Week 4 Anxiety, Trauma/Stressor Related Obsessive Compulsive and Related Disorders + 5 Trauma and Stressor Related Disorders Flashcards
What is a panic attack?
Abrupt experience of intense fear where there is no real danger.
Accompanied by physical reactions; heart palpitations, chest pain, shortness of breath, dizziness.
Inspired by the Greek god Pan, who terrified travellers with blood-curdling screams.
What is an unexpected (uncued) panic attack?
A panic attack that might come on at any time, without warning. More common in panic disorder.
What is an expected (cued) panic attack?
A panic attack brought on by a particular situation i.e. heights, driving over long bridges etc. The panic attack only occurs in such situations.
Common to specific phobias and social anxiety.
What are the DSM5 diagnostic criteria for a panic attack?
An abrupt surge of intense fear during four or more of the following occur:
Palpitations, pounding heart
Sweating
Trembling
Shaking
Feeling of choking
Chest pain
Nausea
Dizziness
Chills
Paresthesias (tingling/numbness)
Derealisation
Fear of losing control
Fear of dying
The DSM5 makes it clear that panic attacks often co-occur with other medical conditions i.e. cardio, respiratory, gastrointestinal, and vestibular disorders even though many patients do not meet the criteria for panic.
What is panic disorder?
Recurrent unexpected panic attacks
Anxiety, worry, or fear of another attack
Persists for one month or more
Not attributable to substance use
Not better explained by another mental disorder
What is agoraphobia?
Fear/anxiety of 2+
open spaces, public transportation, enclosed spaces, standing in line, being outside of the house alone
Concern about being unable to escape in event of panic symptoms
Anxiety not proportional to danger
Symptoms for 6+ months that cause excessive impairment
Panic disorder and agoraphobia
Often studied together
2.7% in a given year
4.7% (life)
female: male = 2:1
Typically begins in adolescence/early adulthood
Symptoms wax and wane
Treatment:
Medication (high relapse rates)
CBT; challenge threats through exposure
Combining treatments does not increase effectiveness
Specific phobias
Fear or anxiety about a specific object or situation
Phobic situation is actively avoided
Fear is out of proportion to actual danger
Last 6+ months
Clinically significant distress
Not better explained by another mental disorder
Examples:
Blood-injection-injury phobia
natural environment phobia
animal phobia
situation phobia
12.5% in a given year
8.7% (life)
female:male = 4:1
Typically begins in childhood and has chronic course
What is the behavioural inhibition system (BIS)?
Part of brain activated by signals from the brain stem of unexpected events such as major changes in body functioning that could signal danger.
What is the Fight/Flight System (FFS)?
A circuit that originates in the brain stem and travels through several midbrain areas including the amygdala, ventromedial nucleus of the hypothalamus and the central grey matter. When stimulated in animals it creates a response similar to panic in humans.
Activated by serotonin deficiency. Factors in the environment can also adjust sensitivity of these brain circuits.
What are the biological influences of panic?
Brain circuitry - the brain inhibition system (BIS) and the fight/flight response (FFS).
What are some examples of psychological influences of panic?
Learning that we have or are able to control situations. Children raised in supportive environments have been shown to have a healthy sense of control.
What are some social contributions to anxiety?
Divorce, moving house, new job, death of a loved one, school pressures etc. Such stressors can trigger physical reactions inducing anxiety.
What is the integrative model of anxiety?
That anxiety is influenced by biological, psychological and disorder-specific vulnerabilities. (The Triple Vulnerability Model).
For example, if a parent has a fear of dogs there is an increased likelihood through biological (genes) and psychological (learning) influences that this fear will be passed on.
What is the most common anxiety disorder?
Major depression.
Occurs in approximately 50% of anxiety cases. Thought to be because of the similarity in symptoms.
Describe fear
Fear is the emotional response to real or perceived imminent threat
A flight or fight response results from the arousal of the sympathetic nervous system.
An immediate alarm reaction to danger.
Alarm response
While fear is usually an adaptive response to environmental situations, excessive, exaggerated fear of situations can be maladaptive.
What is anxiety?
A negative mood state characterised by bodily symptoms of physical tension and by apprehension about the future.
A bit of anxiety is good for us as it enhances social, physical and intellectual performance.
What disorders does the DSM5 categorise as anxiety disorders?
Generalised anxiety disorder (GAD)
Panic disorder and agoraphobia
Specific phobias
Social anxiety disorder
Separation anxiety disorder
Selective mutism
Describe the typical demographics for GAD.
Median age of onset is 30 years, but there is a broad range of age of onset.
12-Month Prevalence:
Adults: 2.9%-3.6%
Adolescents: 0.9%
Females: males = 2:1
The symptoms overlap greatly with those of other common mental disorders; and we could regard the disorder as part of a spectrum of mood and related disorders rather than an independent disorder
What are the diagnostic criteria for GAD?
Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
The individual finds it difficult to control the worry.
The anxiety and worry are associated with 3+ 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 one item is required in children.
Restlessness or feeling keyed up or on edge.
Being easily fatigued.
Difficulty concentrating or mind going blank.
Irritability.
Muscle tension.
Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
The anxiety, worry, or physical symptoms (sweating, nausea, diarrhea, and exaggerated startle response) cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks
In panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in post-traumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).
What causes GAD?
Threat:
The world is dangerous, and unpredictable
Patients have a varied and dynamic “worry content”
Routine life matters (e.g. job performance)
Health of family members
Minor matters (household chores, being late for appointments)
Content in clinical and non-clinical worry is similar, difference lies in the severity of the worry
Describe GAD coping behaviours
Approach behaviours
Reassurance seeking
Information seeking
Excessive list-making
Doing everything yourself (refusal to delegate tasks)
Double-checking
Over-preparing
Avoidance
Avoidance of novel/uncertain/spontaneous situations
Procrastination
Maintenance of a predictable routine
Asking others to make decisions for you
Impulsive decision-making
Distraction/keeping busy
Coping
Specific coping responses when experiencing anxiety in GAD not mentioned in DSM
Cognitive or behavioural attempts to reduce anxiety actually present in all anxiety disorders
Uncertainty as theme of threat:
coping will involve attempts to reduce, avoid, or circumnavigate uncertainty
What is the purpose of worrying in GAD?
Worry = strategy to mentally plan and prepare for any eventuality
For example “what if I’m late for an appointment? I might not be able to get another appointment; I could leave early. But what if there is traffic or I get lost?”
Worry as an attempt to reduce uncertainty
What are the common beliefs in anxiety disorders?
Overestimation of threat
Underestimation of coping
Within GAD, this manifests as: “uncertain events will turn out negative”
“when that negative event occurs, I will be unlikely to cope with it”
Consequences of GAD
Worry prevents effective problem solving.
GAD can be self-fulfilling – worrying about the situation may lead to inaction – confirming initial worry.
Best treatment for GAD?
Cognitive therapy
Exposure to the worry process
Coping strategies
Preferably 4 month, 1 time per week
CBT is moderately effective – around 50% show clinically significant change
(e.g., Borkovec & Costello, 1993; Borkovec & Ruscio, 2001; Fisher, 2006)
What are the diagnostic criteria for SAD?
Fear/anxiety about a social situation involving scrutiny by others
Fears of being negatively appraised
Social situations met with intense fear/anxiety
Fear/anxiety out of proportion with actual threat
Lasts 6+ months
Clinically significant distress/impairment
Not better explained by symptoms of another medical condition
Can present as shyness, tantrums, freezing, refusing to speak - sometimes can be restricted to performance i.e. public speaking.
12.1% (life)
6.8% (year)
13.6% in ages 18-29
6.6 in ages 60+
Typically begins in adolescence
What is separation anxiety disorder?
Developmentally inappropriate and excessive anxiety related to separation from home or from those to whom the individual is attached.
Lasts 4+ weeks in children, 6+ months in adults
Clinically significant impairment/distress
4.1% of children meet criteria
Treated with parent training + CBT
Describe selective mutism
Consistent failure to speak in specific situations i.e. school
Interferes with educational/occupational achievement and social communication
Last 1+ month
Not attributable to a lack of knowledge or better explained by a communication disorder.
.3% (year)
Best treated with CBT.
What is the difference between fear and anxiety?
fear is immediate, present-oriented and activates the sympathetic nervous system i.e. sweating, heart palpitations, rapid breathing, urge to run.
anxiety is apprehension and future-oriented with somatic symptoms including muscle tension, restlessness, elevated heart rate.
What is the most common anxiety disorder?
Specific phobias and social anxiety disorder (SAD) both score in excess of 12% prevalence within a given year.
How does culture influence the expression of anxiety?
Different cultures have different interpretations of anxiety.
For example, in Japan Taijin Kyofusho is the fear of offending others
