Anxiety Disorders

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Anxiety Disorders

• Chapter Four

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Defining Anxiety

• Mood state with marked negative affect and
  somatic symptoms of tension.
• Person is apprehensive about future
• Anticipation of future danger and misfortune
• Lack of confidence about ability to deal with
  future
• Often accompanied by depression

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Defining Anxiety

• Subjective unease, worry-related behaviors and
  possible physiological arousal
• Problematic when it becomes excessive and
  interferes with functioning
• When does test-taking anxiety become excessive?

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FEAR
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Fear

• Immediate alarm reaction
• As if life threatening or dangerous
• A present mood state with strong avoidance and
  sympathetic nervous system arousal
• Maladaptive when excessive in the absence of
  real danger and interference with life functioning

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Panic Attack

• Abrupt experience of intense fear or discomfort
  with
• Heart palpitations
• Chest pain
• Shortness of breath
• Dizziness

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DSM types of Panic Attack

• Situationally bound (cued)
• Unexpected (uncued)
• Situationally Predisposed

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Biological Contributions

• Inherited tendency to be anxious or highly
  anxious
• Low levels of GABA
• Corticotropin releasing factor (CRF)
• Limbic system fight or flight

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Psychological Contributions

• Sense of situations not in ones control and that
  this is dangerous
• Are parents responsive, encouraging, predictable?
• Do parents fail to provide a secure home, often
  overprotective or intrusive?
• Uncontrollability central risk factor for
  vulnerability to anxiety

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Social Contributions

• Life stressors many are interpersonal

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Comorbidity

• 55 have meet the criteria for at least one other
  disorder
• Relationship with depression

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Generalized Anxiety Disorder (GAD)

• Intense unfocused anxiety
• Formerly referred to as Neurosis or
  Psychoneurosis
• Excessive worry for at least six months
• Difficult to turn off or control worry key
  feature in distinguishing from normal worry

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GAD..

• Muscle tension
• Worry
• Easily fatigued
• irritability
• Insomnia
• Male female 12
• Onset usually in early adulthood in response to
  stressor
• More gradual course than other anxiety disorders

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Treatment

• Benzodiazepines not such a good idea
• Cognitive Behavioral and Exposure
• Tends to be a chronic condition

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Panic Disorder

• Unexpected panic attacks and anxiety about their
  reoccurrence
• Agoraphobia
• Panic Disorder with or without Agoraphobia
• If untreated likely to develop Agoraphobia

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Etiology

• Biopsychosocial approach
• Biological predisposition with stress and
  tendency toward catastrophic thinking/misinterpret
  ation of cues

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Treatment

• SSRIs
• CBT
• Mini exposures to panic sensations
• Cognitive tx address attitudes/misperceptions
  about feared sensations and situational triggers
• Relaxation
• Breathing retraining
• Best practice try CBT first and add meds if it
  does not help

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Phobia

• Specific Phobia extreme irrational fear of
  specific object or situation that markedly
  interferes with functioning
• Most people recognize their fear as irrational

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Separation Anxiety Disorder

• Childhood disorder
• Persistent worry that something terrible will
  happen to self or parents
• Different from school phobia
• Causation exposure plus anxiety about future
  occurrence
• Exposure-based therapies with relaxation training

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Social Phobia

• Extreme and painful shyness in almost all social
  and performance-related situations
• Social phobia-generalized type social anxiety
• 13.3 lifetime incidence
• Begins in adolescence most are single

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Social Phobia Etiology

• Biological vulnerability
• Conditioning during social situation or social
  trauma
• Modeling socially anxious parents learn that
  social evaluation is dangerous

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Social Phobia Treatment

• CBT
• Rehearsal, role play
• Exposure
• Social support
• SSRIs

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PTSD

• Chaplain Dave Giammona

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Obsessive-Compulsive Disorder

• Dangerous event is internal (thoughts, images,
  impulses)
• Obsessions intrusive, nonsensical thoughts,
  images or urges that one tries to suppress or
  eliminate.
• Compulsions Thoughts or actions designed to
  counter obsessions
• Thought-action-fusion

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Obsessive-Compulsive Disorder

• Treatment
• SSRIs
• Exposure and Response Prevention