Chapter 6 Flashcards

Question

Phobic disorders, or phobias

Answer 1

The most common anxiety disorder. A phobia is a persistent and disproportionate fear of some specific object or situation that presents little or no actual danger and yet leads to a great deal of avoidance of these weird situation’s

Answer 2

1. Specific phobia 2. Social phobia 3. Agoraphobia

Answer 3

Said to be present if a person shows a strong and persistent fear that is triggered by the presence of a specific object or situation and leads to significant distress and or impairment in a persons ability to function

Answer 4

They often show an immediate fear response that often resembles a panic attack except for the existence of a clear external trigger. These individuals also experience anxiety if they anticipate they may encounter a phobic object or situation and so go to great lengths to avoid encounters with their phobic stimulus. They often even avoid seemingly harmless representations of it such as photographs or images.

Answer 5

People with specific phobias recognize that their fear is somewhat excessive or unreasonable although occasionally they may not have this insight

Answer 6

Avoidance is characteristic of phobias. It occurs both because the phobic response itself is so unpleasant and because of the phobic person‘s irrational appraisal of the likelihood that something terrible will happen

Answer 7

They are overcome with fear or anxiety, which may vary from mild feelings of apprehension and distress, usually well still at some distance, to full fledged activation of the fight or flight response.

Answer 8

Phobic behaviour tends to be reinforced because every time the person with a phobia avoids a feared situation, their anxiety decreases. Also the secondary benefits derived from being disabled, such as increased tension, sympathy, and some control over the behaviour of others, can also sometimes reinforce a phobia

Answer 9

Occurs in approximately 3 to 4% of the population. People with this phobia typically experience at least as much discussed as fear. They also show a unique physiological response when confronted with the site of blood or injury. Rather than showing the simple increase in heart rate and blood pressure scene when most people with phobias encounter their phobic object, these people show an initial acceleration, followed by a dramatic drop in both heart rate and blood pressure. This is very frequently accompanied by nausea, dizziness, or fainting, which does not occur with other specific phobias. People with this phobia demonstrate this unique physiological response pattern only in the presence of blood and injury stimuli. They exhibit the more typical physiological response pattern characteristics of the fight or flight response to their other feared objects

Answer 10

The unique physiological response pattern may have evolved for a specific purpose: by fainting, the person being attacked might inhibit further attack, and if an attack did occur, the drop in blood pressure it would minimize blood loss. This type of phobia appears to be highly heritable

Answer 11

Specific phobias are common, occurring in about 12% of people at some point in their lifetime,. Phobias are much more common in women than men, although the gender ratio varies by type of phobia. 90 to 95% of people with animal phobias are women, but the gender ratio is less than 2 to 1 for blood injection injury phobias

Answer 12

Animal phobias usually begin in childhood, as do blood injection injury phobias and dental phobias. Other phobias such as claustrophobia and driving phobia tend to begin in adolescence or early adulthood

Answer 13

These range from deep-seated psychodynamic conflicts, has seen from a psychoanalytic viewpoint, or straightforward traumatic conditioning of fear

Answer 14

According to the psychoanalytic view, phobias represent a defence against anxiety that stems from repressed impulses from the id. Because it is too dangerous to know the repressed impulse, the anxiety is displaced onto some external object or situation that has some symbolic relationship to the real object of the anxiety. Criticisms: this account may be too speculative, so a simpler account from learning theory was proposed

Answer 15

Six to explain the development of phobic behaviour through classical conditioning. The fear response can be conditioned to previously neutral stimuli when these stimuli are paired with traumatic or painful events. Once acquired, phobic fears could generalize to other similar objects or situations

Answer 16

Simply watching a phobic person behaving fearfully with their phobic object can be distressing to the observer and can result in fear being transmitted from one person to another through vicarious or observational classical conditioning. Also watching a non-fearful person undergoing a frightening experience can also lead to vicarious conditioning.

Answer 17

Individual differences in life experiences strongly affect whether conditioned fears or phobias actually develop. Some life experiences may serve as risk factors and make certain people more vulnerable to phobias than others, whereas other experiences may serve as protective factors for the development of phobias. this is also true for vicarious learning. Certain aspects of the conditioning experience and our response to it are also important in determining the level of fear that is conditioned. Also our cognitions or thoughts can help maintain our phobias once they have been acquired. People with phobias are constantly on the alert for their phobic objects or situations and other stimuli but non-phobic persons tend to direct their attention away from threatening stimuli. Phobics also over estimate the probability that feared objects have been or will be followed by frightening events. This cognitive bias may help maintain or strengthen phobic fears with the passage of time

Answer 18

Revolutionary history has affected which stimuli we are most likely to come to fear. Primates and humans seem to be evolutionarily prepared to rapidly associate certain objects, such as snakes spiders water and enclosed spaces, with frightening or unpleasant events. This prepared learning occurs because, over the course of evolution, these primates and humans who rapidly acquired fears of certain objects or situations that posed real threats to our early ancestors may have enjoyed a selective advantage.

Answer 19

Over the course of evolution, primates and humans who rapidly acquired fears of certain objects or situations that pose real threats to our early ancestors may have enjoyed a selective advantage. Thus, prepared fears are not inborn or innate but rather are easily acquired or especially resistant to extinction.

Answer 20

It was found that fear is conditioned more effectively to fear relevant stimuli then to fear irrelevant stimuli. Also once the individuals acquired the conditioned responses to fear relevant stimuli, these responses could be elicited even when the fear relevant stimuli were presented subliminally. This subliminal activation of responses to phobic stimuli may help to account for certain aspects of the irrationality of phobias. I.e. people with phobias may not be able to control their fear because the fear may arise from cognitive structures that are not under conscious control

Answer 21

Lab reared monkeys in a vicarious conditioning paradigm can easily acquire fears of fear relevant stimuli but not of fear irrelevant stimuli. Thus, both monkeys and humans seem selectively to associate certain fear relevant stimuli with threat or danger. These monkeys had no prior exposure to any of the stimuli involved, supporting the evolutionary-based preparedness hypothesis even more strongly than the human experiments

Answer 22

Genetic and temperamental variables also affect the speed and strength of conditioning of fear.

Answer 23

It was found that individuals who are carriers of one of the two variants of the serotonin transporter gene, the S allele which has been linked to heightened neuroticism, show superior fear conditioning than those without the S allele. However those with one of the two variants of a different gene, the COMT met/met genotype, did not show superior conditioning but did show enhance resistance to extinction.

Answer 24

It was found that behaviourally inhibited toddlers, who are excessively timid, shy, easily distressed etc., at 21 months of age were at higher risk of developing multiple specific phobias by 7 to 8 years of age then were uninhibited children

Answer 25

Large twin studies show that monozygotic, identical twins are more likely to share animal phobias and situational phobias, such as heights or water, then were dizygotic, non-identical twins. However the same studies also found that non-shared environmental factors such as individual specific experiences not shared by twins play a substantial role in the origins of specific phobias, a result that supports the idea that phobias are learned behaviours. Another study found that the heritability of animal phobias was separate from the heritability of complex phobias such as social phobia and agoraphobia

Answer 26

Exposure therapy is the most effective treatment for specific phobias. It is a form of behaviour therapy that involves controlled exposure to the stimuli or situations that elicit phobic fear. In Exposure therapy, clients are encouraged to gradually expose themselves, either alone or with the aid of a clinician or friend, to their feared situation for long enough periods of time so that their fear begins to subside.

Answer 27

A variant of exposure therapy. It is often more effective than exposure alone. Hear the therapist calmly models ways of interacting with the phobic stimulus or situation. These techniques enable clients to learn that these situations are not as frightening as they had thought and that their anxiety, well unpleasant, is not harmful and will gradually dissipate. The new learning is believed to be mediated by changes in brain activation in the amygdala, which is essentially involved in the emotion of fear

Answer 28

For these phobias, exposure therapy is often highly effective when administered in a single long session of up to three hours. This can be an advantage because some people are more likely to seek treatment if they have to go only once. This treatment has also been shown to be highly effective in youths with specific phobias

Answer 29

Psychologists have begun to use virtual reality to simulate different kinds of phobic situations. Controlled studies have yielded very promising results and show results comparable to those seen with live exposure

Answer 30

Do use of cognitive restructuring techniques alone has not produced results as good as those using exposure-based techniques, and the addition of cognitive techniques to exposure therapy has generally not added much. Medication treatments are in effective by themselves, and there is even some evidence that anti-anxiety medication‘s may interfere with the beneficial effects of exposure therapy. Recently however studies have shown that a drug called D-cycloserine, Which is known to facilitate extinction of conditioned fear in animals, can enhance the effectiveness of exposure therapy for fear of heights in a virtual reality environment; this drug by itself however it has no effect

Answer 31

A.k.a. social anxiety disorder. Characterized by disablebling fears of one or more specific social situations such as public speaking, urinating in a public bathroom, or eating or writing in public. In these situations, a person fears that she or he may be exposed to the scrutiny and potential negative evaluation of others or that they may act in an embarrassing or humiliating manner. Because of their fears, people with social phobia avoid the situation or endure them with great distress. There are two subtypes of social phobia

Answer 32

The DSM – five identifies to subtypes of social phobia. One centres on performance situation such as public speaking and one is more general and includes non-performance situation such as eating in public. People with the more general subtype of social phobia often have a significant fears of most social situation rather than simply a few and often also have a diagnosis of avoidant personality disorder

Answer 33

Intense fear of public speaking is the single most common type of social phobia

Answer 34

Approximately 12% of the population meets the diagnostic criteria for social phobia at some point in their lives. It is more common among women and typically begins during adolescence or early adulthood. 2/3 of people with social phobia suffer from one or more additional anxiety disorders at some point in their lives and 50% also suffer from a depressive disorder at the same time. 1/3 abuse alcohol to reduce anxiety. People with social phobia on average have lower employment rates and lower socioeconomic status, and about 1/3 have severe impairment in one or more domains of their life. The disorder is persistent, with one study finding that only about a third recover spontaneously over a 12 year period

Answer 35

Like specific phobias social phobia generally involves learned behaviours that have been shaped by revolutionary factors. Such learning is most likely to occur in people who are genetically or temperamentally at risk

Answer 36

Social phobia often seems to originate from simple instances of direct or vicarious classical conditioning such as experiencing or witnessing a perceived social defeat or humiliation, or being or witnessing the target of anger or criticism. Studies show people with social phobia recall and identify direct traumatic experiences is having been involved in the origin of their social phobias. Another study reports a large percent of people with social phobia reported a history of severe teasing in childhood. People with social phobia show especially robust conditioning of fear when the unconditioned stimulus was socially relevant as opposed to more non-specifically negative stimuli. Another study showed 96% of people with social phobia remembered some socially traumatic experience that was linked to their own current image of themselves in socially phobic situations. Keep in mind that not everyone who experiences direct or vicarious conditioning in social situations develops social phobia. Individual differences play a part

Answer 37

Social fears and phobia involve fears of members of one’s own species. It has been proposed that social fears and phobia evolved as a byproduct of dominance hierarchy‘s that are a common social arrangement among animals such as primates. Dominance hierarchy‘s are established through aggressive encounters between members of a social group and a defeated individual typically displays fear and submissive behaviour but only rarely attempts to escape the situation completely, similarly to people with social phobia who endure being in their feared situation rather than running away. Humans have an Evolutionarily faced predisposition to acquire fears of social stimuli that signal dominance and aggression from other humans, which may include facial expressions of anger or contempt.

Answer 38

A study demonstrated that subjects develop stronger conditioned responses when slides of angry faces are paired with mild electric shocks then when happy or neutral faces are paired with the same shocks. Even very brief subliminal presentations of the angry face that had been paired with shock were sufficient to activate the conditioned responses, probably because even these subliminal angry faces activate the amygdala. People who have social phobia showed greater activation of the amygdala in response to negative facial expressions than normal controls. This may help explain the seemingly irrational quality of social phobia, in the angry faces are processed very quickly and an emotional reaction can be activated without a persons awareness of any threat

Answer 39

Being exposed to uncontrollable and unpredictable stressful events may play an important role in the development of social phobia. Perceptions of uncontrollability and unpredictability often lead to submissive and on assertive behavior, which is characteristic of people who are socially anxious or phobic. This kind of behaviour is especially likely if the perceptions of uncontrollability stemmed from an actual social defeat. People with social phobia have a diminished sense of personal control over events in their lives. This may develop at least in part as a function of having been raised in families with somewhat overprotective parents

Answer 40

Cognitive factors also play a role in the onset and maintenance of a social phobia. It has been suggested that people with social phobia tend to expect that other people will reject or negatively evaluate them. This leads to a sense of vulnerability when they are around people who might pose a threat. It has been proposed that these danger schemas of socially anxious people lead them to expect that they will behave in an awkward and unacceptable fashion, resulting in rejection and loss of status. This leads to their being preoccupied with bodily responses and stereotypical negative self images in social situations, to over estimating how easily others will detect their anxiety, and to miss understanding how well they come across to others. This interferes with their ability to interact skillfully. They vicious cycle may evolve, confirming the cognitive bias. Another cognitive bias is a tendency to interpret ambiguous social information in a negative rather than a benign manner. It is also been suggested that these biased cognitive processes combine to maintain social phobia and possibly even contribute to the development

Answer 41

Most important temperamental variable is behavioural inhibition, which shares characteristics with both neuroticism and introversion. Behaviourally inhibited infants who are easily distressed by unfamiliar stimuli and who are shy and avoidant are more likely to become fearful during childhood and adolescence to show increased risk of developing social phobia

Answer 42

One classic study was connected on behavioural innovation as a risk factor in a large group of children, most of him were already known to be at risk for anxiety because their parents had an emotional disorder. Those who had been assessed as being high on behavioural inhibition between two and six years of age were nearly 3 times more likely to be diagnosed with social phobia even in middle childhood then we’re children who are low on behavioural inhibition at 2 to 6 years. Results from twin studies have shown that there is a modest genetic contribution to social phobia. Estimates are that about 30% of the variance in liability to social phobia is due to genetic factors. However these studies suggest that an even larger proportion of variance and who develops social phobia is due to non-shared environmental factors which is consistent with a strong role for learning

Answer 43

Treatment centre around both cognitive and behavioural therapy’s and sometimes involve medication

Answer 44

Prolonged and graduated exposure to the feared situation has proven to be a very effective treatment. Cognitive restructuring techniques have been added to the behavioural techniques, generating a form of cognitive behavioural therapy. Many studies over the years have shown that exposure therapy and cognitive behavioural therapy produce comparable results. However one study suggests that this new very effective variant and cognitive treatment may be more effective than exposure therapy. At least one study has now shown that simply training individuals with social phobia to disengage from negative social cues during a 15 minute lab task that is repeated eight times over 4 to 6 weeks produced such remarkable reductions in social anxiety symptoms that nearly 3 out of four of the participants no longer met the criteria for social phobia

Answer 45

In cognitive restructuring the therapist attempts to help clients with social phobia identify their underlying negative, automatic thoughts. After helping clients understand that such automatic thoughts often involve cognitive distortions, the therapist helps the clients change these inner thoughts and beliefs through logical reanalysis. A process of logical reanalysis might involve asking oneself questions to challenge the automatic thoughts

Answer 46

Social phobia can sometimes be effectively treated with medications. The most effective and widely used medications are several categories of antidepressants. In some studies the effects of these antidepressant medications have been comparable to those seen with cognitive behavioural treatments. However in several studies the newer version of cognitive behaviour therapy produced much more substantial improvement than the medication. Also the medication‘s must be taken over a long period of time to help ensure relapse does not occur. Several studies have also suggested that when D- cycloserine is added to exposure therapy the treatment gains occur more quickly and are more substantial

Answer 47

They generally produce more long lasting improvement with very low relapse rates. Clients often continue to improve after treatment is over

Answer 48

Panic disorder is defined and characterized by the occurrence of panic attacks that often seem to come out of the blue. Panic attacks are fairly brief but intense, with symptoms developing abruptly and usually reaching peak intensity within 10 minutes. The attacks often subside in 20 to 30 minutes and rarely last more than an hour. Periods of anxiety, by contrast, do not typically have such an abrupt onset and are more long lasting

Answer 49

According to the DSM five criteria for panic disorder, the person must have experienced recurrent, unexpected attacks and must’ve been persistently concerned about having another attack or worried about the consequences of having an attack for at least a month. For such an event to qualify as a full-blown panic attack, there must be abrupt onset of at least four of 13 symptoms. Most of these symptoms are physical although three are cognitive

Answer 50

Panic attacks are often unexpected or UnCute in the sense that they do not appear to be provoked by identifiable aspects of the immediate situation. They sometimes occur in situations in which they might be least expected, such as during relaxation or sleep. In other cases they are said to be situationally predisposed, occurring only sometimes while the person is in a particular situation such as well driving a car or being in a crowd

Answer 51

Because most symptoms of a panic attack or physical, as many as 85% of people having a panic attack may show up repeatedly at ERs or doctors offices for what they are convinced is a medical problem, usually cardiac respiratory or neurological. The correct diagnosis is often not made for years due to the normal results on numerous medical tests. Further complications may arise because patients with cardiac problems are at a nearly twofold elevated risk for developing panic disorder. Prompt diagnosis and treatment are also important because panic disorders cause approximately as much impairment in social and occupational functioning is that caused by major depressive disorder, and panic disorder can contribute to the development or worsening of a variety of medical problems

Answer 52

1. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. 2. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated 3. The social situations almost always provoke fear or anxiety 4. Social situations are avoided or injured with intense fear or anxiety 5. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the social cultural context 6. The fear, anxiety or avoidance is persistent, typically lasting for six months or more 7. The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning 8. If you’re, anxiety or avoidance is not attributable to the physiological effects of a substance or another medical condition 9. I fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder 10. If another medical condition is present, fear, anxiety or avoidance is clearly unrelated or is excessive

Answer 53

A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the following symptoms occur: 1. Palpitations, pounding heart or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feelings of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, Unsteady, light headed or faint 9. Chills or heat sensations 10. paresthesias (numbness or tingling sensations) 11. Derealization (feelings of unreality) or depersonalization (being detached from oneself) 12. Fear of losing control or going crazy 13. Fear of dying B. At least one of the attacks has been followed by one month or more of one of the following: 1. Persistent concern or worry about additional panic attacks were the consequences 2. A significant maladaptive change in behaviour related to the attacks C. The disturbance is not attributable to the physiological effects of a substance or another medical condition D. The disturbance is not better explained by another mental disorder

Answer 54

Numbness or tingling sensations

Answer 55

Feelings of unreality

Answer 56

Being detached from oneself

Answer 57

Most commonly feared and avoided situations include streets and crowded places such as shopping malls, movie theatres and stores. Standing in line can be particularly difficult. Sometimes agoraphobia develops as a complication of having panic attacks in one or more such situation. Concerned that they may have a panic attack, people with agoraphobia or anxious about being in places or situations from which escape would be difficult or embarrassing or immediate help would be unavailable if something bad happened. Typically people with agoraphobia are also frightened by their own bodily sensations so they avoid activities that will create sensations of arousal

Answer 58

As agoraphobia first develops, people tend to avoid situations in which attacks have occurred, but usually the avoidance gradually spreads to other situations where attacks might occur. In moderately severe cases people with agoraphobia may be anxious even when venturing outside their homes alone. In very severe cases, agoraphobia is an utterly disabling disorder in which a person cannot go beyond the narrow confines of home, or even particular parts of the home

Answer 59

Agoraphobia is a frequent complication of panic disorder. However many patients with agoraphobia do not experience panic, so in DSM-V agoraphobia is now listed as a distinct disorder. Is agoraphobia develops there is often a gradually spreading fearfulness in which more and more aspects of the environment outside of the home become threatening. Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individuals presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned

Answer 60

Approximately at 4.7% of the adult population has had panic disorder with or without agoraphobia at sometime in their lives, with panic disorder without agoraphobia being more common

Answer 61

Panic disorder with or without agoraphobia typically begins in the 20s to the 40s, but sometimes begins in the late teen years. Once panic disorder develops, it tends to have a chronic and disabling course, although the intensity of symptoms often waxes and Wayne’s overtime. Indeed one 12 year longitudinal study found that less than 50% of patients with panic disorder with agoraphobia had recovered in 12 years, and 58% of those who had recovered at some point had had a reoccurrence

Answer 62

Panic disorder is about twice as prevalent in women as in men. Agoraphobia also occurs much more frequently in women than men and the percentage of women increases as the extent of agoraphobic avoidance increases. Among people with severe agoraphobia, approximately 80 to 90% or female.

Answer 63

The explanation is a sociocultural one. In our culture, it is more acceptable for women who experience panic to avoid the situations they fear and to need a trusted companion to accompany them when they enter fear situations. Men who experience panic are more prone to tough it out because of societal expectations and they’re more assertive, instrumental approach to life. Some evidence indicates that men with panic disorder may be more likely to self medicate with nicotine or alcohol as a way of coping with and enduring panic attacks rather than developing agoraphobic avoidance

Answer 64

A. Marked fear or anxiety about two or more of the following five situations: 1. Using public transportation 2. Being in open spaces 3. Being in enclosed spaces 4. Standing in line or being in a crowd 5. Being outside of the home alone B. The individual fears or avoids these situations because of thoughts escape might be difficult or help might not be available in the event of developing panic like symptoms or other incapacitating or embarrassing symptoms C. The agoraphobic situation’s almost always provoke fear or anxiety D. The agoraphobic situation’s are actively if we did, require the presence of a companion, where are injured with intense fear or anxiety E. I fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situation and to the socio-cultural context F. The fear, anxiety or avoidance is persistent, typically lasting for six months or more G. The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning H. If another medical condition is present, fear, anxiety or avoidance is clearly excessive I. The fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder. For example the symptoms are not confined to a specific phobia, situational type; do not involve only social situations; and are not related exclusively to obsessions, perceived defects or flaws in physical appearance, reminders of traumatic events, or fear of separation

Answer 65

The vast majority of people with panic disorder have at least one comorbid disorder, most often generalized anxiety disorder, social phobia, specific phobia, PTSD, depression, and substance use disorders. Depression is especially common among those with panic disorder, approximately 50 to 70% of people with panic disorder experience serious depression at some point. They may also meet criteria for dependent or avoidant personality disorder. Panic disorder is a strong predictor of suicidal behavior.

Answer 66

The link between panic and suicidal behaviour is largely explained by the presence of comorbid disorders such as depression and substance abuse, leading researchers to conclude that panic itself doesn’t increase the risk of suicidal behavior. However other recent studies have found that panic disorder is indeed associated with increased risk for suicidal ideation and attempts independent of its relationship with comorbid disorders

Answer 67

The first one frequently occurs following feelings of distress or some highly stressful life circumstance such as loss of a loved one, loss of an important relationship, loss of a job, or criminal victimization. Some studies have estimated that approximately 80 to 90% of people report that their first panic attack occurred after one or more negative life events. Not all people who have a panic attack following a stressful event go on to develop full-blown panic disorder. About 23% of adults have experienced at least one panic attack in their lifetimes but most do not develop panic disorder.

Answer 68

Biological causal factors include genetics, brain activity, and bio chemical abnormalities

Answer 69

Panic disorder has a moderate heritable component. In a twin study, it was estimated that 30 to 34% of the variance in liability to panic symptoms is due to genetic factors. This genetic vulnerability is manifested at a psychological level by the important personality trait called neuroticism. Several studies have begun to identify which specific genetic polymorphisms are responsible for this moderate irritability, either alone or in interaction with certain types of stressful life events. Twin studies suggest there is overlap in the genetic vulnerability factors for panic disorder, phobias and separation anxiety. But another study suggests overlap in the genetic vulnerability for a panic disorder, generalized anxiety disorder, and agoraphobia. Further research is needed

Answer 70

An early prominent theory implicated the locus coeruleus in the brainstem and a particular neurotransmitter, norepinephrine, that is essentially involved in brain activity in this area. Now it is known that the amygdala plays a more essential role

Answer 71

Today it is recognized that it is increased activity in the amygdala that plays a more central role in panic attacks than activity in the locus coeruleus. Stimulation of the central nucleus of the amygdala is known to stimulate the locus coeruleus as well as the other autonomic, Nuro endocrine, and behavioural responses that occur during panic attacks. Other recent research has also implicated the periaqueductal gray area in the midbrain

Answer 72

A collection of nuclei in front of the hippocampus in the Olympic system of the brain that is critically involved in the emotion of fear

Answer 73

Some research has it suggested that the amygdala is the central area involved in what has been called a fear Network, with connections not only to lower areas in the brain like the locus coeruleus, but also to higher brain areas like the prefrontal cortex. According to this view, panic attacks occur when they fear Network is activated, either by cortical inputs or by inputs from lower brain areas. According to this influential theory, panic disorder is likely to develop in people who have abnormally sensitive fear networks that get activated too readily to be adaptive, this theory is also consistent with findings that individuals with panic disorder showed heightened startle responses to loud noise stimuli as well as slower habituation of such responding. Abnormally sensitive fear networks may have a partially heritable basis but may also develop as a result of repeated stressful life experiences, particularly early in life

Answer 74

People with panic disorder also become anxious about the possibility of another attack, and those with agoraphobia also engage in phobic avoidance behavior. Different brain areas are probably involved in these different aspects of panic disorder. The panic attacks themselves arise from activity in the amygdala. For people who go on to develop significant condition anxiety about having another attack, the hippocampus, also a part of the limbic system, is thought to generate this condition anxiety and is probably also involved in the learned avoidance associated with agoraphobia. The cognitive symptoms that occur during panic attacks and over reactions to the danger are likely to be mediated by higher cortical centres

Answer 75

A study argued that panic attacks are alarm reactions caused by biochemical dysfunctions, showing that people with panic disorder are much more likely to experience panic attacks when they are exposed to various biological challenge procedures. Two primary neural transmitter systems are most implicated in panic attacks: the noradrenergic and the serotonergic systems.

Answer 76

Different types of laboratory tests that may involve infusions of sodium lactate, inhaling air with altered amounts of carbon dioxide, or ingesting large amounts of caffeine. Such procedures produce panic attacks and panic disorder clients at a much higher rate than in normal subjects. Some of these procedures are associated with quite different and even mutually exclusive no biological processes. Therefore no single neurobiological mechanism could possibly be implicated. What all of these biological challenge procedures have in common is that they put stress on certain neurobiological systems, which intern produce intense physical symptoms of arousal.

Answer 77

Noradrenergic activity in certain brain areas can stimulate cardiovascular symptoms associated with panic. Increased serotonergic activity also decreases noradrenergic activity. This fits with results showing that medication‘s most widely used to treat panic disorder today, SSR eyes, seem to increase serotonergic activity in the brain but also to decrease noradrenergic activity. By decreasing noradrenergic activity, these medication‘s decrease many of the cardiovascular symptoms associated with panic that are ordinarily stimulated by noradrenergic activity

Answer 78

The inhibitory neurotransmitter GABA has also been implicated in the anticipatory anxiety that many people with panic disorder have about experiencing another attack. GABA is known to inhibit anxiety and has been shown to be abnormally low in certain parts of the cortex in people with panic disorder

Answer 79

The cognitive theory of panic disorder proposes that people with panic disorder are hypersensitive to their bodily sensations and are very prone to giving them the most dire interpretation possible. This is a tendency to catastrophize about the meaning of a persons bodily sensations. These very frightening thoughts may cause many more physical symptoms of anxiety, which further fuelled the catastrophic thoughts leading to a vicious circle culminating in a panic attack. The person is not necessarily aware of making these catastrophic interpretations. These automatic thoughts are the triggers of panic. The cognitive model proposes that only people with this tendency to catastrophize go on to develop panic disorder.

Answer 80

People with panic disorder are much more likely to interpret their bodily sensations in a catastrophic manner, and the greater the tendency to do so, the greater the severity of panic. The cognitive model also predicts that changing their cognitions about their bodily symptoms should reduce or prevent panic. Evidence that cognitive therapy for panic works is consistent with this prediction. Also a brief explanation of what to expect in a panic provocation study can prevent or reduce panic symptoms

Answer 81

Suggests that initial panic attacks become associated with initially neutral internal and external cues through an Interoceptive conditioning or exteroceptive conditioning process, which leads Anxiety to become conditioned to these CSs. The more intense the panic attack, the more robust conditioning that will occur. Other types of instrumental and avoidance learning are also involved. This conditioning of anxiety sets the stage for the development of anticipatory anxiety and sometimes agoraphobic fears. Another important effect is that panic attacks themselves are also likely to be conditioned to certain internal cues

Answer 82

When people experience their initial panic attacks, interoceptive and exteroceptive Conditioning can occur to different kinds of cues, arranging from heart palpitations and dizziness to shopping malls. Because anxiety becomes conditioned to these CSs, anxious apprehension about having another attack, particularly in certain contacts, may develop, as me agoraphobic avoidance of context in which panic attacks might occur in a subset of individuals. Once an individual has developed panic disorder, that person shows a greater generalization of conditioned responding to other similar cues then do controls without panic disorder. Extinction of conditioned anxiety responses occurs more slowly than in normal controls.

Answer 83

Because extinction involves inhibitory learning, which seems to be impaired in panic disorder, it is not surprising that individuals with panic disorder also show impaired discriminative conditioning because of their deficits in learning that a CS is a safety cue

Answer 84

Panic attacks themselves are likely to be conditioned to certain internal cues. This leads to the occurrence of panic attacks that seemingly come out of the blue when people unconsciously experience certain internal bodily sensations. Example: panic attacks occurring when heart is racing, which can occur when someone is happy and excited, and also frightened. Also some people even have panic attacks well not consciously focussed on their internal state at all, even while sleeping. This theory explains why only certain people with certain genetic, temperamental or personality, or cognitive behavioural vulnerabilities will show stronger conditioning of both anxiety and panic

Answer 85

Approximately 50 to 60% of people report that they have experienced a panic attack during sleep at least once. Nocturnal panic refers to waking from sleep in a state of panic. It seems to occur with some regularity in about 20 to 40% of people with panic disorder and is frequently associated with insomnia and frequent awakenings during sleep. It does not typically occur in response to nightmares. Nocturnal panic attacks typically occur during stage two and early stage three sleep, usually a few hours after falling asleep, in sleep stages were dreaming does not occur. It is also important to note that nocturnal panic attacks are different from sleep terrors or night terrors, Which occurred during stage four sleep. Nocturnal panic attacks also differ from isolated sleep paralysis, which occurs during the transition from sleep to waking

Answer 86

A trait like a belief that certain bodily symptoms may have harmful consequences. People with high levels of anxiety sensitivity are more prone to developing panic attacks and perhaps panic disorder. People with anxiety and sensitivity endorse statements such as when I noticed that my heart is beating rapidly, I worry that I might have a heart attack. Anxiety sensitivity has been shown to predict the development of panic attacks and the onset of other anxiety disorders

Answer 87

Simply having a sense of perceived control reduces anxiety and even blocks panic. If a person with panic disorder is accompanied by a safe person when undergoing a panic provocation procedure, that person is likely to show a reduced distress, lowered physiological arousal, and reduced likelihood of panic relative to someone who came alone. Also anxiety sensitivity has a greater affect on panic symptoms and people with low perceived control. People with panic disorder may also be protected against the development of agoraphobic avoidance if they have relatively high levels of perceived control over their emotions and threatening a situations

Answer 88

Evidence suggests that such disconfirmation does not occur because people with panic disorder frequently engage in safety behaviours such as breathing slowly before or during an attack. They then mistakenly tend to attribute the lack of catastrophe to their having engaged in this safety behaviour rather than to the idea that panic attacks actually do not lead to heart attacks. Research suggests that it is important during treatment to identify these safety behaviours so that the person can learn to give them up and finally see that the feared catastrophe still does not occur. Studies have found that asking people to drop their safety behaviours during cognitive behavioural treatment can increase the effectiveness of the treatment

Answer 89

People with panic disorder are biased in the way they process threatening information. These people not only interpret ambiguous bodily sensations as threatening but they also interpret other ambiguous situations as more threatening than controls. People with panic disorder also seem to have their attention automatically drawn to threatening information in their environment such as words that represent things they fear such as palpitations, numbness, or faint. People with panic disorder showed greater activation to threat words than normal people in brain areas involved in memory processing of threatening material. It is unclear whether these information processing biases are present before the disorder begins, but these biases help maintain the disorder.

Answer 90

Treatment for panic disorder includes behavioural and cognitive behavioural approaches and different categories of medication

Answer 91

Involved prolonged exposure to feared situations, often with the help of a therapist or family member. The idea was to make people gradually face the situations they feared and learned that there is nothing to fear. Such exposure-based treatments were quite effective and helped about 60 to 75% of people with agoraphobia show clinically significant improvement. These effects were generally well-maintained. But this left approximately 25 to 40% not improved to a clinically significant degree

Answer 92

They did not specifically target panic attacks.

Answer 93

Technique one involves the variant on exposure known as interroceptive exposure, meaning the deliberate exposure to feared internal situation. The idea was that fear of these internal sensations should be treated in the same way that fear of external agoraphobic situations is treated, through prolonged exposure to those internal sensations so that the fear may extinguish. The second set of techniques that were developed is cognitive restructuring techniques, and recognition that catastrophic automatic thoughts may help maintain panic attacks. One kind of integrative cognitive behavioural treatment for panic disorder is called panic control treatment, PCT

Answer 94

Targets both agoraphobic avoidance and panic attacks. Is a kind of integrative cognitive behavioural treatment for panic disorder. Has several aspects: first clients are educated about the nature of anxiety and panic and how the capacity to experience both is adaptive. Second people are taught to control their breathing. Third clients are taught about the logical errors that people who have panic disorders are prone to making and learn to subject their own automatic thoughts to illogical re-analysis. Finally they are exposed to feared situations and feared bodily sensations to build up a tolerance to the discomfort.

Answer 95

This treatment produces better results than the original exposure-based techniques that focussed exclusively on exposure to external situations. 7290% of people with panic disorder were panic free at the end of 8 to 14 weeks of treatment and gains were wellmaintained at follow ups. Overall the magnitude of improvement is often greater with these cognitive and behavioural treatments than with medications. These treatments are also useful in treating people who also have nocturnal panic

Answer 96

Many people with panic disorder are prescribed anxiolytics (Anti-anxiety medication’s) from the benzodiazepine category such as Xanax or Klonopin. The other category of medication that is useful in the treatment of panic disorder and agoraphobia is the anti-depressants, including primarily the tricyclics, the SSRIs, and the serotonin norepinephrine reuptake inhibitors.

Answer 97

One major advantage of these drugs is that they act very quickly and so can be useful in acute situations of intense panic or anxiety. However these medications can also have undesirable side effects such as drowsiness and sedation, which can lead to impaired cognitive and motor performance. Also with prolonged use, most people using moderate to high doses develop physiological dependence on the drug, which results in withdrawal symptoms when the drug is discontinued. Withdrawal from these drugs can be very slow and difficult and leads to relapse in a high percentage of cases. This is why benzodiazepines are no longer considered as a first choice treatment

Answer 98

These medications have both advantages and disadvantages compared to anti-anxiety medication‘s. One major advantage is that they do not create physiological dependence in the way benzodiazepines can, and they also can alleviate any comorbid depressive symptoms or disorders. However it takes about four weeks before they can have any beneficial effects, so they are not useful in an acute situation or a person is having a panic attack. Troublesome side effects mean that large numbers of people refused to take the medication‘s or discontinue their use. Also relapse rates when the drugs are discontinued are quite high, so not as high as with benzodiazepines. SSRIs are more widely prescribed then they tricyclics because SSRIs are generally better tolerated by most patients. Also both are generally preferred by physicians to benzodiazepines because of the risk associated with the latter

Answer 99

In the short term, combined treatment sometimes produces a slightly superior result compared to either type of treatment alone. One study showed that individuals who had received combined treatment showed fewer medication side effects and fewer dropouts than those who had used medication alone. But in the long term, after medication has been tapered, clients who have been on medication with or without cognitive or behavioural treatment seem to show a greater likelihood of relapse. This may be because they have attributed their gains to the medication rather than to their personal efforts. The one medication that has shown promise for enhancing responsiveness of panic disorder to CBT is de cycloserine, the same medication that can enhance the speed of treating specific and social phobias

Answer 100

When worry about many different aspects of life becomes chronic, excessive and unreasonable. DSM five criteria specify that the worry must occur on more days than not for at least six months and that it must be experienced as difficult to control. The worry must be about a number of different events or activities and its contents cannot be exclusively related to the worry associated with another concurrent disorder, such as the possibility of having a panic attack. The worry must also be accompanied by at least three of six other symptoms such as muscle tension or being easily fatigued.

Answer 101

There was discussion leading up to the DSM five as to whether the definition and criteria for GAD was optimal and whether this is the optimal name for the disorder. Ultimately a conservative approach was taken and no changes were made to this diagnosis

Answer 102

People suffering from GAD live in a relatively constant, future oriented mood state of anxious apprehension, chronic tension, worry and diffuse uneasiness that they cannot control. They also show marked vigilance for possible signs of threat in the environment and frequently engage in subtle avoidance activities such as procrastination, checking, or calling a loved one frequently to see if they are safe. Such anxious apprehension also occurs in other anxiety disorders, but this apprehension is the essence of GAD, leading people to refer to it as the basic anxiety disorder. The nearly a constant worries of people with GAD leave them continually upset and discouraged. People with GAD experience a similar amount overall impairment and lessened quality of life to those with major depression

Answer 103

Family, work, finances, and personal illness.

Answer 104

People with GED have difficulty making decisions and after they have managed to make a decision they worry endlessly over possible errors and unforeseen circumstances that may prove a decision wrong and lead to disaster. They have no appreciation of the logic by which most of us conclude that it is pointless to torment ourselves about possible outcomes over which we have no control.

Answer 105

A. Excessive anxiety and worry, occurring more days than not for at least six months about a number of events or activities B. The individual finds it difficult to control the worry C. The anxiety and worry are associated with three or more of the following six symptoms with at least some symptoms having been present for more days than not for the past six months. Only one item is required in children: 1. Restlessness or feeling keyed up or on edge 2. Being easily fatigued 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle tension 6. Sleep disturbance D. The anxiety, worry or physical symptoms caused clinically significant distress or impairment in social, occupational or other important areas of functioning E. The disturbance is not attributable to the physiological effects of a substance or another medical condition F. The disturbance is not better explained by another mental disorder

Answer 106

Approximately 3% of the population suffers from GAD in any one year. And 5.7% at some point in their lives. It also tends to be chronic. 42% of people diagnosed had not remitted 13 years later and of those who had remitted, nearly half had had a recurrence. After age 50 the disorder it seems to disappear for many people however it often tends to be replaced by a somatic symptom disorder and characterized by physical symptoms and health concerns

Answer 107

GAD is approximately twice as common in women as in men.

Answer 108

Most people with this disorder manage to function in spite of their high levels of worry and low perceived well-being. They are less likely to go to clinics for psychological treatment than are people with panic disorder or major depressive disorder. However people with GAD do frequently show up in physicians offices with medical complaints and are known to be over users of healthcare resources

Answer 109

This is difficult to determine because 60 to 80% of people with GAD remember having been anxious nearly all of their lives and many others report a slow and insidious onset. However research has also documented that GAD often develops in older adults for whom it is the most common anxiety disorder

Answer 110

GAD often Kocurs with other disorders, especially other anxiety and mood disorders such as panic disorder, social phobia, specific phobia, PTSD, and major depressive disorder. Also many people with GAD experience occasional panic attacks without qualifying for a diagnosis of panic disorder

Answer 111

According to this viewpoint, generalized or free-floating anxiety results from an unconscious conflict between ego and id impulses that is not adequately dealt with because the persons defence mechanisms have either broken down or have never developed. Freud believed it was primarily sexual and aggressive impulses that had been either blocked from expression or punished upon expression that led to free-floating anxiety. Defence mechanisms may become overwhelmed when a person experiences frequent and extreme levels of anxiety, as might happen if id impulses are frequently blocked from expression. Primary difference between specific phobias and free-floating anxiety is that in phobia is the defence mechanisms of repression and displacement of an external object or situation actually work, whereas in free-floating anxiety these defence mechanisms do not work, leaving the person anxious nearly all the time. This viewpoint is not testable and therefore it has been largely abandoned among researchers

Answer 112

Uncontrollable and unpredictable aversive events are much more stressful than controllable and predictable aversive events, so it is not surprising that the former create more fear and anxiety. This is lead researchers to hypothesize that people with GAD may have a history of experiencing many important events in their lives as unpredictable or uncontrollable. Some evidence indicates that people with GAD may be more likely to have had a history of trauma and childhood and individuals with several other anxiety disorders. Also people with GAD have far less tolerance for uncertainty than non-anxious controls and even people with panic disorder. This low tolerance for uncertainty in people with GAD suggests that they are especially disturbed by not being able to product the future. Also the greater the intolerance of uncertainty, the more severe the GAD. A similar and tolerance for uncertainty also seems to be elevated in people with OCD

Answer 113

A persons history of control over important aspects of their environment is another significant experiential variable strongly affecting reactions to anxiety provoking situations. In children, experiences with control and mastery often also occur in the context of parent child relationship and so parents responsiveness to their children’s needs directly influences their children’s developing sense of mastery. Parents of anxious children often have an intrusive, over controlling parenting style, which may serve only to promote their children’s anxious behaviours by making them think of the world as an unsafe place in which they require protection and have a little control themselves

Answer 114

One longitude and all experiment with infant recess monkeys found that infant monkeys reared with a sense of mastery and control over their environments for 7 to 10 months later adapted more readily to frightening events and anxiety provoking situations than it did monkeys weird in environments that were identical except for the experiences with control.

Answer 115

Superstitious avoidance of catastrophe. Avoidance of deeper emotional topics. Coping and preparation. For a subset of people with GED, these positive beliefs about worry play a key role in maintaining high levels of anxiety and worry especially in the early phases of the development of GAD. When people with GAD worry, their emotional and physiological responses to aversive imagery are actually suppressed. This suppression of aversive emotional physiological responding may serve to reinforce the process of worry. Because worry suppresses physiological responding, it also insulates the person from fully experiencing or processing the topic that they are worrying about and it is known that such full processing is necessary if extinction to that anxiety is to occur. Thus the threatening meaning of the topic being worried about is maintained

Answer 116

Where are you can lead to a greater sense of danger and anxiety. Also people who worry about some thing attend subsequently to have more negative intrusive thoughts than people who do not worry. People with GAD tend to experience more intense negative emotions when reacting to a sad film for example. There is now considerable evidence that attempts to control thoughts and were it may paradoxically lead to increased experience of intrusive thoughts and enhanced perception of being unable to control them. These intrusive thoughts conserve as further trigger topics for more worry and a sense of uncontrollability over or it may develop and people caught in a cycle that occurs in GAD. Perceptions of uncontrollability are also known to be associated with increased anxiety, so a vicious circle of anxiety, worry and intrusive thoughts may develop

Answer 117

People with G a D process threatening information in a biased way, perhaps because they have prominent or dangerous schemas. Anxious people tend to preferentially allocate their attention toward threatening cues when both threat and non-threat cues are present in the environment. This intentional vigilance for threat cues can occur at a very early stage of information processing, even before the information has entered the persons conscious awareness. If a person is already anxious, having their attention automatically focussed on threat cues in the environment only maintains the anxiety or makes it worse. Also recent evidence strongly supports the idea that such attentional biases play a causal role in anxiety as well. Anxious people are more likely than non-anxious people to think the bad things are likely to happen in the future and they have a much stronger tendency to interpret ambiguous information in a threatening way. This tendency to interpret ambiguous information negatively has been shown to increase anxiety and several situations

Answer 118

Several studies have shown that training non-anxious individuals to show an attentional bias toward threat leads to the showing a greater increase in anxiety in stressful situations. Conversely training anxious people to attend away from thread leads to a decrease in their anxiety symptoms

Answer 119

Experience with unpredictable and or uncontrollable life events may create a vulnerability to anxiety and promote current anxiety. People also believe that worry serves a number of important functions and it may actually be reinforced because it dampens physiological arousal. But worry also has negative consequences including the fact that worry begets further worry and creates a sense of perceived uncontrollability over at the worry process which further enhances anxiety. Finally anxiety is associated with an automatic attentional and interpretive bias toward threatening information

Answer 120

Biological factors involved in GAD can be attributed to genetics, neurotransmitter abnormalities, and neurobiological differences

Answer 121

Seems to be modest heritability, although perhaps smaller than that for most other anxiety disorders except phobias. The problem for research in this area is the evolving nature of our understanding of GAD and what it’s diagnostic criteria it should be. Some twin studies have revealed that heritability estimates very as a function of one’s definition of GAD, and indicated that 15 to 20% of the variance in liability to GAD is due to genetic factors.

Answer 122

The evidence is increasingly strong that GAD and major depressive disorder have a common underlying genetic predisposition. What determines whether individuals with a genetic risk for a GAD or major depression develop one or the other disorder seems to depend entirely on the specific environmental experiences they have. Part of this common genetic predisposition for GAD and major depression is best conceptualized as a basic personality trait commonly known as neuroticism

Answer 123

GAB a is a neurotransmitter that is strongly implicated in generalized anxiety. It appears that highly anxious people have a kind of functional deficiency in GABA, which ordinarily plays an important role in the way our brain inhibits anxiety in stressful situations. Whether the functional deficiency in GABA and anxious people causes their anxiety or occurs as a consequence of it is yet unknown but it does appear that this functional deficiency promotes the maintenance of anxiety

Answer 124

In the 1950s the benzodiazepine category of medication was found to reduce anxiety. Later it was discovered that these drugs probably exert their effects by stimulating the action of GABA. The benzodiazepine drugs appear to reduce anxiety by increasing GABA activity in certain parts of the brain implicated in anxiety such as the limbic system, and by suppressing the stress hormone cortisol

Answer 125

More recently researchers have discovered that another neural transmitter, serotonin, is also involved in modulating generalized anxiety. It seems that GABA, serotonin and perhaps norepinephrine all play a role in anxiety, but the ways in which the interact remain largely unknown

Answer 126

An anxiety producing hormone called corticotropin releasing hormone, CRH, has also been strongly implicated as playing an important role in generalized anxiety and depression. When activated by stress or perceived threat, CRH stimulates the release of adrenocorticotropic hormone, a CTH, from the pituitary gland which in turn causes release of the stress hormone cortisol from the adrenal gland. Cortisol helps the body deal with stress. CRH may play an important role in generalized anxiety through its effects on the bed nucleus of the stria terminalis, an extension of the amygdala, which is now believed to be an important brain area mediating generalized anxiety

Answer 127

Fear and panic involve activation of the fight or flight response and the brain areas and neural transmitters that seem most strongly implicated in these emotional responses are the amygdala and the neurotransmitters norepinephrine and serotonin. Generalized anxiety is a more diffuse emotional state than acute fear or phobia that involves arousal and a preparation for possible impending threat; the brain area neurotransmitters and hormones that seem most strongly implicated are the limbic system, GABA, and CRH. Although serotonin may play a role in both anxiety and panic it probably does so in somewhat different ways. Recently people with GAD have been found to have a smaller left hippocampal region similar to what is seen with major depression; this may represent a common risk factor for the two disorders

Answer 128

Most treatment for GAD involves medication or cognitive behavioural approaches

Answer 129

Most often medication from the benzodiazepine category are used for tension relief, reduction of other somatic symptoms, and relaxation. A new or a medication called buspirone is also effective, and it is neither sedating nor does it lead to physiological dependence. It also has greater effects on psychic anxiety than do the benzodiazepines. However it may take 2 to 4 weeks to show results. Several categories of antidepressant medications are also useful in the treatment of GAD, and they also seem to have a greater effect on the psychological symptoms of GAD than the benzodiazepines. However they also take several weeks before their effects are apparent

Answer 130

benzodiazepines are used for tension relief, reduction of other somatic symptoms, and relaxation. Their affects on worry and other psychological symptoms are not as great. Also they can create physical and psychological dependence and withdrawal and are therefore difficult to taper.

Answer 131

CBT for generalized anxiety disorder has become increasingly affective as clinical researchers have refined the techniques used. It involves a combination of behavioural techniques, such as training and applied muscle relaxation, and cognitive restructuring techniques aimed at reducing distorted cognition and information processing biases associated with GAD as well as reducing catastrophize Ing about minor events. CBT approaches resulted in large changes in most symptoms measured. The magnitude of the changes seen with CBT was at least as large as those scene with benzodiazepines, and it led to fewer drop outs. CBT has also been found to be useful in helping people who have used benzodiazepines for over a year to successfully taper their medication

Answer 132

Obsessive compulsive and related disorders used to be classified in the DSM as anxiety disorders however as of DSM five they have been classified separately as their own type of disorder. This new category includes not only OCD but also body dysmorphic disorder, hoarding disorder, excoriation disorder, and trichotillomania

Answer 133

Obsessive compulsive disorder is defined by the occurrence of both obsessive thoughts and compulsive behaviours performed in an attempt to neutralize such thoughts. OCD is often one of the most disabling mental disorders in that it leads to a lower quality of life and a great deal of functional impairment

Answer 134

Persistent and recurrent intrusive thoughts, images or impulses that are experienced as disturbing, inappropriate and uncontrollable. People who have such obsessions actively try to resist or suppress them or to neutralize them with some other thought or action

Answer 135

Involve overt repetitive behaviours that are performed as lengthy rituals. Compulsions may also involve more covert mental rituals. A person with OCD usually feels driven to perform this compulsive, ritualistic behaviour in response to an obsession and there are often very rigid rules regarding exactly how the compulsive behaviour should be performed. Deep compulsive behaviours are performed with the goal of preventing or reducing distress or preventing some dreaded event or situation.

Answer 136

Anxiety is not generally used as an indicator of OCD severity. For people with certain forms of OCD anxiety is not even a prominent symptom. Anxiety occurs in a wide range of disorders so the presence of some anxiety is not a valid reason to regard OCD as an anxiety disorder. The neurobiological underpinnings of OCD appear to be rather different from those of other anxiety disorders, focussing on frontal striatal neural circuitry including the orbitofrontal cortex, anterior cingulate cortex, and striatum. are there anxiety disorders respond to a wider range of medication treatments then does OCD, which seems to respond selectively to SSRIs.

Answer 137

There is a continuum of insight among people with OCD about exactly how senseless and excessive their obsessions and compulsions are. In a minority of cases this insight is absent most of the time.

Answer 138

25% of people in the US report experiencing obsessions or compulsions at some time in their lives. With OCD however the thoughts are excessive and much more persistent and distressing, and the associated compulsive acts interfere with every day activities. Diagnosis requires that obsessions and compulsions take at least one hour per day and in severe cases they may take most of the persons waking hours. Normal and abnormal obsessions and compulsive behaviours exist on a continuum, differing in the frequency and intensity of the obsessions and in the degrees to which the obsessions and compulsions are resisted and are troubling

Answer 139

Many obsessive thoughts involve contamination fears, fears of harming one south or others, and pathological doubt. Other fairly common themes are concerns about or need for symmetry, sexual obsessions, and obsessions concerning religion or aggression. These themes are quite consistent across culturally and across the lifespan. There also may be obsessive thoughts involving themes of violence or aggression, and even though such obsessive thoughts are very rarely acted on, they remain a source of often excruciating torment to a person plagued with them.

Answer 140

Cleaning such as handwashing and showering, checking, repeating, ordering or arranging, and counting, and many people exhibit multiple kinds of rituals. For a smaller number of people the compulsions are to perform various every day acts extremely slowly, and for others the compulsions are to have things exactly symmetrical or evened up.

Answer 141

A. Presence of obsessions, compulsions or both: obsessions are defined by: 1. Recurrent and persistent thoughts, urges or images that are experienced, at sometime during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress 2. The individual attempts to ignore or suppress such thoughts, urges or images, or to neutralize them with some other thought or action Compulsions are defined by: 1. Repetitive behaviours or mental acts that the individual feels driven to perform in response to an obsession or according to the rules that must be applied rigidly 2. The behaviours ornamental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation; however these behaviours or mental ask are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive B. The obsessions or compulsions are time consuming or cause clinically significant distress or impairment in social, occupational or other important areas of functioning C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition D. The disturbance is not better explained by the symptoms of another mental disorder

Answer 142

Washing or cleaning rituals vary from relatively mild ritual like behaviour such as spending 15 to 20 minutes washing one’s hands after going to the bathroom, two more extreme behaviour such as washing one’s hands with disinfectants for hours every day to the point where the hands bleed. These acts are usually performed a specific number of times and involve repetitive counting

Answer 143

Checking rituals also very in severity from relatively mild such as checking all the lights, appliances, and locks two or three times before leaving the house to very extreme such as going back to an intersection where one thinks one may have run over a pedestrian and spending hours checking for any sign of the imagined accident. These acts are usually performed a specific number of times and involve repetitive counting

Answer 144

The performance of a compulsive act were the ritualized series of acts usually brings a feeling of reduced tension and satisfaction, as well as a sense of control, although this anxiety relief is typically fleeting. This is why the same rituals need to be repeated over and over

Answer 145

Approximately 2 to 3% of people meet criteria for OCD at some point in their lifetime and approximately 1% meet criteria in a given year. Over 90% of treatment seeking people with OCD experience both obsessions and compulsions. When mental rituals and compulsions such as counting are included as compulsive behaviors, this figure jumps to 98%. Divorced and unemployed people are somewhat overrepresented among people with OCD

Answer 146

Some studies showed little or no gender difference in adults, which would make OCD quite different from most of the rest of the anxiety disorders. However one British study found a gender ratio of 1.4 to 1 women to men.

Answer 147

OCD typically begins in late adolescence to early adulthood but can also occur in children, where its symptoms are strikingly similar to those of adults. Childhood or early adolescent onset is more common in boys than girls and is often associated with greater severity and greater heritability. In most cases the disorder has a gradual onset and once it becomes a serious condition it tends to be chronic, although the severity of symptoms sometimes waxes and wanes overtime

Answer 148

OCD frequently occur occurs with other anxiety disorders, most commonly social phobia, panic disorder, GAD, and PTSD. Approximately 25 to 50% of people with OCD experience major depression at some time in their lives and as many as 80% experience significant depressive symptoms, often at least partly in response to having OCD

Answer 149

The dominant behavioural or learning view of OCD is derived from the two process theory of avoidance learning. According to this theory, neutral stimuli become associated with frightening thoughts or experiences through classical conditioning and come to elicit anxiety. Once having made this association, the person may discover that the anxiety produced can be reduced by something like handwashing. Then the compulsion is reinforced which makes it more likely to occur again in the future when other situations evoke anxiety. Once learned, such avoidance responses are extremely resistant to extinction and any stressors that raise anxiety levels can lead to a heightened frequency of avoidance responses or compulsive rituals. This model predicts that exposure to feared objects or situation should be useful in treating OCD if the exposure is followed by prevention of the ritual, enabling the person to see that the anxiety will subside naturally in time without the ritual

Answer 150

It was found that for most people with OCD, exposure to a situation that provoked their obsession did indeed produce distress, which would continue for a moderate amount of time and then gradually dissipate. If the person was allowed to engage in the compulsive ritual immediately after the provocation, their anxiety would generally decrease rapidly although only temporarily and therefore reinforce the compulsive ritual

Answer 151

It has not shown why people with OCD develop of sessions in the first place and why some people never develop compulsive behaviours

Answer 152

The fact that many people with OCD have obsessions and compulsions focussed on dirt, contamination and other potentially dangerous situation has led many researchers to conclude that these features of the disorder likely have deep revolutionary roots. Some theorists have argued that the displacement activities that many species of animals engage in your situation of conflict or high arousal resemble the compulsive ritual seen in obsessive compulsive disorder. Displacement activities often involve grooming or nesting under conditions of high conflict or frustration. They may therefore be related to distress induced grooming or tidying rituals seen in people with OCD, which are often provoked by obsessive thoughts that elicit anxiety

Answer 153

When most people attempt to suppress unwanted thoughts they sometimes experience a paradoxical increase in those thoughts later. People with normal and enorm obsessions differ primarily in the degree to which they resist their own thoughts and find them unacceptable. One factor contributing to the frequency of obsessive thoughts and the negative moods with which they are often associated may be these attempts to suppress them. Also thought suppression leads to a more general increase in obsessive compulsive symptoms beyond just the frequency of obsessions (On days when people were told to suppress the intrusive thoughts they had more intrusive thoughts then on days when they were not told to). Also studies of people with OCD revealed that they engage in frequent, strenuous and time-consuming attempts to control the intrusive thoughts, although they are generally not effective in doing so

Answer 154

People with OCD often seem to have an inflated sense of responsibility. In a some vulnerable people, this inflated sense of responsibility can be associated with beliefs that simply having a thought about doing something is morally equivalent to actually having done it, or that thinking about the behaviour increases the chances of actually doing so. This is known as thought action fusion. This inflated sense of responsibility for the harm they may cause can motivate compulsive behaviours to try to reduce the likelihood of anything harmful happening. Part of what differentiates normal people who have obsessions and can ordinarily dismiss them from people with OCD is this sense of responsibility that makes the thought so concerning to them

Answer 155

People with OCD have an attentional bias toward disturbing material relevant to their obsessive concerns, much as occurs in the other anxiety disorders. They also have difficulty blocking out negative irrelevant input or distracting information so they may attempt to suppress negative thoughts stimulated by this information. Trying to suppress negative thoughts made paradoxically increase the frequency. Those with OCD have low confidence in their memory ability, which may contribute to the repeating the ritualistic behaviours over and over again. An additional factor contributing to the repetitive behaviour is that people with OCD have deficits in their ability to inhibit both motor responses and irrelevant information

Answer 156

The evidence accumulating from studies about OCD‘s genetic basis, abnormalities in brain function and neurotransmitter abnormalities suggests that biological causal factors may play a stronger causal role for OCD relative to other disorders

Answer 157

Evidence from twin studies reveals a moderately high concordance rate for OCD for monozygotic twins and a lower rate for dizygotic twins. This is consistent with a moderate genetic heritability, although it may be at least partially a nonspecific neurotic predisposition. Most family studies have found 3 to 12 times higher rates of OCD in first-degree relative of OCD clients then would be expected from current estimates of the prevalence of OCD. Evidence also shows that early onset OCD has a higher genetic loading than later onset OCD.

Answer 158

This disorder is known to have a substantial genetic basis. One study found that 23% of first degree relatives of people with Tourette’s syndrome had diagnosable OCD even though Tourette’s syndrome itself is very rare

Answer 159

In recent years a number of molecular genetics studies have begun to examine the association of OCD with specific genetic polymorphisms. Preliminary findings indicate that different genetic polymorphisms are implicated in OCD with Tourette’s syndrome and in OCD without Tourette’s syndrome, suggesting that these two forms of OCD at least partially distinguishable at a genetic level level

Answer 160

Abnormalities occur primarily in certain cortical and subcortical structures such as the basal ganglia. People with OCD have abnormally high levels of activity in two parts of the frontal cortex, the orbital frontal cortex and the cingulate cortex, which are also linked to the limbic area. People with OCD have abnormally high levels of activity in the sub cortical caudate nucleus, which is part of the basal ganglia. These primitive brain circuits are involved in executing primitive patterns of behaviour such as those involved in sex, aggression, and hygiene concerns. Activity in these areas is further increased when symptoms are provoked by relevant stimuli that activate obsessive thoughts. Partial normalization of at least some of these abnormalities with successful treatment through either medication or behaviour therapy

Answer 161

Primitive urges come from the orbital frontal cortex. These urges are ordinarily filtered by the caudate nucleus as they travel through the cortical basal ganglionic thalamic circuit, allowing only the strongest to pass on to the thalamus. The caudate nucleus or corpus striatum is part of an important neural circuit linking the orbital frontal cortex to the thalamus. The basal ganglia also include two other structures that are involved in this cortical basal ganglionic thalamic circuit. Hey thalamus is an important relay station that receives nearly all sensory input and passes it back to the cerebral cortex

Answer 162

It is normally involved in the preparation of complex sets of interrelated behavioural responses used in specific situations such as those involved in territorial or social concerns.

Answer 163

One theory cited evidence that when the circuit is not functioning properly, inappropriate behavioural responses may occur, including repeated sets of behaviours stemming from territorial and social concerns and from hygiene concerns. Thus the over activation of the orbital frontal cortex combined with a dysfunctional interaction among the orbital frontal cortex and the thalamus may be the essential component of the brain disfunction in OCD. The disfunctions in this circuit intern prevent people with OCD from showing the normal inhibition of sensations, thoughts and behaviours that would occur if the circuit were functioning properly. Impulses toward aggression, sex, hygiene and danger that most people keep under control with relative ease leak through as obsessions and distract people with OCD from ordinary goal directed behavior. At least part of the reason this circuit does not function properly may be due to abnormalities in white matter in some of these brain areas

Answer 164

Part of the set of structures called the basil ganglia, which are involved in the execution of voluntary, gold directed movements

Answer 165

A tricyclic drug that is often effective in the treatment of OCD even though other tricyclic antidepressants are generally not very effective. This is because this drug has greater effects on the neurotransmitter serotonin which is strongly implicated in OCD

Answer 166

Serotonin is strongly implicated in OCD. This is why several other anti-depressant drugs from the SSRI category I have also been shown to be equally effective in the treatment of OCD.

Answer 167

Current evidence suggests that increased serotonin activity and increased sensitivity of some brain structures to serotonin are involved in OCD symptoms. Drugs that stimulate serotonergic systems lead to a worsening of symptoms. Long-term administration of clomipramine causes a down regulation of certain serotonin receptors, further causing a functional decrease in the availability of serotonin. Even though this drug increases serotonin levels in the short term, the long-term effects are quite different. This is why these drugs must be taken for at least 6 to 12 weeks before a significant improvement in OCD symptoms occurs. However disfunction in serotonergic systems cannot by itself fully explain OCD

Answer 168

Other neurotransmitter systems such as dopaminergic, GABA, and glutamate systems also seem to be involved, although their role is not yet well understood

Answer 169

Treatment for OCD includes behavioural and cognitive behavioural approaches as well as medication

Answer 170

The most effective treatment for OCD. A behavioural treatment. The exposure component involves having individuals with OCD repeatedly expose themselves to stimuli that provoke their obsessions. The response prevention component requires that they then refrain from engaging in the rituals that they ordinarily would perform to reduce their anxiety or distress. Preventing the rituals is essential so they can see if they allow enough time to pass the anxiety created will dissipate naturally even if this takes several hours. This is often distressing, so the treatment typically starts out with manageable first steps in the persons fear hierarchy and gradually works out to more intense exposure. Homework is liberally assigned during treatment.

Answer 171

Although some people refuse such treatment and drop out early, most who stick with it show a 50 to 70% reduction in symptoms and improved quality of life. These results are superior to those obtained with medication. There is also evidence that D cycloserine enhances the effectiveness of CBT however this enhancement is blocked if the person is also taking an antidepressant.

Answer 172

Some of the goals were to determine whether it might help a higher percentage of people with OCD or help increase the degree of symptom improvement or decrease drop it rates. Current evidence suggests that this form of treatment can also be quite effective but it has not been shown to be superior to exposure and response prevention therapy in any of the predicted ways. Also some researchers have concluded that exposure and response prevention treatment might be enhanced by the addition of cognitive therapy. Given that OCD rarely remits completely, leaving the client was some residual obsessional problems or rituals, there is clearly a need to improve further at the efficacy of these treatments

Answer 173

OCD seems to respond best to medication‘s that affect the serotonin system. These medication‘s reduce the intensity of OCD symptoms, with approximately 40 to 60% of people showing at least a 25 to 35% reduction in symptoms. About 30 to 50% of clients don’t show any clinically significant improvement. In about 1/3 of people who failed to respond to these medication‘s, small doses of certain antipsychotic medication may produce significantly greater improvement

Answer 174

When medication is discontinued relapse rates are generally very high. Many people who do not seek alternative forms of behaviour therapy that have more long lasting benefits may have to stay on these medications indefinitely. Studies in adults have generally not found that combining medication with exposure and response prevention is much more effective than behaviour therapy alone. The one study showed that a combination treatment was superior in the treatment of children and adolescents with OCD

Answer 175

Because severe OCD Is such a crippling and disablebl disorder, psychiatrists have begun to examine the usefulness of certain neurosurgical techniques for the treatment of severe OCD. Before such surgery is even contemplated, the person must have had severe OCD for at least five years and must not have responded to any of the known treatments. Approximately 35 to 45% of these severe cases respond quite well to neurosurgery designed to destroy brain tissue in one of the areas implicated in this condition. However a significant number of these have adverse side effects.

Answer 176

People with BDD or obsessed with some perceived or imagined flaw or flaws in their appearance to the point they firmly believe they are disfigured or ugly. This preoccupation is so intense that it causes clinically significant distress and impairment in social or occupational functioning. Most people with BDD have compulsive checking behaviours. Another common symptom is avoidance of unusual activities because of fear that other people will see the imaginary defect and be repulsed. In severe cases they may become so isolated that they lock them selves up in their houses and never go out. The average employment rate for people with BDD is about 50%. Quality of life is poor

Answer 177

Body dysmorphic disorder it was classified as a somatoform disorder in the DSM four because it involves preoccupation with certain aspects of the body. However because of its very strong similarities with OCD, it was moved out of the somatoform category and into the OCD and related disorders category in DSM five

Answer 178

Skin 73%, hair 56%, nose 37%, eyes 20%, breasts 21%, stomach 22%, face size and shape 12%. Many suffers have perceived defects in more than one body part. These concerns are complete preoccupation and significant emotional pain. Half of the people with BDD have concerns about their appearance that are of delusional intensity

Answer 179

People with BDD frequently seek reassurance from friends and family about 30 facts but the reassurances almost never provide more than very temporary relief. They also frequently seek reassurance for themselves by checking their parents in the mirror countless times in a day. They are usually driven by the hope that they will look different and sometimes they may think their perceived defect does not look as bad as it has it other times. But much more commonly they feel worse after mirror gazing.

Answer 180

People with BDD frequently engage in excessive grooming behavior, often trying to camouflage they are perceived defect through the hairstyle, clothing or make up

Answer 181

A. Preoccupation with one or more perceived defects or flaws and physical appearance that are not observable or appear slight to others B. At some point during the course of the disorder, the individual has performed repetitive behaviours or mental acts in response to the appearance concerns C. Preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning D. The appearance preoccupation is not better explained by concerns with body fat or wait in an individual his symptoms me to diagnostic criteria for an eating disorder

Answer 182

Good estimates of the prevalence of BDD are difficult to obtain because of the great secrecy that usually surrounds this disorder. Some leading researchers estimate that this is not a rare disorder, affecting 1 to 2% of the general population and up to 8% of people with depression

Answer 183

The prevalence seems to be approximately equal in men and women, although the primary body parts that are focussed on tend to differ in men and women. Men are more likely to obsess about their genitals, body build and balding where is women tend to obsess more about their skin, stomach, breasts, buttocks, hips and legs

Answer 184

Age of onset is usually in adolescence, when many people start to become preoccupied with their appearance.

Answer 185

People with BDD very commonly also have a depressive diagnosis and it can even lead to suicide attempts or death. 80% of people with BDD report a history of suicidal ideation and 28% had a history of a suicide attempt. rates of comorbid social phobia and OCD are also quite substantial, although not as high as for depression.

Answer 186

Suffers of BDD commonly make their way into the office of a dermatologist or plastic surgeon, with an estimated 75% seeking non-psychiatric treatment. One study found that 8% of those seeking cosmetic medical treatments met criteria for BDD, though it could be as high as 20%. An astute doctor will not do the requested procedures and may make a referral to a psychologist but often the patient does get what they request and are almost never satisfied with the outcome. Even if they are satisfied, such patients still tend to retain their diagnosis of BDD

Answer 187

People with BDD have prominent obsessions and they engage in a variety of ritualistic behaviours such as reassurance seeking, mirror checking, comparing themselves to others and camouflage, which is similar to OCD. Also they are even more convinced that their obsessive believes are accurate than are people with OCD. There is also overlap in the potential causes. For example the same neural transmitter serotonin and the same sets of brain structures are implicated in the two disorders, and the same kinds of treatments that work for OCD are also the treatments of choice for BDD

Answer 188

Some researchers have noted similarities between BDD and eating disorders, especially anorexia. The most striking similarities between these disorders are the excessive concern and preoccupation about physical appearance, dissatisfaction with one’s body, and a distorted image of certain features of one’s body. It’s important to remember that people with BDD look normal and yet are terribly obsessed and distressed about some aspect of their appearance. By contrast people with anorexia are emaciated and generally satisfied with this aspect of their appearance

Answer 189

A possible reason is that its prevalence may actually have increased in recent years as contemporary western culture has become increasingly focussed on luxe. A second reason BDD has been under studied is that most people with this condition never seek psychological or psychiatric treatment but suffer silently and go to dermatologists or plastic surgeons. Part of the reason why more people are now seeking treatment is that the disorder has received a good deal of media attention recently resulting in the secrecy and shame surrounding it decreasing

Answer 190

Reasons for the secrecy and shame include worries that others will think they are superficial, silly, or vein and that if they mention their perceived defect, others will notice it and focus more on it

Answer 191

Recent research suggests that a biopsychosocial approach offers reasonable hypotheses for the causes of BDD. A twin study found that over concerned with a perceived or slight defect in physical appearance is a moderately heritable trait. Second, BDD seems to be occurring at least today in a Socio cultural context That places great value on attractiveness and beauty and people who develop BDD often hold attractiveness as their primary value. It may be because people with BDD were reinforced as children for their overall appearance more than their behavior. Another possibility is they were teased for their appearance. additionally there is evidence that people with BDD show biased attention and interpretation of info relating to attractiveness.

Answer 192

People with BDD selectively attend to positive or negative words such as ugly or beautiful more than other emotional words not related to appearance, and they tend to interpret ambiguous facial expressions as contemptuous or angry more than controls. When shown in pictures of their own face that have been manipulated, they show a greater discrepancy then controls between judgements of their actual face and their ideal face. Controls choices were more symmetrical than their real faces while patients with BDD lacked this bias. Patients with BDD also show fundamental differences in visually processing other peoples faces relative to controls; they show a bias for extracting local detailed features rather than the more global holistic processing of face is seen and controls. Another study showed that when patients with BDD are shown a picture of their own face, they demonstrate greater activation then healthy controls in brain regions associated with inhibitory processes and the rigidity of behaviour and thinking. Compared to two controls, patients with BDD demonstrate performance deficits on tasks that measure executive functioning which is thought to be guided by prefrontal brain regions.

Answer 193

Effective treatments for BDD are similar to OCD. Antidepressant medications from the SSRI category often produce moderate improvement in patients with BDD, but money or not helped or show only modest improvement. It is possible that in adequate doses of the medication were used this leading to an under estimation of the true potential effects. Higher doses of these medications are needed to effectively treat BDD relative to OCD.

Answer 194

A form of cognitive behavioural treatment emphasizing exposure and response prevention has been shown to produce marked improvement in 50 to 80% of treated patients. These treatment approaches focus on getting the patient to identify and change distorted perceptions of their body during exposure to anxiety provoking situation and on prevention of checking responses. The treatment gains are generally well-maintained at follow up

Answer 195

Traditionally, hoarding was thought of as one particular symptom of OCD, but this categorization was increasingly questioned and hoarding was added as a new disorder in the DSM five.

Answer 196

Compulsive hoarding as a symptom occurs in approximately 3 to 5% of the adult population, and in 10 to 40% of people diagnosed with OCD

Answer 197

People with hoarding disorder both acquire and fail to discard many possessions that seem useless or a very limited value, in part because of the emotional attachment they develop to their possessions. Their living spaces are extremely cluttered and disorganized to the point of interfering with normal activities that would otherwise occur in the spaces such as cleaning, cooking, and walking through the house. In severe cases people have literally been buried alive in their own home by their hoarded possessions

Answer 198

Recent neural imaging research has found that people diagnosed with OCD who have compulsive hoarding symptoms also show patterns of activation in certain brain areas when their symptoms are provoked. These brain activation patterns are different from those of people diagnosed with OCD who do not have hurting symptoms. This means people with compulsive hoarding maybe neurologically distinct from people with OCD. This also could explain the lack of responsiveness to the same medication’s that are often successful in reducing the severity of other forms of OCD and with recent findings that different genes seem to be implicated in OCD without hoarding versus ocd with hoarding

Answer 199

People with hoarding disorder have a poor prognosis for treatment than people without hoarding symptoms. Although the medication typically used to treat OCD are generally not effective in treating people with compulsive hoarding symptoms, some studies have suggested that one antidepressant can be somewhat effective. Traditional behavioural therapy using exposure and response prevention is also less effective than for traditional OCD, although there are some promising new intensive and prolonged behavioural treatments that include home visits which seem to be more effective

Answer 200

Also known as compulsive hair pulling. It has its primary symptom the urge to pull out one’s hair from anywhere in the body, most often in the scalp, eyebrows or arms, resulting in noticeable hair loss. The hair pulling is usually preceded by an increasing sense of tension, followed by pleasure, gratification or relief when the hair is pulled out. The symptoms must cause clinically significant distress or impairment in some important areas of functioning. That usually occurs when a person is alone and the person often examines the hair root, twirls it off and sometimes pulls the strand between their teeth or eats it

Answer 201

In earlier additions of the DSM, trichotillomania was categorized as an impulse control disorder. However, reflecting its relationship to OCD, in DSM five it is now placed in the obsessive compulsive and related disorders category.

Answer 202

The onset can be in childhood or later, with onset post puberty being associated with a more severe course.

Answer 203

Cross-cultural research suggests that although anxiety is a universal emotion and anxiety disorders probably exist in all human societies, there are some differences in prevalence and in the form in which the different disorders are expressed in different cultures. Researchers note that recognition of the cognitive component of most anxiety disorders leads one to expect many cross cultural variations in the form that different anxiety disorders take. Anxiety disorders can be considered disorders of the interpretive process. Because cultures influence the categories and schemas that we used to interpret are symptoms of distress, there are bound to be significant differences in the form that anxiety disorders take a different cultures

Answer 204

Within the United States, lifetime prevalence rates of several anxiety disorders vary in somewhat surprising ways across different racial and ethnic groups. Lifetime risk for social phobia, generalized anxiety disorder, and panic disorder is somewhat lower among ethnic minority groups than among the non-Hispanic whites. These differences were slightly larger for people under age 45 and from lower socioeconomic classes. However once a disorder has developed, the disorders are equally persistent across ethnic groups

Answer 205

Show higher rates of a variant of panic disorder called ataque de nervios then other grapes. Most of the symptoms of this disorder are the same as in a panic attack, but they may also include bursting into tears, anger, and uncontrollable shouting. Other symptoms can include shakiness, verbal or physical aggression, dissociative experiences, and seizure like or fainting episodes. Such attacks are often associated with a stressful event relating to the family and the person may have amnesia for the episode. At least in Puerto Rico, this disorder is quite common in children and adolescents, affecting about 9%. Individuals who experience this disorder also seem to be vulnerable to a wider range of other anxiety and mood disorders

Answer 206

One large study showed that anxiety disorders or the most common category of disorder reported in all but one country, Ukraine. Reported prevalence rates for all the anxiety disorders combined varied from 2.4% in Shanghai to 18.2% in the US. Other countries with moderately high rates of reported anxiety disorders were Columbia, France and Lebanon, and other countries with moderately low rates were China, Japan, Nigeria and Spain.

Answer 207

In this culture, three primary clusters of symptoms are associated with generalized anxiety: worry, dreams, and bodily complaints. However the sources of worry are very different than those in western society; they focus on creating and maintaining a large family and on fertility. Dreams are a major source of anxiety because they are thought to indicate that one may be bewitched. The common somatic complaints are also unusual from a western standpoint, feeling like water in the brain, ants on various parts of the body, worms in the head. Nigerians with this syndrome often have paranoid fears of malevolent attack by witchcraft

Answer 208

In India there are all so many more worries about being possessed by spirits and sexual inadequacy then are seen in generalized anxiety in western cultures

Answer 209

Another culture related syndrome that occurs in places like China and other south east Asian countries. For men it involves intense, acute fear that the penis is retracting into the body and that when this process is complete the suffer will die. It occurs less frequently in women, for whom the fear is that their nipples are retracting and their breasts are shrinking. It tends to occur in epidemics, sometimes referred to as a form of mass hysteria, especially in cultural minority groups when their survival is threatened, and it is often attributed to either malicious spirits or contaminated food. A variant on this syndrome occurs in west African nations. This occurs in cultures where there are serious concerns about male sexual potency

Answer 210

Afflicted individuals report shrinking of the penis or breasts, but not retraction, which they fear it will lead to loss of sexual functioning and reproductive capacity but not death. Frequently, another person who is present at the time is blamed and often severely beaten or otherwise punished. This occurs in cultures where there are serious concerns about male sexual potency

Answer 211

A Japanese disorder that is related to the Western diagnosis of social phobia. It is a fear of interpersonal relations or of social situations. Most people with this disorder are concerned about doing some thing that will embarrass or offend others. They may fear offending others by blushing, admitting an offensive odour Etc. This fear of bringing shame on others or offending them is what leads to social avoidance. Body dysmorphic disorder also commonly occurs in people with this disorder. Researchers have argued that the pattern of symptoms has been shaped by cultural factors. Japanese children are raised to be highly dependent on their mothers and have a fear of the outside world. Babies are praised for being obedient and docile. A great deal of emphasis is placed on implicit communication. The society is very hierarchical and structured.