PSYB32 lec 5: anxiety, somatic symptom, and dissociative disorders

comborbidity

occurrence with other mental disorders

anxiety disorders as a whole

• future focused

• physiological: heightened arousal

• cognitive: worry

• crippling ability to function

• initiated when there is no objective threat/disproportionate reaction

Beck Anxiety Inventory

survey for anxiety

specific phobia

fear around specific object or situation

• object/situation always provokes anxiety

• avoidance or endurance with intense fear

• persistent over 6+ months

DSM-5 specifiers for specific phobia

subdivided by source of fear

• animal

• natural environment

• blood-injection-injury

• situational

• other

social anxiety disorder (SAD)

fear about social situations, usually from being judged, embarrassed, perceived negatively

• DSM-5 specifier: performance only (SAD present only with public speaking)

• divided into: performance based, social interactions, being observed in public  

• social situation always provokes anxiety

• avoidance or endurance with intense fear

• persistent over 6+ months

Panic disorder

recurrent panic attacks

• abrupt surges of intense fear or discomfort within minutes (often UNCUED)

• comes with fear of future panic attacks

• not because of substance

agoraphobia

fear or anxiety about being trapped and having a panic attack in 2/5:

• transport

• open spaces

• enclosed spaces

• standing in lines or being in crowds

• being outside of the home alone

social situation always provokes anxiety

avoidance or endurance with intense fear

persistent over 6+ months

generalized anxiety disorder (GAD)

excessive worry and anxiety that creates a disability

• persistent over 6+ months

• worry cannot be controlled

• worry associated with 3+ symptioms

how do specific phobias develop

• aversive (classical) and avoidance (operant) conditioning

• modeling (vicarious learning)-watching something happen to someone else

• evolutionary

• diathesis-stress model (predisposition to developing a disorder)

how does agoraphobia develop

• interoceptive conditioning: bodily sensations become associated with panic or distress and are catastrophized

• avoidance conditioning

how does social anxiety disorder develop

• classical or operant conditioning

• modeling (vicarious conditioning) - seeing others get embarrassed or humiliated

• avoidance conditioning

• car beliefs about self

how does GAD develop?

• operant conditioning: negative reinforcement of worry (worrying reduces arousal)

• intolerance of uncertainty

• belief that worry is good

• modeled by family

flooding

treatment by full exposure to feared stimuli

types of exposures

• in vivo - real llife

• imaginational

• VR

hierarchical exposures vs surprises/non-hierarchical

gradual exposure vs throwing in a surprise

systematic desensitization

1. create hierarchy of anxiety provoking situations

2. teach relaxation methods (ex. breathing)

3. gradually exposing the person

treatment of GAD and SAD

• cognitive-behavioral models

• cognitive restructuring of worry cycles, intolerance of uncertainty, fear of evaluation, negative core beliefs of oneself

• worry exposures

somatic symptom disorders in general

attachment of something psychological (like bullying) to something in the body (like stomach aches)

Illness anxiety disorder

• symptoms are nonexistent or mild

• disproportionate anxiety about health and having a serious illness

• performs extreme health-related behavior (checking body) or health avoidant (not seeing doctor)

• lasts 6+ months

• DSM-5 specifiers: care-seeking type and care-avoidant type

functional neurological symptom disorder (FNSD)

• something wrong with neural communication (ex. 1+ symptoms such as motor weakness, tremors, seizures, paralysis)

• no recognized neurological or medical condition

• DSM-5 specifiers: symptom type, duration, and stressor

somatic symptom disorder

• 1+ physical symptoms that are distressing and disrupting daily life

  • excessive thought in seriousness of symptoms, high level of anxiety about health, excessive time devoted to symptoms

• state of being symptomatic is persistent, not necessarily one symptom

• DSM specifiers

  • symptom type (with predominantly pain)

  • duration (persistent: severe and 6+ months)

  • severity: mild, moderate, severe

treatment of somatic symptom disorders

• psychoeducation

• addressing secondary gain (maybe they just want love or attention)

• addressing iatrogenic disability (treatment or pathologizing can worsen condition)

• addressing underlying anxiety and depression

• cognitive behavioral approach: validating pain, relaxation trainin

dissociative amnesia

• unable to recall important autobiographical information (usually trauma) or some event

• DSM-5 specifier: with or without dissociative fugue (purposeful traveling or bewildered wandering while amnestic)

dissociative identity disorder (DID)

• individual has two or more distinct personality states

• gaps in memory of everyday events, important personal information, and/or traumatic events

depersonalization/derealization disorder

having either one or both

• depersonalization: experience of detachment from ones mind and body

• derealization: experience of detachment from surroundings/environment

• reality testing remains intact