Transcript Anxiety Disorders - Home

Chapter 5
Anxiety, Trauma, & Stress-Related, &
Obsessive-Compulsive-Related Disorders
Nature of Anxiety and Fear
• Anxiety – The Future-Oriented Mood State
– Apprehension about future danger or
misfortune
– Somatic symptoms of tension
• Fear – The Present-Oriented Mood State
– Immediate fight or flight response to
danger or threat
– Involves abrupt activation of the
sympathetic nervous system
• Anxiety and Fear are Normal Emotional
States
Panic Attacks
– Abrupt experience of intense fear or
discomfort
– Several physical symptoms (e.g.,
breathlessness, chest pain)
– Fear as an alarm response
Two types
Expected
Unexpected
Causes of Anxiety Disorders
Biological
Psychological
• Genetic Vulnerability
• Freud’s views
• Anxiety and brain
circuits
• Behavioral and
Cognitive Views
• Depleted levels of
GABA
– Anxiety and fear are
learned responses
Social Contributions
– Catastrophic thinking
and appraisals play
a role
• Stressful life events
trigger vulnerabilities
• Early Childhood
Contributions
Generalized Anxiety Disorder:
The “Basic” Anxiety Disorder
– Shift from possible crisis to crisis
– Worry about minor, everyday concerns
(Job, family, chores, appointments)
– Problems sleeping
– Persists for 6 months or more
Prevalence of Generalized Anxiety Disorder
– Affects about 3.1% (in a year) to 5.7% (in a
lifetime) of the general population
– Tends to more common in women
– Onset is often insidious, beginning in early
adulthood
– Very prevalent among the elderly
– Tends to run in families
Treatment of Generalized Anxiety Disorder
– Benzodiazapines (i.e. Valium, Xanax) –
Often Prescribed
– Antidepressants (i.e. Paxil & Effexor)
– Psychological interventions – CognitiveBehavioral Therapy
– Combined treatments – Acute vs. LongTerm Outcomes
Panic Disorder and Agoraphobia
– Experience of unexpected panic attack
– Develop anxiety, worry, or fear about another
attack
– Many develop agoraphobia
• Prevalence of panic disorder
– Affects about 2.7% (in a year) & 4.7% (in a
lifetime) of the general population
– Onset is often acute, median between 20 and 24
years of age
– 75% of individuals with agoraphobia are female
• Causes of panic disorder
- Combination of psychological, biological, & social
Treatment of Panic Disorder
• Medication Treatment
– SSRIs (e.g., Prozac and Paxil) are preferred drugs
– Relapse rates are high following medication
discontinuation
• Psychological and Combined Treatments
– Cognitive-behavior therapies are highly effective
– No evidence that combined treatment produces
better outcome
– Best long-term outcome is with cognitive-behavior
therapy alone
Social Phobia
– Extreme and irrational fear in
social/performance situations
– Often avoid social situations or endure
them with great distress
Prevalence of Social Phobia
– Affects about 6.8% (in a year) & 12.1% (in
a lifetime) of the general population
– Onset is usually during adolescence
Social Phobia
• Causes
– Biological and evolutionary vulnerability
– Conditioning and modeling (i.e. socially anxious
parents)
• Psychological Treatment
– Cognitive-behavioral treatment
– Cognitive-behavior therapies are highly effective
• Medication Treatment
– SSRIs Paxil, Zoloft, and Effexer – Are FDA
approved
Posttraumatic Stress Disorder (PTSD)
– Main etiologic characteristics
Trauma exposure and response
– Reexperiencing
(e.g., memories, nightmares, flashbacks)
– Avoidance
– Emotional numbing and interpersonal problems
– Markedly interferes with one's ability to function
– PTSD diagnosis – Only after 1 month post-trauma
– Additional categorizations: Acute Stress Disorder
& Delayed Onset
Prevalence and Treatment of PTSD
•
Prevalence & Causes of PTSD
- Approximately 3.5% (in a year) & 6.8% (in a
lifetime)of the general population
- Physical violence, accidents, & sexual
assault are most common traumas
• Treatment
-Cognitive-behavior therapies (CBT) are highly
effective
– CBT may include graduated or massed (e.g.,
flooding) imaginal exposure
– SSRIs have shown to be helpful
Obsessive-Compulsive Disorder (OCD)
– Obsessions - Intrusive and nonsensical thoughts,
images, or urges
– Compulsions - Thoughts or actions to neutralize
thoughts
– Vicious cycle of obsessions and compulsions
– Cleaning and washing or checking rituals are
common
Prevalence of OCD
– Affects about 1% (jn a year) & 1.6%-2.3% (in a
lifetime) of the general population
Causes & Treatment of ObsessiveCompulsive Disorder (OCD)
• Causes of OCD
– Learning that some thoughts are
dangerous/unacceptable
– Thought-action fusion -- The thought is similar to
the action
•
Medication Treatment
– SSRIs
• Psychological Treatment
– ERP (exposure & ritual prevention) is most
effective
Body Dysmorphic Disorder
– Preoccupation with imagined defect in
appearance
– Often display ideas of reference for imagined
defect
– Suicidal ideation and behavior are common
Body Dysmorphic Disorder
– Seen equally in males and females
– Onset usually in early 20s
– Most remain single
• Treatment
– Treatment parallels that for obsessive compulsive
disorder (comorbid with OCD 10% of the time)
– Medications (i.e., SSRIs) that work for OCD
provide some relief
– Exposure and response prevention is also helpful
– Plastic surgery is often unhelpful