Week 7 Lecture 7 - Anxiety, obsessive-compulsive disorder & trauma/stressor-related disorders (DN) Flashcards Preview

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What are the three main DSM categories?

Anxiety Disorders

Obsessive Compulsive Disorders

Trauma- and Stressor-Related Disorders


Overview of DSM-5 categories

Anxiety disorders

  • Separation anxiety disorder
  • Selective mutism
  • Specific phobia
  • Social anxiety disorder
  • Panic disorder
  • Agoraphobia
  • Generalised anxiety disorder
  • Substance/medication induced anxiety
  • Disorder due to another medical condition
  • Other-specified/unspecified


Obsessive-compulsive and related disorders

  • Obsessive-compulsive disorder
  • Body dysmorphic disorder
  • Hoarding disorder
  • Trichotillomania (hair pulling disorder)
  • Excoriation (skin picking) disorder
  • Substance/medication induced disorder
  • Disorder due to another medical condition
  • Other-specified/unspecified 

Trauma and stressor related disorders


  • Reactive attachment disorder
  • Disinhibited social engagement disorder
  • Posttraumatic stress disorder
  • Acute stress disorder
  • Adjustment disorder

Other-specified/unspecifiedBold: focus for exam


Anxiety (definition)

Negative mood state, characterised by bodily symptoms of physical tension & apprehension about the future 4:15

  • Set of characteristic behaviours
    • fidgeting, pacing, looking worried
  • Physiological response
    • increased heart rates, sweating, brethlessness
  • Subjective experiences
    • thoughts, images, fear, guilt anger
  • Good for us in moderate amounts
  • Drives & enhances social, physical & intellectual performance
  • Concern over & preparation for things that ‘might’ go wrong > ‘future oriented’

bold bits are key take home messages


Why are moderate amounts of anxiety good for us?

  • Drives & enhances social, physical & intellectual performance
  • e.g.,
    • sitting exam (studying extra coz anxious
    • meeting new people (trying to impress)
    • job interview
    • crossing road (pays to be a little bit anxious about being run over



What does Jo say is an important feature of anxiety for us to remember?

  • its a future oriented mood state
  • concern over things that might go wrong


What type of curve is associated with anxiety?

What does this tell us about the adaptiveness of anxiety?

  • U-shaped curve
    • No anxiety > unprepared
    • Little anxiety > adaptive
    • Too much anxiety > detrimental


Fear (definition) 

  • Emotion related to anxiety - also good for us!
  • Protects us from threats by activating fight or flight response
    • massive response from autonomic nervous system (inc. heart rate, breathlessness, sweaty)



What are the distinguishing features of anxiety and fear?


  • Anxiety:
    • Thoughts of unpredictability or uncontrollability
    • Apprehension about perceived potential threat
    • Future – oriented
  • Fear:
    • Strong escapist action tendencies
    • Present-oriented


  • What happens when you experience an alarm response of fear when there is actually nothing to be frightened of
  • i.e., there is no fight or flight response as there is nothing to fight against or flee from?


Panic attack

  • “An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes”: DSM5
    • (not transient moment)
  • Occur in the context of many anxiety disorders, other mental disorders,
    medical conditions
  • Diagnosis noted by clinician as a specifier
  • Can be expected (cue), or unexpected (no cue)


Is Panic Attack a DSM-5 disorder?

  • No, Panic disorder is a disorder, not panic attack. 
  • Panic attack typically occurs within context of another disorder



What is DSM5 criteria for panic attack?

In a calm or anxious state, 4 or more of the following physical and cognitive symptoms

  • Palpitations, pounding heart, accelerated heart rate
  • Sweating
  • Trembling, shaking
  • Sensations of shortness of breath or smothering
  • Chest pain or discomfort
  • Nausea or abdominal discomfort
  • Feeling dizzy, unsteady, lightheaded, faint
  • Chills, hot flushes
  • Paraesthesia (abnormal sensations in extremities - buzzing) 
  • Derealisation, depersonalisation
  • Fear of ‘going crazy’ or ‘losing control’
  • Fear of dying


Physiology of anxiety, fear, panic



  • Autonomic nervous system
    • provides rapid response to any threat
    • violent muscular action - getting body ready for fight or flight
    • sympathetic nervous system (SNS) engaged
    • parasympathetic nervous system (PNS) withdrawn
  • Adrenaline (norepinephrine) released
  • Acute anxiety/fear response
    • cardiovascular, respiratory, gastro-intenstinal, renal and endocrine changes
    • growth, reproduction & immune system goes on hold
    • blood flow to skin decreases
    • body eventually has enough of all of these reponses
  • adrenaline eventually destroyed & PNS re-engaged & restores relaxed feeling
    • cyclical


What does the Cohen, Barlow & Blanchard graph illustrate about panic attack?


  • Occurs over about 15 minutes
  • Enormous surge in heart rate & muscle tension
  • Increase in body temperature

Dying down of response occurs over about 3 minutes 


Which system (axis) is involved in the biological response in a panic attack?


  • Hypothalamic-pituitary-adrenocortical (HPA) axis activated in panic attack
    • major part of neuro-endocrine system
    • secretion of Cortisol
    • acute (whole body) response to stress
  • also contributes to stopping response
    • via inhibitory feedback
  • longer term stress response


Describe the HPA axis.


Hypothalamus / paraventricular nucleus - contain neurons that synthesise and secrete:

  • corticotropin releasing factor (CRF)
  • vasopressin 

which regulate

Pituitary gland (anterior lobe) & stimulate secretion of

  • Adrenocorticotropic hormone (ACTH)

which acts on

Adrenal gland

  • cortisol (glucocorticoid hormone)
    • survival responses

acts back on

  • Pituitary & Hypothalamus to suppress CRF & ACTH
  • production of cortisol mediates the alarm reaction to stress
  • then faciliates adaptive response
  • where alarm reactions are suppressed
  • allows body to restore to rest



What is prolonged exposure to cortisol (stress hormone) thought to result in)


  • atrophy of hippocampus
  • (memory formation & retention of memory)
  • thought to lead to brain forgetting appropriate stress responses & learning appropriate responses


What are the four areas associated with risk factors for Panic Attack?

  • Neurobiological factors
  • Personality factors
  • Psychological factors
  • Social factors


Neurobiological factors

*Genetic influence

*Neurotransmitter systems

  • GABA
  • Norepinephrine, Serotonin

*Corticotropin-releasing factor system 

  • Activates HPA axis
  • Hypothalamus, pituitary gland, adrenal glands

*Wide ranging effects on brain regions implicated in anxiety

  • limbic system, hippocampus & amygdala, locus ceruleus, PF ctx




Which system is most associated with panic & anxiety disorders (from a neurobiological perpective)?


Limbic system most associated

('mediator' between brain stem & cortex)

Amygdala centrally involved by

  • assigning emotional significance (non-aversive stimulus)
  • overly responsive to stimulation
    = abnormal bottom-up processing

Medial prefrontal cortex also involved

  • Fails to down-regulate hyper-excitable amygdala
  • = abnormal top-down processing


Personality risk factors?


 Behavioural inhibition:

  • Strong predictor of social phobia
    • (found in infants as young as 4 mnths - when exposed to novel situations)
  • Neuroticism:
  • Tendency to react with greater neg affect > High levels = strong predictor of anxiety disorder


What two research examples does Jo talk about when considering personality risk factors for developing an anxiety disorder?


Jo's example

  • 7000 adults
  • those with high level of neuroticism were more than twice as likely to develop an anxiety disorder

Firefighters (text example)

  • fire fighters: originally enlisted 
  • measured skin conductance to loud tone
  • larger physiological response = greater risk of developing PTSD following major traumatic event 


Psychological factors


Behaviourist theories:

  • Anxiety as a learned response
  • Classical & operant conditioning
  • Modeling

Perceived lack of control:

  • In childhood, total confidence > real uncertainty of control over environment (spectrum)
  • Parents foster sense of control/not
  • Anxiety following exposure to trauma as function of control over the incident 

Attention to threat:

  • Negative cues in the environment


What two factors are thought to contribute to psychological vulnerability to anxiety?

  • Perceived control/or lack of control over environment
  • Attention to threat: attention to negative cues


Social factors

  • Stressful life events trigger biological & psychological vulnerabilities to anxiety
  • Social & interpersonal
  • Physical
  • Familial
  • 70% report severe stressor prior to onset 


What integrated model of anxiety does Jo present?


Barlow's  (2002) -  Triple Vulnerability Theory

  • Biological vulnerability
    • heritable contribution to negative affect
    • glass is half empty
    • irritable
    • driven
  • Specific psychological vulnerability
    • hypochondriac
    • non-clinical panic
    • learn from early experience
  • Generalised psychological vulnerability
    • sense that events are uncontrollable
    • grow up believing world is dangerous place, out of your control
  • cycle feeds on its self - viscious cycle - even after stressor has gone


Common features for diagnosis of Anxiety Disorders:


  • Typically lasting more than 6 months
  • Causes clinically significant distress or impairment (social, occupational, other)
  • Not attributable to substance/medication use
  • Not better explained by symptoms of another mental disorder
  • Some have specifiers.....


Specific phobia

  • Marked fear or anxiety about a specific object or situation:
  • Almost always provokes immediate fear/anxiety
  • Actively avoided or endured with intense fear/anxiety
  • Disproportionate to actual danger


What are the four major sub-types of specific phobia?

  • Blood, injection, or injury
    • inc heart rate, blood pressure, think going to faint
  • Situational
    • specific situations: chlostrophobia, fear of flying
    • never experience outside of situation itself
    • 1st degree relatives also tend to have
  • Animals & insects
    • common: debilitating
  • Natural environments
    • commmon: many have element of danger anyway
    • leads to avoidant behaviours

peak onset around 7yrs of age


What weakens the utility of sub-typing specific phobias?

tendency for multiple phobias


Aetiology of specific phobias?


Specific phobias come out in a variety of ways:
  • Direct experience
    • e.g., choking 


  • Experiencing a false alarm in specific situation
    • many people have unexpected panic attack > develop phobia in that situation e.g., while driving
    • Classical conditioning
  • Observing someone experiencing fear (modelling)
    • Learn fears vicariously
  • Being told about a danger (verbal instruction)
    • Information transmission e.g., being told about a snake (do not need to actually see one)