Chapter 3: Anxiety, Trauma, Stressor Related & OCD Related Disorders | Cla

1. Low GABA Levels = Increased Anxiety

2. Low Serotonin = Increased Anxiety

3. Corticotropin-Releasing Factor (CRF) and Hypothalamic-Pituitary Adrenocortical (HPA) axis

4. Limbic System

5. Behavioral Inhibition System

6. Fight/Flight (FSS)

Biological Contributions

1. Behaviorism

2. Interaction and Treatment of Parents

3. Anxiety Sensitivity

Psychological Contribution

1. Stressful life events

2. Repeated denials of thought

3. Fail to receive Unconditional Positive Regard

4. Hold silent assumptions

5. Metacognitive Theory

6. Intolerance of Uncertainty

7. Avoidance Theory

Social Contribution

Hypothalamic-Pituitary-Adrenocortical Axis

Has wide raging effects on the brain implicated in anxiety

Limbic System

Mediator between brain stem and cortex

Behavioral Inhibition System

Activated by signals from brain stem when experienced unexpected events.

Fight/Flight (FSS)

Activated partly by deficiencies in serotonin. Produced immediate response/alarm

Behaviorism

Anxiety may be a product of learning, conditioning, or modeling.

Anxiety Sensitivity

Important personality trait that will determine who will/will not experience anxiety under stressful conditions.

Stressful Life Events

Can trigger biological/psychological vulnerabilities.

Fail to receive UPR

Can develop harmful self-standard

Metacognitive Theory

Holds both the positive and negative belief about worrying. Believes that worrying is a useful way of appraising and coping with threats of life.

Intolerance of Uncertainty Theory

People can’t tolerate the knowledge that negative events may occur.

Avoidance Theory

An individual can have a greater bodily arousal that worrying reduces this arousal.

Triple Vulnerability Theory

Combination of biological, psychological, and social that contributes to the development of anxiety disorders. Most vulnerable when faced with stressful events.

Comorbidity

Identification of two or more disorders in an individual at one time. Dual diagnosis at one time.

Anxiety

Negative mood state characterized by body symptoms of physical tension and by apprehension about the future.

Fear

immediate alarm reaction to danger.

Panic

sudden overwhelming reaction without certain reason.

Panic Attack

Abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms (2-3 minutes)

1. Expected (Cued)

2. Unexpected (Uncued)

2 kinds of Panic Attack

Expected (Cued)

Have a clue of what/where situations a panic attack could occur

Unexpected (Uncued)

Do not have a clue when/where the next attack will occur

1. Palpitations, pounding heart, or accelerated heart rate

2. Sweating

3. Trembling/Shaking

4. Sensations of shortness of breath/smothering

5. Feelings of choking

6. Chest pain/discomfort

7. Nausea/abdominal distress

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

9. Chills/heat sensations

10. Paresthesias (numbness or tingling sensations)

11. Derealization or depersonalization

12. Fear of losing control “going crazy”

13. Fear of dying

Symptoms of Panic Attack

Social Phobia

A. Marked by fear/anxiety about one or more social situations/performance situations.

B. Fear of being negatively evaluated

C. Social situations almost always provoke fear or anxiety.

More than 6 Months

Criteria for anxiety includes persistent symptoms for

TRUE

T or F: People with Social Phobia have no difficulty in social interaction but when doing something in front of other people, anxiety takes over, when others are watching.

1. Great activation of amygdala

2. Possible social trauma

Causes of Anxiety

1. Treatment Behavioral Therapy

2. Emotional Processing

Treatment for Anxiety

Treatment Behavioral Therapy

Talking therapy to manage problems by changing the way they think and behave.

Starts at age 13, prevalent among 18 years old.

Social Phobia Prevalence: Start at age ___ but prevalent among _____

Specific Phobia

Irrational fear of specific object or situation that marked increase or mark interferes with an individual’s ability to function.

1. Blood-Injected Injury Phobia

2. Situational Phobia

3. Natural Environmental Phobia

4. Animal Phobia

Kinds of Specific Phobia

Blood-Injury Injected Phobia

May feel like going to faint and increased heart rate; fear of blood/injections

Situational Phobia

Fear of public transportation/enclosed spaces

Natural Environmental Phobia

Fear of events occurring in nature. (Heights, natural disasters)

Animal Phobia

Fear of animals/insects and starts at around 7 years old

More than 6 Months

Specific Phobia Criteria: Peristent for

Social phobie never experience panic attacks, they can relax after a phobic situation unlike Specific Phobia.

Difference of Social Phobia to Specific Phobia

1. Experience false alarm

2. Observing someone else (Vicarious Experience)

3. Being told about danger

4. Susceptibility

5. Traumatic Conditioning Experience

Causes of Specific Phobia

Exposure based experiences:

1. Flooding

2. Systematic Desensitization

Treatment for Specific Phobia

Flooding

Exposure to the phobic stimuli until you get used to it

Desensitization

Induced by situation through imagining. Letting you imagine certain scenarios involving your phobia.

TRUE

T or F: Specific Phobia tend to last a lifetime and has a 2:1 women to men ratio.

Panic Disorder

Excessive worry about additional panic attack

TRUE

T or F: In panic disorder, the attack has been followed by 1 or both:

1. Persistent worry about additional attacks.

2. Significant change in behavior related to attacks.

1 attack + 1 criteria either A (physical symptoms) or B for more than 1 month

Criteria for Panic Disorder:

1. Biopsych-cognitive Vulnerabilities

2. Irregular Norepinephrine

Causes of Panic Disorder

Mid teens to 40 years old; rare among childhood

Panic Disorder is prevalent among ___

1. Drugs (noradrenergic, serotonergic, GABA)

2. Exposure based treatments

3. Panic control treatment

Treatment for Panic Disorder

1. Susto

2. Ataque De Nervios

3. Kyo/Goeu

Cultural Syndrome and Disorder

Susto

Disorder that is characterized by sweating, increased heart rate, insomnia; Experienced by the Latin American

Ataque De Nervios

Hispanic American ; Quite similar to panic attacks but with shouting or bursting into tears.

Kyo/Goeu

Asian Countries ; Wind overload, too much wind/gas in the body which may cause blood vessels to burst.

Agoraphobia

Fear and avoidance in situations in which they feel unsafe, unable to escape. Fear of the “marketplace.” Fears are due to thoughts that escape might be difficult.

More than 2 situations for More than 6 Months

Criteria for Agoraphobia:

If the fear, anxiety is limited to one of the agoraphobic situation

When should a diagnosis be considered as Specific Phobia and not Agoraphobia?

1. Vulnerabilities

2. Early object loss and/or separation anxiety

3. Predispose to someone to develop the condition as an adult

Causes of Agoraphobia

TRUE

T or F: Agoraphobia starts to develop before 35 years old and it has the same treatment with Panic Disorder (Drugs such as noradrenergic, serotonergic, GABA, Exposure based treatment, and Panic control treatment)

Generalized Anxiety Disorder

Chronic Worries; Characterized by muscle tension, mental agitation, fatigue, irritability, difficulty sleeping, worry about minor everyday life events. Do not respond strongly to stressors.

3 or more symptoms, at least 6 months, occurring most days

GAD occurs in adults when there is the presence of ____

Only 1 symptom

As for children, GAD occurs when there is the presence of ___

1. Generalized biopsych vulnerability

2. Heritability

3. Intense cognitive processing in frontal lobes and left hemisphere of the brain

Causes of GAD

1. Drugs (Benzodiazepines)

2. Cognitive behavioral therapy

3. Metacognition

Treatment for GAD

Metacognition

Changing beliefs and maladaptive beliefs

Post-Traumatic Distress Disorder

Exposure to traumatic event which an individual experiences or witnesses death.

Re-experiencing went through memories, flashbacks accompanied by strong emotions.

Avoiding anything reminds of trauma and easily startled and quick to anger.

Cannot remember exactly the aspect of event.

Social Media or Television

PTSD does not apply by witnessing only through____

Atleast 6 symptoms

PTSD can be diagnosed if there are _____ symptoms

1. Traumatic Event

2. Witnessed/experienced the traumatic event

3. Learned the traumatic event

4. Threatened by family members

5. Exposed to traumatic details

6. Psychological distress

7. Loss of memory but not the feeling

8. Avoidance of memory

Symptoms of PTSD

1. Exposure to assaultive violence

2. High vulnerability

3. SS allele

4. Social Factors

5. Damaged Hippocampus

Causes of PTSD

Hippocampus

Part of the brain that is damaged causing PTSD

1. Prolonged Exposure

2. Cognitive Behavioral Therapy

Treatment for PTSD

Acute Stress Disorder

Cannot be diagnosed until 3 days (72 hours) after a traumatic event.

Diagnosis will be changed to PTSD

If symptoms of Acute Stress Disorder persists for more then 1 month what will happen?

Psychological Debriefing

Form of crisis intervention that has victims of trauma, talk extensively about their feelings and reactions within the days of critical incident.

Adjustment Disorder

Anxious or depressive reactions to life stress, generally milder than Acute Stress Disorder or PTSD. No traumatic event required but they are unable to cope with demands of situation. Beyond 1 to 3 months of the normal adjustment period

The diagnosis will no longer apply

If symptoms of Adjustment Disorder persist beyond 6 months after the stressor or its consequences have ceased, what will happen?

Separation Anxiety Disorder

Persist or unrealistic worry that something will happen to parents when being separated. Worry about the proximity and safety of key attachment figures

3 or more symptoms for 4 weeks

Required number of symptoms and duration of Separation Anxeity for Children to be diagnosed

3 or more symptoms for 6 months

Required number of symptoms and duration of Separation Anxeity for Adults to be diagnosed

1. Excessive worry about some possible harm to their major attachment figures

2. Refusal to go out

3. Nightmare involving theme of separation

4. Complain physical symptoms

Symptoms of Separation Anxiety

1. High-potency Benzodiazepines

2. SSRIs

3. Closely related serotonin-norepinephrine reuptake inhibitors

4. Panic control treatment

5. Exposure exercises

6. Cognitive Behavioral Therapy

Treatment for Separation Anxiety

School phobia mainly focus on school-related or school-based activities that individuals avoid while Separation Anxiety Disorder focuses more on the fear of separating from key attachment figures

Diffential Diagnosis of School Phobia vs. Separation Anxiety Disorder

Selective Mutism

A. Consistent failure to speak in specific social situations

B. Disturbance interferes with educational or occupational achievement or social communication

1 or more setting, atleast 1 month but not limited to first month of school

When can it be diagnosed as Selective Mutism?

1. Behavioral Interventions

2. Modeling

3. Shaping

4. Gradual exposure with reward system

Treatment for Selective Mutism

Obsession

Instrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist or eliminate

Compulsion

Thoughts or actions used to suppress the obsessions and provide relief. Thoughts turned to action for relief.

1. Symmetry

2. Forbidden Thoughts/Actions

3. Clearing/Contamination

4. Hoarding

4 Major Types of Obsessions

2 or more symptoms, 6 months

When can it be diagnosed as OCD?

Obsessive Compulsive Disorder

Strongly associated with certain kind of rituals

1. Biopsyhological Vulnerability

2. Shame of Negative Toilet-training experience during Anal stage

Causes of OCD

Exposure and Ritual Prevention

Treatment for OCD

Body Dysmorphic Disorder

Fear of ugliness, imagined ugliness, imagined defect in appearance. Individual think a horrible grotesque feature “deformity”

1. Excessive grooming

2. Skin picking

3. Fixated in mirrors

Symptoms of BDD

1. Cognitive Behavioral Treatment

2. Exposure and response prevention

Treatment for BDD

Body areas and eating patterns

BDD in Men: body building, genitals, hair, muscles :: BDD in Women: ________

Hoarding Disorder

Excessive acquisition of things, emotional attachment to possessions, living with excessive gross disorganization. Strong distress about throwing anything away, feel like its the extension of their own identity.

Cognitive Behavioral Therapy

Treatment for Hoarding Disorder

Ages 15-19 years old

What age does Hoarding Disorder start?