PSYC 238 EXAM 2

obsessions

intrusive thoughts, images, urges that one tries to resist or eliminate 

-individual tries to suppress and ignore the thoughts 

-out of the blue with certain themes 

-random 

compulsions

mental acts or behaviors a person feels driven to carry out, often in response to an obsession 

 

• individual uses this to soothe the intrusive thoughts 

-repetitive behaviors 

-washing hands, checking if you locked door certain times, blinking amount, praying, counting in your head, thinking certain thoughts in your head 

-rules that are felt and must be applied 

-in aims to prevent distress and decrease anxiety, gives relief but they may not want to, it could be distressful  

- not connected in a realistic way 

examples of obsessions and compulsive behaviors

 

E.g. obsessive thought that family will die, and she has to blink a certain amount of times to make her feel better about the thoughts 

E.g. someone has a rule that both sides of her body had to touch something in the same way or time, germinal-wash hands multiple times until skin is raw and cracked 

E.g. perfectionism or symmetry, obsessed over other people being harmed 

typical obsessions

-need things to be in order

-fear of losing control

-possible need - hoarding

-violent themes: acting on impulse and hurting someone

-responsibility obsession

-religious or moral obsession

-very excessive concern of right or wrong / morality

etiological mechanisms that contribute to and explain OCD

• Thought suppression and the rebound effect 

  1. Born with a predisposition to be very emotionally reactive 

  2. Emotional trigger / event 

  3. Try to suppress emotional response 

  4. But the more you suppress, the more aware you become 

orbiotofrontal cortex

Overactive in signaling threat, salience, and persistent worry ("what's important"). 

Anterior cingulate cortex

deals with conscious internal emotional control “something is wrong”

rebound effect

is the loop and controls our, more attempts to suppress makes you more anxious 

-a phenomenon where suppressed thoughts, emotions, or behaviors return with greater frequency or intensity once you stop trying to suppress them. 

exposure and response prevention (ERP)

 is the most successful for OCD, helps manage severe anxiety disorders and obsessive-compulsive disorder (OCD) by breaking the cycle of fear, intrusive thoughts, and compulsive avoidance 

why is it effective for treating OCD

1.  

• There’s target as EXPOSURE and RESPONSE, to expose people to their anxious cues and try to cause them to avoid doing their compulsions 

-expose to obsessional cue: dirty things or obsessed about being able to sleep the exposure may be articles or videos of people with insomnia, and prevent them in erp from engaging in compulsions and just let anxiety be there 

-patient given homework to provoke themselves to anxiety stimulus and see how long they can 

-build up tolerance 

-response prevention: push them farther than they would go, put stove on and walk out of house 

-a problem is people drop out of this treatment at high rates because they are in trouble 

what is trauma (as defined by the DSM-5)?

Trauma: an event that involves actual or threatened death, serious injury or sexual violence in one of the following ways: 

• directly experiencing the event 

• Witnessing the event (eye witness, not usually through representation or reproduction of the event) 

-Vicarious trauma 

• Learning that an event occurred to a close friend or family member 

• Repeated exposure to details of a traumatic event (first responders and getting info and peoples deaths) 

-doesn’t include television or media only work

criterion A and changes in this criterion

DSM- III-R (1987): An event “outside the range of usual human experience that would cause “significant symptoms of distress in almost anyone” 

• DSM-IV (1994): 

1. Person experienced, witnessed, confronted with event that involved actual or threatened death / serious injury or a threat to the physical integrity of others 

-required a specific response 

-experience in PTSD 

2. Person’s specific response involved intense fear, helplessness, or horror 

• DSM - V (2013): an event that involves actual or threatened death, serious injury, or sexual violence – focus on event itself 

-don’t have person response to it like in DSM 4 

*DSM 3 is nature and trauma and dsm 4 added the specific response to the traumatic event, added that trauma could be learning about the death of close friend or relative 

What experiences are included vs. excluded based on this definition? Should the definition change to be more inclusive? Why or why not? 

Right now it’s directly experiencing, witnessing event,, learning it happened to family member, and detailed know exposure to family or friend 

*situations not included: repeated exposure to details of traumatic events, doesn’t apply to exposure unless it’s work related, If grow up in environment where you hear reoccuring stories about mass stories 

*people who are a part of your demographic group that have crimes or discrimination – doesn’t have to be close 

* emotional abuse and neglect: chronic crtiscism, rejection and humiliation with trauma event 

*bullying, financial hardship, discrimination and hardship – bullying with physical violence or threat of death could account for being traumatic event 

The definition should be expanded because there are traumatic life events that don’t necesarily slways fit the criterion but have long lasting psychological effects 

-people who go through these other traumatic events may feel that their suffering is being minimized or may have difficulty receiving an appropriate assessment. For this reason, I would favor a more inclusive approach that recognizes a wider range of potentially traumatic experiences while maintaining specific requirements for diagnosing PTSD. Clinicians should be able to acknowledge and treat the effects of emotional abuse, discrimination, and other chronic stressors even when those experiences do not meet Criterion A. 

the differences and similarities between trauma and adversity

-Adversity can help you grow where trauma can't necessarily be turned into a positive experience. Trauma psychologically affects person where adversity is more broad 

Trauma is 1 event, outcome from adversity, adversity is from environmental context and more general, chronic 

differences and similarities between adversity and stressful life events

​Both are environmental toxins. both are negative life events. But adversity is unexpected where life stressors can be expected to go throug it in development (e.g. college, breakuo, hard exam)​ 

PTSD in Dsm has 4 broad symptom category criteria

•  

1. ​Intrusion (1+) - Criterion B:  

2. ​Avoidance (1+) - criterion c 

3. ​Cognition / Mood (2+) - criterion D 

4. ​Arousal (2+) - criterion E 

PTSD summary

 

• ​Core symptom: experience of trauma - criterion A 

• ​At least the following symptoms: 

​-intrusion (1+) 

​Avoidance (1+) 

​-negative alterations in  cognition mood (2+) 

​Alterations in arousal & reactivity (2+) 

• ​Significant distress and impairment: can’t do whats needed in daily life 

• ​Duration: more than 1 month 

Intrusion symptoms

​Intrusion (1+) - Criterion B: distressing memories of insistence, someone exposed to interpersonal violence and may have flashbacks. Terrifying dreams or nightmares, dissociative reactions in which the person feels and acts that it’s recurring. Psychological and physiological stress or cues from environment; triggers: someone in a house fire can smell smoke at barbeque and it can trigger the distress.  

​-need at least 1 one symptom of intrusion 

​

avoidance symptoms

 

• ​Avoidance (1+) - criterion c: persistent avoidance of stimuli from the trauma  

• ​ways to avoid distressing memories that are closely related to the event. Might distract or repress 

• ​avoiding physical things / external reminders as people or places or activities that remind a person of trauma and memories of the traumatic events pop up.  

​-  one of these 

cognition & mood symptoms

 

​Cognition / Mood (2+) - criterion D 

• ​Negative changes in cognitions or mood in 2 or more of following 

​-inability to remember aspectects of an event, remember the child abuse they went through but forgot certain things 

​-inability to remember events 

​-persistent and negative beliefs of ones self: I’m bad, I’m worthless 

​-negative belief about others - world dangerous 

​- Persistent distorted cognitions of cause or consequences of event that lead individual blame himself or others, false memories in a way 

​-persistent negative emotional state: fear, worry, anger, shame, 

​- diminished interest in activities you used to enjoy like exercise or being w friends, after traumatic event might withdrawal 

​-feelings of detachment from others 

​-persistent inability to experience positive attitude feel joy or happiness 

arousal & reactivity symptoms

 

1. ​Arousal (2+) - criterion E 

• ​Changes in arousal and reactivity in 2 or more of following: 

​-irritability 

​-reckless, self destructive behavior 

​-hypervigalence 

​-exaggerated startled response: startled easily 

​-problems with concentration: brain fog 

​-sleep disturbances: sleeping too little or too much 

• ​People who experience trauma have higher anxiety and easily more angry or irritable, excessive fear 

• ​Soldier might be sensitive to traffic or fireworks 

acute disorder symptom clusters

 
Core symptom: experience of trauma Symptoms: some of the four categories:  -intrusion -avoidance -cognition & mood symptoms -arousal & reactivity symptoms -dissociative symptoms (9 or more from any of the 5 categories) Significant distress and impairment ​​ 

acute stress disorder duration

3 days - 1 month after trauma, after they experience a traumatic event people may have responses to symptoms. Immediate traumatic response PTSD is a month or longer, acute stress disorder is a risk factor​ 

What are the main response​s ​to potentially traumatic events (PTE)? And what are factors that affect those responses to PTEs? 

-4 prototypical response patterns

-pre, peri, and post-trauma factors affecting PTE responses

-latent vulnerability approach and 3 threat biases

4 prototypical response patterns

• Resilience

• Recovery

• Delayed:

• chronic

resilience

Low symptoms of distress after exposure to PTE 

recovery

• elevated distress after pte that decreases over time especially after therapy 

delayed

• low distress after PTE and becomes elevated after some time 

chronic

t’s stable from when it happened to years later, elevated distress 

pre factors affecting PTE response

• demographic: age, gender, previous trauma, personality traits, SES, copying styles, access to resources family history, prior mental health: depressive or aggressive behavior, family history of mental illness, intergenerational trauma 

-families who have been through korean war may have lower function, lower emotional expression and it affects their children and grandchildren in how they share emotions 

peri-trauma factors affecting PTE responses

(those during or immediately after PTEs): nature or subtype of trauma, interpersonal, abuse, domestic violence, neglect, associated with ptsd symptoms than with non-interpersonal traumas (natural disasters, accidents), interpersonal events can affect, early onset, childhood trauma is later risk factor to PTEs and brain development, chronicity and frequency: trauma and xposure to multiple,examined and duration of exposure over periods of time: early childhood to 18 yrs old. Frequency: experience to chronic or multiple traumas 

post-trauma factors affecting PTE responses

• level of social support, do they have support system, do they have good resources like counseling, ongoing stressors: is the same or similar thing still going on  

-social support 

-access to resources 

-mental health care 

-hospitals 

Latent vulnerability approach

approach: PTEs exert influence by creating lasting change in specific vulnerabilities across multiple units of analysis (e.g. neural, cognitive behaviroal) 

-measurable challenges that follow potential traumatic event disposure that are latent 

-latent: doesn’t have immediate clinical manifestation, or impact on person that you can see 

-increase risk or vulnerability to psychiatric disorders 

-affect persons well being over time and later on 

latent vulnerability 3 biases

1. threat biases

2. reward biases

3. social-emotional defecits

threat biases

1. dysregulated stress response system, post traumatic cognition, avoidant behaviors, hypersensitivity, or blunted response to threats in general,  

-the interventions are targeted through exposure based trauma focused interventions, related trauma exposed interventions, can alleviate symptoms of PTSD by reducing the biases 

reward biases

deficits in reward learning, experiencing or dissipating awards Salient within context of emotionally numb presentations of PTSD 

-poverty, neglect - physical resource, can be seen in emotionally numb presentations of PTSD, interventions with healthy reward process, empower people to do behavior 

-promote healthy reward processing, behavioral activation 

social-emotional deficits

difficulties identifying and demonstrating appropriate responses to own and other emotions around you, social cognitive processes like trust after traumatic experience and find it difficult to trust others or themselves emotion dysregulation, have problems with appropriate emotions and those around them 

-diff cognitive processes like trust 

PTE and PTSD epidemiology. How common are PTEs?? PTSD?

Epidemiology of potentially traumatic events (PTEs) 

Prevalence of PTEs and PTSD 

• Experience of PTEs is quite common 

• Lifetime prevalence: 40-90% 

• Higher prevalence for female - identifying, non-binary individuals, and trans individuals 

• Still PTSD is rare: 

• People who have PTEs may not get diagnosed with ptsd 

• Research suggests that black and hispanic have higher exposure but white have higher. SES, poverty factors 

• Lifetime prevalence 6.8% 

• 12 month prevalence: 3.5% 

main etiological risks Trauma-related disorders. 

Etiology **(ON THE EXAM AND ESSAY): unlike many disorders, PTSD / acute stress disorder have a clear etiology 

-people who are more like to have PTSD 

• Vulnerable communities: 

• Children 

• Veterans 

• Those who live in low SES communities: more likely to include minority populations, high exposure can experience discrimination, community violence and is chronic can have effects on well-being when growing up 

• Resilience: age, identities, stressors 

main etiological models for trauma related disorders

• intersectionality

• racial trauma

intersectionality

• Intersectionality: can play a big role in determining risk 

• Response to trauma where multiple stressors in response to  

-natural resilience 

-groups can be more at risk 

-a group you identify as can have initial vulnerabilities, 

-influence likelihood of experiencing PTSD and acute stress disorder 

• Conceptualized by black feminist that was responding to racism in feminist movement  

• The term was officially by Crenshaw, black women said they were facing discrimination and court dismissed this and said there was no discrimination and wouldn’t consider 

• Explains how multiple identities leads to unique experiences of depression and privilege, by examining single identities it shows impact of one’s collective identity of how they navigate the world and result of system 

racial trauma

 

• A real or perceived racial discrimination 

-threats of harm or injury 

-humiliating or shame events 

-witness harm or racism to others 

-experiences of micro aggressions 

know the main, evidence-based treatments for Trauma related disorder

medication, prolonged exposure, cognitive processing, therapy, EMDR

medication

• can be used to provide relief from intense PTSD symptoms 

-anti-depressants: ssris to alleviate depression, intrusive thoughts, flashbacks, avoidance-behaviors, intrusion behaviors 

-antipsychotic medications 

psychotherapeutic treatments

 

• To help with PTSD and acute stress disorder 

• Exposure therapy: like with OCD, brings something up that person doesn’t want to experience and same thing with PTSD 

-try to relive and experience it and not block it out 

Prolonged Exposure, Cognitive Processing Therapy, EMDR. 

trauma narrative

 

• Approach that helps process clients instead of avoid, use a narrative for gradual exposure therapy since you’re talking about your trauma in small doses in safe controlled environment 

-sense of self 

• Able to think and talk about the trauma, particularly the worst moments 

-helping people approach and talk about their feelings, thoughts, memories 

-gradual exposure so people feel comfortable to say it’s a part of my history to say i experienced this and it’s a part of my history 

• Identify unhelpful or inaccurate cognitions (e.g., “it was my fault”) and altered views of self, others, or the world 

-cognitive distortions about themselves or the world 

-identify when the person is trying to blame themselves 

-combat that by giving them 

• Identify more helpful and accurate ways of thinking about traumatic events, self, others, the world, the future 

prolonged exposure

Exposure based program for clients to process trauma events and reduce trauma induced psychological disturbances 

• Talk about traumatic event in first person as if it were happening in the moment 

• use psychoeducation, imaginable exposure, in vivo (live)) exposure

psychoeducation

teaching people about mental health, reactions to trauma, helps normalize and validate experiences, help post trauma difficulties 

imaginable exposure

repeated recounting of traumatic memory: emotional reliving, talk about it with therapist, write about it, talk and record yourself and then hearing it play back 

In (vivo) live exposure

3.  

-gradually approaching reminders of event, situations or objects 

-despite being safe you're avoidant and fearful 

-approach trauma of objects and situations 

-if got attacked at restaurant you might try to approach other restaurants that bring those traumas and reminders - might avoid restaurant 

-talk about it in the first person 

cogntive processing therapy

 

• The focus is on cognitive restructuring: 

1. Self blaming thoughts 

2. Meaning of the event 

3. Implications of traumatic events, trauma on their lives 

4. Beliefs about safety trust, power, control, self-esteem, intimacy 

eye movement desensitization and reprocessing (EMDR)

*some clinicians thinks this works and others don’t, some people are suspicious 

*form of exposure with strong cognitive component and rapid eye movements 

• Exposure: have the patient imagine scene for the trauma or sequence of what happened 

• Strong cognitive component: patient or client imagines trauma  

• Accompanied by rapid eye movements: have patient track my finger or moving object  

-use finger or pencil with fuzzy 

-think of traumatic event and eyes follow the stimulus, the sequence repeated until distress decreases  

-patient is focusing on negative and can make a positive thought 

-eye movement is irrelevant but it is exposure and cognitive restructuring, which is why it might work 

Anxiety disorders

fear, anxiety, GAD, Specific Phobia, SAD

fear

a stress response from immediate danger 

anxiety

stress response just from your thoughts e.g. “What if the big bad fish comes out today?” 

fear duration

 

• Fear is present focused: immediate threats or stimuli 

-e.g. Spiders come out of nowhere and freak out 

anxiety duration

 

• Anxiety is Future focused: future threat, don’t know what the future will look like, distant or less concrete stimuli or worries 

-something that may or may not happen 

fear immediacy

 

• Fear is Brief: short term acute response specific stressor, builds intensity in the moment and panic 

anxiety immediacy

• Anxiety is Sustained: concerned longer than a moment with future-oriented stimuli or worries 

fear specificity

 

• Fear is a Specific Threat: “This Viper!” 

anxiety specificity

• Anxiety is a Diffuse Threat: “something bad happening” feel the anxiety everywhere and that something bad is happening 

fear adaptivity

 

• Fear is generally adaptive: a spike in ability to cope.  

-flight or fear response 

anxiety adaptivity

 

• Anxiety is only adaptive in moderation: wears down your system over time 

-worrying about a trip signals you to prepare but in anxiety you overestimate the risk and fixate on the out comes 

-worry about an exam is okay because it motivates you, but at a certain point its not helpful, anxiety is helpful in moderation 

anxiety epidemiology

• ​Prevalence 

​-anxiety is most common: trauma related, ocd,  

• ​Lifetime Prevalence: Up to 33.7% of the general population will experience an anxiety disorder during their lifetime. [1] 

• ​Annual Prevalence: Past-year rates range from roughly 8.4% to 24.9% globally, with US adult past-year prevalence around 19.1%. [1, 2] 

• ​Sex and Gender: Women are affected approximately twice as often as men (roughly 1.6 to 2 times higher rates). [1, 2] 

• ​Age of Onset: Anxiety disorders frequently begin early in life, with a median age of onset around 11 years old. Specific phobias often start even earlier (average age 7), while social anxiety typically emerges around age 13. [1, 2] 

anxiety comorbidity

•  

​-anxiety is comorbid with other disorders or anxiety disorders itself e.g. GAD, Social Anxiety, Separation Anxiety, Phobia 

​-high comorbidity between anxiety and substance abuse, mood disorders: depression, bipolar disorders 

​-some researches think GAD is preexisting for other anxiety disorders 

what do anxiety and depression have in common

1. ​Both defined by negative emotional experience: don’t feel could 

2. ​Can be triggered by stressful experiences - could be anything: death of loved one, negative experiences, stressful experience 

​Comorbidity: Clark & Watson’s tripartite model 

 

• ​General distress is common in depression and anxiety 

​-irritability, upset, feeling unpleasant in general 

• ​Depression is characterized of low levels of positive affect: lack of energy, inability to experience pleasure, lack of drive, not interested in thinks 

• ​“Pure depression” 

• ​Anxiety: increased levels of somatic arousal: increased heartbeat, sweating, chills, stomach discomfort, aches 

​-”pure anxiety” 

• ​Both triggered by stress full experience shared and distinct etiological factors  

affect

• any experience of feeling or emotion 

​-positive: positive emotions 

​-negative: negative emotions, high negative affect is distress 

Generalized Anxiety Disorder symptoms

1.  

• Core symptom: excessive worry 

-applies to two or more areas: family and friends at school home or relationships - find it difficult to control their worry in everyday activity or events, not unusual events 

Other Symptoms - need 3 or more of the following 

1. Restlessness or on edge 

2. Tiredness and fatigue 

3. Difficulty concentrating or mind going blank - can’t listen in class during notes 

4. Irritability 

5. Muscle aches, tension, soreness 

-can’t pin where the ache in your body is coming from 

0. Sleep problems related to insomnia 

*for someone to be diagnosed with GAD must cause significant distress or impairment in their lives 

  

GAD duration

Duration: 6 months, more days than not 

• Worry has to apply to two or more areas of life: school, family or friends, work 

• The person must find it difficult to control the worry 

-may want to decrease anxiety but can’t 

etiology of GAD

• traigt anxiety runs in families, neurotransmitters, overactive brain circuits, chronic stress, stressful life events

• intolerance of uncertainty

• belief that worry is adaptive

• avoidance of threatening information

cognitive appraisals associated with GAD: Intolerance of uncertainty

characteristic that is result of negativity beliefs of uncertainty , tendency to react negatively on emotional, cognitive, behavioral level to uncertain situations or events. Find uncertain situations stressful and upsetting e.g. always worried about the future and concerned because they can’t predict future 

cognitive appraisals associated with GAD: belief that worry is adaptive

positive beliefs that worrying serves them, that it helps them cope with events or prevents events to not panic e.g. think that worrying about exam helped me do good on the exam 

cognitive appraisals associated with GAD: avoidance of threatening information

may focus on threat, then avoid mild threat cues to regulate anxiety, however feelings of worry are likely to continue, which is not adaptive bc chronic worry has negative impacts on the body and affect parts of life 

epidemiology of GAD

 

• Prevalence: 2x likely for women to be diagnose  

• Gender differences: 2-1 female to male, 5% of population meet criteria for GAD,  

• *Onset: develops in adolescence, 10-19 years old or can be in response to a life stressor in women over 40 

-high overlap of comorbidity 

specific phobia symptoms

Excessive or unreasonable fear to specific object / situation Immediate fear / anxiety Avoidance or distress: avoids or endures situation with intense fear or anxieety Proportionality: fear of anxiety is out of proportion to actual threat and social cultural context -might start crying or screaming Somatic symptoms: see spider, might have heart palpitations, dizziness, nausea, sweating, chills, shaking, trembling, upset stomach, out of breath          

specific phobia duration

must occur for 6 months or more, persistent level of fear / anxiety or avoidance

subtypes

animal type, natural environment type, blood / injection / injury type, situational type

animal type

fear or avoidance of animals, arises in childhood    

natural environment type

fear of heights or water. Fear of storms, can arise in childhood       

blood / injection / injury type

seeing blood, injections, watching surgery, bodily infections. Faints when get blood drawn. Runs in families or in early childhood

other type

doesn’t fall into the 4 categories, fear of falling down, fear of choking, vomiting or illness, fear of costume characters like clowns, random objects Snacks and heights are most common phobia and have associated panic attacks when seeing the object or situation  

specific phobia etiology

preparedness modal, social learning, classical conditioning, operant conditioning

preparedness model

indicates there’s something we are naturally afraid of because it leads to evolutionary disadvantage. Less experience to gain response like fear of fark. Leads to fear and can become phobias, evolutionary advantage: afraid of insects or certain animals if our ancestors were killed by those and that’s why we’re scared -negative information from others like parents or TV, e.g. hear that walking alone at night can be dangerous and that’s why person has fear                                             

social learning

you can learn fear by watching others behaviors and interactions to a stimulus, their response. You see it and then copy, direct observation -e.g. Baby monkeys learn from adult monkeys to be afraid of snacks - classical conditioning? -see parents scared to get blood drawn you might develop that fear

classical conditioning

learned from repeated pairing of specific stimulus, little albert, racism can be classically conditioned in children if fear of certain racial group    

operant conditioning

behavior learned by the reduction of anxiety, learned through negative reinforcement and that a fear of a stimulus is continually reinforced by a stimulus because it avoids anxiety .e.g fear of dogs and avoid them when crossing the street, avoid at all costs

epidemiology for specific phobia

Prevalence: 12 month prevalence is 9%, lifetime prevalence is 12%

Gender differences: women are 2-3x more likely to have than man, but different for each phobia -animal, and specific situation is common in women but blood is common in men and women -animal most common

Age of onset: can develop throughout lifetime. Can begin in childhood, see how people around you act. Mostly arrive unexpectedly in early adolescence or adulthood ​ 

situational type

fear of particular situation e.g. airplane, elevator, enclosed space. Arises in childhood but can have onset in mid 20s

social anxiety disorder

Fear / anxiety of social or performance situations; exposed to possible scrutiny by others -people being socially anxious can be debilitating  -persistant fear of anxiety of 1 or more -e.g having a conversation, meeting unfamiliar people, talking to people you know well, being observed -e.g. Anxiety in restaurants and cafeteria, performing infront of others like a speech      

-fear of negative evaluation

-avoidance or distress

SAD epidemiology

Prevalence: lifetime is 12%, more common in women and stronger in childhood / adolescence

Gender differences: women's sense of self is more dependent on others compared to men, care about interpersonal connections, women have more anxiety and got to health provider, women experience more than men

Onset: childhood or adolescence - 15 years old

SAD etiology

classical conditioning applied here: social negative experience as teasing or bullying, a bad response to social situation,

-classical conditioning from early on preparedness: there’s somethings were naturally afraid of and this can be a cause, we need others to survive,

other researches say this doesn’t make sense because we need social bonds to survive and shouldn’t be avoiding it ​​ 

panic attacks & panic disorder

just because you have panic attacks doesn’t mean you have panic disorder

panic attacks

By an abrupt intense fear that appears, symptoms are Sudden and quickly peak symptoms, Reaches peak within 10 minutes 

4 or more of following symptoms 

1. Heart palpitations 

2. Sweating 

3. Trembling or shaking 

4. Sensations of shortness of breath Can’t breathe 

5. Choking 

6. Chest pain 

7. Nausea / abdominal distress 

8. Dizzy / faint 

9. Chills / hot flushes 

10. Numbness or tingling 

11. Derealization / depersonalization - outside of your body 

12. Fear of losing control / going crazy 

13. Fear of dying 

panic disorder

panic attacks are necessary but insufficient for panic disorder recurrent unexpected panic attacks, history of 1 panic attack, more than one month of fear of panic attack / behavioral changes 

• Recurrent, unexpected panic attacks 

• Fear of having panic attacks (or its consequences) And /OR behavioral changes  to avoid panic attacks 

IMPORTANT: 

• Panic disorder is reoccurent, they show up over and over again in situations you wouldn’t expect them too, in one or more panic attacks experience 

1. Persistent concern or worry of attack happening again/ consequences of the attack 

-worry certain feelings will bring attack 

2. Behavioral changes to avoid panic attacks 

-avoid elevators or enclosed spaces, take stairs, stop exercising 

* panic attacks are necessary but insufficient for panic disorder 

panic attack vs. panic disorder

Panic Attacks VS. Panic Disorder 

Panic Attack:  

• physical symptoms 

• often isolated: NOT TIED TO EMOTIONAL AND BEHAVIORAL SYMPTOMS  

Panic disorder: emotional / behavioral symptoms: 

• Either fear of further panic attackers AND / OR changing behavior to avoid further panic attacks 

-stop working out so heart rate doesn’t increase 

• Involves a (potential) pattern!! 

agoraphobia

 

• Can be related to panic disorder, used to be related 

• Anxious apprehension about being in places or situations from which: 

• escape might be difficult or embarrassing e.g. can’t get out of elevator and they’ll suffer inside 

E.g. crowded streets, shops, enclosed spaces (theatre, church, concert, public transit), bridges, tunnels 

• help may not be available if one has a panic attack 

agoraphobia situations

•  

• Need marked fear or anxiety of 2 or more of the situations 

1. Public transportation 

2. Open spaces 

3. Enclosed spaces 

4. Being in crowd / standing in line 

5. Being outside of the home alone 

Example: fear is out of proportion of what the situation is. Someone who’s in a grocery store may be scared they’re going to die there, fear of places of assembly, different situations of threat stimuli 

• Actual exposure to public spaces 

• People avoid these places 

agoraphobia cognitive theories

 

• Focus on how individual interprets bodily sensations 

-internal stimuli provokes panic attacks 

• Anxiety sensitivity:  

• Interoceptive awareness 

panic disorder etiology

-stressful life events

-biological