Ch. 5: Anxiety and Obsessive-Compulsive and Related Disorders

Agoraphobia

An intense fear of being in public places where escape or help may not be readily available

Alleles

The gene pair responsible for a specific trait

Anxiety

An anticipatory emotion that produces bodily reactions that prepare us for “fight or flight”

Anxiety Produces….

tension, worry, and physiological activity

Anxiety Disorder

An unfounded fear or anxiety that interferes with day-to-day functioning and produces clinically significant distress is a sign of an

Ruling out medical or physical causes of anxiety symptoms is important. This includes ruling out…

Medication side effects, excessive caffeine intake, hyperthyroidism, cardiac arrhythmias, and withdrawal from alcohol

Amygdala

Plays a central role in triggering state of fear or anxiety

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HPA activity triggers “fight-or flight” response and in some cases a “freeze” response

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Primitive survival responses may take over and interfere with rational thinking

Anxiety Disorder

Fear or anxiety symptoms that interfere with an individual’s day-to-day functioning

GABA Activity

Anxiety and fear is linked to a reduction in….

Anxiety Sensitivity

A trait involving fear of physiological changes within the body

Behavioral Inhibition

Shyness

Body Dysmorphic Disorder (BDD)

A condition involving a preoccupation with a perceived physical defect or excessive concern over a slight physical defect

Caudate Nuclei

The deep brain structure that stores and processes memories and signals when something is amiss

Cognitive Restructuring

A cognitive strategy that attempts to alter unrealistic thoughts that are believed to be responsible for fears and anxiety

Comorbid

Existing simultaneously with another condition

Compulsions

The need to perform acts or mental tasks to reduce anxiety

Concordance Rates

The degree of similarity between twins or family members with respect to a trait or disorder

Delusions

A false belief that is firmly and consistently held

Endophenotype

Measurable characteristics (neurochemical, endocrinological, neuroanatomical, cognitive, or neuropsychological) that can give clues regarding the specific genes involved in disorders

Etiological Models

Model developed to explain the cause of a disorder

Excoriation (Skin-Picking) Disorder

Distressing and recurrent compulsive picking of the skin resulting in skin lesions

Exposure Therapy

A treatment approach based on extinction principles that involves gradual or rapid exposure to feared objects or situations

Fear

An intense emotion experienced in response to a threatening situation

Flooding

A technique that involves inducing a high anxiety level through continued actual or imagined exposure to a fear-arousing situation

Gamma-aminobutyric Acid (GABA)

An inhibitory neurotransmitter involved in inducing sleep and relaxation

Generalized Anxiety Disorder (GAD)

A condition characterized by persistent, high levels of anxiety and excessive worry over many life circumstances

Hippocampus

The brain structure involved with the formation, organization, and storing of emotionally relevant memories

Hoarding Disorder

A condition involving congested living conditions due to the accumulation of possessions and distress over the thought of discarding them

Interoceptive Conditioning

When internal bodily sensations of fear and anxiety that have preceded panic attacks serve as signals for new panic attacks

Modeling Therapy

A treatment procedure involving observation of an unfearful individual successfully interacting with a phobic object or situation

Negative Appraisal

Interpreting events as threatening

Obsessions

An intrusive, repetitive thought or image that produces anxiety

Obsessive-Compulsive Disorder (OCD)

A condition characterized by intrusive, repetitive anxiety-producing thoughts or a strong need to perform acts or dwell on thoughts to reduce anxiety

Orbitofrontal Cortex

The brain region associated with planning and decision making

Panic Attack

An episode of intense fear accompanied by symptoms such as a pounding heart, trembling, shortness of breath, and fear of losing control or dying

Panic Disorder

A condition involving recurrent, unexpected panic attacks with apprehension over future attacks or behavioral changes to avoid attacks

Phobia

A strong, persistent, and exaggerated fear of a specific object or situation

Polymorphic Variation

A common DNA mutation of a gene

Predisposition

A susceptibility to certain symptoms or disorders

Reappraisal

Minimizing negative responses by looking at a situation from various perspectives

Remit

Diminish or disappear

Response Prevention

A treatment in which an individual is prevented from performing a compulsive behavior

Serotonin

A neurotransmitter associated with mood, sleep, appetite, and impulsive behavior

What neurotransmitter is linked to depression and anxiety?

Serotonin; a reduction in serotonin can cause increased anxiety-related behaviors

Social Anxiety Disorder (SAD)

An intense fear of being scrutinized in social or performance situations

Specific Phobia

An extreme fear of a specific object (such as snakes) or situation (such as being in an enclosed place) where exposure almost always produces intense panic or anxiety

Striatum

The region within the basal ganglia associated with movement planning, goal-directed action, memory, and decision making

Systematic Desensitization

A treatment technique involving repeated exposure to a feared stimulus while a client is in a competing emotional or physiological state such as relaxation

Trichotillomania

Recurrent and compulsive hair pulling that results in hair loss and causes significant distress

Skill of Reappraisal

Looking at a situation from various perspectives & minimizing negative responses

What seems to reduce susceptibility to anxiety in humans?

A sense of self-control and mastery

Social Anxiety Disorder

Twice as common in females with an age of onset in the mid-teens

Specific Phobia

12-month prevalence from 7% up to 9% with an age of onset in childhood or early adolescence

Agoraphobia

12-month prevalence of up to 1.7% with an onset usually in late adolescence, with two thirds before age

Panic Disorder

12-month prevalence of 2.7% with an onset of late adolescence and early adulthood

Generalized Anxiety Disorder

12-month prevalence ranges from 1.2% to 2.9% with a median age of diagnosis which is about 30 (but symptoms onset much earlier)

Symptoms cause significant suffering and interfere with work, school, or relationships.

What’s meant by distress and dysfunction?

Chest pain and palpitations prompt ER workup; if cardiac causes are ruled out, consider stress or panic disorder.

Example of ruling out in panic-like symptoms?

Habitually interpreting situations as threatening fuels worry; reframing reduces perceived danger.

Negative appraisal: impact on anxiety?

Often starts mid-teens; intense fear of social scrutiny leads to avoidance like dropping classes to evade presentations.

Onset and features of social anxiety disorder?

Serotonin modulates mood and anxiety; enhancing serotonin transmission can reduce anxiety symptoms.

Why might SSRIs help anxiety?

Through conditioning and observational learning, not inborn; associations link neutral cues to fear.

How are most phobias learned?

As a stimulant, it raises heart rate and arousal, mimicking or worsening anxiety symptoms.

How can caffeine confound assessment?

Body-based signs like headaches, stomach aches, sweating, lightheadedness, and increased heart rate without clear medical cause.

What are somatic symptoms?

Risk assessment informs safety planning and urgency of intervention.

Why document self-harm or violence history?

Public self-labels can lower expectations, solicit special treatment, and narrow identity.

How can labeling oneself backfire?

Catching a worst-case thought before presenting and generating balanced alternatives reduces fear.

Example of reframing in CBT?

Prenatal, birth, and early milestones reveal delays or risks that shape current functioning and differential diagnosis.

Why collect developmental history?

Learning issues, retentions, talents, and peer functioning clarify strengths, risks, and needed supports.

Why gather academic and social history?

Low GABA signaling elevates anxiety; medications may boost GABAergic activity to restore balance.

How does GABA relate to anxiety?

Anxiety arises from interacting biological, psychological, social, and cultural factors; no single cause fits all.

Multipath perspective: why use it?

Intensity, dysfunction, and loss of control beyond normal worry that impairs daily functioning.

What distinguishes anxiety from disorder?

When avoidance is persistent, excessive, and causes distress or impairment beyond normal caution.

When is avoidance diagnostic?

Economics, norms, environments, and relationships influence stressors and symptom expression.

How does culture shape anxiety?

It regulates emotions and triggers fight-or-flight; dysregulation increases anxiety responses.

Role of the amygdala in anxiety?

It can cause sweating, weight loss, and palpitations that mimic anxiety symptoms.

Why rule out hyperthyroidism?

Side effects, caffeine, alcohol, drugs, or allergens can mimic anxiety; excluding them prevents misdiagnosis.

Why list current meds, substances, and diet?

Classical conditioning can create fear responses; learned fears can generalize to similar cues.

Little Albert taught us what?

Panic Attack: An acute episode

Panic Disorder: Attacks plus ongoing fear of another.

Panic disorder vs. panic attack?

Tension, nausea, sweating, concentration problems, rapid heartbeat, and altered breathing.

Common physiological signs of anxiety?

It reveals hereditary risks and patterns that inform formulation and treatment planning.

Why include family mental health history?

Chronic, diffuse worry without a single identifiable trigger, affecting many areas of life.

Generalized anxiety disorder’s hallmark?

Gradual, supported exposure builds tolerance and shows feared outcomes are less likely or manageable.

Purpose of exposure therapy?

Fear intensity exceeds real threat; even knowing this, the person can’t easily turn off the worry.

What is meant by unfounded fear?

Family structure, living situation, developmental, educational, social, medical, mental health, and substance use history.

Key background elements to gather when evaluating a client?

You must rule out medical, substance, or medication causes before labeling symptoms as a psychological disorder.

How does medical history affect diagnosis?

Fear is an intense emotion experienced in response to an existing, threatening situation

How is “fear” defined in contrast to anxiety?

Biological, psychological, social, and sociocultural dimensions

According to the multipath model, what four dimensions interact to result in an anxiety disorder?

Amygdala

What brain structure plays a central role in triggering a state of fear or anxiety by activating the HPA axis?

Hippocampus and Prefrontal Cortex

When a threatening stimulus is encountered, a slower neural pathway involving the…process the input to evaluate the danger.

GABA (Gamma-Aminobutyric Acid)

A reduction in the activity of which inhibitory neurotransmitter has been linked with anxiety and fear?

5-HTTLPR

What is the name of the gene variation where short alleles are associated with reduced serotonin activity and increased fear-related behaviors?

A stressful environment with low levels of maternal social support.

The short allele of the 5-HTTLPR gene showed behavioral inhibition only when raised in what type of environment?

What is the term for the trait characterized by distress and emotional reactivity to environmental changes, often seen in shy and wary infants and toddlers?

Behavioral Inhibition

Having a sense of self-control and mastery appears to…

reduce susceptibility to anxiety in humans.

Poverty, an unsafe environment, adverse working conditions, discrimination, or acculturation conflicts.

What are some social and sociocultural factors that can produce or exacerbate anxiety?

Being offensive to others.

In Western cultures, social anxiety typically involves fear of embarrassing oneself; in some Asian cultures, it involves worries about what?

What are the three main categories of phobias?

Social anxiety disorder (SAD), specific phobias, and agoraphobia.

Four primary types of specific phobias

Living creatures, natural environmental, blood/injections or injury, and situational.

Fainting

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It results from an initial increase in arousal followed by a sudden drop in blood pressure and heart rate.

What unique physiological response is associated with blood phobia that differs from other phobias?