Flashcards in L6 - Anxiety part 2 Deck (39):
What is separation anxiety disorder/
- Developmentally INAPPROPRIATE and EXCESSIVE FEAR or anxiety concerning separation from attachment figure
- 3 of:
- reluctance/refusal to go out, away from home because of separation fear.
- reluctance about being alone without attachment figure
- refusal to sleep away from home
- repeated night mares
- repeated complaints about physical symptoms
Separation anxiety onset?
can be either acute or insidious - often develops following a life stressor
Separation anxiety and comorbidities?
as high as 73% in young people with panic attacks
Separation anxiety and gender differences?
More common in girls.
Possibly symptoms don't manifest in the same way in boys, so we don't recognise it - maybe they receive more encouragement to be independent.
consequences of separation anxiety?
- limited independent activites away from home
- miss out on school camps/sleep overs with friends
- difficulty with appropriate separation as they mature.
Link between childhood SA and panic attacks?
- Strong genetic link between childhood SAD and childhood onset PA.
- Both disorders are associated with heightened sensitivity to inhaled CO2 - and can be influenced by childhood parental loss (early traumatic event)
what is panic?
An abrupt experience of intense fear or acute discomfort accompanied by physical symptoms that include...
- chest pain
- shortness of breath
- dizziness/feeling faint
DSM Panic disorder symptoms?
- increased HR
- shortness of breath
- chest pain
- choking sensation
- fear of dying
- fear of losing control
1 Attack followed by 1 month of persistent change of behaviour to avoid another panic attack
What are the consequences of suffering a panic attack?
- worry about having another panic attack
- avoiding situations where they have experienced an attack (Safety behaviours), leading to avoidance of leaving home (agoraphobia).
Describe the biology of panic.
Fear leads to adrenaline release and activation of sympathetic NS.
This increases HR, hyperventilation, muscle tension.
Creates light headedness due to less CO2 in lungs, tingling, numbness... leading to MORE PANIC
leading to MORE fear..
Risk Factors for panic?
- Abnormally sensitive fear network
- major life stressors
- a history of sexual or physical abuse in childhood
Some things that may contribute to panic?
- CNS stimulants: caffeine, amphetamines, cocaine
- withdrawal from CNS depressants: alchohol
- medical conditions: hyperthyroidism, arrhythmias
Describe the cognitive model for panic.
- Panic attacks come from CATASTROPHIC MISINTERPRETATION of bodily or mental events.
- Vicious cycle of events is triggered - associated with rising levels of anxiety/panic
internal/external trigger --> perceived threat --> Anxiety --> physical/cognitive symptoms --> avoidance/safety behaviours --> symptoms misperceived as physical illness --> anxiety...-> more cog/physical symptoms
Subtypes of panic attacks?
- Unexpected/uncued - can happen even in sleep.
- Situationally predisposed.
Peak age onset for panic disorder?
- age of gaining independence/finding yourself
Course of panic disorder?
Usually chronic, but fluctuates.
often people don't seek treatment, and it's also hard to keep them in treatment.
What is the impact of PD?
Panic Disorder is associated with decrease in QOL, and impairment in several domains, particularly employment, due to not being able to be in a stressful environment.
What is Koro?
This is a culture-bound syndrome related to panic disorder, of malaysian origin.
Individuals have an overpowering belief that his or her genitals are retracting and will disappear. Despite the lack of any true longstanding changes to genitals.
What is Shen-k'uei, or Shenkui?
This is a culture-bound syndrome related to panic disorder, of taiwanese and chinese origin.
There is anxiety or panic with somatic complaints for which no physical cause can be demonstrated. Attributed to excessive semen loss from frequent intercourse, masturbation.
What is Dhat?
This is a culture-bound syndrome related to panic disorder, of indian origin.
There is severe anxiety and hypochondriacal concerns associated with the discharge of semen, whitish colouration of urine and feelings of weakness and exhaustion.
What is the difference between anxiety and fear?
Anxiety is apprehension and worry that a more general reaction that is out of proportion to the threats of the environment, about the future and can be adaptive if not excessive.
Fear is experienced only when a person is in imminent danger, and can be adaptive. It is usually in proportion!
What is a specific phobia?
- Irrational fear of a specific object/situation
- markedly interferes with functioning
- individual recognises fear is excessive and unreasonable
- exposure to phobic stimulus results in anxiety response (eg. panic attack)
- phobic situation is avoided or endured with intense distress (interferes with person's normal routine)
- typically 6 months or more.
specific phobia subtypes?
environments - heights, water, storms
situations - aeroplanes, elevators, enclosed spaces
animals - spider
blood, injections, injuries
other - vomiting, choking, illnesses, people in costumes.
Name some examples of specific phobia types.
Claustrophobia - fear of enclosed spaces
Arachnophobia - fear of spiders
Dentophobia - fear of dental procedures
Gender differences in specific phobias?
Male 1: female :4
only the most severe seek treatment, however.
what is the psychodynamic theory for specific phobia?
- Castration Anxiety and oedipus complex..
- freud theorised that phobias were actually displaced fears or conflicts.
What is the classical conditioning theory for specific phobia?
- Little albert study by John B Watson
- the child was conditioned to be afraid of a white rabbit (by being paired with a loud noise), but this lead to generalisation, where the child became scared of other small fluffy things.
- individual learns to associate a threating stimulus with non-threatening stimulus - so it on its own, later, can induce anxiety
- Fear is maintained through avoidance - they don't get the chance for 'reality testing' and new learning.
What are some limitations to the classical conditioning theory for specific phobia?
- many phobias don't have an obvious environmental cause, direct or indirect.
- some phobias are more common than others, even though there are fewer encounters with them (eg. snakes) - innate?
Social learning theory to specific phobia?
- Fears may be learnt through observation of trauma in others, or hearing about it.
- Fear can also be modeller or instructed
What is the evolutionary perspective to specific phobia?
- Organisms which learned to fear environmental threats faster had a SURVIVAL AND REPRODUCTIVE ADVANTAGE!!
What is social anxiety disorder?
A. marked fear about 1 or more social sitations
B. fears that they will act in a way or show anxiety, and will be negatively evaluated
C. Social situations almost always provoke fear or anxiety.
D. Social situations are avoided or endured with intense fear or anxiety
E. Fear out of proportion
F. 6 months +
G. Clinical distress
H. Not due to anything else
Social anxiety risk factors?
- Genetics- specific or general heritability of emotional disorders
- Cognitive factors - negative appraisal of social interactions? stems of adverse social interactions
- Social Skills Deficits
- Temperament - shyness
Psychological fear of being in public places.
Marked fear or anxiety of..
- 2 or more of: using public transport, being in open spaces, being in enclosed places, standing in line or being in a crowd, being outside of the home alone.
- Fears that escape might be difficult or help unavailable.
Gender differences in agoraphobia?
twice as many females as men
Prognosis for agoraphobia?
persistence and chronic.
full remission is rare, only 10%
It's difficult for them to even go and get treatment/care, have to leave home
What does the term exposure refer to?
This is an important part of treatment.
Without exposure, people with anxiety disorders cannot fully get over their fear!
What is the limitation of using medication as a treatment for anxiety?
It reduces anxiety, however, they do not learn how to control it.
Describe the ABC Model
- Cross sectional formulation of problem
- Assists in describing CBT to patient
A -> B -> C
Triggering event -> thoughts -> emotional and behavioural responses
triggering event can be very early, not close to time of symptoms