Anxiety Disorders and Obsessive-Compulsive and Related Disorders
Anxiety Disorders and Obsessive-Compulsive and Related Disorders PSYCH 3830
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This 8 page Class Notes was uploaded by Margaret Bloder on Monday February 22, 2016. The Class Notes belongs to PSYCH 3830 at Clemson University taught by Pam Alley in Winter 2016. Since its upload, it has received 16 views. For similar materials see Abnormal Psychology in Psychlogy at Clemson University.
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Date Created: 02/22/16
Anxiety Disorders and Obsessive-Compulsive and Related Disorders I. Reorganization of Disorders in the DSM DSM-IV-TR Anxiety Disorders Specific phobia Social phobia Panic disorder Generalized anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder Adjustment Disorders Adjustment disorder DSM-5 Anxiety Disorders Specific phobia Social anxiety disorder Panic disorder Generalized anxiety disorder Obsessive-Compulsive and Related Disorders Obsessive-Compulsive Disorder Trauma- and Stressor- Related Disorders Post-Traumatic Stress Disorder Adjustment Disorder These are the differences that were made from the DSM-IV to the DSM- 5. Social phobia was changed to a different name of Social anxiety disorder, obsessive-compulsive disorder was no longer under anxiety disorders; It became its own category, and a new category was added called trauma- and stressor- related disorders where PTSD and adjustment disorder fall under. II. Terminology A. Fear: basic emotion that: Occurs in response to a perceived threat Is often times adaptive Involves the mobilization of the fight-or-flight response Fear is normal B. Phobia Excessive or unreasonable fear triggered by the presence of a specific object or situation C. Anxiety: blend of emotions that includes: Negative affect Concern about possible threat or danger The sense of being unable to predict or control threat III. Anxiety Disorders A. Specific Phobia Diagnostic Criteria The person has excessive or unreasonable fear or anxiety about a specific object or situation The phobic stimulus almost always provokes immediate fear or anxiety The phobic stimulus is avoided or endured with marked fear or anxiety The fear or anxiety is out of proportion to the actual danger The fear or anxiety typically lasts for 6 or more months The person experiences clinically significant distress or impairment in functioning Subtypes 1. Animal (ex: spiders, snakes, birds) 2. Natural Environment (ex: storm, heights, water) 3. Situational (ex: public transportation, driving a car, crossing a bridge, being in a closed space) 4. Other: anything that doesn’t fit into the other subtypes (ex: choking, fear of falling when walking down stairs) 5. Blood-Injury-Injection (ex: afraid of seeing blood, getting a shot, seeing someone in a wheelchair) Phobic object encountered initial heart rate acceleration dramatic drop in heart rate and blood pressure nausea, dizziness, and/or fainting (only for blood-injury-injection) Demographics and Etiological Factors Those who have a phobia usually have more than one Symptoms typically begin early on; 7-11 is the median age of onset “Waxing and Waning”: symptoms come and go If the phobia persists into adulthood, it’s unlikely to remit without treatment Females are more likely to develop a specific phobia Greater risk if family member has a phobia Those who have a phobia are at increased risk for developing other anxiety and mood disorders Caused by traumatic experience, observing someone else go through a traumatic experience, hearing information from mom or dad B. Social Anxiety Disorder Diagnostic Criteria The person experiences an excessive and unreasonable fear of one or more social or performance situations in which he or she is exposed to unfamiliar people or to possible scrutiny of others The individual fears that he or she will act in a way that will be humiliating or embarrassing Exposure to the feared social situation almost invariably provokes a fear response (exposure always produces fear) The feared social or performance situation is avoided or endured with great distress or anxiety (If individual only demonstrates fear during performance, specifier of performance is tacked onto social anxiety disorder) The fear or anxiety typically lasts for six or more months The person experiences clinically significant distress or impairment in functioning Demographics and Etiological Factors More common in women than men Median age: 13 Significant cases tend to be persistent Someone with this disorder is more likely to drop out of school, have a poorer quality of life, lower socioeconomic group, more likely to be unemployed Can be learned If a family member has it, more likely to develop it Hard to determine whether its genetic or environmental Behavioral Inhibition Behavior inhibition is a temperamental predisposition characterized by shyness and fearfulness; those born with this disposition are at greater risk for developing an anxiety disorder. Behaviorally inhibited infants are easily distressed by unfamiliar stimuli they are increasingly fearful and anxious in childhood they are at risk of developing an anxiety disorder. C. Panic Disorder First we must know what a panic attack is in order to diagnose a panic disorder. Panic Attack (not a diagnosis) Diagnostic Criteria for Panic Attack A discrete period of intense fear or discomfort in which four (or more) of the following symptoms developed abruptly and reached a peak within minutes: 1. Palpitations, pounding heart, or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feeling of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, lightheaded, or faint 9. Chills or hot flashes 10. Paresthesias (numbness or tingling sensations) 11. Derealization (feelings of unreality) or depersonalization (being detached from oneself) 12. Fear of losing control or going crazy 13. Fear of dying Two Kinds of Panic Attacks 1. Expected: obvious cue with trigger 2. Unexpected: out of the blue (when watching TV or when sleeping Demographic and Etiological Factors -Usually reaches peak within 10 minutes -Usually last about 20-30 minutes (relatively short term) Panic Disorder (actual disorder) Diagnostic Criteria The person experiences recurrent, unexpected panic attacks At least one of the attacks is followed by at least one of the following for a period of at least a month: o Persistent concern or worry about additional attacks or their consequences o A significant maladaptive change in behavior related to the attacks The person experiences clinically significant distress or impairment in functioning Demographics and Etiological Factors Typical age of onset: 20-24 years of age If left untreated, symptoms come and go Chronic (long-lasting) Highly comorbid with other anxiety disorders and mood disorders More common in women than men More common in individuals who have a parent that has it D. Generalized Anxiety Disorder (GAD) Diagnostic Criteria The person experiences excessive anxiety and worry about a number of events or activities for at least a six month period The person finds it difficult to control the worry The person experiences at least three of the following symptoms: o Restlessness or feeling keyed up or on edge o Easily fatigued o Difficulty concentrating o Irritability o Muscle tension o Sleep disturbance The person experiences clinically significant distress or impairment in functioning Demographics and Etiological Factors Median age at onset: 30 years (this onset is later than that for any other anxiety disorder) GAD is generally chronic (long-lasting) with symptoms that wax and wane throughout the lifespan Full remission is unlikely GAD is believed to have a genetic component Behavioral inhibition is an innate temperamental risk factor associated with GAD More common in women than men IV. Obsessive-Compulsive and Related Disorders A. Obsessive-Compulsive Disorder (OCD) Diagnostic Criteria Presence of obsessions, compulsions, or both The obsessions or compulsions are time-consuming (e.g. take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning Demographics and Etiological Factors About 90% of individuals with OCD will experience both obsession and compulsions Range in severity (mild, severe) Average age of onset: 20 years 25% of cases have started by the age of 14 Onset is gradual Tends to be long-term (waxes & wanes) Comorbid with other anxiety disorder and/or mood disorders In adulthood, slightly higher in females than males In childhood/adolescents, OCD is more common in boys than girls Early onset tends to be more severe Tends to be related with individuals getting a divorce Abused individuals are at greater risk for developing There is a genetic component (concordance rate is stronger for monozygotic than dizygotic twins) What are Obsessions and Compulsions? Obsessions Compulsions Recurrent thoughts, impulses, or Repetitive behaviors or mental acts images that: that: Are experienced as intrusive and unwanted The person feels driven to Typically cause marked anxiety perform in response to an or distress obsession or according to rules that must be applied rigidly Are suppressed with some other thought or action Are aimed at preventing distress or some dreaded Most Common Obsessions: event (purpose of engaging in Contamination fears (afraid of compulsive behavior is to reduce anxiety) getting sick, germs) Fear of harming oneself (not Are not connected in any suicidal, doesn’t want to harm realistic way with what they oneself) are designed to neutralize OR are clearly excessive Fear of harming others (as well, doesn’t want to harm others) 5 Primary Compulsive Behaviors: Pathological doubt: abnormal Cleaning concern about having failed to Repeated checking Repeating (ex: washes hands perform a particular action (ex: can’t remember if you locked over and over again) the door) Ordering/Arranging Counting V. Treatment of Anxiety Disorders Some combination of behavioral and cognitive therapy Some conditions are easier to treat than others (specific phobia: shows most improvement) Medication is sometimes helpful when treating short-term effects, but symptoms often reappear. In the long run, improvement is not continuous Exposure therapy: gradually place patient in situations that are potentially more and more frightening to them (can occur in one session) o Participant modeling: therapist will model ways Cognitive therapy: used to treat social anxiety disorder; identify irrational fears
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