Pyschopathology Chapter 8

What is the difference between fear and anxiety?

Fear is a present-focused response to immediate danger; anxiety is future-focused anticipation of possible danger.

How can fear and anxiety be adaptive?

Fear helps a person escape immediate danger; anxiety encourages preparation and vigilance.

When does anxiety become a disorder?

When it is persistent or pervasive, involves excessive avoidance, and causes significant distress or impairment.

What is comorbidity?

The presence of two or more disorders in the same person.

How common is comorbidity among people with anxiety disorders, according to the lecture?

More than 50% meet criteria for another anxiety disorder, about 75% have another psychological disorder, and about 60% experience depression.

How does comorbidity affect anxiety disorder outcomes?

It is associated with greater severity and poorer outcomes.

Why might anxiety disorder prevalence estimates be too low?

Only about 25% of people who qualify for an anxiety disorder seek treatment.

What is the defining fear in Social Anxiety Disorder (SAD)?

Fear of being noticed, observed, or scrutinized and negatively evaluated or rejected by others.

How does Social Anxiety Disorder affect social situations?

Social situations cause persistent distress and are avoided or endured with intense anxiety; the fear is disproportionate to the actual threat.

A student avoids presentations because they fear classmates will notice their shaking and judge them negatively. Which disorder does this suggest?

Social Anxiety Disorder, because the central fear is negative evaluation by others.

What is generalized anxiety disorder (GAD)?

A disorder involving excessive, difficult-to-control worry about multiple events or areas of life that causes distress or impairment.

What kinds of topics might someone with GAD worry about?

Health, school, finances, and other areas of everyday life.

What symptoms can accompany GAD?

Restlessness or feeling keyed up, fatigue, difficulty concentrating or a blank mind, irritability, muscle tension, and sleep disturbance.

How many associated symptoms does the lecture list for GAD?

At least three of the listed symptoms.

How can GAD be distinguished from major depressive disorder (MDD)?

GAD centers on excessive, uncontrollable worry; MDD centers on depressed mood or loss of interest or pleasure. Evidence that GAD occurs outside depressed episodes helps support a separate diagnosis.

A student worries uncontrollably about grades, family health, and money and experiences muscle tension and poor sleep. Which disorder does this suggest?

Generalized Anxiety Disorder, because the worry spans multiple areas and is difficult to control.

What is a panic attack?

A sudden episode of intense apprehension, terror, or impending doom that peaks quickly, often within about 10 minutes.

What physical symptoms can occur during a panic attack?

Shortness of breath, palpitations, nausea, chest pain, choking sensations, dizziness, sweating, chills or heat, numbness or tingling, and trembling.

What psychological symptoms can occur during a panic attack?

Depersonalization, derealization, fear of losing control or going crazy, and fear of dying.

What is depersonalization?

Feeling detached from oneself or as if observing oneself from outside the body.

What is derealization?

Feeling as if the surrounding world is unreal.

Does experiencing one panic attack mean someone has Panic Disorder?

No. Many people experience a panic attack without developing Panic Disorder.

What proportion of college students experience a panic attack, according to the lecture?

About 20%; most do not experience more than one.

What three features characterize Panic Disorder?

Recurrent unexpected panic attacks, persistent worry about further attacks or their consequences, and significant behavior changes related to the attacks.

A person experiences repeated unexpected panic attacks and stops exercising because they fear another attack. Which disorder does this suggest?

Panic Disorder, because recurrent attacks are accompanied by persistent concern and behavior change.

What is the panic feedback loop?

Physical symptoms trigger catastrophic interpretations, which increase anxiety and intensify physical symptoms, creating a self-reinforcing cycle.

How can catastrophic thinking intensify a panic attack?

A person may interpret a pounding heart as a heart attack, increasing fear and bodily arousal and making the symptoms feel worse.

What is agoraphobia?

Fear or anxiety about situations where escape might be difficult or help might be unavailable if distressing symptoms occur.

Can agoraphobia occur without Panic Disorder?

Yes. Agoraphobia can occur with or without Panic Disorder.

Does agoraphobia necessarily mean someone is housebound?

No. Someone may fear or avoid particular situations without being completely unable to leave home.

What characterizes a specific phobia?

Intense, excessive fear of a particular object or situation, immediate anxiety upon exposure, avoidance or intense distress, persistence for at least six months, and significant interference with daily life.

What are the five specific-phobia categories listed in the lecture?

Blood-injury-injection, situational, natural environment, animal, and other.

Which specific-phobia category includes fear of heights or storms?

Natural environment.

Which specific-phobia category includes fear of public transportation or claustrophobic situations?

Situational.

Which specific-phobia category includes fear of choking or vomiting?

Other.

A person intensely fears dogs, avoids parks, and has experienced this pattern for over six months. What diagnosis might fit?

Specific Phobia, animal type, if the fear is excessive and significantly interferes with daily life.

What is the lifetime prevalence of specific phobias in the lecture?

About 12%; they are approximately three times more common in women and tend to be chronic.

What prevalence and course does the lecture report for Social Anxiety Disorder?

About 12% prevalence, slightly higher prevalence in women, onset in adolescence to early adulthood, and a chronic course.

What prevalence and course does the lecture report for GAD?

About 6% prevalence, about twice as common in women, variable onset, and a chronic course.

What prevalence and course does the lecture report for Panic Disorder?

About 3-4% prevalence, about twice as common in women, variable onset, and an intermittent course that may come and go.

How heritable are anxiety disorders, according to the lecture?

Heritability is modest, approximately 30-50%.

Which brain regions are implicated in anxiety disorders?

The limbic system is important; heightened amygdala and insula activity and diminished prefrontal cortex activity in response to threatening stimuli are implicated.

Which neurotransmitters are implicated in anxiety disorders?

Serotonin, GABA, and norepinephrine.

How can the sympathetic nervous system contribute to anxiety?

It produces physical symptoms such as a racing heart and sweating, which may be interpreted as signs of danger and increase anxiety.

What is attention to threat?

A tendency to selectively notice negative environmental cues or signs of possible danger.

How can negative beliefs about the future maintain anxiety?

Expecting bad outcomes can lead to safety behaviors and avoidance, preventing a person from learning that feared outcomes may not occur.

How can classical conditioning help explain specific phobias?

A previously neutral object or situation can become associated with fear through learning.

How effective is exposure treatment for anxiety, according to the lecture?

Exposure is effective for about 70-90% of clients who complete it.

What does the lecture say about anxiety medication and relapse?

Relapse rates are high after medication is stopped; SSRIs are described as a better long-term medication choice.

Why are medications generally not recommended for specific phobias?

They do not address the learned fear as effectively as psychological treatment, and short-term relief can become a safety behavior.

What are the limitations of benzodiazepines for specific phobias?

They act quickly as sedatives but can be addictive and are a short-term solution.

What are the limitations of beta blockers for specific phobias?

They are non-addictive but provide only a short-term solution.

What is exposure therapy?

A treatment in which a person gradually encounters feared objects or situations, often progressing from less frightening to more frightening situations.

What is a fear hierarchy?

A ranking of feared situations from least to most anxiety-provoking, used to organize gradual exposure.

How might a fear hierarchy be used to treat fear of dogs?

Progress from low-anxiety steps, such as looking at pictures or dog toys, toward hearing a bark, seeing dogs at a park, approaching a leashed dog, and eventually interacting with a dog.

Which treatments for Social Anxiety Disorder are discussed in the lecture?

SSRIs, CBT involving exposure and rehearsal or role-play, social skills training, and Attention Bias Modification Training.

What is social skills training intended to improve?

Social behavior through modeling and practice.

What is Attention Bias Modification Training intended to address?

The tendency to direct attention toward threatening or negative social cues.

What is the main CBT strategy for GAD described in the lecture?

Identify, track, and challenge worries and predictions.

How does a CBT worry worksheet help someone with GAD?

It records the worry or prediction, belief strength, how to test the prediction, the actual outcome, and what the person learns about unhelpful worry.

A student predicts with 75% confidence that classmates will think they are stupid during a presentation. How could CBT help?

The student tests the prediction by practicing with a friend, compares the predicted outcome with what actually happens, and reconsiders the worry based on the evidence.

What is Mindfulness-Based Cognitive Therapy (MBCT) intended to help with in GAD?

Returning attention to the present, stepping away from "what if" thoughts, relaxing, recognizing that thoughts and emotions are not facts, and practicing self-compassion.

Why does the lecture say benzodiazepines are not a good solution for GAD?

GAD involves worry across large portions of daily life, so short-term sedation does not address the ongoing pattern of worry.

How can you distinguish SAD, GAD, Panic Disorder, and specific phobia in a scenario?

SAD centers on negative social evaluation; GAD centers on excessive worry across multiple life areas; Panic Disorder involves recurrent unexpected attacks plus ongoing concern or behavior change; specific phobia centers on a particular object or situation.