Suicide + Anxiety Disorders

What are the 4 groupings under the umbrella of anxiety disorders?

• GAD

• Social anxiety

• Phobias

• Panic disorder

What is anxiety, and what could it do?

Apprehension and diffused aversive experience in anticipation of future event ​

• could increase preparedness (moderate levels)

What is worry?

Repeated negative thoughts about a future event. ​

What is fear, and what does it do?

Specific emotion experienced in the face of immediate perceived danger. ​

• could trigger fight or flight (may save life)

What is panic

Acute, intense, and uncontrollable series of fear-related cognitive and physiological experiences. ​

What does the graph look like for arousal (anxiety) and performance?

What are the 2 keys to differentiate anxiety disorders?

1. Intensity and Frequency​

2. Causes and Context ​

What are some common symptoms of anxiety?

• nervousness​

• jitteriness​

• tension, trembling​

• feeling tired​

• dizziness​

• urinating a lot​

• heart palpitations​

• worry, sweating​

• sleeplessness​

• difficulty concentrating​

• apprehension, vigilance​

True/False: Comorbidity is extremely common with anxiety disorders.

True

What is GAD?

• Intense but vague anxious apprehension​

• “Free-floating anxiety”​

• Persistent worry that something terrible will happen​

• Somatic complaints​

What are the DSM diagnostic criteria for GAD?

• Excessive anxiety and worry – more days than not for 6 months about a number of events or activities​

• Difficult to control worry​

• 3 or more (only 1 in children)​

  • Restless/feeling keyed up​

  • Easily fatigued​

  • Difficulty concentrating or mind going blank ​

  • Irritability ​

  • Muscle tension​

  • Sleep disturbance​

• impairment​

• ​Common worries:​

  • Relationships, health, finances, daily hassles​

• Often begins in adolescence or earlier​

  • I’ve always been this way

What is social anxiety (social phobia)? What’s the prevalence?

• Disabling fears of one or more specific social or performance situations ​

• Fear of negative evaluation of others and/or embarrassing actions​

• Restriction of social life ​

• Lifetime prevalence - 12%​

• 1 year prevalence – 8 %​

What are the DSM diagnostic criteria for social anxiety disorder?

• Marked fear/anxiety about 1 or more social situations in which person is exposed to possible scrutiny ​

• Fear of acting in a way or show anxiety symptoms that will be negatively evaluated​

• Social situations almost always provoke fear/anxiety​

• Social situations are avoided or endured with intense fear/anxiety​

• Out of proportion reaction to situation ​

• Persistent for at least 6 months​

• impairment​

What is a phobia and what do they do?

• Excessive, unreasonable fear​

• Phobia may place huge limitations on everyday activities​

What are some common phobias?

snakes, blood, flying, spiders, small spaces ​

*Not random stimuli that evoke phobias – often something that could present real danger​

What is the Specific Phobia – DSM criteria​

• Marked fear/anxiety about specific object/situation​

• Object/situation almost always provokes fear/anxiety​

• Object/situation avoided or endured with intense fear/anxiety​

• Out of proportion​ (to reality of danger of situation)

• Persistent for at least 6 months​

• impairment​

How common are phobias?

• Relatively common​

  • Lifetime prevalence - 12%​

  • 1 year prevalence – 9 %​

*about twice as prevalent for women than men

What is the difference between phobias and fears?

With phobias, an individual will attempt to avoid places the phobia might be and there’s an extreme reaction when they can’t avoid it

True/false: the age of onset for phobias is typically during early childhood and it tends to be chronic.

False, the typical age of onset is childhood or young adulthood

What is the DSM criteria for panic disorder?

• Recurrent, unexpected panic attacks​

• At least 1 attack has been followed by 1 month of at least 1 of these: ​

  • persistent concern about another attack​

  • Change in behavior due to worry about implications of attack/AVOIDANCE​

  • DSM-IV – panic attacks alone not diagnosable​

  • DSM-5 – panic attacks diagnosed as specifier (e.g., PTSD) even if not panic disorder​

What is a panic attack?

• Panic attack​

• Sudden, intense episode of apprehension, terror, feelings of impending doom​

  • Symptoms reach peak intensity within 10 minutes​

• Accompanied by at least 4 other symptoms:​

  • Palpitations/pounding heart/accelerated heart​

  • Sweating​

  • Shaking/trembling​

  • Sensations of Shortness of Breath​

  • Feeling of choking​

  • Chest Pain​

  • Nausea​

  • Dizziness​

  • Depersonalization or derealization ​

  • Fear of losing control or “going crazy”​

  • Fear of dying​

  • Paresthesias – numbness or tingling​

  • Chills or heat sensations​

• Fear of going crazy, losing control, or dying​

• Panic Attacks versus Panic Disorder​ (constant fear of panic attacks)

  • Cued versus un-cued attacks​

What is agoraphobia?

• Fear of public places or unfamiliar situations in which escape may be difficult​

  • Afraid of losing control in a crowd​

  • May dread anxiety of a panic attack​

What are the DSM diagnostic criteria for agoraphobia?

• Marked fear/anxiety about 2+ of the following:​

  • Using public transportation​

  • Being in open spaces​

  • Being in enclosed spaces (e.g., theaters)​

  • Standing in line or in a crowd​

  • Being outside of the home alone​

• Fear/avoidance because of thoughts that escape might be difficult in the event that panic symptoms start, or other embarrassing symptoms arise (e.g., incontinence)​

• Situations almost always provoke anxiety​

• Actively avoided or endured with intense fear​

• Out of proportion to actual danger presented​

• Persistent (6 months +)​

• impairment​

What are the causes/correlates across all anxiety disorders?

What is the Stress Sensitization Hypothesis?

• people with more past stressors more likely to have anxiety disorders​

• Recent stressors also predicts onset of anxiety disorders​

What are social risk factors?

• Negative life events​

  • Job loss, end of relationship, etc.​

  • Severe stressors often precede onset (Kendler et al., 2003)​

    • 80% with panic disorder (Barlow, 2004)​

    • 70% with any anxiety disorder (Finlay-Jones, 1989)​

Draw out the causes/correlated for classical conditioning?

Draw out the causes/correlated for operant conditioning?

What are cognitive risk factors?

1. Belief that one lacks control over environment​

   • More vulnerable to developing anxiety disorder​

     • Childhood trauma or punitive parenting may foster beliefs​

     • Amount of control during trauma may influence whether anxiety disorder will develop (Mineka & Zinbarg, 2007)

2. Attention to threat​

   • Tendency to notice negative environmental cues​

     • Selective attention to signs of threat​

     • Perseverate or spend more time attending to emotional and/or negative cues​

What are genetic and personality risk factors?

• Most anxiety disorders moderately heritable​

  • 20 – 40 % heritable specific phobia, GAD, PTSD​

  • 50% for Panic ​

• Personality​

  • Behavioral inhibition​

    • Tendency to be agitated, distressed, and cry in unfamiliar or novel settings​

      • Observed in infants as young as 4 months​

      • May be inherited​

    • Predicts anxiety in childhood and social anxiety in adolescence​

• Neuroticism and trait anxiety​

  • React with negative affect ​

  • Linked to anxiety and depression (deGraaf et a., 2002)​