Chapter 5 - Anxiety and Obsessive Compulsive Related Disorders Flashcards Preview

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Fear vs. Anxiety

Fear: more focused and specific
Anxiety: more diffuse and generalized, both fear and apprehension


What are the anxiety disorders?

*Generalized Anxiety Disorder (GAD)
*Panic Disorder


Characteristics of GAD?

Chronic, prolonged, "free-floating" anxiety and dread


According to DSM, what are the criteria for diagnosis of GAD?

Must report symptoms for at least 6 months


GAD types of symptoms

1) Motor Tension - muscular tension
2) Autonomic Reactivity - increased heart rate, BP, arousal
3) Apprehension about the future - sense of impending doom
4) Hypervigilance


GAD onset

50% of those diagnosed are diagnosed during childhood/adolescence


Panic Disorder characteristics

*Can be cued or un-cued
*Sudden intense arousal - symptoms may resemble heart attack
*Must experience some un-cued episodes


GAD vs. PD

*Onset more abrupt for PD
*Onset typically later for PD (avg 20-24 yrs old)
*More heredity evidence for PD
*Higher rates of alcoholism and depression for PD


What is PD comorbid with?

Comorbid with agorophobia


Characteristics of phobias

Irrational unrealistic fear of an object, event, or situation


How can phobias be acquired?

May begin with real trauma, GAD, or be vicariously acquired (like being around mother who has phobia)


What is the effect of avoidance in a phobia?

When you avoid a feared stimulus, it negatively reinforces the fear and avoidance. Treatment for this is exposure treatment


Phobia subtypes

*Animal type - spiders, snakes, dogs, cats
*Natural environment type - storms, wind, bodies of water, heights
*Blood-injection-injury type - seeing blood/injury, injection, medical procedure, may induce fainting
*Situational type - elevators, tunnels, bridges, flying, driving, enclosed spaces
*Other type - cued by other stimuli, fear of situations that could lead to choking, vomiting, or illness


What is a social phobia? What is the basis?

*Fear and embarrassment (extreme discomfort) around other people
*Basis: fear of being observed and evaluated negatively in our culture
*Most common manifestation: public speaking and meeting new people


What is Taijin Kyofusho?

Japanese social anxiety disorder about offending or embarrassing other people


Diagnosis requirements for Taijin Kyofusho?

*Fear of blushing
*Fear of emitting odors or being flatulent
*Fear of staring inappropriately
*Fear of making inappropriate facial expressions
*Fear of having physical deformity


What is agoraphobia?

Fear of open spaces, the marketplace, novel situations, losing control in public
*Onset: 20-40s, more common among females
*Co-morbid with PTSD and GAD


What is the difference between compulsions and obsessions?

Obsessions: Intrusive, unwanted, related thoughts
Compulsions: repetitive acts/behaviors


What is "magical thinking"?

Thoughts during OCD that defy logic - patient believes performing the compulsion will enable them to control their outcomes, reduces anxiety


Common forms of compulsions?

Counting, ordering/organizing, checking (locks at front door), touching, washing/cleaning


What is hoarding? How is it categorized?

Collecting and keeping a large amount of things
*Now is its own category in DSM-5 as an OCD-related disorder, used to just be a compulsion


OCD Onset

Late adolescence to early adulthood


OCD Prevalence

Equal among males and females, more common with higher income and intellectual functioning


What are OCD spectrum disorders?

Disorders that co-vary with rates of OCD - co-morbid with OCD or run in OCD families (trichotillomania, motor tics) - characterized by problems with impulse control


What is body dysmorphic disorder?

Preoccupation with perceived defect in appearance - exaggerated or imagined flaws


When is BDD diagnosed?

When it causes significant distress or impairment of functioning


Gender differences in BDD?

Equal prevalence between genders, but differ by sites:
*Males: body build, genitalia, hair, height
*Females: breasts, hips, thighs, weight


BDD Onset

Early adolescence to early adulthood


What is the course of BDD?

Will continue without treatment


Comorbidity with BDD

* ~1/3 with BDD also have OCD
*Social anxiety disorders
*Avoidant personality disorders
*Major depression and suicidality
*Substance abuse


How does BDD differ with culture?

*American men vs Taiwanese men - Americans express significantly more body dissatisfaction than Taiwanese men
*College students in Germany vs. US - Germany: 5.3%, US: 13% with BDD symptoms


Basis of behavioral treatment of anxiety/OCD?

If anxiety is learned and avoidance negatively reinforces these behaviors, anxiety can also be extinguished by removing this reinforcement


What are exposure treatments?

*Systematic desensitization: gradual exposure to source of anxiety - establish fear hierarchy, train in relaxation, "walk-through" hierarchy
*Reciprocal inhibition - underlying principle is that two incompatible responses cannot coexist and that they would reciprocally inhibit one another


What is flooding?

Sudden, intense exposure to fear. Person must remain with stimulus until anxiety subsides, so that avoidance is not negatively reinforced


What is virtual reality exposure?

Virtual stimulus exposure - seems to work by classical conditioning


What is exposure response prevention therapy (ERP)?

For OCD treatment - expose patient to anxiety of obsession and prevent compulsive behavior


What is modeling?

Observing someone engaging in desired behavior - most effective in participant modeling where they watch a model, then work up to a point when participant can do the behavior


What is cognitive restructuring?

Learning to "construct" situations differently


What is thought-stopping?

1) Train participant to recognize maladaptive thoughts
2) Teach to tell self "stop" when they come up


What is cognitive rehearsal?

Anticipates anxiety-provoking situation and rehearses thought process to do when situation occurs


What is acceptance commitment therapy?

"3rd gen" cog therapy
*Acceptance: accept and not avoid thoughts/feelings
*Mindfulness: be present in the moment, increased awareness of what is current
*Studies: ACT is effective for mild to moderate anxiety problems


Biological treatments for anxiety and OCD

*Drug treatments
*Anxiolytics (GAD, panic, phobias)
*Antidepressants like SSRIs (most commonly for OCD, panic)