Psychosocial Exam 3: anxiety and related disorders

an emotion that serves as an adaptive response to a threatening or harmful stimuli

anxiety

the most common of al psychiatric disorders

anxiety

what is anxiety?

an emotion that serves as an adaptive response to a threatening or harmful stimuli

produces physiological autonomic response

becomes a disorder when the protective fear response is prolonged and inappropriate to the actual threat level

t/f anxiety produces a physiological autonomic response

true

when does anxiety becomes a disorder?

when the protective fear response is prolonged and inappropriate to the actual threat level

anxiety vs fear

anxiety

- INTERNAL response to an UNKNOWN threat

- response to future threat

- situations out of our control

- leads to conflicted feelings

fear

- response to KNOWN threat

- EXTERNAL threat

- DEFINITE threat

anxiety disorders

Anxiety can be pathological when individuals:

• Response is prolonged and inappropriate

• Excessive worrying about things that cannot be controlled or

changed

• Begins to negatively impact ability to engage in occupations (ADLs & iADLs)

--Work

--School

--Socialization

Share underlying elements of excessive fear and anxiety

seven anxiety disorders:

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

characterized by excessive fear or anxiety about separation from home or primary attachment figures.

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

1) separation anxiety

worry about events that could happen to them that would keep them from their attachment figures (e.g., being kidnapped or getting lost).

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

separation anxiety

criteria to be diagnosed with separation anxiety

symptoms for 4 weeks in children and teens

6 months or longer in adults

inability to speak in social situations

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

selective mutism

high social anxiety

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

selective mutism

marked fear or anxiety about a specific object or situation, such as flying, heights, animals, or receiving an injection.

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

3) phobia

Phobias differ from the normal, transient fear experienced in the general population in that

the fear or anxiety persists over time and is out of proportion to the risk presented by the object

often high levels of anxiety occur with anticipation of the possibility of encountering the feared object.

irrational fears that leads to avoidance of certain objects/situations

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

3) phobia

response that is out of proportion to the risk presented by the object

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

3) phobia

phobias are:

a) linear

b) up and down

linear

they remain constant with no ups and downs

Many individuals with phobias exhibit what types of behaviors?

avoidance behaviors that can dramatically impact their occupational performance

for example, refusal to seek medical attention because injec- tions or phlebotomy may be necessary

5 categories of phobias

1) situational (flying)

2) Natural environment (heights)

3) Blood-injection injury

4) Animals

5) Other types- clowns

Persistent fear or anxiety regarding being in one or more social situations where the individual has the potential to be scrutinized by others (judged)

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

social anxiety disorder

signs include: blushing, trembling, sweating

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

social anxiety disorder

what are the signs of social anxiety disorder?

signs include: blushing, trembling, sweating

social anxiety disorder and fear of public speaking are the same thing

false

abrupt surge of intense fear/intense discomfort which can peak within minutes and includes short, sudden attacks of fear and/or fear of losing control, terror

Panic attacks

diagnosed when an individual experiences recurrent, unexpected panic attacks

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

5) panic disorder

The individual may fear losing control or dying and also experience feelings of derealization or depersonalization.

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

5) panic disorder

During a ... a person may feel that he or she is numb or in a dream, have perceptual distortions, or have a sense of unreality.

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

5) panic disorder

individual experiences lead to persistent worry about additional panic attacks

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

5) panic disorder

panic disorder symptoms

Four or more of the following symptoms occur in a panic attack:

• Heart palpations, Increase heart rate, pounding heart

• Sweating

• Shaking or trembling

• Shortness of breath

• Feeling of choking

• Chest discomfort or pain

• Nausea

• 4 panic attacks in one month or

• 1 panic attack followed by excessive worrying for 1 month or longer

fear of open spaces

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

agoraphobia

someone fears and avoids situations because they think escape may me difficult or that help may not be available

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

agoraphobia

The diagnosis of agoraphobia requires that an individual experience symptoms of marked fear or anxiety in at least two of the following five situations:

1) using public transportation

2) being in open spaces (e.g., parking lots and market places)

3) being in enclosed spaces (e.g., shops and theaters)

4) standing in line or being in a crowd

5) being outside of the home alone.

excessive fear or anxiety about several everyday life circumstances.

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

generalized anxiety

symptoms of generalized anxiety disorder

• Feelings of being on edge, restless

• Becoming easily fatigued

• Feeling mind is going blank and difficulty with concentration

• Irritability

• Tension in muscles

• Difficulty with sleep

involves worry through a greater range of life circumstances than other anxiety disorders

1) separation anxiety

2) selective mutism

3) phobia

4) social anxiety

5) panic disorder

6) agoraphobia

7) generalized anxiety disorder.

generalized anxiety

t/f The content of the individual's worries is directly connected to her or his developmental stage

true

(i.e., children tend to worry about their performance in school or sporting events, whereas older adults are more likely to worry about safety—especially falling—when facing chronic physical dis- eases).

GAD

How is OCD different from anxiety?

the defining features of OCD are obsessions and compulsions which are not present in anxiety disorders

obsessions vs compulsions

Obsessions

• recurrent persistent thoughts, urges , and/or images

• unwanted & intrusive

• Lead to anxiety and distress

Compulsions

• Repetitive behaviors or mental acts as a response of obsessive thoughts or to comply with rules

• Response to deal with the distress caused by obsessions

• May include avoidance

recurrent and persistent thoughts, urges, and/ or images that are experienced as intrusive and unwanted

a) compulsion

b) obsession

obsessions

cause marked anxiety and distress

a) compulsion

b) obsession

obsession

unwanted and intrusive

a) compulsion

b) obsession

obsession

repetitive behaviors or mental acts

a) compulsion

b) obsession

a) compulsion

response to deal with distress caused by obsessions

a) compulsion

b) obsession

a) compulsion

may include avoidance

a) compulsion

b) obsession

a) compulsion

These behaviors and mental acts are intended to prevent or reduce the anxiety and distress asso- ciated with the obsessive thoughts, but they are excessive and not connected in a realistic way to what they are designed to prevent.

a) compulsion

b) obsession

a) compulsion

what are compulsions

repetitive behaviors (e.g., hand wash- ing and checking that a door is locked) or mental acts (e.g., counting and praying) that the individual feels driven to perform in response to obsessive thoughts or to comply with perceived rules.

characterized by obsessions and compulsions that are involuntary and unwanted, cause distress to the individual, and consume more than 1 hour per day.

1) separation anxiety

2) OCD

3) phobia

4) social anxiety

5) panic disorder

6) body dysmorphic disorder

7) generalized anxiety disorder.

OCD

The content of the obsessions and compulsions is specific to each individual, but some common themes in OCD include :

contamination/cleaning, symmetry, forbidden or taboo thoughts, and harm.

hoes does OCD affect someone occupationally?

Leads to avoidance of close relationships and specific

situations, school failure or job loss, and health issues.

refers to the preoccupation with perceived flaws or defects in an individual's physical appearance that are not apparent, or appear only slight, to others.

1) separation anxiety

2) OCD

3) phobia

4) social anxiety

5) panic disorder

6) body dysmorphic disorder

7) generalized anxiety disorder.

6) body dysmorphic disorder

leads to repetitive behaviors or mental acts (e.g., comparing oneself with others) that are difficult to control and, on average, consume 3 to 8 hours per day.

1) separation anxiety

2) OCD

3) phobia

4) social anxiety

5) panic disorder

6) body dysmorphic disorder

7) generalized anxiety disorder.

6) body dysmorphic disorder

body dysmorphic disorder can lead to

isolation

body dysmorphic disorder

Excessive concerns about a perceived flaw or defect in physical appearance

• Behaviors that are repetitive and difficult to control

• Can consume 3 to 8 hours per day

• Can lead to social isolation

Excessive, repetitive behaviors associated with all forms of body dysmorphic disorder include

seeking reassurance about appearance, compulsive skin picking, excessive lifting of weights, using anabolic steroids, and having cosmetic surgical procedures.

Severe symptoms of body dysmorphic disorder result in impaired psychosocial functioning in all areas, but especially in social participation; this ranges from avoiding specific social situations to becoming completely housebound.

This also negatively impacts an individual's ability to engage in school or work

persistent difficulty discarding items

hoarding disorder

t/f Behaviors alleviating anxiety can be reinforcing in obsessive-compulsive disorders

true!

Significant levels of impairment in functional ability have been reported in individuals with adult separation anxiety disorder and social anxiety disorder:

For people with separation anxiety, both children and adults, participation in independent activities away from home or the primary attachment figure may be severely limited, with obvious negative impact on school and work performance

Social anxiety disorder can result in functional impairments in educational status, financial status, employability, marital status, and social supports. An individual with social anxiety disorder may refuse to attend work or family events with a spouse, causing disruption in the marriage. Others may be impaired in the workplace when they cannot face strangers in a meeting or speak in public

impact of anxiety disorders and OCD

• Co-occurring physical impairments frequently occur with

anxiety disorders.

• Elevated anxiety levels may result in cognitive impairments.

• Attention, reduced recall, time-management, problem-

solving, decision making

• Psychosocial impairments result in disrupted engagement in

meaningful /required social interactions.

anxiety disorders medical management - what drug? other non medical tx?

benzodiazepines --> Xanax (alprazolam) and Ativan (lorazepam).

antidepressants such as SSRIs

electrovonvusive therapy

repetitive transcranial electromagnetic stimulation

deep brain stimulation

role of OT in anxiety disorders

• Assessment: Role Checklist, OSA, COPM

• Interventions targeted to changing performance deficits in

areas of occupation

• Analyze activity demands and modification to activity and

environment

• Cognitive Behavioral - CBT

• Sensory Processing Approach