Abnormal Psychology Anxiety and Panic Disorders

Anxiety

a negative mood state that is accompanied by bodily symptoms such as increased heart rate, muscle tension, a sense of unease, and apprehension about the future. Most of us feel some anxiety everyday!

Fear

an instantaneous reaction to an imminent threat

Why anxiety is important?

motivates us to take action

motivates us to avoid certain things

Anxiety statistics

25-30% of U.S pop.

more common in women

most frequent occurring class of of mental disorders

often comorbid

Generalized anxiety disorder (GAD)

a relatively continuous state of excessive uncontrollable, and “pointless” worry and apprehension for most days (for at least 6 months) about personal health, work, social interactions, and daily routines

Symptoms of GAD (must have 3 to be diagnosed)

feeling restlessness, wound up or on edge

being easily fatigued

having difficulty concentrating; mind going blank

being irritable

having muscle tension

difficulty controlling feelings of worry

having sleeping problems

GAD treatment

CBT and SSRIs

self monitoring, relaxation, self control desensitization, cognitive restructuring, present-moment focus, mindfulness, experimental exposure

Panic attack

a period of extreme fear and discomfort that develops abruptly and reaches a peak within 10 minutes

Panic Attack Symptoms

accelerated heart rate, sweating, trembling, choking sensations, hot flashes or chills, dizziness or lightheadedness, fears of losing control or gong crazy, fears of dying

Panic disorder

a person must experience both panic attacks and intense anxiety and avoidance related to attack for at least one month. View physical sensations in a catastrophic way. Fear future attacks and modify their behavior to avoid future attacks.

Agoraphobia

anxiety disorder characterized by intense fear, anxiety, and avoidance of situations in which it might be difficult to escape if one experiences symptoms of panic attack.

treatment for panic disorder

psychotherapy, medication, or both

CBT-learn to react differently to physical sensations of a panic attack.

specific phobia

experiences excessive, distressing, and persistent fear or anxiety about a specific object or situation.

4 major phobia types

natural environment

animals

mutilation/medical treatment

situations

other

etiology of phobias

classical conditioning

vicarious learning, such as modeling

verbal transmission

treatments for specific phobias

CBT and exposure therapy

onset of specific phobias is childhood to adolescence

social anxiety disorder

extreme/persistent fear/anxiety and avoidance of social situations where a person could potentially be evaluated negatively by others. Fear of humiliation that leads to rejection. May experience a panic attack and it is now a conditioned response

safety behaviors

mental or behavioral acts that reduce anxiety in social situations by reducing the chance of negative social outcomes.

avoiding eye contact

rehearsing sentences

talking briefly

not talking about oneself

minimizing interactions

wearing neutral clothing

social anxiety through conditioning

unpleasant childhood/school experiences

behavioral inhibition is thought to be an inherited trait and it characterized by a consistent tendency to show fear and restraint when presented with unfamiliar people or situations

separation anxiety disorder

an individual experiences excessive anxiety regarding separation from home and/or from people to to whom the individual has a strong emotional attachment called the attachment figure.

most common in infants and children

is natural and in most cases is not an issue

selective mutism (SM)

anxiety disorder in which a person normally capable of speech cannot speak in specific situations or to specific people if triggered

usually starts in childhood

stay silent even with consequences

avoidance strategy for children with social anxiety disorder

sometimes confused with autism, but those with autism display other repetitive behaviors and social isolation from family

treatment for SM

psychodynamic/play therapy, behavioral therapy, family therapy, or medications (antidepressants)

biological perspective

seeks to understand the neurological and biological connections to anxiety

neurotransmitters are connected with anxiety: GABA, serotonin, and norepinephrine

anti-anxiety medications

help reduce symptoms, such as panic attacks, or extreme fear and worry (benzodiazepines like Valium and Xanax)

can build up tolerance and need higher doses; some become dependent

cognitive theories

suggest anxiety disorders develop from thought patterns that overestimate threats of safety, therefore anxiety is caused by cognitive misinterpretations and can be treated by developing strategies to combat these thoughts

CBT

exposure therapy

humanistic perspective

anxiety may develop if people do not see themselves honestly or do not practice self-acceptance

client-centered therapy

motivational interviewing- asking open-ended questions and talking about the pros and cons of change

obsessive compulsive disorder (OCD)

experiencing thoughts and urges that are intrusive and unwanted (obsessions) and/or the need to engage in repetitive behaviors or mental acts (complusions)

obsessions

concerns about germs and contamination, doubts, order and symmetry, urges that are aggressive or lustful

they often know the urges are irrational and try to suppress or ignore them

compulsions

repetitive and ritualistic acts that are typically carried out primarily as a means to minimize distress that obsessions trigger

excessive hand washing, checking, and ordering also include mental acts like counting, praying, or reciting something to oneself

Neurology of OCD

orbitofrontal cortex involved in learning and decision making and becomes hyperactive when provoked with certain tasks

under activation in brain areas responsible for stopping habitual behavior

PANDAS (pediatric autoimmune neuropsychiatric disorders associated with strep infections)

strep triggers a misdirected immune response and results in inflammation of the child’s brain

OCD symptoms appear quickly

ages 3-12

Body Dysmorphic Disorder (BDD)

preoccupied with a perceived flaw in one’s physical appearance that is either nonexistent or barely noticeable to other people

believe they are ugly and unattractive

typically involve skin face and hair

engage in repetitive behavior and ritualistic behavior and mental acts such as constantly looking in the mirror, trying to hide the offending body part, and cosmetic surgery

causes include: low serotonin levels, OCD, GAD, and childhood abuse/trauma

suicide rate is 2x higher than depression

hoarding disorder (HD)

an inability to part with personal possessions regardless of how valueless or useless these possessions are

accumulate excessive amounts of usually worthless items that clutter the individual’s living space

believes items will one day be of use

diagnosis may only occur if it is not caused by another medical disorder

possible symptom for OCD

stressful and traumatic events are associated with the onset of symptoms

inversely related to household income

more common in men than women

symptoms of HD

do not allow visitors

keep shades drawn

have arguments with family members regarding the clutter

at risk of fire, falling, infestation, or eviction

feel depressed or anxious due to the clutter

have suspicions of other people touching items

checking the garbage for accident discarded objects

*CBT intervention*

trichotillomania disorder (TTM)

a disorder characterized by a long term urge that results in the pulling of hair

hair loss can occur anywhere but most common in the scalp

often pull one hair at a time and episodes can last for hours at a time

strongly related to stress

feeling relaxed or bored are conducive to hairpulling

behavior modification

excoriation (skin-picking) disorder

an obsessive-compulsive spectrum disorder that is characterized by the repeated urge or impulse to pick at one’s own skin to the extent that physical damage is caused

most common on face

often have a primary picking area, but move to other areas to allow for healing

infections due to tissue damage

is a coping mechanism to deal with stress or arousal

strong link between childhood event and disorder

link to dopamine and the urge to pick, which is why meth and cocaine users uncontrollably pick

chronic stressors

events that persist over an extended period of time such as caring for a parent with dementia, long term unemployment, or imprisonment

acute stressors

brief focal events that sometimes continue to be experienced as overwhelming well after the event has ended such as falling on the ice and breaking your leg

daily stressors

minor irritations and annoyances that are part of our everyday lives-can build one another and leave us just as stressed as life change events

traumatic events

event or situation where a person is exposed to actual or threatened death or serious injury

post traumatic stress disorder (PTSD)

extremely stressful or traumatic events, such as combat, natural disasters, and terrorist attacks, that place the people who experience them at an increased risk for developing psychological disorders

formerly known as shell shock

PTSD diagnosis

must be exposed to or witnessed or experience the details of a traumatic event one that involves actual or threatened death, serious injury, or sexual violence

only dsm5 disorder listed with a “cause”

PTSD symptoms

intrusive and distressing memories of the event

flashbacks

avoidance of stimuli connected to the event

persistently negative emotional states

feelings of detachment from others'

proneness toward outbursts

exaggerated, startled responses

acute stress disorder

similar to PTSD but describes a disorder that lasts between 3 days and 1 month of a traumatic event. After one month it would be diagnosed as PTSD

acute stress disorder symptoms

intrusion (memories, dreams, flashbacks)

negative mood

dissociation (altered sense of reality)

avoidance

arousal (sleep disturbance, irritable behavior, problems concentrating, exaggerated startle response

attachment style

refers to the various types of attachment arising from early care experiences, known as either secure, avoidance, resistant, or disorganized

secure attachment

toddlers prefer their parent over a stranger. The attachment figure is used as a secure base to explore the environment and is sought out in times of stress-most common and healthiest

avoidant attachment

children are unresponsive to the parent, do not use the parent as a secure base, and do not care if the parent leaves-caregiver is insensitive and inattentive

resistant attachment

children tend to show clingy behavior, but then reject the attachment figure’s attempts to interact with them-caregiver inconsistent level of response

disorganized attachment

children behave oddly in a strange situation. Children freeze, run around the room in an erratic manner, or try to run away when the caregiver returns-often from abused or neglected upbringings

Reactive Attachment Disorder (RAD)

a stressor-related disorder caused by social neglect during childhood (meaning a lack of adequate caregiving)

persistent failure to initiate or respond to most social interactions in a developmentally appropriate way

Disinhibited Social Engagement Disorder (DSED)

the uninhibited form of RAD, which manifests as a lack of inhibitions or externalizing behavior-appear more outgoing

treatment for DSED and RAD

increased responsiveness of caregiver; placed with different caregiver; play therapy

Adjustment Disorder (AD)

abnormal stress response, different from normal adaptive reactions, that occurs within three months of the onset of the stressor

usually follows a stressful event

persistent AD can lead to MDD and anxiety disorders

caused by an outside stressor and generally resolves once the individual is able to adapt

little research natural recovery is the norm