Anxiety Disorders

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Anxiety Disorders
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Fundamental Features of Anxiety Disorders

• Fear and Threat
• Effortful Avoidance
• Compulsions or Rituals
• Detachment
• Experiential Avoidance
• A person is unwilling to remain in contact with
  particular private experiences (e.g., bodily
  sensations, emotions, thoughts, memories, images,
  behavioral predispositions) and takes steps to
  alter the form or frequency of these experiences
  or the contexts that occasion them, even when
  these forms of avoidance cause behavioral harm

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Multidimensional Construct

• Three Categories
• Subjective Distress (Cognitive Symptoms)
• Worry about specific events harm/danger
• Broader constellation of anxious cognitions
• Physiological Responses
• Sympathetic nervous system
• Tachycardia
• Tremulousness
• Dizziness
• Lightheadedness
• Parathesias
• Dyspnea
• Avoidance or Escape Behaviors

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Anxiety symptom baserates

• 1/3 of nonclinical populations have had symptoms
  of a panic attack at some time in their lifetimes
• 90 of nonclinical populations have had obsessive
  thoughts no different from OCD

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Types of Anxiety Disorders

• Panic Disorder (w/o Agoraphobia)
• Agoraphobia without panic
• Social Anxiety Disorder
• Specific Phobia
• Obsessive Compulsive Disorder
• Posttraumatic Stress Disorder
• Acute Stress Disorder
• Generalized Anxiety Disorder
• Other Anxiety Conditions secondary to medical
  conditions

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Medical Conditions and Other Etiologies

• Mitral valve prolapse
• Hypothyroidism
• Cardiovascular problems
• Vestibular abnormalities
• Hyperthyroidism
• Cushings Syndromes
• Alcohol, caffeine, amphetamines, cannabis,
  cocaine, hallucinogens, inhalants, phencyclidine,
  sedatives, hypnotics, anxiolytics and a host of
  medications

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Comorbidity

• ½ of patients with an anxiety disorder have had
  at least one other clinically significant anxiety
  or depressive disorder diagnosis
• Panic Disorder with Agoraphobia had the highest
  comorbidity rates
• GAD and Social Phobia had the highest rates as
  assignments to other disorders (e.g. depression
  or other anxiety disorders)

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Prevalence

• Anxiety disorders are very prevalent second only
  to substance abuse (LT) and highest (past year)
• 31 lifetime rate 18.7 past year rate
• Most common are social phobia and specific phobia
• Women experience anxiety dx 2x rate of men
• Exceptions are that social phobia is
  disproportionate but not as great
• OCD rates are roughly comparable for men and
  women

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Diatheses

• Evidence for heritability for the broad category
  of anxiety disorders and
• Specific category for panic, agoraphobia, social
  phobia and OCD (less evidence for GAD and
  specific phobia)
• Depression and anxiety may share common genetic
  factors
• Modest support for genetic markers for AD, better
  evidence for genetic marker for temperament

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Personality

• Children who were more inhibited at earlier ages
  evidenced more social inhibition as adults

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Theories

• Mowers Two Factor Theory
• Exposure Therapy
• Guidelines for Exposure
• Identify the entire stimulus complex (including
  verbal processes)
• Avoid small exposures that potentiate fear
• Be attuned to escape behavior
• When escape is blocked watch out for
  frustration/anger
• Reconditioning of fear occurs more rapidly than
  the original conditioning

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Panic Disorder Phenomenology

• Misinterpretation of bodily sensations. Fear of
  physical sensations.
• A panic attack appears at inappropriate or
  unexpected times with no apparent stimulus.
• Intense fear and discomfort
• Palpitations
• Smothering
• Dizziness
• Losing Control
• Fear of dying or going crazy
• Peak within 10 minutes often within 1-5 minutes

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Physiology of Panic

• Panic is an emergency response
• If safe, look for explanation of symptoms
• Sympathetic system either runs its course or the
  parasympathetic system takes our and stops the
  response
• Cardiovascular effects
• Respiratory effects
• Sweat glands
• Effect of overbreathing

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