NURS 340 - Anxiety Disorders & Obsessive-Compulsive Disorders

stress

_____ is not a disorder—it is part of everyday life and is not intrinsically good or bad

anxiety

feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat

anxiety

affects us at a deeper level—it affects the core of the personality and erodes feelings of self-esteem and personal worth

fear

a reaction to a specific danger

defense mechanisms

used to help reduce anxiety

when the anxiety disrupts the individual's life + normal functioning

when are anxiety disorders diagnosed?

separation anxiety disorder

anxiety disorder: a normal part of infant development that begins around 8 months of age, peaks at about 18 months, and begins to decline after that

separation anxiety disorder

anxiety disorder: individual's exhibit developmentally inappropriate levels of concern over being away from a significant other

separation anxiety disorder

anxiety disorder: adults with this disorder often have extreme difficulties in romantic relationships and are more likely to be unmarried

separation anxiety disorder

anxiety disorder: fear of separation is accompanied by a significant level of discomfort and disability that impairs social and occupational functioning

separation anxiety disorder

anxiety disorder: the anxiety is so intense that it inhibits normal activities and causes sleep disruptions and nightmares

specific phobia

anxiety disorder: a persistent irrational fear of a specific object, activity, or situation that leads to a desire for avoidance or actual avoidance of the object, activity, or situation

specific phobia

anxiety disorder: characterized by the experience of high levels of anxiety or fear in response to certain objects or situations

acrophobia

fear of heights

agoraphobia

fear of open spaces

mysophobia

fear of germs or dirt

claustrophobia

fear of closed spaces

nyctophobia

fear of darkness

specific phobias

anxiety disorder: are anticipated and not unexpected

social anxiety disorder

anxiety disorder: characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that could be evaluated negatively by others

social anxiety disorder

anxiety disorder: individuals avoid situations in which they may be exposed to strangers or scrutiny from others (e.g., having a conversation, public speaking, meeting unfamiliar people, eating or performing in front of others)

if they are unable to avoid these situations, they endure the situation with intense anxiety and emotional distress

fear of public speaking

the most common manifestation of social anxiety disorder

panic attacks

the key feature of panic disorder

panic attack (panic disorder)

anxiety disorder: the sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom

panic attack (panic disorder)

anxiety disorder: feelings of terror present during an episode are so severe that normal functioning is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur

unpredictablity

*panic attacks come "out of the blue" (i.e., suddenly and not necessarily in response to stress), last about 10 minutes, then subside

a key aspect of panic disorder in children and adolescents

Palpitations, pounding heart, or accelerated heart rate

Sweating

Trembling or shaking

Sensations of shortness of breath or smothering

Feelings of choking

Chest pain or discomfort

Nausea or abdominal distress

Feeling dizzy, unsteady, lightheaded, or faint

Chills or heat sensations

Paresthesias (numbness or tingling sensations)

Derealization (feelings of unreality) or depersonalization (being detached from oneself)

Fear of losing control or "going crazy"

Fear of dying

*MIMICS A HEART ATTACK*

according to the DSM-5, panic disorder is characterized as recurrent unexpected panic attacks. a panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes. during the attack, four (or more) of the following symptoms occur:

panic attack

according to the DSM-5, a _____ is an abrupt surge of intense fear or discomfort that reaches a peak within minutes

- persistent concern or worry about additional panic attacks or their consequences

- a significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations)

according to the DSM-5, at least one of the panic attacks has been followed by 1 month (or more) of one or both of the following:

agoraphobia

anxiety disorder: refers to intense excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or where help might not be available

agoraphobia

anxiety disorder: avoidance behaviors can be extremely debilitating and life-constricting. the anxiety may become so severe that the patient isolates themself

agoraphobia

anxiety disorder: adverse childhood experiences and stressful life events are associated with the development of this disorder

agoraphobia

anxiety disorder: has a strong heritability factor of 61%

agoraphobia

anxiety disorder: after the onset, individuals often experience depressive disorders and alcohol use disorder

excessive worry

the key pathological feature of generalized anxiety disorder is _____, which is out of proportion to the true impact of events or situations

generalized anxiety disorder

anxiety disorder: family members and friends are overtaxed as the person with this disorder seeks continual reassurance and perseverates about meaningless details

generalized anxiety disorder

anxiety disorder: sleep disturbances are common because the individual worries about the day's events and real or imagined mistakes, reviews past problems, and anticipates future difficulties

generalized anxiety disorder

anxiety disorder: parental overprotection and adverse experiences are associated with this disorder

generalized anxiety disorder

anxiety disorder: often comorbid with major depressive disorder and frequently accompanied by other anxiety disorders

6 months

according to the DSM-5, an individual is diagnosed with generalized anxiety disorder when they experience excessive anxiety and worry occurring more days than not for at least _____ about a number of events or activities (such as work or school performance)

Restlessness or feeling keyed up or on edge

Being easily fatigued

Difficulty concentrating or mind going blank

Irritability

Muscle tension

Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)

according to the DSM-5, the anxiety and worry of generalized anxiety disorder are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the previous 6 months):

defense mechanisms

automatic coping styles that protect people from anxiety and enable them to maintain their self-image by blocking feelings, conflicts, and memories

adaptive

_____ use of defense mechanisms helps people to lower their levels of anxiety and to achieve their goals in acceptable ways

maladaptive

_____ use of defense mechanisms occurs when one or several are used to excess, particularly immature defenses

altruism

defense mechanism: unconscious motivation to feel caring and concern for others and act for the well-being of others

altruism (adaptive)

defense mechanism: volunteering at a food bank

adaptive or maladaptive?

altruism (maladaptive)

defense mechanism: rescuing animals without the means to care for them

adaptive or maladaptive?

compensation

defense mechanism: used to counterbalance perceived deficiencies by emphasizing strengths

compensation (adaptive)

defense mechanism: deciding to focus on academics after failing at sports

adaptive or maladaptive?

compensation (maladaptive)

defense mechanism: becoming a perfectionist or people pleasure out of the fear of rejection

adaptive or maladaptive?

conversion

defense mechanism: the unconscious transformation of anxiety into a physical symptom with no organic cause

conversion (maladaptive)

*conversion is NOT adaptive

defense mechanism: having pseudoseizures in response to overwhelming stress

adaptive or maladaptive?

denial

defense mechanism: involves escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence

denial (adaptive)

defense mechanism: initially denying the death of a loved one

adaptive or maladaptive?

denial (maladaptive)

defense mechanism: keeping items of a loved one who died 3 years ago and continuously referring to them in present tense

adaptive or maladaptive?

displacement

defense mechanism: the transference of emotions associated with a particular person, object, or situation to another non-threatening person, object, or situation

displacement (adaptive)

defense mechanism: taking anger out on a punching bag

adaptive or maladaptive?

displacement (maladaptive)

defense mechanism: taking anger out on a child

adaptive or maladaptive?

disassociation

defense mechanism: a disruption in consciousness, memory, identity, or perception of the environment that results in compartmentalizing uncomfortable or unpleasant aspects of oneself

disassociation (adaptive)

defense mechanism: ignoring a patient's family crying during a code

adaptive or maladaptive?

disassociation (maladaptive)

defense mechanism: becoming disconnected with reality and forgetting oneself as a result of sexual assault

adaptive or maladaptive?

identification

defense mechanism: attributing to oneself the characteristics of another person or group—may be done consciously or unconsciously

identification (adaptive)

defense mechanism: a sick child pretending to be a nurse

adaptive or maladaptive?

identification (maladaptive)

defense mechanism: an abused child becoming a bully

adaptive or maladaptive?

intellectualization

defense mechanism: a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing

intellectualization (adaptive)

defense mechanism: receiving feedback from your boss on your work performance

adaptive or maladaptive?

intellectualization (maladaptive)

defense mechanism: immediately focusing on creating a funeral plan after being informed of your terminal diagnosis instead of emotional processing

adaptive or maladaptive?

projection

defense mechanism: the unconscious rejection of emotionally unacceptable features and attributing them to others

projection (maladaptive)

*projection is NOT adaptive

defense mechanism: accusing your spouse of an affair when you're cheating on them

adaptive or maladaptive?

rationalization

defense mechanism: justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener

rationalization (adaptive)

defense mechanism: believing a boy must already have a girlfriend after being rejected by him

adaptive or maladaptive?

rationalization (maladaptive)

defense mechanism: a child believing that they deserved it after being physically abused

adaptive or maladaptive?

reaction formation

defense mechanism: unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite emotion or behavior

reaction formation (adaptive)

defense mechanism: an alcoholic educating others on the dangers of drinking

adaptive or maladaptive?

reaction formation (maladaptive)

defense mechanism: a man acting overly aggressive towards women after feeling insecure about his masculinity

adaptive or maladaptive?

regression

defense mechanism: reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been exhibited previously

regression (adaptive)

defense mechanism: an older child with a new baby brother begins sucking their thumb

adaptive or maladaptive?

regression (maladaptive)

defense mechanism: throwing objects around the office after someone upsets you at work

adaptive or maladaptive?

repression

defense mechanism: an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness

repression (adaptive)

defense mechanism: blocking the memory of freezing on stage when giving a presentation

adaptive or maladaptive?

repression (maladaptive)

defense mechanism: forgetting a doctor's appointment due to your extreme fear of needles

adaptive or maladaptive?

splitting

defense mechanism: the inability to integrate the positive and negative qualities of oneself or others into a cohesive image

splitting (maladaptive)

*splitting is NOT adaptive

defense mechanism: a woman who is in love with her new boyfriend claims he is the worst boyfriend ever after one fight

adaptive or maladaptive?

sublimation

defense mechanism: an unconscious process of transforming negative impulses into less damaging and even productive impulses

sublimation (adaptive)

*sublimation is NOT maladaptive

defense mechanism: cleaning the entire house in response to stress

adaptive or maladaptive?

suppression

defense mechanism: the conscious decision to delay addressing a disturbing situation or feeling

suppression (adaptive)

defense mechanism: a nursing student puts off resolving the fight with her friend to study for her exam

adaptive or maladaptive?

suppression (maladaptive)

defense mechanism: a women delays making a doctor's appointment for 6 months after finding a lump in her breast

adaptive or maladaptive?

undoing

defense mechanism: when a person makes up for a regrettable act or communication

undoing (adaptive)

defense mechanism: offering to do the dishes after fighting with your mom

adaptive or maladaptive?

undoing (maladaptive)

defense mechanism: a man buys flowers for his wife after an abusive episode

adaptive or maladaptive?

mild anxiety

level of anxiety: heightened sensory awareness

mild anxiety

level of anxiety: the individual sees, hears, and grasps more information

mild anxiety

level of anxiety: problem solving becomes more effective

mild anxiety

level of anxiety: propels us to action

moderate anxiety

level of anxiety: the perceptual field narrows and some details are excluded from observation

mild anxiety

level of anxiety: symptoms include slight discomfort, restlessness, irritability, mild tension-relieving behaviors (e.g., nail biting, foot or finger tapping, fidgeting)

moderate anxiety

level of anxiety: the individual sees, hears, and grasps less information and may demonstrate selective inattention, where only certain things in the environment are seen or heard unless they are pointed out

moderate anxiety

level of anxiety: learning and problem solving can still take place, though not at an optimal level

moderate anxiety

level of anxiety: sympathetic nervous system symptoms begin, including tension, a pounding heart, increased pulse and respiratory rates, perspiration, mild somatic symptoms (e.g., gastric discomfort, headache, urinary urgency)