adult psychopathology exam 3

what are common elements for fear and anxiety?

fear keeps us away from danger and some anxiety can help us perform better

• both can cause problems when they become excessive

how do we distinguish fear from anxiety? 

• fear is about the now and anxiety is about the future 

• negative affect 

• strong sympathetic nervous system arousal 

• immediate alarm reaction 

• panic attacks 

• response matters 

  • avoidance 

phobia

a disruptive fear of a particular situation or object that is out of proportion to any danger posed

• Fear is disruptive

  • interfere with the person’s daily life

• The fear is present every day

what are the three main categories of phobias?

specific phobia, social phobia, agoraphobia

diagnostic criteria for specific phobias 

• marked fear or anxiety about a specific object or situation 

• The phobic object or situation almost always provokes immediate fear or anxiety 

• The phobic object or situation is actively avoided or endured with intense fear or anxiety 

• The fear or anxiety is out of proportion to the actual danger posed 

• The fear, anxiety, or avoidance is persistent (6 months)

• the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other areas of functioning

• the disturbances is not better explained by a mental disorder 

what are the specific types of specific phobia?

• animal

• natural environment

• blood-injection-injury

• situational 

• choking, vomiting, contracting an illness, loud sounds 

what are some natural environment phobias?

storms, water, fire, heights 

what are some situational phobias?

elevators, airplanes, closed spaces

what is the 12-month prevalence rate for specific phobias?

8%-12%

what is the age onset for specific phobias?

typically before 10 years old

do phobias in adults go away?

no; without treatment it never goes away

what gender is specific phobia most prevalent in?

females; except for blood-injection-injury

what are some specific phobia consequences?

• decreased quality of life

• occupational/interpersonal functioning impairment

• substance use disorder

• avoidance of medical care

  • those with blood-injection-injury

• Reduced food consumption

  • those with choking or vomiting phobia

diagnostic criteria for social anxiety disorder (social phobia)

• marked fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others, or performing in front of others 

• the fear that they will act in a way that shows anxiety symptoms, which will be negatively evaluated 

• Social situations almost always provoke fear or anxiety

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

• Fear or anxiety is out of proportion to the actual threat posed by the social situation

• fear, anxiety, or avoidance is persistent (6 months)

• fear, anxiety, or avoidance causes clinically significant distress or impairment in social or occupational areas of functioning

• fear, anxiety, or avoidance is not attributed to the effects of a substance

• Another mental disorder does not better explain fear, anxiety, or avoidance

• If another medical condition is present, the fear, anxiety, or avoidance is not related

what is the 12-month prevalence rate for social phobia?

7%

what is the median age onset of social phobia?

13 years old; adulthood is rare (humiliating experience to trigger it)

What gender is social phobia most prevalent in?

Both male and female; depends on the sample

Is social phobia a performance only specifier?

Yes

What are social phobia consequences?

• decreased quality of life

• School dropout

• Problems with unemployment (particularly women) and lower productivity at work

• Lower SES

• Single status/never married/divorced/no children (particularly men)

• Difficulties with friendships

Diagnostic criteria for agoraphobia

• marked fear or anxiety about two or more of the five situations

  • Public transportation, open spaces, enclosed places, standing in line or being in a crowd, being outside the home alone

• Fears of avoids these situations due to thoughts that escape might be difficult or help might not be available

• Agoraphobic situations almost always provoke fear or anxiety

• Situations are avoided, require the presence of a companion, or are endured with intense fear or anxiety

• Fear or anxiety is out of proportion to the actual danger posed

• Fear, anxiety, or avoidance is persistent (6 months)

• Fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational functioning

• If another medical condition is present the fear, anxiety, or avoidance is clearly excessive

• Fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder

What is the 12-month prevalence rate for agoraphobia?

1%-7%

What is the mean age onset for agoraphobia?

21 years old

What gender is more likely to develop agoraphobia?

Females

Why is treatment needed for remission for agoraphobia?

Need treatment or it won’t go away

what are some comorbidity for agoraphobia?

• Comorbidity with other disorders can make the course of agoraphobia more difficult

  • Depression, other disorders in this chapter, substance use disorders, personality disorders

what are some agoraphobia consequences?

• impairment regarding role functioning

  • work productivity

• high risk of inability to leave home or work

• agoraphobia + panic disorder + earlier onset = unmarried

diagnostic criteria for panic disorder

• recurrent unexpected panic attacks

• One attack has been followed by 1 month or more of:

  • persistent worry about additional panic attacks

  • significant change in behavior due to the attack

• disturbance is not attributable to the physiological effect of a substance

• disturbance is not better explained by another mental disorder 

diagnostic criteria for a panic attack

• palpitations, pounding heart, or accelerated heart rate

• sweating

• trembling or shaking

• sensations of shortness of breath or smothering 

• feeling of choking

• chest pain or discomfort

• nausea or abdominal distress

• feeling dizzy, unsteady, lightheaded, or faint

• derealization or depersonalization 

  • feeling out of body

• fear of dying

• paresthesias (numbness)

• chills or heat sensation

what is the 12-month prevalence rate for panic disorder?

2%-3%

what gender is panic disorder more prevalent in?

females 2:1

what is the median age onset for panic disorder?

20-24 years; rare after age 55

panic disorder course

chronic, but can wax and wane; complicated by comorbid disorders

• more likely to be chronic if African American

panic disorder consequences

• decreased quality of life

• high levels of disability regarding 

  • social, occupational, and physical functioning

• medical visits

• work and school absences

• unemployment or dropping out of school

diagnostic criteria for generalized anxiety disorder

• excessive anxiety or worry about events or activities

• difficult to control the worry

• The worry is associated with 3 or more of the following

  • restlessness or feeling keyed up or on edge

  • being easily fatigued

  • difficulty concentrating or mind going blank

  • irritability

  • muscle tension

  • sleep disturbances

• Worry causes clinically significant distress in social, occupational, or other areas of functioning

• disturbances not due to direct physiological effects of a substance

• disturbance not better explained by another mental disorder

what is the 12-month prevalence rate for GAD?

2.9%

what gender is GAD more prevalent in?

effects more females (2:1)

what is the mean age of onset for GAD?

35 years old

• showed up in childhood

• mean age of diagnosis 

where is GAD more likely to receive treatment?

primary care

what culture is GAD more prevalent in?

individuals with a European background

GAD consequences

• significant distress

• moderate to severe disability

  • decreased work performance

  • disability days (110 million per year)

  • increased use of medical resources

  • increased likelihood of cardiac problems

• difficulty completing tasks quickly

  • time spent worrying and dealing with what happens to the body

PTSD diagnostic criteria point A

• exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

  • directly experiencing the traumatic event

  • witnessing, in person, the event

  • learning that the event occurred to a relative or friend, the events must have been violent or accidental

  • experiencing repeated or extreme exposure to aversive details of the traumatic event

PTSD diagnostic criteria point B

• presence of one (or more) of the following intrusion symptoms associated with the traumatic events, beginning after the traumatic event occurred

  • recurrent, involuntary, and intrusive distressing memories of the event

  • recurrent distressing dreams in which the content of the dream is related to the event

  • dissociative reactions (flashbacks) in which the individual feels or acts as if the event were recurring

  • intense or prolonged psychological distress at exposure to internal or external cues that resemble an aspect of the event

PTSD diagnostic criteria point C

• persistent avoidance of stimuli associated with the traumatic event, beginning after the event occurred

  • avoidance to avoid distressing memories, thoughts, feelings, or conversations associated with the event

  • avoidance of external reminders (people, places, conversations, activities, objects, situations)

  • inability to recall an important aspect of the trauma

  • markedly diminished interest in activities

  • feeling of detachment from others

  • restricted range of affect (loving feelings)

  • sense of a foreshortened future

PTSD diagnostic criteria point D

• negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the event occurred

  • inability to remember an important aspect of the event (due to dissociative amnesia)

  • persistent negative beliefs or expectations about oneself

  • Persistence distorted cognitions about the cause of the event that leads the individual to blame themselves or others

  • persistent negative emotional state

  • markedly diminished interest in activities

  • feelings of detachment from others

  • persistent inability to experience positive emotions

PTSD diagnostic criteria point E

duration of the disturbance (criteria B,C,D, and E) is more than one month 

PTSD diagnostic criteria point F

the disturbances causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

what is the 12-month prevalence rate for PTSD?

4.7%

what events have the highest rates in PTSD?

survivors of rape, military combat/captivity, genocide 

• male and female rates depend on the type of trauma 

what ethnicities have a higher rate for PTSD?

latinx, african americans, and native americans

PTSD consequences

impairment in social, occupational, and physical functioning; decreased quality of life

OCD diagnostic criteria point A

• presence of obsessions, compulsions, or both:

  • recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that in most individuals cause marked anxiety or distress

  • The individual attempts to ignore or suppress such thoughts, impulses, or images, or ot neutralize them with some other thought or action

OCD diagnostic criteria point A continued 

• Compulsions are defined by:

  • Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rigidly

  • The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected realistically with what they are designed to neutralize or prevent, or are clearly excessive

OCD diagnostic criteria point B

the obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational or other important areas of functioning 

OCD diagnostic criteria point C

the disturbances is not due to the direct physiological effects of a substance

OCD diagnostic criteria point D

the disturbance is not better explained by the symptoms of another mental disorder

what is the 12-month prevalence rate for OCD?

1.2%

which gender is OCD more prevalent in?

slightly more in females, but males more likely have it

what is the mean age of onset for OCD?

19.5 years old; diagnosis not typical after 35

is OCD a gradual onset?

yes 

what are some OCD consequences?

• decreased quality of life

• high impairment in social and occupational functioning

• health consequences

diagnostic criteria for body dysmorphic disorder

• preoccupation with one or more defects or flaws in physical appearance that are not observable or appear slight to others

• repetitive behaviors such as mirror checking, excessive grooming, skin picking, reassurance seeking, or mental acts in response to the appearance concerns

• the preoccupation causes clinically significant distress or impairment in social, occupational, or other areas

• the appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder 

what is the prevalence rate for BDD?

2.4%

what is the prevalence rate for females with BDD?

2.5%

what is the male prevalence rate for BDD?

2.2%

what is the mean age of onset for BDD?

16-17; subclinical - 12 or 13

what is common to all disorders?

stress

what are some treatment options for disorders?

• behavioral 

  • exposure and ritual prevention

• cognitive behavioral 

  • panic control treatment

  • CT

• medication 

for GAD and social anxiety which treatment is better? 

psychotherapy; not advised to combine meds and psych treatment for social anxiety

exposure

the client is exposed to the object or situation he/she fears

why does exposure work?

• done in a safe, professional, structured way

• stops the avoidance

• learn something new about themselves

• SUDS goes down over time because fear naturally declines 

fear hierarchy 

• client and therapist develop a list of specific items that are fearful to the client 

• client rates each item (0-100), and this determines the order treatment will proceed in 

• list of things you do over several sessions 

• done at home, in a clinic, or where fears are located 

live exposure

• involves exposure to actual feared object or situation

• treatment of choice for specific phobia

• used to treat agoraphobia

imaginal exposure

• involves thinking about the feared object or situation

• used when actual exposure is not possible or patient refuses

• used to treat PTSD, agoraphobia

what is systematic desensitization?

imaginal exposure + relaxation

used to treat specific phobia, PTSD, agoraphobia