5. Anxiety, Obsessive-Compulsive and Related Disorders, and Trauma- and Stress-Related Disorders

Fear

Emotional response to real or perceived imminent threat

Anxiety

Anticipation of a future threat

Separation Anxiety Disorder

Excessive fear or anxiety concerning separation from attachment figures, beyond developmental expectations

At least 4 weeks in children and adolescents, 6 months or more in adults

Separation Anxiety Disorder Diagnostic Duration

Social Anxiety Disorder Specifier (Performance-only)

Fear limited to performance or being observed (e.g., speeches, public performance)

Selective Mutism

Consistent failure to speak in expected social situations despite speaking in other contexts

At least 1 month (not limited to first month of school)

Selective Mutism Duration

Usually before age 5, often noticed at school entry

Selective Mutism Onset

CBT adapted for speech, e.g., Brave Buddies Camp

Selective Mutism Treatment

Specific Phobia

Irrational fear of specific object or situation that markedly interferes with an individual's ability to function.

Persistent for 6 months or more

Specific Phobia Diagnostic Duration

three

The average individual with specific phobia fears _ or more objects or situations.

75%

Approx. percentage of individual with specific phobia fear more than one situation or object.

Blood-Injection-Injury Phobia

Phobia with inherited vasovagal response, fainting risk at sight of blood/injection

Situational Phobia

Fear of enclosed spaces or public transportation

Claustrophobia

Fear of small enclosed spaces

Nature-Environment Phobia

Fears of situations or events occurring in nature, such as heights, storms, water

Animal Phobia

Fear of animals or insects that impairs functioning

Behavioral inhibition, negative affectivity

Specific Phobia Risk Factors (Temperamental)

Heritability - animal (32%), blood-injection (33%), situational (25%)

Specific Phobia Risk Factors (Genetic)

Exposure-based therapy under supervision

Specific Phobia Treatment

Usually childhood, median age 7–11, mean age at 10

Specific Phobia Period of Onset

Social Anxiety Disorder (Social Phobia)

medical condition that causes fear and anxiety when you’re around people in social situations due to fear of being judged, embarrassed, or scrutinized

Symptoms last 6 months or more

Social Anxiety Disorder Duration

Social Anxiety Disorder Specifier (Performance-only SAD)

Fear limited to performance or being observed (e.g., speeches, public performance)

Behavioral inhibition, harm avoidance, fear of negative evaluation

Social Anxiety Disorder Risk Factor (temperament)

Heritable, relatives have 2–6x greater risk

Social Anxiety Disorder Risk Factors (Genetic)

Peer victimization, negative social experiences

SAD Risk Factors (Environmental)

Taijin kyofusho (Japan, Korea)

fear of making others uncomfortable, sometimes with delusional intensity

CBT with real-life exposures highly effective (84% success in Clark’s study)

Social Anxiety Disorder Treatment

Common in adolescence, adult-onset is rare and often after humiliation/life changes

Social Anxiety Disorder Period of Onset

Panic Attack

Abrupt sudden surge of intense fear peaking within minutes

4 or more

How many of the 13 symptoms listed makes it a panic attack?

Panic Disorder

An anxiety disorder in which an individual experiences severe, unexpected panic attacks in which they may think that they’re dying or otherwise losing control.

1 month

At least one of the panic attacks has been followed by how many months of one or both of the list?

Expected Panic Attack

Type of panic attack triggered by a specific cue

Unexpected Panic Attack

Type of panic attack occurs without warning

Interoceptive Avoidance

Avoidance of internal sensations (e.g., exercise, caffeine)

Neuroticism, anxiety sensitivity, harm avoidance, behavioral inhibition, history of “fearful spells”, separation anxiety in childhood

Panic Disorder Risk Factors (Temperamental)

Stressors, trauma, childhood adversities, smoking, few economic resources

Panic Disorder Risk Factors (Environmental)

CBT, Panic Control Therapy, medications include SSRIs, SNRIs, benzodiazepines (If combo, psych muna bago medication)

Panic Disorder Treatment

Median 20–24 years, mean ~34.7 years, rare after 55

Panic Disorder Period of Onset

women

The rate of panic disorder is higher in women or men?

Agoraphobia

Is fear and avoidance of situations in which a person feels unsafe or unable to escape to get home or to a hospital in the event of a developing panic, panic-like symptoms, or other physical symptoms, such as loss of bladder control.

2 or more

Agoraphobia is marked fear or anxiety about how many of the following five listed situations (using public transpo, being in open spaces, enclosed places, standing in line or being in a crowd, outside of the home alone)

Lasts 6 months or more

Agoraphobia Duration

Karl Westphal

a German physician coined the term agoraphobia in 1871

fear of the marketplace

original Greek meaning of agoraphobia

panic disorder

what was integrated with agoraphobia into one disorder in the past?

Agoraphobia Complication

Often develops after panic disorder but can exist independently

Behavioral inhibition

Agoraphobia Risk Factor (Temperamental)

Negative social events

Agoraphobia Risk Factor (Environmental)

CBT, medication, or combined therapy

Agoraphobia Treatment

Mean ~21 years, usually before 35, without preceding panic attacks or panic disorder is 25-29 rare in childhood

Agoraphobia Period of Onset

substance use disorders

In Agoraphobia, men have higher rates of comorbid _

Excessive, uncontrollable worry about multiple domains (work, health, school, relationships) for 6+ months

Generalized Anxiety Disorder (GAD)

occurring more days than not in 6 months or more

Duration of GAD

3 or more of the ff - Restlessness, fatigue, irritability, poor concentration, muscle tension, sleep disturbance

GAD Symptoms

Neuroticism, harm avoidance, attentional bias to threat

GAD Risk Factors (Temperamental)

One-third of risk is genetic, overlaps with depression

GAD Risk Factors (Genetic)

Benzodiazepines (short-term)

GAD treatment

Mean ~35 years in North America, often lifelong course

GAD Period of Onset

Anxiety Disorder Due to Another Medical Condition

Feeling anxious because of a physical illness or health problem (e.g., heart disease, thyroid problems, asthma, etc.), not just from stress or worries alone

Obsessive-Compulsive Disorder (OCD)

Mental disorder characterized by unwanted intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing anxiety

Obsessions

unwanted, intrusive, and distressing thoughts, urges, or images that keep coming back.

Compulsions

Repetitive behaviors (e.g., washing, checking) or mental acts (e.g., counting, praying) that the person feels they must do to reduce anxiety or prevent something bad from happening

Obsessions

intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resistor eliminate

Compulsions

thoughts or actions used to suppress the obsessions and provide relief

symmetry obsessions, forbidden thoughts or actions, cleaning and contamination, hoarding

description of OCD

Symmetry Obsessions

Refers to keeping things in perfect order or doing something in a specific way. Putting things in a certain order.

Forbidden Thoughts or Actions

Fears, urges to harm self or others. Checking, avoidance, and repeated requests for reassurance.

Cleaning and Contamination

Fear of germs or contaminants characterized by repetitive or excessive washing and use of gloves/masks

Hoarding (within OCD)

Fears of throwing anything away. Collecting/saving objects with little or no actual or sentimental value such as food wrappings.

Good/Fair insight

OCD Specifier - Recognizes beliefs are unreasonable

Poor insight

OCD Specifier - Believes their beliefs are probably true

Absent insight/delusional

OCD Specifier - Fully convinced beliefs are true

Up to 30% have lifetime tic disorder, especially males with childhood onset

OCD and Tic Disorder

Mean age 19.5 years, 25% before 14, rare after 35, typically gradual, however acute onset may occur, men have earlier onset than women

OCD Onset

chronic

If OCD is untreated, the course is usually _, often with waxing and waning symptoms.

Greater internalizing symptoms, higher negative emotionality, and behavioral inhibition in childhood

OCD Risk Factors (Temperamental)

Adverse perinatal events, premature birth, maternal tobacco use during pregnancy, physical and sexual abuse in childhood, and other stressful or traumatic events

OCD Risk Factors (Environmental)

Familial, first-degree relatives of childhood-onset OCD have 10x higher risk

OCD Risk Factors (Genetic)

Dysfunction in orbitofrontal cortex, anterior cingulate cortex, and striatum

OCD Brain Areas

psychosurgery (in severe cases), SSRIs, Exposure and Ritual Prevention (ERP)

OCD Treatment

Exposure and Ritual Prevention (ERP)

process whereby the rituals are actively prevented and the patient is systematically and gradually exposed to the feared thoughts or situations.

19.5 (period of onset)

Mean age of onset of OCD

Body Dysmorphic Disorder (BDD)

Preoccupation with imagined or slight defects in appearance, causing distress and repetitive behaviors (e.g., mirror checking, grooming)

Body Dysmorphic Disorder (BDD)

Most people fantasize about improving something, but some relatively normal-looking people think they are so ugly they refuse to interact with others or otherwise function normally for fear that people will laugh at their ugliness.

Muscle Dysmorphia

BDD Specifier – Belief body is too small or not muscular enough

With Good/Fair insight

BDD Insight Specifiers - The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.

With Poor Insight

BDD Insight Specifiers - The individual thinks that the body dysmorphic disorder beliefs are probably true.

With Absent Insight/Delusional beliefs

BDD Insight Specifiers - The individual is completely convinced that the body dysmorphic disorder beliefs are true.

dysmorphophobia

BDD is previously known as _

3-8 hours per day on average

how long does a person with BDD consume thinking about their “deformity” which is difficult to resist or control

Mean 16–17 years, median 15, most common age is 12-13 basta before 18

BDD Onset

Childhood neglect, abuse, trauma, elevated rates of teasing

BDD Risk Factors (Environmental)

Heritability estimated at 37–49%

BDD Risk Factors (Genetic)

SSRIs, CBT focusing on cognitive distortions and exposure

BDD Treatment

dermatology treatment, plastic surgery

most sought after treatment received for BDD

Hoarding Disorder

Characterized by excessive acquisition of things, difficulty discarding anything, and living with excessive clutter under conditions best characterized as gross disorganization