Social Anxiety, OCD, & Related Disorders

Social Anxiety Disorder (SAD) is also known as

social phobia

social anxiety disorder (SAD)

pronounced, disproportionate, and repeated anxiety about social situations in which the individual could be exposed to scrutiny by others

specified (e.g. public speaking) or general (social setting and eval)

SAD onset

late childhood/early adolescence

how long must SAD symptoms last

at least 6 months

SAD symptoms

exposure to social situations creates anxiety causing distress/impairment which leads to avoidance

How many people with SAD seek treatment? Patients are likely to rate themselves as les _____ than they are

40%; competent

SAD cycle

belief —> action —> perception —> self-fulfilling prophecy

SAD cause (CBT)

beliefs (social-realm dysfunction and expectations) create avoidance

anticipation of social disasters and dread of social situations (pre-dysregulation of self)

avoidance and safety behaviors performed to reduce or prevent disasters (anticipation persists —> avoidance —> loss of social life and skills)

SAD treatments

address overwhelming social fears

address lack of social skills (social skills and assertiveness traning)

how are overwhelming social fears addressed?

ERT

systematic therapy

benzos, antidepressants

why is psychotherapy sometimes preferred over drug therapies?

just as effective with a lower chance of relapse

obsessions

persistent, intrusive, and foreign thoughts, ideas, impulses, or images that invade consciousness

ignoring/resisting causes anxiety

basic themes of obsessions

dirt/contamination

violence/agression

orderliness

religion

sexuality

compulsions

repetitive, rigid, voluntary behaviors or mental acts that people feel they must perform to reduce or prevent anxiety usually develop into rituals and feel mandatory, often recognized as unreasonable

basic themes of compulsions

cleaning

checking

order/balance

touching/verbalizing/counting

OCD symptoms

obsessions and/or compulsions

OCD prevalence

1-2% of world pop

40% seek treatment

OCD onset

childhood/young adulthood

OCD

hold selves to higher level of standards, thoughts can be dangerous and lead to actions

OCD psychodynamic cause

battle between id and ego

defence mechanisms lessen anxiety in overt thoughts and actions

related to anal stage of development

OCD psychodynamic treatment

free association

therapist intervention

direct and action-orientated

OCD CBT cause

grows from human tendencies to have unwanted/unpleasant thoughts

Attempt to neutralize thoughts with actions or other thoughts to avoid negative outcomes

Cycle of temporary relief → obsessive thoughts → anxiety → compulsive behavior

OCD CBT treatment

ERP (50-70% improvement)

focus on cognitive processes to manage avoidance with exposure

OCD biological causes

low serotonin, glutamate, DA

hyperactive cortico-striato-thalamo-cortical circuit

hyperactive amygdala

OCD biological treatments

SSRIs (improvement in 50-80% of patients)

types of obsessive-compulsive-related disorders

hoarding disorder

trichotillomania/excoriation disorder

body dysmorphic disorder

hoarding disorder

perceived need to save items and to distress associated with discarding them

Causes clinically significant distress/impairment in social/occupation/other areas of functioning

trichotillomania

hair pulling

excoriation

skin-picking

trichotillomania/excoriation disorder treatment

pharmacology and psychotherapy

CBT to identify and alter thoughts and emotions that lead to this behavior

body dysmorphic disorder

Individuals become preoccupied with belief that they have certain (imagined or greatly exaggerated) defects/flaws in physical appearance