Anxiety, OCD, and Trauma/Stressor Related Disorders

Anxiety

Mood state characterized by marked negative affect and somatic symptoms of tension in which the person apprehensively anticipates future danger or misfortune

• May be expressed as subjective unease, worries behaviors, and/or physiological responses/rumination

Panic Attack

An abrupt surge of intense fear or discomfort accompanied by physical symptoms such as heart palpitations, chest pain, shortness of breath, and dizziness as well as feelings of losing control and dying

3 Types of Panic Attacks

1. Situationally bound/cued → When exposed to a situational trigger or anticipation of it

2. Unexpected/uncued → Occurs without obvious trigger

3. Situationally predisposed → Usually occurs with a trigger, but not always

Generalized Anxiety Disorder (GAD) Overview and Criteria

Characterized by intense, unfocused, and uncomfortable anxiety

DSM-5 specifies excessive anxiety and worry must be present for more days than not for a period of at least 6 months

Must be accompanied by at least 3/6 associated physical symptoms (restlessness, muscle tension, easily fatigued, concentration difficulty, irritability, sleep disturbance)

• Different ages worry about different things (E.g., elderly worry about health issues)

• ~4% of population meet criteria for GAD

Panic Disorder Overview

A person must experience recurrent, unexpected panic attacks AND develop anxiety about possibility of another attack or the implications of the attack

• A single panic attack does not automatically mean panic disorder

• Panic disorder affect ~2-3% of general population

• Preferred treatment is SSRI therapy

Phobias

Specific phobia: Characterized by clinically significant anxiety provoked by exposure to (or anticipation of exposure to) a specific feared object or situation → Avoidance behaviors

• Can be managed

• Exposure to the feared situation almost always produces anxiety and may produce a situationally bound panic attack

• ~12.5% of general population (common include snakes and heights)

Social Anxiety Disorder aka…

Social Phobia → Clinically significant anxiety provoked by exposure to certain types of social or performance situations

Anxiety Disorders are Associated with…

• Higher risk of suicidal thoughts/attempts

• Comorbid anxiety and depression increase likelihood of suicide over depression alone

Obsessive Compulsive Disorder (OCD) Overview

Characterized by recurrent obsessions and/or compulsions that are severe enough to be time consuming or cause significant distress/impairment

• Lifetime prevalence ~1.6%

• Typically onsets between adolescence and mid-20’s (Most describe gradual onset and worse during stress)

• OCD is associated with high rates of comorbidity w/ mood disorders, other anxiety disorders, and personality disorders

Obsessions are…

Recurrent or persistent thoughts, images, or images that are intrusive & cause marked anxiety and distress (Typically include thoughts about contamination, aggressive impulses, somatic concerns, need for symmetry)

Compulsions are…

Repetitive behaviors or mental acts that are engaged in to prevent/reduce anxiety or distress

Can be behavioral (checking, washing, hoarding) or mental (counting, praying)

Post-Traumatic Stress Disorder (PTSD) Overview

Characterized by the development of symptoms related to the exposure to one or more traumatic events

• Prevalence in general population ~7%

• PTSD rates are higher among veterans and other vocations with high risk of traumatic exposure

• About 1/2 diagnosed with PTSD will see complete recovery within 3 months

• Comorbidity w/ other disorders is high → Most common is MDD and alcohol dependence

DSM-5 Exposure Meaning in PTSD

Directly experiencing, witnessing in person, learning about trauma to a close family/friend, or extreme exposure to the details of a traumatic event

Symptoms of PTSD

Clinical presentation varies and can include:

1. Intrusion — Memories, distressing dreams, flashbacks

2. Avoidance — Avoiding thoughts or feelings associated w/ trauma, activities/places that bring back trauma, inability to recall aspects of trauma, detachment

3. Increased Arousal — Difficulties sleeping, irritability, anger outbursts, hypervigilance, difficulty concentrating, exaggerated startle response, reckless behavior

4. Negative Cognitions & Dysphoric Mood — Negative beliefs about oneself/others/world, self-blame for trauma, depressed-like presentation

Presentation may include dissociative symptoms for some — Specifier would apply

Acute Stress Disorder Overview

Used when PTSD symptomology is present within one month after exposure to a traumatic event

Length for PTSD to be Diagnosed

More than ONE MONTH

Length for Acute Stress Disorder to be Diagnosed

WITHIN one month

Adjustment Disorders Overview

Essential feature is a psychological response to an identifiable stressor that results in clinically significant emotional/behavioral symptoms

• Begins within 3 months of the stressor

• DOES NOT meet criteria for another disorder

• When stressor/its consequences have subsided…

  • the symptoms do NOT persist for more than an additional 6 months

Subtypes of Adjustment Disorders

Depend on the prominent symptoms…

1. with depressed mood

2. with anxiety

3. with mixed anxiety and depressed mood

4. with disturbance of conduct

5. with mixed disturbance of emotions

6. unspecified

Treatment for GAD

Benzodiazepines (Valium/Xanax) and therapy targeting worry and coping

Treatment for Panic Disorder

Benzodiazepines can work, but SSRIs (Paxil/Prozac) are preferred because of dependence concerns; CBT is commonly used

Treatment for PTSD

Gradual re-experiencing in a supportive context; SSRIs may help severe anxiety/panic

Treatment for OCD

SSRIs may help, but exposure and response prevention (ERP) is the most effective treatment in the notes