Psych 155 part 8

anxiety

a normal human response to perceive threat or uncertainty

• disorders involve more than occassional fear

DSM-5

_____-__ standardizes clinical diagnoses across cultural frameworks

common language

DSM-5

• tool

  • harmonizes with the WHO;s ICD system to provide a ______ _______ for clinicians and researchers

culture

DSM-5

• cultural lens

  • mental disorders are defined relative to cultural and familial norms

  • _______ shapes the expression and interpretation of symptoms

diagnosis

DSM-5

• threshold of significance

  • _________ requires that the disturbance causes clinically significant distress or impairment in social occupational or other important areas of functioning

anixety, fear, panic

What are the distuingishing baseline mood states:

anxiety

future oriented

• negative mood state characterized by physical tension and apprehension about the future

moderate

Anxiety in __________ amounts are beneficial and improve performance

fear

immediate

• an immediate emotional reaction to current danger, marked by a sympathetic nervous system surge and ascapist action tendencies

panic

overwhelming

• an abrupt experience of intense fear or acute discomfort

• can be expected, or unecpected

biological contributions

• inherited tendency to be tense

• depleted GABA levels associate with increased anxiety

environment

BIOLOGICAL CONTRIBUIONS

• _________ alters brain circuit sensitivity

• teens smoking 20+ cigarettes daily are 15x more likely to develop GAD

psychological contributions

overprotective parents who clear the way prevent children from learning how to cope with unexpected adversity, preventing healthy sense of control

uncontrollability

PSYCHOLOGICAL CONTRIBUTIONS

• early childhood upbringing dictates a sense of _____________

Social contributions

reaction patterns to stress, such as panic attacks or headaches, tend to run heaviliy in families

vulnerabilities

SOCIAL CONTRIBUTIONS

• stressful life events trigger underlying __________

triple vulnerability theory

this explains how disorder activates

generalized biological vulnerability

TRIPLE VULNERABILITY THEORY

• an inherited diathesis or tendency to be high-strung, tense or neurobiologically overactive

generalized psychological vulnerability

TRIPLE VULNERABILITY THEORY

• a deep-seated belief, formed by early experiences, that the world is dangerous and uncontrollable

specific psychological vulnerability

TRIPLE VULNERABILITY THEORY

• learned associations from early experience teaching that specific objects or situations are fraught with danger

generalized anxiety disorder, panic disorder & panic attacks, agoraphobia, specific phobia, separation anxiety disorder, social anxiety disorder, selective mutism

DSM-5 anxiety disorder spectrum

1. GAD

2. PD & PA

3. A

4. SP

5. SpAD

6. ScAD

7. SM

generalized anxiety disorder

DSM-5 anxiety disorder spectrum

• excessive worry occuring more days than not for 6+ months

• individual finds worry difficult to control

• requires 3+ physical symptoms

  • restlessness

  • easily fatigued

  • poor concentration

  • irrtability

  • muscle tension

  • sleep disturbances

generalized anxiety disorder

DSM-5 anxiety disorder spectrum

• Clinical insights

  • demographics: prevalent among older adults; twice as many females as males

  • biological traits: high heritability for anxiety sensitivity

  • cognitive processing: EEG actively shows intense cognitive processing in the frontal lobes, indicating frantic worry without accompanying mental images of the threat

panic disorder & panic attacks

DSM-5 anxiety disorder spectrum

• recurrent unexpected attacks and reaching peak intensity within minutes

• requires 4+ physical symptoms (palpitations, swearting, shaking, nuasea, etc)

• followed by 1+ month of persistent worry about additional attacks or maladaptive behavioral changes

panic disorder & panic attacks

DSM-5 anxiety disorder spectrum

• clinical insights

  • catastrophic thinking: driven by a specific cognitive vulnearbility where individuals interpret normal physical sensations as impending death or incapacitation

  • nocturnal panic: 60% experience attacks during sleep; attacks occur most frequently between 1:30-3:30 am

  • onset: median age 20-24; rare in prepubescent children

agoraphobia

DSM-5 anxiety disorder spectrum

• marked fear of 2+ situations:

  • public transpo

  • open and enclosed spaces

• situations are avoided due to thoughts that excape might be difficult of help unavailable if panic symptom occurs

• actively avoided, require a companion, or endured with intense dread for 6+ months

agoraphobia

DSM-5 anxiety disorder spectrum

• clinical insights

  • relation to panic: oftem develops as a coping mechanism for unespected panic attacks through diagnosed irerespective of panic disorder presence

  • coping mechanism: sufferers may resort to using or abusing drugs and alcohol to endure agoraphobic situations

  • Origin: name by physician Karl Westphal in 1871

    • Gree: agora = marketplace

specific phobia

DSM-5 anxiety disorder spectrum

• marked, immediate fear out of proportion to a specific object or situation

• object/situation is actively avoided or endured with intense anxiety

• Persistent, typically lasting 6+ months

specific phobia

DSM-5 anxiety disorder spectrum

• clinical insights

  • Acquisition: acquired via direct experience (true alarm), experiencing a false alarm in a specific situation, vicarious experience (observing others), or being told about danger

  • Subtypes:

    • Blood-injection-injury: involves an inherited vasovagal response causing dropped blood pressure/fainting

  • Situational: public transit/enclosed places (no panic occurs outside the specific context)

    • Natural environment: storms, heights, water

    • Animal: insects, animals

seperation anxiety disorder

DSM-5 anxiety disorder spectrum

• Diagnostic criteria

  • Developmentally inappropriate fear concerning separation from attached figures

  • Evidenced by 3+ symptoms: excessive distress upon separation, persistent worry about harm befalling attachment figures, refusal to go out/sleep away from home, repeated separation nightmares, physical symptoms (nausea, headaches) upon separation

  • Lasts 4+ weeks in children; 6+ months in adults

seperation anxiety disorder

DSM-5 anxiety disorder spectrum

• clinical insights

  • adult persistence: historocally viewed as a childhood issue, but extends into adulthood in 35% of untreated cases. Occurs in 6.6% of the adult population over a lifetime

  • Adult onset: focus of anxiety remains the same across ages– an unrealistic worry that harm may befall loved ones during separation

social anxiety disorder

DSM-5 anxiety disorder spectrum

• marked fear of 1+ social situations where exposed to possible scrutiny (conversations, eating, performing)

• Fear of acting in humiliating, embarrassing, or offensive way that leads to negative evaluation

• Out of proportion to actual threat, lasting 6+ months

DSM-5 anxiety disorder spectrum

clinical insights

• Evolutionary theory: inherited tendency to fear angry faces. Ancestors who avoided hostile, domineering people were more likely to survive

• Temperamental profile: a trait of inhibition or shyness is evident as early as 4 months of age (crying at a new stimuli)

• Specifier: performance only(public speaking), where individuals have no difficulty with normal social interaction

selective mutism

DSM-5 anxiety disorder spectrum

• Consistent failure to speak in specific social situations where expected despite speaking in other situations

• Interferes with educational, occupational, or social communication

• Lasts at least 1 month

• Not attributable to a lack of language knowledge or a communication disorder

DSM-5 anxiety disorder spectrum

• clinical insights

  • Comorbidity: strongly related to social anxiety, featuring high comorbidity rates with SAD

  • Behavioral context: children will speak at home with immediate family but often refuse to speak to close friends. They do not initiate or reciprocally respond in social interactions

  • Onset: usually before age 5, but comes to clinical attention at school entry when reading aloud is required

trauma

may occur when memories are suddenly, accompanied by strong emmotion, and victims find themselves reliving the event

heterogenous

unlike anxiety disorders, trauma responses are deeply _____________

shared origin

DSM-5-TR groups these conditions based on their ________ ________

exposure to traumatic event

common blueprint

childhood neglect dyad

origin: extremes of insufficient care

• social neglect or deprivation of emotional basic needs

• repeated changes or primary caregivers

• rearing in an unusual setting with high child-to-caregiver ratios

reactive attachment disorder

1. inhibited behavior (rarely seeks or responds to comfort when distressed)

2. persistent social and emotioanl disturbance characterized by: (more than 12 months)

   1. minimal social and emotional responsiveness to others

   2. limited positive effects

3. episodes of unexplained irritability, sadness or fearfulness

4. criteria are not met for ASD

5. disturbance is evident before age 5 years

6. child has a developmental age of at least 9 months

attachments

Children with RAD have the capacity to form __________, but fail to show behavioral manifestations due to early limited opportunities

true

true or false

REACTIVE ATTACHMENT DISORDER

• Cultural expectations of attachment behaviors and caregiving practices may influence development of and concern about these patterns of behaviors and their presentations in different settings 

disinhibited social engagement disorder

• A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:

  • Reduced or absent reticence in approaching and interacting with unfamiliar adults

  • Overly familiar verbal or physical behavior that is no consistent with culturally sanctioned and with age-appropriate social boundaries 

  • Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings

  • Willingness to go off with an unfamiliar adult with minimal or no hesitation

• child has a developmental age of 9 months

• persistent for more than 12 months

trauma disorders

• Origin: exposure to actual or threatened death, serious injury or sexual violence

  • Direct experiencing

  • Witnessing in person

  • Learning of event

  • repeated/ extreme indirect exposure

acute stress disorder

• Presence of nine (or more) of the following symptoms from any of the five categories on intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic events occurred

  • Intrusion symptoms (memories, dreams, flashbacks)

  • Negative mood- (persistent inability to experience emotions)

  • Dissociation (altered reality)

  • Avoidance (avoiding internal/external reminders)

  • Arousal (sleep disturbance, irritability, hypervigilance, startle response)

• duration of the disturbance is 3 days to 1 month

  • symptoms begin immediately

  • The disturbance causes clinically significant distress of impairment in social, occupational, or other important areas of functioning

post traumatic stress disorder

• Intrusion: (recurrent memories, dreams, flashback, physiological reactions at cues)

• Avoidance: (avoidance of internal & external stimuli)

• Cognition & mood: (amnesia, exaggerated negative belief, diminished interest, inability to feel positive emotions)

• Arousal & reactivity: (irritability, reckless, self-destructive, hypervigilance, startle reactions)

• Individuals older than 6 years of age

• Duration of the disturbance (criteria B, C, D, and E) is more than 1 month

• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

• The disturbance is not attributable to the physiological effects of substance 

stress and loss dyad

• Presence of identifiable life stressor

• Evidence of bereavement

adjustment disorder

• The development of emotional or behavioral symptoms in response to an identifiable stressors occurring within 3 months of the onset of the stressors 

• These symptoms or behaviors are clinically significant, as evidenced by one or both of the following

  • Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation

  • Significant impairment in social, occupational, or other important areas of functioning 

acute, persistent

• Adjustment disorder duration specifiers

  • ________: symptoms last <6 months

  • ___________ (chronic): last > 6 months

    • Applies when stressor is chronic or has long-lasting consequences

    • If stressor ends, symptoms cannot continue >6 months after its termination

• Adjustment disorder subtypes (DSM-5-TR)

  • F43 21- with depressed mood

  • F43 22- with anxiety

  • F43 23- with mixed anxiety and depressed mood

  • F43 24- with disturbance of conduct; predominant behavioral/ conduct problems

  • F43 25- with mixed disturbance of emotions and conduct; both emotional (depression/anxiety) and conduct symptoms predominate

  • F43 20- unspecified; maladaptive reactions not fitting other subtypes

prolonged grief disorder

• Death or a close person

  • >12 months ago (adults); >6 months (children/adolescents)

• Persistent grief response (most days, >1 month)

  • Intense yearning/longing for the deceased, and/or

  • Preoccupation with thoughts/memories of the deceased in youth, may focus on death circumstances

• At least 3 additional symptoms (most days, >1 month)

  • Identify disruption (feeling part of oneself has died)

  • Marked disbelief about the death

  • Avoidance of reminders that the person is dead

  • Intense emotional pain (anger, bitterness, sorrow)

  • Difficulty reintegrating into relationship/activities

  • Emotional numbness

  • Life feels meaningless

  • Intense loneliness

• Causes clinically significant distress or impairment

• Exceeds expected cultural/religious norms for bereavement

• Not better explained by another disorder or substance/medical condition

stressful

SYNTHESIS

• a precipitating ________ event is a common link

diverse

SYNTHESIS

• reactions to trauma are?

fear-based, aggressive, dissociative

SYNTHESIS

• Response can be _____-_____, _________ or __________