PSYC3607 - Chapter 6 & 7 Anxiety and Obsessive Compulsive Disorders

* nothing from the textbook sorry ^^

What is Anxiety?

• an affective state whereby an individual feels threatened by the potential occurrence of a future negative events

  • characterized by tension and apprehension and worry

  • “future-oriented”

What is Fear?

• emotional response to a real or perceived current threat

What is Panic?

• extreme fear when there is nothing to be afraid of

What is the Fight-Or-Flight system?

• increased heart rate

• increases sweating on palms

• dilation of pupils

• underlies the fear and anxiety involved in almost all anxiety disorders

What is comorbid disorders to Anxiety?

• 50% of people with an anxiety disorder are also depressed

• approx. 10-25% with anxiety disorders abuse or are dependent on alcohol

  • with phobias abuse develops after the anxiety symptoms

  • other anxiety disorders abuse may occur before or after the onet of symptoms

What is the three-part model of Anxiety and Depression?

• high level of negative emotions

  • generate distress

• low level of positive emotions

  • lack of enjoyement

• physiological hyperarousal

What is Generalized Anxiety Disorder?

• persistently and excessively anxious and often about minor items

  • chronic, uncontrollable worry about everything

  • primarily focused on finances, work, and illness

• often it is not the stress in the patients life, but the anxiety and worry they experience

• other features include

  • difficulty concentrating

  • tiring easily, restlessness

  • irritability

  • high level of muscle tension

• lifetime prevalence of 5% for the general population

• GAD typically begins in mid-teens

• stressful life events play role in onset

What is the DSM-5 criteria for GAD?

• excessive anxiety and worry (apprehensive expectation), occuring more days than not for at least 6 months, about an umber of events or activities (such as work or school performance)

• individual finds it didfficult to control the worry

• the anxiety and worry 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 past six months)

  1. restlessnes or feeling keyed up or on edge

  2. being easily fatigued

  3. difficulty concentrating or mind going blank

  4. irritability

  5. muscle tension

  6. sleep disturbance

• the anxiety, worry, or physical symptoms causing clinically significant distress or impairment in social, occupational, or other important areas of functioning

• the disturbance is not attributable to the physiological effects of a substance or another medical conditon

• not better explained by another mental disorder, worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder, combination or  other obsession in OCD, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in PTSD, gaining weight in anorexia nervosa, physical complains in SSDs, perceived appearance flaws in BMD, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia 

what is the etiology of GAD?

• decreased arousal due to highly responsive parasympathetic nervous system

  • worry temporarily: reduces any arousal, suppresses negative emotions, and produces muscle tension

• dopamine in the frontal lobes does not function nomrally

• possible dysfunction in GABA, serotonin, norepinephrine, and other neurotransmitters

• heritability between 15-40%

What are the biology perspectives for GAD?

• GAD may have a genetic component

• neurobiological model for GAD based on fact that benzodiazepines are often effective in treating anxiety

  • receptor in the brain for benzodiazepines has been linked to the inhibitory neurotransmitter GABA

  • benzodiazepines may lower anxiety by enhancing the release of GABA

    • drugs that block or inhibit the GABA system enhance anxiety

What are the psychological perspectives of GAD?

• three characteristic modes of thinking and behaving

  • being particularly alert for possible threats

    • hypervigilance is a heightened search for threats

  • feeling that the worrying is out of contorl

  • sensing that the worrying prevents panic, giving an illusion of coping

What is Panic Disorder?

• panic attack: person suffers a sudden and often inexplicable attack of alarming symptoms:

  • laboured breathing, heart problems

  • nausea and chest pain

  • feelings of choking and smothering

  • dizziness, sweating, and trembling

  • intense apprehension, terror, and feelings of impending doom

• may also experience depersonalization and derealization

• other features

  • cued — associated with particular objects, situations, or sensations

  • uncued — spontaneous, not associated with a particular project or situation

  • can occur at any time, even when sleeping

  • panic disorder is diagnosed as with or without agoraphobia

• lifetime prevalence

  • typically begins in adolescnece

  • onset associated with stressful life experience

  • > 80% of patients diagnosed as having an anxiety disorder also experience panic attacks

What is the DSM-5 criteria for Panic Disorder?

• reccurent unexpected panic attacks

• at least one of the attacks has been followed by 1 month (or more) of one or both of the following

  1. persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, ‘going crazy’)

  2. a significant maladaptive change in behaviour related to the attacks

• the disturbance is not attributable to the physiological effects of a substance or another medical condition

• the disturbance is not better explained by another mental disorder

What is Agoraphobia?

• persistent avoidance of situations that might trigger panic

  • avoidance of places in which it would be embarassing or hard to obtain help in case of a panic attack

  • extreme agoraphobics may become housebound

  • usually develops within the first year of recurrent panic attacks

What are cognitive theories of Panic Disorder?

• cognitive theories

  • focus on how a person interprets and then responds to alarm signals from the body

  • misinterpretation of normal bodily sensations as indicating catastrophic effects

    • catastrophic thinking

    • these interpretations can turn a panic attack into a panic disorder

    • tendency for caatastrophic thinking related to anxiety sensitivity — tendency to fear bodily sensations that are related to anxiety

What is the psychological theories of Panic Disorder?

• the fear-of-fear hypothesis

  • suggests that agoraphobia is not a fear of public places per se, but having a fear of having a panic attack in public

  • misinterpretation of physiological arousal symptoms

What are the social factors of Panic Disorder?

• social stressors contribute to panic disorder

  • tend to have had a higher than average number of stressful events during childhood and adolescence

  • 80% of people with panic disorder reported that the disorder developed after a stressful life event

• presence of a close relative or friend helps decrease catastrophic thinking and panicking in agoraphobia

  • may be the opposite tho

What is Social Phobia?

• persistent, irrational fears linked generally to the precense of other people

  • can be extremely debilitating

  • people with a SP may tried to avoid situations in which they might be evaluated because they fear that they will reveal signs of anxiousness or behave in an embarassing way

• can either be generalized or specific

  • generalized: involves many different interpersonal situation

  • specific: intense fear of one particular situation

• general Sp has an earlier age of onset and is more comorbid with other disorders than specific SP

What are individuals with Social Phobia like?

• very sensitive to criticism and rejection; worried about meeting expectations of others

• dread being evaluated and may not perform to their potential

  • diminished performance challenges their self-esteem, increasing anxiety

• are less likely to be in a romantic relationship

• may not complete school or advance at work due to avoidance of social interactions

What is the Neurological Factors of Social Phobia?

• amygdala is strongly activated when afraid and when shown faces

  • social phobia will inhibit that response for all faces

• hippocampus and the cortical areas near the amygdala do not function normally

• right hemisphere also appears to play a part

• dopamine, serotonin, and norepinephrine may function abnormally

• the heritability of social phobia is 37% on average

  • children with shy temperament or behavioural inhibiton

What are the Psychological Factors of Social Phobia?

• cognitive biases and distortions

  • chronically hypervigilant

  • distorted emotional reasoning

• classical conditioning

  • social situation + negative social experience = conditioned emotional response

• operant conditoning

  • avoidance of social situations in order to decrease probability of an uncomfy experience

  • negative reinforcement of avoidance behaviour because avoidance decreases anxiety

What are the Social Factors of Social Phobia?

• parent-child interactions

  • extremely overportective parents may lead children to cope with their anxiety through avoidance

• different cultures emphasize different concerns about social interactions, and these concerns influence the specific nature of social phobia

What are Phobias?

• disturpting, fear-mediated avoidance that is out of proportion to the danger actually poses and is recognized by the sufferer as groundless

• distinguish from legitimate fear

What are the 3 Subtypes to Phobias?

• agoraphobia - covered

• social phobia - covered

• specific phobia

What is a Specific Phobia?

• unwarranted fears caused by the presence or anticipation of a specific object or situation

• specific phobias sub-divided according to 5 sources of fear

  • blood, injuries, and injections (trypanophobia)

  • situations

  • animals

  • natural environment

  • other

What is the DSM-5 criteria for a Phobia?

• 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 of anxiety is out of proportion to the actual danger posed by the specific object or situation and the sociocultural context

• the fear, anxiety, or avoidance is persistent, typically lasting for six months or more

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

• the disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms; objects or situations related to obsessions; separation from home or attachment figures; or social situations

What is the Neurological Factors of Phobias?

• amygdala appears to have a hair-trigger

• pet scans: activates the limbic system + somatosensory cortex and left anterior insular cortex

  • pictures may trigger mental imagery of feeling the animal of touching the body

• anxiety evoked by specific phobias is associated iwth too little of the nt GABA

• different specific phobias appear to be influenced to different degrees by genetics and the environment

What is the Psychological Factors of Phobias?

behaviourism is applied

• unrealistic fears of usually harmless things. believed these people must have had a bad experience with the target of the phobia at some point

• little albert

behavioural theories

• focus on learning as the way in which phobias are acquired

• avoidance conditioning — reactions are learned avoidance responses (negative reinforcement)

two sets of learning

1. classical conditioning

2. person learns to reduce conditioned fear by escaping from or avoiding cs

modeling - person can also learn fears throguh imitating the reactions of others

• learning of fear by observing others is referred to as vicarious learning

prepared learning - people tend to only certain objects and events

• fear spiders, snakes, and heights but not lambs

• some fears may reflect cc, but only to stimuli to whcih an organism is physiologically prepared to be sensitive

Is diathesis needed?

• cognitive diathesis such as the tendency to believe that similar traumatic experiences will occur in the future or not being able to control the environment may be important in developing a phobia

What are Cognitive Theories of Phobias?

• focus on how people’s thoughts processes can serve as a diathesis and on how thoughts can maintain a phobia

• anxiety is related to being more likely to

  1. attend to negative stimuli

  2. interpret ambiguous information as threatening

  3. believe that negative events are more likely than positive ones to re-occur

What is the difference between Obsession and Compulsions?

OBSESSIONS

• INTRUSIVE and RECURRING thoughts, IMPULSES, and IMAGES

• most frequent obsessions: fears of contamination, fears of expressing some sexual or aggressive impulsive, and hypochondriacal fears of bodily dysfunction

COMPULSIONS

• repetitive behaviour or mental act that the person feels driven to perform or reduce the distress caused by obsessive thoughts or to prevent some calamity from occuring

What are some features of OCD?

• gender ratio is equal

• most common obsession among children

  • germs

  • fear of harm to self or others

  • need for symmetry

  • most common compulsions are washing and cleaning, checking, counting, repeating, touching, straightening

  • children change obsessions and compulsions more than adults

  • more vague, magical

CONTAMINATION →

WASHING

ORDER →

ORDERING

LOSING CONTROL →

COUNTING

DOUBT →

CHECKING

What are faulty appraisals in OCD?

• thought - action fusion

  • believing that a certain thought increases the likelihood that thought will come true

  • belief that having a thought is equal to behaving in that way

What are Hoarders?

• loss of control

• wanting to save things despite having no functional value

• mistakenly believes that items have value

• strong personal value to items

  • book, animals

• some families clean the house for them, but the behaviour continues

What are the Psychological Factors of OCD?

• obsessions are caused by the person’s reactions to intrusive thoughts

What is Rachman’s theory of obsessions in OCD?

• unwanted intrusive thoughts are the roots of obsessions

• obsessions often involve catastrophic misinterpretations of negative intrusive thoughts

• thus the person is compelled to engage in suppression, neutralization, and avoidance

• trying to suppress obsession can increase their frequency — the rebound effect

What are the Neurological Factors of OCD?

• ocd symptoms may be caused by dysfunctional connections among the frontal lobes, the thalamus, and the basal ganglia

• both the frontal cotext and the basal ganglia function abnormally in ocd patients

What are Impulse Control Disorders?

• occurs between ages 7-15

• key feature of these disorders - thought of seeking a small, short-term gain at the expense of a large, long-term loss

• repeatedly demonstrates failure to resist their behavioural impetuosity

• impulse control disorders are considered to be part

What is the DSM-5 criteria for Kleptomania?

• recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value

• increasing sense of tension immediately before committing the theft

• pleasure, gratification, or relief at the time of comitting the theft

• stealing is not committed to express anger or vengeance and is not in response to a delusion or hallucination

• stealing is not better accounted for by conduct disorder, manic episode, or aspd

What are neuropsychosocial factors for Kleptomania?

• ocurs in fewer than 5% of identified shoplifters

• common in females than in males

• age average is about 35

  • although some individuals report the onset of kleptomania as early as age five

• evidence linking it with abnormalities in the brain chemical serotonin

• stressor such as major losses may also precipitate kleptomaniac behaviour

What is Trichotillomania?

• hair loss from repeated urges to pull or twist the hair until it breaks off

  • symptoms begin before age 17

    • uneven appearance to hair

    • bare patches or all around loss of hair

    • bowel blockage if people eat the hair they pull out

    • constant tugging, pulling, or twisting of hair

    • denying the hair pulling

    • hair regrowth that feels like stubble in the bare spots

    • increasing sense of tension before the hairpulling

    • other self-injury behaviours

    • sense of relief, pleasure, or gratification, after the hair pulling

What is the DSM-5 criteria for Trichotillomania?

• reccuent pulling out of one’s hair resulting in noticeable hair loss

• increasing sense of tension immediately before pulling out the hair or when attempting to resist the behaviour

• pleasure, gratification, or relief when pulling out the hair

• the disturbance is not better accounted for by another mental disorder and is not due to a general medical condition

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

What is Dermatillomania?

• dopamine → urge to pick

• begins with the onset of acne

  • compulsion continues even after acne has gone away

  • grooming of skin is disproportionate to the severity of acne

• certain stressful events including marital conflicts, deaths of friends or family, and unwanted pregnancies have been linked to the onset

What is Pyromania?

• purposefully sets fires on more than one occasion

• before the act of lighting the fire the person usually experiences tension and an emotional buildup

• when around fires, a person suffering from pyromania gains intense interest or fascination and may also experience pleasure, gratification or relief

• most studied cases of pyromania occur in children and adolescents and 90% of all pyromania cases are male

What is PSTD?

• category of trauma and stressor-related disorders

What are the four general symptoms of PTSD?

• marked by four general types of persistent symptoms

  • intrusive re-experiencing of the traumatic event

  • avoidance

  • negative thoughts and mood, and dissociation

  • increased arousal and reactivity

What are reactions to traumatic stressors?

• traumatic events challenge the basic assumptions that most people have about the world

  • belief in a fair and just world

  • belief that is possible to trust others and be safe

  • belief that is it possible to be effective in the world

  • the sense that life has purpose and meaning

• people react differently to stressors and traumatic events based on previous experiences, apprasial of the stressors, and coping styyle

What is the three major categories of PTSD?

• re-experiencing the traumatic event

• avoidance of stimuli associated with the event of numbing of responsiveness

• symptoms of increased arousal

What are risk factors of PTSD?

• exposure to trauma and severity of trauma

• more females diagnosed

• perceived threat to life

• personality traits of neuroticism and extraversion

• early conduct problems

• family history of psychiatric disorders

• presence of preexisting psychiatric disorders

• earily separation from parents

• previous exposure to trauma

• tendency to take personal responsibility for failures to cope with stress by focusing on emotion

• attachment style

• stressful occupations

What is the Neuropsychosocial approach of PTSD?

• psychological

  • arises from a classical conditioning of fear

  • anxiety sensitivity

• biological

  • genetics

  • domains of noradrenergic system

    • trauma arises levels of norepinephrine

    • evidence for increased sensitivty

  • associated with small hippocampal vol

  • associated with