Anxiety Disorders

(Overview)

-most common type of abnormal behaviour

-overlap with mood disorders

-negative affect

-more common in women

-phobias

-panic disorder

-generalized anxiety disorder

-obsessive compulsive disorder

-post traumatic stress disorder

-acute stress disorder

-Present-Oriented mood state

-fight or flight response to real danger or threat

-involves abrupt activation of sympathetic nervous system

-strong avoidance/escapist tendencies

-Future-Oriented mood state

-generally out of proportion to threats in the environment

-somatic symptoms of tension

-pervasive and persistent symptoms of anxiety and fear

-involve excessive avoidance and escape

-cause clinically significant distress and impairment

Symptoms and Associated Features

(Anxiety,

Maladaptive Anxiety,

Excessive Worry)

-Anxiety:

-different from fear

-low levels can be adaptive

-Maladaptive Anxiety:

-high levels of diffuse negative emotion

-sense of uncontrollability

-shift in attention to state of self-preoccupation

-Excessive Worry:

-common in anxiety

-relatively uncontrollable sequence of negative emotional thoughts and images anticipating future threats or danger

-pathological worry

-persistent, excessive, unrealistic fear of a specific object/situation

-avoidance behaviour:

-disrupting, fear-mediated avoidance that is out of proportion to the danger actually posed

-recognized by the sufferer as groundless

Obsessions:

-repetitive unwanted thoughts, images, impulses

-person realizes their unreasonable nature (not delusional)

-themes of sex, violence, contamination

-repetitive behaviours

-behavioural responses to obsessions ("tension reduction")

-rituals

-mental acts

-Specific Phobias

-Social Phobia

-Panic Disorder

-Generalized Anxiety Disorder

-Obsessive Compulsive Disorder

-Post Traumatic Stress Disorder

-Acute Stress Disorder

-marked, persistent fear

-unrealistic (with awareness)

-significant life impairments

-affects 7-11% of general population

-sub-divided accourding to source:

-blood, injuries, injections

-situations

-animals

-natural environment

-affects 3-13% of general population

-persistent, irrational fears linked generally to the presence of other people

-fear of social situations:

-performance anxiety

-interpersonal interactions

-rooted in fear of negative evaluations

Panic Attack

(Somatic Symptoms)

DSM-IV requires at least 4 of the following symptoms:

-palpitations

-sweating

-trembling/shaking

-sensations of shortness of breath / smothering

-feelings of choking

-chest pain/discomfort

-nausea

-feeling dizzy/light-headed

-derealization/depersonalization

-fear of losing control/going crazy

-fear of dying

-tingling/numbness of extremities

-chills/hot flushes

Panic Attack

(Cognitive Symptoms)

-catastrophic misinterpretation of bodily sensations

-sudden overwhelming experience of terror or intense fear involving somatic and cognitive symptoms

-can be distinguished from anxiety

-DSM-IV subtypes:

-situationally bound (cued)

-unexpected (uncued)

-situationally predisposed

-recurrent unexpected panic attacks

-persistent concern about additional attacks for one month

-with or without agoraphobia

-excessive, uncontrollable anxiety and worry

-majority of days for at least six months

-affective, cognitive, and somatic symptoms

-must have 3+ symtoms to be diagnosed

-presence of obsessions or compulsions

-attempts to suppress thoughts or impulses

-mind is flooded w/ persistent & uncontrollable thoughts

-individual compelled to repeat certain acts over and over

-most difficult of anxiety disorders to treat

-CBT treatment seems to be most effective

-extreme response to a severe stressor, including increased anxiety, avoidance of a stimuli associated with the trauma, and a numbing of emotional responses

-symptoms are grouped into 3 major categories:

1. Re-experiencing the traumatic event

2. Avoidance of stimuli associated with the event or numbing of responsiveness

3. Symptoms of increased arousal

-Prevalence rate: 1-3%

-Exposure to trauma and severity of trauma

-Gender (more females)

-Perceived threat to life

-Personality traits of neuroticism and extroversion

-Early conduct problems

-Family history of psychiatric disorders

-Presence of pre-existing psychiatric disorders

-Early separation from parents

-Previous exposure to traumas

-Tendency to take personal responsibility for failures and to cope with

stress by focusing on emotions

-Attachment style

-Stressful occupations

Chronic Conditions

-general predisposition to having anxiety tends to be something that has been there since early on

Individual Differences in Recovery

-best to treat it early on

-people tend to respond better when things haven't been entrenched for years

Prevalence

-more common than any other disorder

Comorbidity

-50% of those with another anxiety disorder will have another anxiety/panic disorder

-GAD very common

Gender

-higher prevalence rate in females

Age

-lower prevalence in elderly

Cross-cultural Studies

-similar to prevalence rates

-different symptom patterns

Objects of fear and anxiety relate to beliefs and attitudes prevalent in the culture where syndromes occur:

-Japan: Taijin kyofusho syndrome

-Inuit: Kayak-angst

-S & E Asia: Koro

-China: Shenkui

-Latin America: Susto

Etiology of Anxiety:

Evolutionary Factors

-evolutionary theories view anxiety as part of an adptive system

-anxiety disorders may represent problems in the regulation of the system

Etiology of Anxiety:

Psychoanalytic View

-unconscious conflict between ego vs id impulses

*focus on sex and aggression

-phobias are a defence against the anxiety produced by repressed id impulses

-OCD results from instinctual sexual or aggressive forces that are not under control due to harsh toilet training

Etiology of Anxiety Disorders:

Social Factors

-Stressful (dangerous) life events

-childhood abuse/neglect

-insecure  attachment

-separation anxiety

Etiology of Anxiety Disorders:

Temperament/Personality Factors

-behavioural inhibition to the unfamiliar (temperamental style)

-can be id'd at as young as 4 months

-neuroticism

-tendency to react to events with negative affect

-more likely to develop anxiety disorders and aggression

Etiology of Anxiety Disorders:

Psychological Factors

-classical conditioning

-could be linked to the development of phobias

-observational learning

-the fear-of-fear hypothesis

-fear of having a public panic attack (ex. suggested real reason of agoraphobia)

-panic: misinterpretation of physiological arousal symptoms

Etiology of Anxiety Disorders:

Cognitive Factors

-lack of control: perceived control vs helplessness

-"catastrophic misinterpretation"

-anxiety sensitivity

-focus on threat-related stimuli

-attention to threats/shifts in attention

-paradox of thought suppression

-"try not to think of a bear"

Etiology of Anxiety Disorders:

Biological Factors

-strong genetic component

-family and twin studies

-two genetic factors identified

-GAD/major depression

-panic disorder/phobias

-neuroanatomy

-autonomic nervous system

-thalamus-amygdala circuit

-OCD: caudate nucleus/orbital prefrontal cortex/anterior cingulate cortex (linked to turrets)

-neurochemistry

-lactate injections

-norepinephrine

-Psychoanalytic approach

-uncovering repressed conflicts

-Alfred Adler on OCD

-Behavioural Approaches

-shift has been to incorporate more of the behavioural aspects sooner

-Systematic Desensitization

-a fear hierarchy

-evidence that direct exposure is better than imagined exposure

-Exposure and Response Prevention

-used a lot in OCD treatment

-prevention from engaging in compulsions

-obsessive thoughts are more difficult to treat than compulsions

-Relaxation Training

-Flooding

-exposure to the most frightening stimuli all at once

-tends to work

-Cognitive Therapy

-usually combined with a behavioural approach

-working on recognizing the faulty logic

-de-catastrophizing

Antianxiety Medications

-benzodiazapines (Valium, Xanax)

-serious side effect: addiction

Antidepressant Medications

-SSRIs (Prozac, Zoloft, Paxil) preferred due to fewer, less serious side effects

-Tricyclics

-Clomipramine for OCD