PSY 363-CH 8

Chapter 3: Anxiety, Obsessive-Compulsive, and Trauma- and Stressor-Related Disorders

Essential Features of Anxiety Disorders

  • Definition of Anxiety: A future-oriented emotional response characterized by a sense of dread about potential future events.

  • Definition of Fear: An innate alarm response that occurs in reaction to immediate danger or life-threatening situations.

The Nature of Anxiety Disorders

  • Components of Anxiety:

    • Thoughts (Cognition):

    • Includes catastrophic thinking (e.g., “I will faint,” “They will hate me”).

    • Behavior:

    • Symptoms can manifest as restlessness, fidgeting, avoidance, or escape behaviors.

    • Example behaviors include leaving social situations early or consuming alcohol to manage anxiety.

    • Physiology:

    • Physical symptoms include heart racing, sweating, hyperventilation, and the activation of the fight, flight, or freeze response.

When Is Anxiety a Problem?

  • Criteria for Problematic Anxiety:

    • Occurs frequently and intensely, causing substantial distress.

    • Can interfere with daily life and functioning.

  • Definition of Anxiety Disorders: A group of psychological disorders characterized by excessive anxiety common among individuals.

Key Concept: Avoidance

  • Definition of Avoidance: Any behavior intended to limit discomfort associated with anxiety (e.g., avoiding specific situations, relying on compulsive rituals, or taking medication).

Separation Anxiety Disorder

  • Description: Intense anxiety regarding separation from home, caregivers, or emotional attachments.

  • Duration: Must last at least 4 weeks and is not restricted to childhood.

  • Prevalence: Approximately 5.3% of individuals experience this disorder in their lifetime; 4.1% of children are diagnosed.

Theories and Treatment of Separation Anxiety Disorder

  • Model: A biopsychosocial model is appropriate for understanding this disorder.

  • Findings from Twin Studies: Indicate strong genetic predisposition.

  • Parental Influence: Children with anxious parents may develop similar anxiety through observational learning.

Selective Mutism

  • Description: A childhood disorder characterized by the refusal to speak despite the ability to verbally communicate in certain contexts (e.g., at home).

  • Prevalence: Ranges from 0.2% to 2%, usually develops between ages 3 and 6, with no significant gender differences.

  • Behavioral Response: Mostly observed in school settings rather than at home, suggesting a social anxiety component.

Treatments for Selective Mutism

  • Effective Therapies:

    • Behavioral Therapy: Utilizing techniques like contingency management, exposure therapy, and cognitive behavioral therapy (CBT).

Case Example: Lucy

  • Patient Profile: 54-year-old advertising executive with intense fear of flying.

  • Impact on Life: Job-related travel caused significant anxiety, leading her to avoid flights altogether.

  • Personal Consequence: Unable to visit her daughter and grandchildren, leading to emotional distress.

Diagnostic Criteria for Specific Phobia

  • Definition: Irrational fear of a specific object, situation, or activity.

  • Typical Types: Include hematophobia (fear of blood), claustrophobia (fear of closed spaces), acrophobia (fear of heights), and aerophobia (fear of flying).

  • Recognition of Excessiveness: Patients often acknowledge their fears as excessive, which may not be present in children.

  • Impact on Behavior: Viable situations are either avoided or faced with significant anxiety.

Examples of Specific Phobias

  • Common Phobias Include:

    • Hematophobia: Fear of blood

    • Claustrophobia: Fear of closed spaces

    • Acrophobia: Fear of heights

    • Ailurophobia: Fear of cats

    • Triskaidekaphobia: Fear of the number 13

    • Metallophobia: Fear of metals

Theories of Specific Phobias

  • Underlying Neural Mechanisms: Suggested abnormalities in the anterior insular cortex and amygdala.

Treatment Options for Specific Phobias

  • Systematic Desensitization: Teaching individuals to substitute relaxation for fear responses.

  • Flooding Techniques:

    • In vivo flooding: Full exposure to fear-inducing situations.

    • Imaginal flooding: Visualization of the feared situation.

    • Virtual Reality Exposure Therapy (VRET): Use of computer-generated environments for exposure.

Case Example: John

  • Patient Profile: 21-year-old student with severe anxiety during public speaking.

  • Symptoms: Past panic attacks when speaking publicly.

  • Historical Context: Fear experienced since middle school, impacting academic performance.

Diagnostic Criteria for Social Anxiety Disorder

  • Criteria Include:

    • Fear of scrutiny in social situations.

    • Excessive worry about humiliating or embarrassing oneself.

    • Avoidance of feared situations or enduring them with extreme anxiety.

    • Diagnosis is categorized as non-generalized or generalized.

Theories and Treatment for Social Anxiety Disorder

  • Biological Factors: Associated with heritable mechanisms.

  • Psychological Treatments: Include motivational interviewing, acceptance and commitment therapy, and mindfulness practices.

Case Example: Julia

  • Patient Profile: 22-year-old actress experiencing panic attacks related to driving.

  • Symptoms: Avoidance of crowded spaces and anxiety when thinking about escaping.

Diagnostic Criteria for Panic Attack

  • Symptoms Include:

    • Palpitations, shortness of breath, dizziness, and feelings of unreality.

    • Must present with 4 or more of the specified symptoms abruptly and peak within 10 minutes.

The Panic Disorder Landscape

  • Description of Panic Disorder: Characterized by recurrent panic attacks and ongoing concern about experiencing more.

Agoraphobia

  • Characteristics: Intense anxiety related to real or anticipated exposure to situations where it may be difficult to find help.

Theories and Treatment of Panic Disorder and Agoraphobia

  • Biological Perspective: Linked to norepinephrine levels.

  • Cognitive-Behavioral Perspective: Involves exposure to feared bodily sensations.

  • Relaxation Techniques: Employ methods to calm autonomic responses during attacks.

Differentiating Disorders

  • Panic Disorder vs. Social Anxiety: Panic disorder fears physical sensations; social anxiety revolves around judgment by others.

Case Example: Leslie

  • Patient Profile: 50-year-old mother concerned about health and safety of her family.

  • Symptoms: Excessive worry, tension, and difficulty sleeping, leading to compulsive checking behaviors.

Diagnostic Criteria for Generalized Anxiety Disorder (GAD)

  • Symptoms Include:

    • Excessive worry for at least 6 months about multiple events.

    • Difficulties controlling worry and associated physical symptoms.

Treatment of GAD

  • Biological Perspective: Involves disturbances in neurotransmitter systems (GABA, serotonin).

  • Cognitive-Behavioral Therapy: Focuses on identifying cognitive distortions and developing more rational thought patterns.

Case Example: Jennifer

  • Patient Profile: 34-year-old secretary with intrusive thoughts about harming her daughter.

  • Symptoms: Recurrent terrifying images leading to compulsive reassurance-seeking behaviors.

Diagnostic Criteria for Obsessive-Compulsive Disorder (OCD)

  • Obsessions: Intrusive thoughts causing distress, not merely excessive worries.

  • Compulsions: Repetitive behaviors aimed at reducing anxiety or preventing feared events.

Dimensions of OCD

  • Dimensions Include:

    • Checking compulsions

    • Need for symmetry and order

    • Cleanliness-related compulsion

    • Hoarding behaviors

Biological Basis of OCD

  • Origin: Linked to abnormalities in the basal ganglia and failure of the prefrontal cortex to regulate intrusive thoughts.

  • Effective Treatments:

    • Clomipramine (tricyclic antidepressant)

    • Other SSRIs

Psychological Treatments for OCD

  • CBT Techniques Include:

    • Exposure with ritual prevention

    • Thought stopping

    • Satiation therapy

Body Dysmorphic Disorder (BDD)

  • Description: A preoccupation with perceived defects in appearance leading to compulsive behaviors such as checking, grooming, and reassurance-seeking.

  • Comorbidity: Frequently co-occurs with depression, social anxiety, OCD, and eating disorders.

Treatment for BDD

  • Medication: SSRIs help reduce anxiety associated with body image concerns.

  • Cognitive-Behavioral Therapy: Aims to counter negative thought patterns about appearance.

Hoarding Disorder

  • Definition: Compulsively collecting or retaining items perceived as valuable, resulting in clutter and dysfunction.

  • Treatment: A biopsychosocial approach is effective, combining behavioral, cognitive, and social strategies.

Trichotillomania (Hair-Pulling Disorder)

  • Definition: The compulsion to pull out hair, often resulting in distress, with a prevalence of approximately 0.6%.

Excoriation (Skin-Picking) Disorder

  • Definition: Recurrent skin-picking with significant distress, affecting an estimated 1.4% of adults.

Trauma- and Stressor-Related Disorders

  • Characteristics: Result from social neglect, changes in caregivers, or institutional upbringing, leading to severe emotional withdrawal.

Post-Traumatic Stress Disorder (PTSD)

  • Definition: Develops after traumatic events, with symptoms persisting for more than a month, including re-experiencing the trauma and avoidance behaviors.

Acute Stress Disorder

  • Description: An anxiety disorder that arises shortly after a traumatic event that lasts up to one month.

  • Symptoms: Include depersonalization, numbness, and intense anxiety.

Treatment Approaches for PTSD

  • Theories and Treatment: Include SSRI antidepressants and virtual reality therapy combined with cognitive restructuring.

Gender Differences in Anxiety Disorders

  • Prevalence: Higher rates of panic disorder, PTSD, and generalized anxiety among females (about 2:1 ratio).

Etiological Factors of Anxiety, OCD, and Trauma-Related Disorders

  • Underlying Causes: Include a combination of biological, psychological, and stress-related factors.

  • Biological Factors: Emphasize inherited tendencies rather than direct transmission of disorders.

  • Psychological Factors: Significant life stresses, protective parenting styles, and learned anxious behaviors contribute.

  • Stress Factors: While not a direct cause, stress increases vulnerabilities that can exacerbate anxiety disorders.

The Maintenance of Anxiety

  • Components of Anxiety:

    • Physical Symptoms: Bodily responses like racing heart or muscle tension.

    • Cognitive Responses: Anxiety helps prepare the mind for perceived threats.

    • Behavioral Responses: Behaviors aimed at alleviating anxiety ultimately reinforce anxiety over time.

The Anxiety Cycle

  • Components Involved:

    • Physical symptoms (e.g., racing heart).

    • Negative thoughts and imagery related to potential threat.

    • Avoidance behavior (e.g., fidgeting, escape).