Psychological and Epidemiological Aspects of Anxiety Disorders

Lifetime prevalence

Ever had disorder.

12-month prevalence

Had it within past year.

NCS-R strengths

Large national sample, DSM-based interviews, good for comorbidity data.

NCS-R limitations

Recall bias, self-report errors, underrepresents severe cases.

Census sex/gender issue

Binary 'sex' question limits gender analysis in prevalence data.

Fear

Present-oriented, real threat, triggers fight-or-flight.

Anxiety

Future-oriented worry about potential threats.

Purpose of anxiety

Motivates preparation; becomes maladaptive when excessive.

Specific Phobia DSM-5 criteria

Marked fear of specific object/situation; lasts ≥6 months; avoidance/impairment.

Types of Specific Phobia

Animal, natural environment, blood-injection-injury, situational, other.

Specific Phobia epidemiology

Approximately 12% lifetime; more common in women.

Preparedness

Biological tendency to fear survival-relevant stimuli.

Panic attack

Sudden intense fear with physical symptoms peaking in minutes.

Cued vs. Uncued Panic Attacks

Cued = triggered; Uncued = unexpected.

Fight or flight

Sympathetic system prepares for action.

Sympathetic vs. Parasympathetic

Sympathetic = arousal; Parasympathetic = calming.

Panic Disorder DSM-5 criteria

Recurrent unexpected attacks + ≥1 month of concern/behavior change.

Agoraphobia

Fear of places where escape/help is difficult.

Panic Disorder epidemiology

Approximately 2-3% lifetime; more in women.

Interoceptive conditioning

Fear of bodily sensations due to learned panic association.

Barlow (2000) findings

CBT exposure > medication alone; most durable results.

Social Anxiety Disorder DSM-5 criteria

Fear of social/performance situations and negative evaluation; ≥6 months.

Social Anxiety Disorder epidemiology

Approximately 7% 12-month; onset in adolescence.

Generalized Anxiety Disorder DSM-5 criteria

Excessive worry ≥6 months + 3+ symptoms (restless, fatigue, etc.).

Generalized Anxiety Disorder epidemiology

Approximately 3% 12-month; more in women.

Worry as cognitive avoidance

Worry prevents full emotional processing of feared events.

PTSD DSM-5 criteria

Trauma exposure + intrusion, avoidance, mood, arousal symptoms >1 month.

PTSD epidemiology

Approximately 6-8% lifetime; higher in women, interpersonal trauma.

Acute stress disorder

Same symptoms as PTSD but <1 month.

OCD obsessions

Intrusive, unwanted thoughts or urges.

OCD compulsions

Repetitive behaviors to reduce anxiety.

Thought-action fusion

Thinking something bad = as bad as doing it.

OCD DSM-5 criteria

Obsessions/compulsions cause distress or impairment.

OCD epidemiology

Approximately 2% lifetime; equal gender distribution.

Body Dysmorphic Disorder

Preoccupation with appearance flaws; repetitive checking.

Hoarding Disorder

Difficulty discarding possessions → clutter/distress.

Excoriation / Trichotillomania

Repetitive skin-picking/hair-pulling causing lesions.

Selective Mutism

Failure to speak in specific social settings.

Separation Anxiety Disorder

Excessive fear about separation.

Pyromania / Kleptomania

Impulsive fire-setting / stealing behaviors.

Two-Factor Model

Classical conditioning acquires fear; operant conditioning maintains it via avoidance.

Catastrophic misinterpretations

Misreading sensations as dangerous.

Overestimation

Believing threat is more likely than it is.

Disgust proneness

Strong disgust reactions linked to specific phobias.

Intolerance of uncertainty

Difficulty tolerating ambiguous situations.

Genetic contributions

Moderate heritability for anxiety traits.

Neuroanatomy

Overactive amygdala, underactive prefrontal control.

Temperament

Early emotional reactivity patterns predict anxiety.

Behavioral inhibition

Shy, cautious temperament → risk for social anxiety disorder.

Systematic desensitization

Pair relaxation with gradual exposure.

Relaxation training

Learn muscle and breathing control.

Graduated practice

Confront feared situations step-by-step.

In-vivo exposure

Real-life confrontation with feared stimulus.

Flooding

Prolonged, intense exposure.

Fear hierarchy

Rank situations from least to most fear-provoking.

Interoceptive exposure

Confront internal panic sensations.

Exposure with response prevention (ERP)

Confront obsessions without rituals (for OCD).

Habit reversal training

Replace repetitive behaviors with alternatives.

Stimulus control

Manage cues that trigger anxiety.

Cognitive restructuring

Identify and change irrational thoughts.

Anxiolytics

Benzodiazepines; short-term relief, risk of dependence.

Antidepressants

SSRIs/SNRIs; first-line for chronic anxiety.

SSRIs mechanism

Block serotonin reuptake → more serotonin.

Psychosurgery/DBS

For severe, treatment-resistant OCD.

Specific Phobia

Feared object/situation.

Panic Disorder

Internal sensations.

Social Anxiety

Social situations.

GAD

Worry/uncertainty.

PTSD

Trauma reminders.

OCD

Obsessional triggers.

BDD

Appearance fears.

Hoarding

Discarding possessions.

Trichotillomania/Excoriation

Urges/triggers.

Mood disorder vs. normal mood

Mood disorders = persistent, impairing changes beyond normal fluctuation.

Major depressive episode

≥2 weeks of depressed mood/loss of interest + ≥4 symptoms.

Manic episode

≥1 week elevated/irritable mood + ≥3 symptoms.

Hypomanic episode

Similar to mania but milder, ≥4 days, no impairment.

MDD criteria

≥1 major depressive episode, no mania.