Lecture Notes on Anxiety Disorders

Flashcards about Obsessive Compulsive Disorders, Specific Phobias, Agoraphobia, and Social Anxiety Disorder (Social Phobia)

OCD Definition (APA, 2013)

A mental disorder characterized by the presence of obsessions and/or compulsions.

DSM-5 Categories of Obsessive-Compulsive and Related Disorders

Obsessive-compulsive disorder (OCD), Body dysmorphic disorder, Hoarding disorder, Trichotillomania (hair pulling disorder), Excoriation (skin-picking) disorder, Substance/Medication-Induced obsessive-compulsive and related disorder, obsessive-compulsive and related disorder due to Another Medical Condition; Other specified obsessive-compulsive and related disorder; and Unspecified obsessive-compulsive and related disorder

ICD-10 Categories Related to OCD

F42.0 Predominantly obsessional thoughts or ruminations, F42.1 Predominantly compulsive acts [obsessional rituals], F42.2 Mixed obsessional thoughts and acts, F42.8 Other obsessive-compulsive disorders, F42.9 Obsessive-compulsive disorder, unspecified.

Obsessions (in OCD)

Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, disturbing, inappropriate and uncontrollable.

Compulsions (in OCD)

Repetitive behaviors or mental acts that an individual feels driven to perform in response to obsessions, to avoid some dreadful situation or must do so, according to the rules that must be applied rigidly.

Common Obsessive Thoughts

Contamination fears, fears of harming oneself or others, and pathological doubt. Other common themes are concerns about or need for symmetry, sexual obsessions, and obsessions concerning religion, violence or aggression.

Washing/Cleaning Rituals (in OCD)

Can range from mild (spending 15 to 20 minutes washing one's hands after going to the bathroom) to extreme (washing hands with disinfectants until the point where the hands bleed).

Checking Rituals (in OCD)

Can range from mild to severe (such as checking all the lights, appliances, and locks two or three times before leaving the house, to going back to an intersection where one thinks one may have accidentally killed somebody without their knowing and spending hours checking for any sign of the imagined incident).

Consequence of Compulsive Acts

The performance of the compulsive acts brings a feeling of reduced tension and satisfaction, as well as a sense of control, although this anxiety relief is very fleeting as the individual is stuck in these cycles of obsessive thoughts and compulsive behaviours.

Genetic Factors (Etiology of OCD)

Twin studies reveal that monozygotic twins are at a slightly higher risk of developing OCD than do dizygotic twins

Neurological Basis of OCD

Abnormalities in the basal ganglia and the amygdala, which control emotional behaviors, can lead to OCD.

Neurotransmitter Abnormalities (Etiology of OCD)

Increased serotonin activity and increased sensitivity of some brain structures to serotonin are involved in OCD symptoms.

Mowrer’s two-process theory of avoidance learning

Neutral stimuli becomes associated with frightening thoughts or experiences through classical conditioning and elicit anxiety

Appraisals of Responsibility for Intrusive Thoughts

People with OCD often seem to have an inflated sense of responsibility and in turn, in some vulnerable people, this inflated sense of responsibility can be associated with beliefs that simply having a thought, of doing something is morally equivalent to actually having done that act

Behavioral Treatment for OCD

Combines exposure and response prevention. Clients develop a hierarchy of upsetting stimuli and rate them on a 0 to 100 scale according to the stimuli’s capacity to evoke anxiety, distress, or disgust.

Medication for OCD

Medications that affect the neurotransmitter serotonin seem to be the primary class of medication to treat persons with OCD. A major disadvantage of medication treatment for OCD, as for other anxiety disorders, is that when the medication is discontinued relapse rates are generally very high.

Specific Phobia (DSM-5)

Lists Specific Phobia under Anxiety Disorders and the diagnosis needs to be specified if it is phobia toward Animals, Natural environment, Blood-injection-injury, Situational or Other.

Specific Phobia (ICD-10)

Listed under the Neurotic, stress-related and somatoform disorders (F40-F48), where F40 is devoted to Phobic Anxiety Disorder, and the code for Specific (isolated) Phobias is F40.2

Animal Type (Specific Phobia Subtype)

Snakes, spiders, dogs, insects, birds

Natural Environment Type (Specific Phobia Subtype)

Storms, heights, water

Blood-Injection-Injury Type (Specific Phobia Subtype)

Seeing blood or an injury, receiving an injection, seeing a person in a wheelchair

Situational Type (Specific Phobia Subtype)

Public transportation, tunnels, bridges, elevators, flying, driving, enclosed spaces

Other (Specific Phobia Subtype)

Choking, vomiting (Emetophobia), “space phobia” (fear of falling down if away from walls or other support)

Psychoanalytic Viewpoint (Etiology of Specific Phobias)

Phobias represent a defense against anxiety that stems from repressed impulses of the id. Anxiety is displaced onto some external object or situation that has some symbolic relationship to the real object of the anxiety.

Behaviorist View (Etiology of Specific Phobias)

Phobic behavior is learnt through classical conditioning, where the fear response is conditioned to previously neutral stimuli when these stimuli are paired with traumatic or painful events. Also, once acquired, phobic fears would be generalized to other, similar objects or situations.

Evolutionary Preparedness (Etiology of Specific Phobias)

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 which we might have carried forward through evolution.

Exposure Therapy (Treatment for Specific Phobias)

Involves controlled exposure to the stimuli or situations that elicit phobic fear.

Agoraphobia Definition

People with agoraphobia are afraid of being in public places or situations where escape might be difficult or help unavailable, should they experience panic or become incapacitated

Agoraphobia (DSM-5)

Lists Agoraphobia under Anxiety Disorders

Agoraphobia (ICD-10)

Lists Agoraphobia under the Neurotic, stress-related and somatoform disorders (F40-F48), and sub-categorized under Phobic Anxiety Disorder (F40), under which the code for Agoraphobia is F40.0

Agoraphobia Treatments

Behaviorists developed a variety of exposure approaches for agoraphobia where therapists help clients to venture farther and farther from their homes and to gradually enter outside places, one step at a time.

Social Phobia Definition

Characterized by disabling fears of one or more specific social situations (such as public speaking, urinating in a public bathroom, or eating or writing in public).

Social Anxiety Disorder (Social Phobia) DSM-5

Lists Social Anxiety Disorder under Anxiety Disorders and the diagnosis needs to be specified if it “performance only”.

Social Anxiety Disorder (Social Phobia) ICD-10

Lists Social Phobia under the Neurotic, stress-related and somatoform disorders (F40-F48), and sub-categorized under Phobic Anxiety Disorder (F40), under which the code for Social Phobia is F40.1

Cognitive Theorists Belief of Social Anxiety Disorder

People with this disorder hold a group of social beliefs and expectations that consistently work against them and lead to disasterous conclusions.

Social Anxiety Disorder Therapies

Over the years therapists understood that Social Anxiety Disorder has two distinct features: (1) Sufferers have overwhelming irrational social fears, and (2) They often lack skill at starting conversations, communicating their needs, or meeting the needs of others