Anxiety Disorders 021605

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Anxiety Disorders 02-16-05
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Anxiety can be manifested in 3 ways

• Cognitive (thoughts, worries)
• Behavioral (e.g., avoidance of anxiety-provoking
  situation)
• Physiological (e.g., heart palpitations, shallow
  breathing, dry mouth, gastrointestinal problems,
  perspiration, cold hands/feet, elevated blood
  pressure, muscle tension)

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Cognitive, physiological, and behavioral symptoms
often act in concert with one another

• Positive feedback loop between cognitions and
  somatic symptoms

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Phobias

• Strong, persistent fear and avoidance of some
  specific object or situation
• Fear is out of proportion to actual danger
• Exposure to feared situation/stimulus produces
  intense anxiety
• Feared situations/stimuli are usually avoided

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Specific Phobias

• DSM-IV specifies 4 main types
• Animal (spiders, snakes)
• Natural environmental (water, thunder)
• Blood/injections/injuries
• Situational (planes, elevators, small spaces)

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Social Phobia

• Intense, excessive fear of being scrutinized,
  embarrassed, and/or humiliated in one or more
  social situations
• 3 types performance, limited interactional,
  generalized
• Onset is often during adolescence

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Agoraphobia

• Intense fear of being in open spaces, public
  places, and/or crowded places where escape or
  help may not be readily available
• Anxiety and avoidance of feared places often
  leads to serious activity limitations
• Often associated with panic disorder and/or
  social phobia

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Class Activity
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All anxiety disorders can involve panic attacks

• Situationally-bound occur before or during
  exposure to a feared stimulus
• Situationally predisposed occur usually but not
  always in the presence of the feared stimulus
• Unexpected / uncued occur spontaneously, without
  warning

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Panic attacks appear to be a relatively common
experience research suggests that

• 1/4 - 1/3 of college students report having had a
  panic attack during a one-year period
• Up to 43 of adolescents report having had a
  panic attack

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Panic Disorder

• Recurrent and unexpected panic attacks involving
  a sudden onset of physiological symptoms, such as
  dizziness, rapid heart rate, trembling, labored
  breathing, chest pain, nausea, and/or
  choking/smothering, accompanied by feelings of
  terror, impending death or doom, and/or losing
  control/going crazy

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Panic Disorder (continued)

• Panic attacks may involve depersonalization
  (feeling of being outside of ones body) or
  derealization (feeling of the world not being
  real)
• Attacks may be cued or uncued
• Disorder involves concern about future panic
  attacks or losing control
• Sometimes accompanied by agoraphobia

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It could not be worse if I were hanging by my
fingertips from the wing of an airplane in
flight. The feeling of impending doom was just
as real and frightening. 25 year-old woman,
describing a panic attack
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Panic disorder may lead to symptoms of
agoraphobia (anxiety about leaving home this may
stem from fear of having a panic attack in public)
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Prevalence of panic disorder

• Two times more prevalent in women than men
• Less prevalent in Mexican-Americans than other
  ethnic groups in the US
• 1/3-1/2 of individuals with panic disorder also
  have agoraphobia

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Generalized Anxiety Disorder (GAD)

• Persistent, excessive, chronic, and
  uncontrollable worries about a variety of life
  circumstances
• Common worries for adults health, work, finances
• Common worries for children schoolwork, tests,
  getting hurt, getting teased

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GAD (continued)

• Somatic symptoms of anxiety are persistent, and
  may include difficulty concentrating,
  restlessness, fatigue, muscle tension,
  irritability, sleep problems, being on edge

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Prevalence of GAD

• GAD is the most frequently diagnosed anxiety
  disorder
• Two times more prevalent in women than men

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Genetic Studies of Anxiety Disorders

• Twin studies show a higher concordance rate for
  anxiety disorders between monozygotic (MZ) twins
  than dyzygotic (DZ) twins.
• Family studies show higher rates of anxiety
  disorders in 1st-degree relatives of individuals
  with anxiety disorders than in 1st-degree
  relatives of healthy controls.

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Genetic Studies of Anxiety Disorders

• Genetic studies provide more support for a
  general inherited vulnerability to anxiety
  disorders than heritability of specific anxiety
  disorders.
• This general inherited vulnerability might take
  the form of constitutional or physiological
  factors that predispose individuals to develop
  fear reactions.

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Genetic Studies of Anxiety Disorders

• Autonomic Nervous System (ANS) Reactivity
  individuals born with high reactivity are more
  easily aroused and respond more strongly to
  stimuli, which may increase the chances of
  developing an anxiety disorder

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Cognitive-Behavioral Explanationsfor PD and GAD

• Anxiety-sensitivity theory overly active body
  vigilance, fear and worry about body sensations,
  and catastrophic interpretations lead to anxiety
  --gt positive feedback loop

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Research support for the relationship between
cognitions and anxiety (positive feedback loop)
Sue3, p. 134
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Biological Explanations of PD GAD

• Panic disorder Mitral valve prolapse Inner ear
  disturbance Oversensitivity in receptors that
  monitor the amount of oxygen in the blood
  oversensitivity of locus ceruleus
• GAD Overactivity in neurons that use
  norephinephrine (a neurotransmitter that
  stimulates high arousal) and/or deficiency in
  GABA or GABA receptors (a neurotransmitter that
  inhibits activity in systems using
  norepinephrine)