CHAPTER 5: ANXIETY, TRAUMA- AND STRESSOR-RELATED, AND OBSESSIVE-COMPULSIVE AND RELATED DISORDERS
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199 Terms
Anxiety
A negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future
Howard and Liddell (1949)
Coined the term "shadow of intelligence" to describe anxiety. They proposed that the human capacity for detailed future planning is intrinsically linked to a persistent, underlying feeling that things might go wrong, motivating us to prepare for potential setbacks. This inherent anticipation of negative outcomes is what they termed the "shadow" of our intelligence
Fear
Immediate alarm reaction to danger.
Characterized by strong escapist action tendencies and, often, a surge in the sympathetic branch of the autonomic nervous system.
Flight or Fight Response
It protects us by activating a massive response from the autonomic nervous system which, along with our subjective sense of terror, motivates us to escape or, possibly, to attack.
What is the origin of the word "panic"?
The word "panic" comes from the Greek god Pan, known for terrifying travelers with his bloodcurdling screams. His sudden, frightening appearances were associated with overwhelming fear
What is a panic attack?
IT is a sudden episode of intense fear or discomfort, accompanied by physical symptoms such as heart palpitations, chest pain, shortness of breath, and possibly dizziness
What are the two main types of panic attacks?
Expected (Cued) Panic Attacks: These are more common in people with specific phobias or social anxiety disorder, triggered by a known situation or object.
Unexpected (Uncued) Panic Attacks: These occur without any apparent trigger, making them unpredictable and a key feature of panic disorder. You don't know when or where the next attack might happen.
Expected (Cued) Panic Attacks:
These are more common in people with specific phobias or social anxiety disorder, triggered by a known situation or object.
Unexpected (Uncued) Panic Attacks
These occur without any apparent trigger, making them unpredictable and a key feature of panic disorder. You don't know when or where the next attack might happen.
How do unexpected panic attacks relate to panic disorder?
Unexpected panic attacks are a significant symptom of panic disorder. The unpredictable nature of these attacks causes significant distress and can significantly impact daily life.
Is anxiety heritable?
Yes, a tendency towards anxiety, tension, and panic can be inherited. This suggests a genetic component, as anxiety runs in families.
What is a key genetic factor in anxiety disorders?
There is an inherited tendency to be tense, uptight, anxious, and to panic, which runs in families and likely has a genetic component.
What neurotransmitter is depleted in individuals with increased anxiety?
Depleted levels of gamma-aminobutyric acid (GABA).
Which neurotransmitter systems are associated with increased anxiety?
The noradrenergic system and the serotonergic neurotransmitter system.
What role does CRF play in anxiety?
CRF is central to the expression of anxiety (and depression) and activates the hypothalamic–pituitary–adrenocortical (HPA) axis.
Which brain area is most often associated with anxiety?
The limbic system.
What activates the Behavioral Inhibition System (BIS)?
Signals from the brain stem of unexpected events that might signal danger.
When the BIS is activated by signals that arise from the brain stem or descend from the cortex, our tendency is to freeze, experience anxiety, and apprehensively evaluate the situation to confirm that danger is present.
What is the origin and function of the Fight/Flight System (FFS)?
The FFS originates in the brain stem and is activated partly by deficiencies in serotonin, producing an immediate alarm-and-escape response similar to panic in humans.
What are the two types of abnormal processing in people with anxiety?
Abnormal Bottom-Up Processing: The limbic system, including the amygdala, is overly responsive to stimulation or new information.
Abnormal Top-Down Processing: Deficiencies in controlling functions of the cortex that would down-regulate the hyperexcitable amygdala.
Abnormal Bottom-Up Processing
The limbic system, including the amygdala, is overly responsive to stimulation or new information.
Reacts quickly to what you see or hear without much thought (like jumping at a loud noise).
Abnormal Top-Down Processing
Deficiencies in controlling functions of the cortex that would down-regulate the hyperexcitable amygdala.
Thinks about what you already know but can’t manage anxious thoughts (like worrying too much after getting feedback).
What is a key factor in developing a sense of uncontrollability?
It develops early due to upbringing and disruptive or traumatic environmental factors
How do parents influence a child's sense of control?
Parents who respond positively and predictably to their children's needs help them develop a healthy sense of control.
Parents who are overprotective and clear obstacles for their children may prevent them from learning to handle adversity.
What is anxiety sensitivity?
It is the tendency to respond fearfully to anxiety symptoms, leading to increased anxiety.
What are the two types of cues involved in panic attacks?
External Cues: Places or situations similar to where the initial panic attack occurred.
Internal Cues: Physical sensations like an increase in heart rate or respiration associated with the initial panic attack.
External Cues
Places or situations similar to where the initial panic attack occurred.
Internal Cues
Physical sensations like an increase in heart rate or respiration associated with the initial panic attack.
What triggers our biological and psychological vulnerabilities to anxiety?
Stressful life events.
What are the three components of the Triple Vulnerability Theory?
Generalized Biological Vulnerability
Generalized Psychological Vulnerability
Specific Psychological Vulnerability
What does generalized biological vulnerability refer to?
It refers to the inherited tendency to be uptight or high-strung.
How does generalized psychological vulnerability develop?
It develops from growing up believing the world is dangerous and out of control, making it hard to cope when things go wrong.
What is specific psychological vulnerability?
It is learned from early experiences, such as being taught by parents that certain situations or objects are dangerous.
How does anxiety relate to panic?
Anxiety increases the likelihood of experiencing panic.
What is comorbidity?
Comorbidity is the co-occurrence of two or more disorders in a single individual.
What is the most common additional diagnosis for all anxiety disorders?
Major depression.
Which anxiety disorders are associated with a higher likelihood of engaging in deliberate self-harm?
Generalized anxiety disorder and social anxiety disorder.
How do additional diagnoses of depression or substance abuse affect recovery from anxiety disorders?
Individuals are less likely to recover from an anxiety disorder and more likely to relapse if they do recover.
What physical disorders are commonly associated with anxiety disorders?
Thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraine headaches, and allergic conditions.
When does an anxiety disorder typically begin in relation to physical disorders?
Anxiety disorders most often begin before the physical disorder.
How might having an anxiety disorder affect physical health?
Having an anxiety disorder might cause or contribute to the development of a physical disorder.
With which medical conditions do panic attacks often co-occur?
Panic attacks often co-occur with cardio, respiratory, gastrointestinal, and vestibular (inner ear) disorders.
What percentage of patients with panic disorder have attempted suicide?
20% of patients with panic disorder have attempted suicide.
How do anxiety and related disorders affect suicidal thoughts?
Having any anxiety or related disorder increases the chances of having thoughts about suicide (suicidal ideation) or making suicide attempts.
Which anxiety disorders have the strongest relationship with suicidal ideation?
The relationship is strongest with panic disorder and posttraumatic stress disorder (PTSD).
What are the key features of Generalized Anxiety Disorder (GAD)?
At least 6 months of excessive anxiety and worry about minor, everyday events.
Symptoms include muscle tension, mental agitation, fatigue, irritability, and difficulty sleeping.
In children, only one physical symptom is required.
What are some key statistics about GAD?
GAD is one of the most common anxiety disorders.
About twice as many individuals with GAD are female than male.
Median age of onset is 31, often in response to a life stressor.
GAD follows a chronic course and is prevalent among older adults, especially those over 45.
What is generalized biological vulnerability in GAD?
Anxiety sensitivity: Distress in response to arousal sensations due to beliefs about harmful consequences.
What are the characteristics of autonomic restrictors in GAD?
Less physiological responsiveness than individuals with other anxiety disorders.
Low cardiac vagal tone leads to autonomic inflexibility.
Intense cognitive processing in the frontal lobes without accompanying images, leading to avoidance of threat-related images.
What is generalized psychological vulnerability in GAD?
High sensitivity to threat and a tendency to focus on sources of threat due to early stressful experiences.
What are benzodiazepines used for in GAD?
Most often prescribed for generalized anxiety, but only for a week or two due to side effects like cognitive impairment and dependence.
Which antidepressants are better choices than benzodiazepines for GAD?
Paroxetine (Paxil) and Venlafaxine (Effexor).
What are the benefits of psychological treatments for GAD?
More effective in the long term, helping patients process threatening information emotionally.
Cognitive-Behavioral Treatment (CBT) confronts threatening images and thoughts.
Meditational and mindfulness-based approaches increase tolerance of feelings and uncertainty.
What are metacognitions in the context of GAD?
They are beliefs about worrying and cognitions, helping patients change their beliefs about worrying.
What characterizes Panic Disorder?
Individuals experience severe, unexpected panic attacks, often thinking they are dying or losing control.
What are the criteria for diagnosing Panic Disorder?
Experience an unexpected panic attack.
Develop substantial anxiety over the possibility of having another attack.
What is nocturnal panic?
Panic attacks that occur during delta wave or slow wave sleep, typically several hours after falling asleep.
Individuals may panic when sinking into delta sleep and awaken amid an attack.
What causes nocturnal panic attacks?
A change in sleep stages to slow wave sleep produces frightening physical sensations of "letting go."
What is isolated sleep paralysis?
Occurs during the transition between sleep and waking, where individuals are unable to move and experience a surge of terror resembling a panic attack.
People are not dreaming during nocturnal panics.
When do panic attacks most often occur?
Panic attacks occur more frequently between 1:30 a.m. and 3:30 a.m. than at any other time.
When does Panic Disorder typically onset?
It usually begins in early adult life, from midteens to about 40 years of age, with a median age of onset between 20 and 24.
How does Panic Disorder affect the elderly population?
Health and vitality become the primary focus of anxiety, and the prevalence of Panic Disorder or comorbid panic disorder and agoraphobia decreases among the elderly.
How do cultural differences affect the presentation of panic disorder?
Asian and African countries show the lowest rates of panic disorder.
Susto: A fright disorder in Latin America characterized by sweating and increased heart rate without anxiety.
Ataques De Nervios: Symptoms similar to panic attacks, including uncontrollable shouting or crying.
Kyol Goeu (Wind Overload): Panic disorder among Khmer (Cambodian) individuals, focusing on catastrophic thinking about too much wind or gas in the body.
Susto
A fright disorder in Latin America characterized by sweating and increased heart rate without anxiety.
Ataques De Nervios
Symptoms similar to panic attacks, including uncontrollable shouting or crying.
Kyol Goeu (Wind Overload)
Panic disorder among Khmer (Cambodian) individuals, focusing on catastrophic thinking about too much wind or gas in the body.
What is orthostatic dizziness?
Dizziness that occurs from standing up quickly, which can be experienced during panic attacks.
What are the primary causes of Panic Disorder?
Panic Disorder is related most strongly to biological and psychological factors and their interaction.
What is generalized biological vulnerability in Panic Disorder?
It refers to a tendency to be neurobiologically overreactive to daily life events, leading to emergency alarm reactions when confronted with stress.
What are learned alarms in the context of Panic Disorder?
Specific situations become associated with external and internal cues present during panic attacks, triggering anxiety.
What is specific psychological vulnerability in Panic Disorder?
It is the tendency to believe that unexpected bodily sensations are dangerous.
What does David Clark emphasize about Panic Disorder?
He emphasizes that individuals interpret normal physical sensations catastrophically, leading to increased anxiety and a vicious cycle resulting in panic attacks.
How might early experiences influence Panic Disorder and Agoraphobia?
Early object loss and/or separation anxiety may predispose someone to develop these conditions as an adult. Agoraphobia is often characterized by dependent personality tendencies.
What medications are indicated for Panic Disorder?
SSRIs: Indicated for panic disorder, but may cause sexual dysfunction.
High-Potency Benzodiazepines: Such as Alprazolam (Xanax), work quickly but can lead to dependence and are not as strongly recommended as SSRIs.
What is exposure-based treatment for Panic Disorder?
It arranges conditions for patients to gradually face feared situations and learn there is nothing to fear.
What does Panic Control Treatment (PCT) involve?
Exposing patients to interoceptive sensations that remind them of panic attacks, creating "mini" panic attacks in a controlled environment.
How does cognitive therapy help in Panic Disorder?
It identifies and modifies basic attitudes and perceptions concerning the dangerousness of feared but objectively harmless situations.
What is the purpose of relaxation or breathing retraining in Panic Disorder treatment?
To help patients reduce anxiety and excess arousal.
What is the goal of the Calm Tools for Living program?
To enhance the integrity of cognitive behavioral therapy by guiding clinicians through specific therapeutic tasks with patients.
Clinician and patient sit side-by-side as they both view the program on screen.
What is the effectiveness of combining drug treatments with psychological interventions for Panic Disorder?
There is no advantage to combining drugs and CBT initially; psychological treatments tend to perform better in the long run.
What is the "stepped care" approach in treating Panic Disorder?
It involves starting with one treatment and adding another if needed, which may be superior to combining treatments from the beginning.
What characterizes Agoraphobia?
It is characterized by avoiding situations or enduring them with intense fear and anxiety, where a person feels unsafe or unable to escape to safety in the event of panic or physical symptoms.
Who coined the term "Agoraphobia" and what does it mean?
Coined in 1871 by Karl Westphal, it comes from Greek meaning "fear of the marketplace."
How can agoraphobic behavior manifest independently of panic attacks?
An individual may exhibit strong agoraphobic avoidance even if they have not had a panic attack for years.
What is interoceptive avoidance?
It is the avoidance of internal physical sensations, which also occurs in panic disorder.
What is the gender distribution among those who suffer from Agoraphobia?
More than 75% of those with agoraphobia are women, as it is more socially accepted for women to report fear and avoid situations.
How do many males cope with unexpected panic attacks?
A large proportion of males cope by consuming large amounts of alcohol, which is culturally acceptable.
How does Agoraphobia typically develop?
It often develops after a person experiences unexpected panic attacks or panic-like sensations.
What factors influence the development and severity of Agoraphobia?
The development and severity of agoraphobia seem to be socially and culturally determined.
What is an effective treatment approach for Agoraphobia?
Gradual exposure exercises combined with anxiety-reducing coping mechanisms, such as relaxation or breathing retraining, have proven effective.
Proved effective in helping patients overcome agoraphobic behavior whether associated with panic disorder or not
What is a Specific Phobia?
An irrational fear of a specific object or situation, previously referred to as 'simple phobia' in earlier versions of the DSM.
Who is Jack D. Maser and what did he contribute to the study of phobias?
He compiled a list of various phobias, contributing to the understanding of specific phobias.
What are the four major subtypes of Specific Phobia?
Blood–injection–injury type
Situational type
Natural environment type
Animal type
*Other: Phobias that do not fit any of the four major subtypes.
What characterizes Blood-Injection-Injury Phobia?
It involves a marked drop in heart rate and blood pressure, often leading to fainting, and is inherited as a strong vasovagal response to blood, injury, or injections.
What is the average age of onset for Blood-Injection-Injury Phobia?
Approximately 9 years.
What is Situational Phobia characterized by?
Fear of public transportation or enclosed places, typically emerging from midteens to mid-20s, and it tends to run in families.
What is Claustrophobia?
A specific fear of small enclosed places.
What is the main difference between Situational Phobia and Panic Disorder?
Individuals with Situational Phobia never experience panic attacks outside the context of their phobic object or situation, while those with Panic Disorder experience unexpected, uncued panic attacks at any time.
What does Natural Environment Phobia involve?
Fears of situations or events occurring in nature, such as heights, storms, and water.
What is the peak age of onset for Natural Environment Phobia?
About 7 years, and it is not considered a phobia if it is only a passing fear.
What characterizes Animal Phobia?
It involves fears of animals and insects, leading to severe interference with functioning, such as being unable to read a magazine