2 short alleles associated with reduction in serotonin activity and increase in fear and anxiety behaviours. Can be affected by behavioural inhibitors in environment.

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Negative appraisal

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Interpreting events as threatening

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Anxiety sensitivity

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Fear of physiological changes in body.

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Predictors of anxiety behaviours

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Anxiety sensitivity and negative appraisal.

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Monkeys and self control study

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Monkeys controlling food and water access had less anxiety when exposed to anxiety inducing behaviours.

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Increased risk of anxiety

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Women, those exposed to long term high stress, those with minimal emotional support, those of marginalized groups have increased risk of anxiety.

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Categories of phobia disorders

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Social anxiety, specific phobias, and agoraphobia.

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Social anxiety disorder

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Intense fear of being scrutinized in social or performance situations. Also fear that anxiety symptoms will be humiliating or offend others. Most common types are public speaking and meeting new people. Public speaking only is called performance only type.

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Social anxiety prevalence

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8.7%, twice as likely in women.

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Specific phobia

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Excessive fear of specific objects or situations. Intense fear of panic attacks produced by exposure. Object or situation avoided or endured with great anxiety.

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Specific phobia prevalence

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7-9% 12m prevalence, twice as common in females depending on phobia. Onset in childhood or adolescence.

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Agoraphobia

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Anxiety or panic in situations where escape is difficult or embarassing. Situations nearly always produce panic and are avoided. Onset in late adolescence but sometimes also late in life.

Must include fear of two of following: being outside of home alone, travelling via public transport, being in open spaces, being in store or theatres, standing in line or being in a crowd.

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Agoraphobia prevalence

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1.7% in 12m, more in females.

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Panic disorder

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Recurrent and unexpected intense attacks of fear or terror. Worry about future panic attacks. Can occur with or without agoraphobia. Onset in late adolescence and early childhood.

Involves recurrent unexpected panic attacks in combination with apprehension over having another attack or about the consequences of an attack or changes in behaviour or activities designed to avoid another panic attack.

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Panic disorder prevalence

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2.7% in 12m. 2x more common in females

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Generalized anxiety disorder

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Excessive anxiety and worry over life circumstances. Difficulty controlling worry. Vigilance, muscle tension, restlessness, edginess, and difficulty concentrating. Onset diagnosis is 30, but symptoms begin earlier.

For diagnosis, symptoms must be present majority of days for at least 6m and cause significant distress or impairment.

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Generalized anxiety disorder prevalence

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1.2-2.9% over 12m. Up to 2x more prevalent in females.

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Recovery and SAD

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40% recover, but low as less than 1% in African American and Hispanic populations.

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Primary types of specific phobias

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-Living creatures

-Environmental conditions

-Blood or injections or injury

-Situational factors

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Age of onset for specific phobias

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-7yo for animals

-9yo for blood

-12yo for dental

-20yo for claustrophobia

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Blood phobias as unique

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Associated with fainting as result in initial increase in physiological arousal followed by sudden drop in blood pressure and heart rate. 70% report fainting.

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Agoraphobia onset in elderly

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11% experience first episode after 65. At risk if have severe depression or tendency to be anxious.

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Biological dimension of phobias

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-Heritability of 31%

-Exaggerated amygdala responses to fear, tend to be anxious and have strong emotional responses

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Biological dimension of phobias: Preparedness theory

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Proposes that it is easier for humans to develop fears to which we are physiologically predisposed, as a means of surviving. Evolutionarily prepared fears exist without occurence of traumatizing event. But many phobias do not fit this model, and phobias that are prepared are usually easy to get rid of.

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Psychological dimension of phobias: Classical conditioning

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Little Albert study.

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Psychological dimension of phobias: Observational learning perspective

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-Participants told they were participating in a study, and then watched a video where someone was shocked in response to stimulus. Activation of amygdala marked fear in response to seeing the stimulus.

-Parents told to act anxiously or calmly before child took spelling test. Anxious parent made child more anxious.

-Children mimic peer emotional responses to novel animals.

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Psychological dimension of phobias: Negative information perspective

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Parents given descriptions for an unfamiliar animal and told to describe it to their child. Negative description (animal as dangerous), ambiguous, and positive (animal as cute). Children whose parents received negative description reacted with more fear.

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Psychological dimension of phobias: cognitive behavioural

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Catastrophic thoughts and cognitive distortions may cause strong fears to develop.

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Social dimension of phobias

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-Parental behaviours influence course of behavioural inhibition and development of social anxiety in children. Overprotection of socially withdrawn children and lack of support for independence increases insecurity and decreases practice approaching novel situations.

-Negative family interactions at age 3 and family stress in middle childhood were associated with social anxiety symptoms, as was bullying.

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Sociocultural dimension of phobias

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-Gender differences in specific phobias often for repulsive animals, which can occur because women show stronger disgust responses.

-social anxiety higher in collectivist cultures where individual reflects on whole family or group. Also high in religiously rigid societies like middle East where deviation from norm is punished.

-Taijin Kyofusho: fear of offending or embarrassing others, consistent with emphasis in Japan on interpersonal harmony.

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Biological treatment of phobias

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Benzodiazepines and SSRIs have efficacy for SAD. Benzodiazepines also for specific phobia.

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Cognitive behavioural treatment of phobias: exposure therapy

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Involves gradual and increasingly difficult encounters with feared situation. For fainting in blood phobias, applied tension is added alongside exposure techniques.

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Cognitive behavioural treatment of phobias: systematic desensitization

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Uses muscle relaxation to reduce anxiety associated with phobias. First teach client to relax muscles. Then visualize feared stimuli while in relaxed state.

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Cognitive behavioural treatment of phobias: Cognitive restructuring

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Unrealistic thoughts believed to be responsible for phobias are altered. Goal to label anxiety as normal and redirect attention from self in fearful situations.

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Cognitive behavioural treatment of phobias: Modelling therapy

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Individual with phobia observes model coping with or responding appropriately to the fear producing situation, and may be asked to replicate models interactions.

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Comorbidity for panic disorder

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Comorbidity with depression, generalized anxiety, or substance abuse. Tend to also develop agoraphobia.

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Biological dimension of panic disorder

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32% heritability.

Fewer serotonin receptors.

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Psychological dimension of panic disorder

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-Score high on anxious sensitivity measures and show heightened fear responses to bodily sensations. Display hypervigilance over changes in heart rate, blood pressure, and respiration, which in turn increases anxiety.

-Cycle of physical response, anxiety, increased response results in panic attack.

-Physiological response can be learned via modelling.

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Psychological dimension of panic disorder: cognitive behavioural perspective

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-Physiological change occurs due to outside factors.

-Catastrophic thoughts develop.

-Thoughts bring increased apprehension and fear, resulting in physiological changes.

-Circular pattern develops, amplifying bodily changes and fearful thoughts.

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Social and sociocultural dimensions of panic disorder

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-Stressful childhood with separation anxiety, family conflict, school problems, or loss of a loved one.

-Victim of bullying increases risk of development.

-Environmental stressors interact with biological predisposition.

-Cultural: Asian and Hispanic American adolescents have higher anxiety sensitivity but fewer panic attacks than caucasians as interpret the anxiety differently.

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Biological treatment of panic disorder

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-Benzodiazepines reduce frequency of attacks.

-Also treated with antidepressants, beta blockers.

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Cognitive behavioural treatment of panic disorder

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-Educate client about disorder.

-Identify and correct catastrophic thoughts.

-Teach client to self induce physiological symptoms of panic in order to extinguish the interoceptive conditioning that occurs in response to bodily sensations.

-Encouraging client to face symptoms.

-Teach coping statements.

-Help client identify antecedents of panic.

Front 52

Biological dimension of GAD

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-Genes associated with anxiety are often expressed in terms of neurotransmitter abnormalities or overactivity of the brain regions associated with anxiety.

-PFC modulation of threatening situations may be disrupted in GAD patients.

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Psychological dimension of GAD

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-Lower threshold for uncertainty.

-Erroneous beliefs regarding worry and assume worry is effective way to deal with problems.

-Negative schemas as playing a role in GAD development.

-if stress of regular worry leads to belief that worry is uncontrollable, harmful, and dangerous, GAD develops.

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Social and sociocultural dimensions of GAD

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-Mothers with anxiety symptoms may be less responsive and engaged with infants, increasing likelihood child will develop GAD.

-Conflict in peer relationships, including bullying, can result in GAD.

-Stressful conditions such as poverty or descrimination can contribute to GAD, resulting in high prevalence of GAD in African Americans and Latinos.

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Treatment of GAD: CBT

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-identify worrisome thoughts

-descriminate between worries that are helpful to problem solving and those that are not

-evaluate beliefs concerning worry, including evidence for and against distorted beliefs

-develop self control skills to monitor and challenge irrational thoughts and substitute positive, coping thoughts.

-use muscle relaxation to deal with somatic symptoms

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OCD

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Obsessions are anxiety inducing thoughts, compulsions are an overwhelming need to engage in an activity to counteract anxiety. Consume at least 1h per day and cause significant distress or impairment.

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Common OCD obsessions

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-contamination

-errors or uncertainty

-unwanted impulses

-orderliness

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Comorbidity of obsessions with compulsions

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Only 25% of those with OCD report obsessions without compulsive behaviours

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OCD prevalence

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1.2% over 12m. Equally common in males and females, less common in African, asian and Latino Americans.

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OCD age of onset

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Adolescence or early adulthood. 25% begin by age 14.

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Body dysmorphic disorder

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Distressing and impairing preoccupation with imagined or slight defects in appearance. Results in repetitive behaviours such as checking ones appearance in mirrors, applying makeup to mask flaws, and comparing appearance to others. May be underdiagnosed because person is unwilling to bring attention to these problems.

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Body dysmorphic disorder prevalence

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Equally common in males and females. 2.4%, but up to 15% in those seeing dermatologists.

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Body dysmorphic disorder age of onset

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Early adolescence to early adulthood.

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Trichotillomania

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Repeated pulling out of hair.

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Trichotillomania prevalence

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1-2% over 12m, 4% lifetime, 10x more common in females.

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Trichotillomania age of onset

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Before 17, may periodically reoccur.

Front 67

Excoriation disorder

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Repeated picking at the skin resulting in lesions. At least 1h per day picking, thinking about picking, or resisting it. Episodes preceded by rising tension and results in relief or pleasure.

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Excoriation disorder prevalence

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Lifetime of 1.4%, 75% affected are female.

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Excoriation disorder age of onset

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Adolescence, but can occur at any age.

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Hoarding disorder

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Difficulty discarding items because of perceived need, resulting in cluttered and unsafe living areas.

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Hoarding disorder prevalence

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2-6%. Females more prevalent in clinical samples. 3x more prevalent in older adults.

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Hoarding disorder age of onset

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Begin age 15, clinically significant impairment by 30.

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Ocd comorbidity

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Comorbidity with depression and substance abuse because of distress associated with symptoms.

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What percent of population has OCD-like symptoms?

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1/4

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Hoarding comorbidity with anxiety

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Up to 25% of individuals with anxiety disorders report significant hoarding symptoms.

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Prevalence of BDD in psychiatric hospital patients

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13%

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BDD comorbidity with anxiety

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60% have an anxiety disorder, 38% have social anxiety.

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BDD Outlook/recovery

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After 1y, only 9% have full remission, 21% had partial. But after 8y, 76% had recovered.

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Muscle dysmorphia

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Type of BDD. Belief that ones body is too small or insufficiently muscular.

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Excoriation disorder comorbidity

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BDD and trichotillomania.

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Biological dimensions for OCD disorders

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-increased activity in the orbitofrontal cortex

-Lower activation in caudate nuclei.

-subgroups differ on genetic and biological involvement.

-reduced availability of serotonin and glutamate.

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Genetics and OCD

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4x risk of OCD for close relatives of someone with disorder. Environmental more important in BDD, trichotillomania, excoriation, and hoarding.

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Orbitofrontal cortex and OCD

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When hyperactive, may tell body that something is very wrong rather than just minimally out of place.

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Neurotransmitters and OCD

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SSRIs help treat. Disrupted transmission of glutamate can cause.

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Psychological dimensions of OCD

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-lack of trust in own performance.

-impulse control conflicts.

-anxiety reduction.

-cognitive distortions.

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Sociocultural dimension of OCD

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-equal in males and females

-onset in childhood more common in boys

-cultural differences in obsessions or compulsions

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Social dimension in OCD

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-social vulnerabilities like divorce, separation, unemployment.

-controlling or critical parenting

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Classical conditioning and OCD

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Compulsions help reduce anxiety caused by obsessions so become conditioned stimuli and are reinforced.

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Cognitive factors of OCD

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-exaggerated estimates regarding probability of harm

-control (if unable to control thoughts, will be overwhelmed with anxiety).

-intolerance of uncertainty

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Disconfirmatory bias and OCD

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Search for evidence that show they failed to perform ritual correctly when something goes wrong. Compulsions occur because they are unable to trust own memories or judgement.

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Cognitive explanations for hoarding disorder

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Individuals believe objects collected are extension of self, so feel responsibility towards items.

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Family variables for OCD

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Family variables such as controlling, over critical style of parenting, minimal parental warmth, and discouragement of autonomy associated with OCD symptoms. Perceiving relatives to be critical or hostile increases intensity.

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Adverse environments and OCD

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Individuals in adverse environments may develop maladaptive beliefs relating to personal responsibility. They may believe it is up to them to prevent harm and overestimate threats.

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Biological treatment for OCD

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SSRIs cause partial relief for 60% of people.

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Behavioural treatment of OCD: flooding

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Technique that involves inducing a high anxiety level through continued actual or imagined exposure to a fear arousing situation.

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Behavioural treatment of OCD: Response prevention with exposure therapy

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-Educate about OCD and the rationale for exposure and response prevention.

-Develop the of an exposure hierarchy

-Exposure to feared situations until anxiety has diminished.

-Prevention of the performance of compulsive rituals such as hand washing.

Does not work for 30%.