generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias

generalized anxiety disorder

A.Excessive anxiety and worry (apprehension expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)

B.The individual finds it difficult to control the worry

C.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 6 months):

1.Restlessness, 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 (difficulty falling or staying asleep, or restless, unsatisfying sleep).

generalized anxiety disorder

D.The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

E.The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism)

F.The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder

panic disorder

A.Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:

1.Palpitations, pounding heart, or accelerated heart rate

2.Sweating

3.Trembling or shaking

4.Sensations of shortness of breath or smothering

5.Feelings of choking

6.Chest pain or discomfort

7.Nausea or abdominal distress

8.Feeling dizzy, unsteady, light-headed, or faint

9.Chills or heat sensations

10.Paresthesia (numbness or tingling sensations)

11.Derealization (feelings of unreality) or depersonalization (being detached from oneself)

12.Fear of losing control or "going crazy"

13.Fear of dying

panic disorder

B.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 behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).

C.The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders). D.The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder)

panic disorder

D.The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder)

social anxiety disorder

A.Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).

B.The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others)

C.The social situations almost always provoke fear or anxiety

D.The social situations are avoided or endured with intense fear or anxiety

social anxiety disorder

E.The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context

F.The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

G.The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

H.The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition

I.The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder

J.If another medical condition (e.g., Parkinson's disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive

specific phobias

A.Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood)

B.The phobic object or situation almost always provokes immediate fear or anxiety

C.The phobic object or situation is actively avoided or endured with intense fear or anxiety

D.The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and the sociocultural context

E.The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

F.The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

G.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 (as in agoraphobia); objects of situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder)

fear

an alarm response when danger is perceived to be present

•Involves a triggering of the fight-flight-freeze

•Purely excitatory input to the FFF mechanism

anxiety

-a future-oriented mood state associated with preparation for possible harm

•Involves a priming (simultaneous excitatory and inhibitory input to) the FFF mechanism when danger is perceived to be possible at a later point in time

•Simultaneous excitatory and inhibitory input to the FFF mechanism

temporal aspects

•Fear (panic) is more immediate

•Anxiety is longer lasting and future oriented

expected panic attack

-the individual is aware of a cue or trigger at the time of the attack

don't have anticipatory anxiety

unexpected panic attack

- the individual is not aware of a cue or trigger at the time of the attack

-Non-clinical panic

•Do not experience anticipatory anxiety about their attacks

panic disorder

•Do experience anticipatory anxiety about their attacks

(is an anxiety disorder)

-Recurrent, unexpected panic attacks

-One of the following:

•Persistent worry about having attacks (or about their consequences)

•The development of significant, maladaptive behavioral changes designed to avoid having attacks

agoraphobia

•the fear and avoidance of situations in which the individual fears having a panic attack and from which it would be difficult to leave or get out

gernalized anxiety disorder

-Excessive, uncontrollable worry about a number of different life circumstances

•This worry must be accompanied by at least three common manifestations of anxiety

-e.g. muscle tension, sleep disturbance, or irritability

5 subtypes of specific phobias

animal

natural environment

blood-injection-injury

situational

other

animal specific phobia

-fear cued by animals or insects

•e.g. dogs, snakes, or spiders

natural environment specific phobia

-fear cued by an object in the natural environment

•e.g. heights, thunderstorms, or water

Blood-injury-injection

- fear cued by seeing blood, injury, or receiving an injection

situational

-fear cued by specific situations

•e.g. driving, enclosed spaces, or flying

other

-fear cued by other triggers

•e.g. falling down, costumed characters such as clowns, or emetophobia (the fear of vomiting)

specific phobia

-The cue has to almost invariably provoke an immediate fear response

-The fear has to be excessive*

-The fear must be associated either with:

•Some avoidance of the phobic cue

•Endurance of exposure to that cue with intense fear

-The fear must be associated either with:

•Some functional impairment

Significant distress about having the fear. OPPOSITE OF GAD!

Social Anxiety Disorder

•Key feature

-A persistent and marked fear of social situations in which the individual might be judged or evaluated by others

•Exposure to the feared social situation(s) has to almost invariably provoke an immediate fear response

•The fear must be associated with either

-Some avoidance of the phobic cue

-Endurance or exposure to that cue with intense fear or anxiety

specific phobia

is the most prevalent of the anxiety disorders

social anxiety

•is the second most prevalent anxiety disorder covered here

•Vicarious conditioning

-Simply observing others experiencing a trauma or behaving fearfully can sufficiently induce phobia

•Both mother and individual reports indicate ________ among families of patients with SAD compared with non-clinical controls

more social avoidance

-Patients with PD receive more parental encouragement ________ during childhood experiences of panic-like symptoms in comparison to non-clinical controls

•e.g. "Take care of yourself and avoid strenuous activities."

for sick-role behavior

prepared fears

•those fears that are not truly inborn or innate, but which are very easily acquired and/or especially resistant to extinction

-e.g. snakes, water, heights, enclosed spaces, elevated heart rate, other people, etc.

fear-relevant stimuli

•(snakes, spiders, and angry faces)

fear-irrelevant stimuli

•flowers, mushrooms, electric outlets, or neutral or happy faces)

learned helplessness

•results from repeated social defeat

-This effect is usually seen in response to uncontrollable shock (and not controllable shock)

•Fear is _____ conditioned when the aversive event is inescapable than when it is escapable

more easily