psyc 337 - generalized anxiety disorder and social anxiety disorder

HiTOP classification

internalizing -> distress, fear -> SAD, MDD, Dysthymia, GAD

DSM-II and GAD

lumped into broad category of anxiety neurosis

DSM-III and GAD

GAD broken out

DSM-III-R and GAD

GAD changed to have more of its own identity. worry begins to pay a larger roll - pathological worry, it has to be about everyday situations, not just about another disorder. sometimes difficult differential diagnosis

DSM-IV and GAD

simplified the criteria - excessive anxiety and worry, more days than not, at least 6 months, about multiple events, activities, and objects, difficult to control the worry, and cannot occur exclusively during a mood episode

DSM criteria for GAD

restlessness, feeling on edge, easily fatigued, difficulty concentrating irritability, muscle tension, sleep disturbance, must cause significant distress or impairment

GAD lifetime prevalence

5-6 percent

12 month prevalence for GAD

3.1 percent

female to male ratio for GAD

2F:1M

is GAD the most commonly diagnosed Axis I disorder in primary care

yes

comorbidity in GAD

As many as 90% of diagnosed cases meet criteria for another disorder. As many as 80% of dx cases meet criteria for a mood disorder. Also panic disorder, social anxiety disorder, and personality disorders

problems with GAD

associated with increased health care utilization - more frequent visits to doctor. increased health care cost. greater chance of concurrent physical illness. significant social, academic, and vocational impairment. days lost at work/school, damage to relationships.

course of GAD

symptoms often evident in adolescence or earlier. median age of onset in the 30s but can onset at any time, gradual onset.

chronic course of GAD

personality disorder. 12 year follow up study - recovery rate is 58%. of those who recover, the recurrence rate is high

familial transmission of GAD

trait anxiety highly familial, strong genetic component. GAD also runs in families

family studies of GAD

increased rates of GAD in families of pro bands with GAD. higher rates than in pro bands with panic disorder. suggests some specificity.

prototypical anxiety disorders

FINISH

tom borkovec

most prominent current theory of GAD comes from him, worry = cognitive avoidance, low probability events. worry as a cognitive, verbal, and mental operation. buffers GAD from high emotional arousal. don't get vivid imagery (exposure TX: you need the imagery to become emotionally aroused. if never aroused, fear structure is never changed). worry inhibits emotional processing

worry in GAD

evidence that GAD tries to control or suppress the worry. viscous cycle, inability to control worry increases sense of lack of control. increases intrusiveness of the thoughts, cycle perpetuates itself.

what does suppressing a thought do

increases probability of it occurring

gad and detection of threat

people with gad often show abnormal attention to threats in the environment. gad have lower threshold for detection of threat - may think neutral face is threatening

rumination

primarily about the past, thinking about things that went wrong

how common is social anxiety

second most common anxiety disorder, third most common psychiatric disorder

social anxiety impairment

romantic and other social relationships, career, education

DSM-5 criterion A for social anxiety

marked fear or anxiety about one or more social situation in which the individual is exposed to possible scrutiny by others

DSM-5 criterion B for social anxiety

person fears that they will act in a way or show anxiety symptoms that will be negatively evaluated (will be humiliating or embarrassing, will lead to rejection or offend others)

DSM-5 criterion C for social anxiety

social situations almost always provoke fear or anxiety

DSM-5 criterion D for social anxiety

these situations are avoided or endured with great distress

DSM-5 criterion E for social anxiety

fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context

common social anxiety disorder fears

fears often involve specific situations, such as speaking in public, eating in public, writing in front of other people, using public bathrooms (slightly more common for men), and also a generalized phobia - multiple situations are feared or avoided

SAD prevalence

12%

SAD female to male ratio

2F:1M, gender differences emergers in adolescence

SAD comorbidity

very high

SAD components

high standards, very self critical, tend to scrutinize themselves. high self criticism in depression

racial/ethnic differences in SAD

rates similar in north and South America. prevalence far lower in East Asian countries (less than 1% lifetime prevalence versus 6-7 in North America). In north American samples, Hispanic or Black

people are also associated with lower risk compared to non‐Hispanic white people

are the racial/ethnic differences in SAD genuine differences in the psychopathology?

insufficient consideration of cultural aspects of the DSM criteria, assessment instruments, or influence of features associated with race, ethnicity, and culture

mean age of onset for animal phobias

7

mean age of onset for blood and injury phobias

9

mean age of onset for dental phobias

11

mean age of onset for social anxiety disorder

16

cognitive theories of social phobia

social situations activate core set of values or beliefs re social competencies. believe others will view them negatively. schemas interfere with interpretation of social situations. begin to see danger and threat. the more anxious they feel, the more likely they think rejection is, makes them more anxious. self focus fact that maintains the disorder, functions as safety/avoidance behavior. used to forestall social disasters - even after situation, a biased memory for negative experiences reinforces negative expectation of self - vicious cycle

social vignettes

stories that prompt assessment of a person's response

research in support of theories

stroop studies, dot-probe, vigilance-avoidance, stimulus duration

SAD controversy

almost always comorbid with something else more than other disorders