anxiety disorders

DSM criteria for panic disorder: B. - at least ______ of the attacks has been followed by ____ ____ or more of _____ or both of the following: (2)

1, 1 month, 1, persistent concern or worry about additional panic attacks or their consequences, significant maladaptive change in behavior related to the attacks

DSM criteria for PTSD: B. presence of ____ or more of the following _________ symptoms associated with the traumatic events, beginning after the traumatic event(s) occurred: (5)

1, intrusion, reccurent/involvuntary/intrusive distressing memories of the traumatic events, recurrent distressing dreams related to traumatic events, dissociative reactions (flashbacks), intense or prolonged psychological distress when exposed to integral or external cues that symbolize the traumatic events, marked physiological reactions to internal or external cues that symbolize the traumatic events

DSM criteria for social anxiety disorder: A. marked fear or anxiety about _____ or more social situations in which the person is exposed to possible scrutiny by others. examples include:

1, social interactions, being observed, performing in front of others

what percent of people have excoriation

1-5%

specific phobias affect about ______ of general population and they tend to run a _________ course

11%, chronic

social anxiety disorder affects about _______ of general population

13%

peak age of onset for social anxiety disorder is

15 years

surveys have shown as many as __________ of americans may be affected by anxiety disorders... may ________

18%, underestimate

hoarding disorder prevalence range between ____- _____ of the population which is ______ as high as prevalence of _______

2%- 5%, twice, OCD

DSM 5 criteria for panic disorder w/ agoraphobia: A. marked fear or anxiety about _____ or more of the following situations (5)

2, public transportation, open spaces, enclosed places, standing in line or being in a crowd, being outside the home alone

OCD affects about _______ of general population

2.6%

onset of panic disorder is often acute, beginning between ______ and _____ years of age

25-29

duration of acute stress disorder

3 days to 1 month following trauma exposure

DSM Criteria for GAD: c. the anxiety and worry are associated with at least _____ (or more) of the following ______ symptoms (with at least some symptoms present for more days than not for the past _____ months) (NOTE: ONLY ONE ITEM IS REQUIRED FOR CHILDREN) : (6)

3, 6, 6, restless or feeling keyed up or on edge, easily fatigued, difficulty concentration or mind going blank, irritability, muscle tension, sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep)

panic disorder affects about _________ of the general population

3.5%

GAD affects about ____ of the vernal population

4%

DSM 5 criteria fro panic attack: an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time _______ or more of the following symptoms occur: (13)

4, palpitations/pounding heart/accelerated heart rate, sweating, trembling/shaking, sensations of shortness of breath/smothering, feeling of chocking, chest pain/discomfort, nausea or abdominal distress, feeling dizzy/unsteady/lightheaded/faint, chills/heat sensations, paresthesias, derealization/depersonalization, fear of losing control/ going crazy, fear of dying

DSM criteria for GAD: A. excessive anxiety or worry, occurring more days than not for at least ______ _______ about a number of events or activities (such as work or school performance)

6 months

DSM criteria for panic disorder w/ agoraphobia: F. the fear, anxiety, or avoidance is persistent, typically lasting for

6 months or more

____________ of individuals with agoraphobia are _______

75%, female

medical Treatment for GAD that is a serotonin agonist

BuSpar

specific phobias: repeatedly presenting ______ with the _____... result - fear will no longer be elicited by the _____

CS, US, CS

are a non-invasive method of measuring brain activity during cognitive processing.

Event-related brain potentials (ERP)

many people who have _______ also lead very _________ (some might say hectic) lives

GAD, active

panic attack quotes (4)

I'm losing control, i feel like I'm going crazy, i must be having a heart attack, I'm smothering and i can't breathe

BDD is comorbid with what?

OCD

treatment for BDD is parallel with

OCD

_________ tends to wax and wane, whereas _________ behavior can begin early in life and get worse with each passing _______

OCD, hoarding, decade

trauma and stress related disorders types (4)

PTSD, acute stress disorder, reactive attachment disorder, disinhibited social engagement disorder

2 treatments for BDD

SSRIs, exposure & response prevention

__________ are often the preferred drugs for panic disorders e.g., (2)

SSRIs, prozac and paxil

FDA approved drugs for social anxiety disorder

SSRIs- paxil, zoloft, and effexor

snake phobia video was example of hybrid treatment.. how?

accelerated "gradual" exposure

DSM criteria social anxiety disorder: B. individual fears that he or she will

act in a way or show anxiety symptoms, that will be negatively evaluated

onset of panic disorder is often _________

acute

onset of social anxiety disorder is during

adolescence

onset of OCD is typically in early __________ or young _________ and it tends to be _________

adolescence, adulthood, chronic

Social anxiety: generalized subtype-

affects many social situations

DSM criteria for panic disorder w/ agoraphobia: C. the agoraphobic situations

almost always provoke fear or anxiety

physiological and psychological state characterized by cognitive, somatic, emotional, and behavioral components

anxiety

________ can be a normal reaction to __________... it may help a person to deal with difficult situation - can be ____________

anxiety, stress, adaptive

____________ is the medication or other intervention that inhibits anxiety

anxiolytics

DSM criteria for PTSD: E. marked alterations in _________ and _______ associated with the traumatic events, beginning or worsening after the traumatic event occurred, as evidenced by _______ _____ _____ of the following: (6)

arousal, reactivity, 2 or more: irritable behavior/outbursts expressed as verbal or physical aggression, reckless or self-destructive behavior, hyper vigilance, startled easily, concentration problems, sleep disturbance

PTSD specifiers: With delayed expression- if the full diagnostic criteria are no met until

at least 6 months after the event (although the onset & expression of symptoms may be immediate)

normal anxiety vs. disorder: embarrassment or self-consciousness vs.

avoidance of common social situations

DSM criteria for PTSD: C. persistent __________ of stimuli associated with traumatic events, beginning after the traumatic events occurred, as evidenced by ________ of both of the following: (2)

avoidance, one, avoidance of distressing memories, thoughts, or feelings about or closely associated with the traumatic events and avoidance of external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with traumatic events

DSM criteria for panic disorder w/ agoraphobia: D. the agoraphobic situations are actively ________, require the presence of a ________, or are endured with ________ fear or anxiety

avoided, companion, intense

(panic disorder) significant maladaptive change in behavior related to the attack e.g

behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations

Compulsions: _______ or ______ acts are aimed at preventing or reducing ___________ or a dreaded ____ or ____

behaviors, mental, distress, event, situation

type of GAD anxiolytic that is also known as a tranquilizer

benzodiazepines

__________ enhance the effects of the neurotransmitter _________ resulting in sedated feeling

benzodiazepines, gaba

unlike _________, ________ does not cause sedation or lead to __________

benzos, BuSpar, dependency

physical effects of social anxiety

blushing, trembling voice, trembling/shaking, dry mouth, sweating, twitching, upset stomach, involuntary twitching, unsteadiness, disorientation, shortness of breath, muscle tension, rapid beating of heart

hoarding can't be attributable to another medical condition

brain injury, cerebrovascular disease, prader-willi syndrome

most common compulsions for OCD

checking and washing

normal anxiety vs. disorder- occasional worry about events vs.

chronic and unsubstantiated worry

for patients with specific phobias who cannot handle flooding, an alternative _________ _____________ technique is used called __________-_________

classical conditioning, counter-conditioning

avoidance model for specific phobias: fear is initially learned through _______ _______, fear is then ________ through _______, consequence is that the _______ does not _________

classical conditioning, maintained, avoidance, fear, extinguish

DSM criteria for GAD: D. the anxiety, worry, or physical symptoms cause

clinically significant distress or impairment in social, occupational, or other important areas of funtioning

medical treatment for OCD

clomipramine, fluvoxamine, fluoxetine, paroxetine, sertraline

anxiety is a physiological and psychological state characterized by what (3) components

cognitive, somatic emotional, and behavioral components

PTSD treatment: ________ threapies are highly affective and may include _________ _________

cognitive-behavior therapies, graduated exposure

what type of therapy is highly effective for panic disorder

cognitive-behavioral therapies

what therapy is most effective for OCD

cognitive-behavioral therapy

there is no evidence that _______ __________ for ______ disorder produces better outcome (combined meaning drugs and therapy? i think)

combined treatment, panic

OCD is characterized by

complaints of persistent or repetitive thoughts- obsessions, and/or behaviors- compulsions

Compulsions are behaviors or mental acts that are either not ___________ in a _______ way with what they are designed to _______ or ______ or are clearly __________

connected, realistic, neutralize, prevent, excessive

people with OCD are compelled to ________ behaviors despite an awareness that the thoughts or behaviors may be _____ or ______... but they feel ________ if they stop them

continue, excessive, inappropriate, distress

DSM criteria for GAD: B. the individual finds it difficult to

control the worry

alternative classical conditioning technique for patients who can't handle flooding

counter-conditioning

DSM criteria PTSD: F. duration of the disturbance-

criteria b, c, d, and e is more than 1 month

DSM criteria: Social anxiety disorder C. the social situations almost always provoke fear or anxiety. note: in children, the fear or anxiety may be expressed by

crying, tantrums,freezing, clinging, shrinking, or failing to speak in social situations

GAD: this excessive worry often interferes with

daily functioning

DSM criteria for PTSD: A. exposure to actual or threatened ______, _______ _____, or ________ ______ in _____ or more of the following ways: (4)

death, serious injury, sexual violence, 1, directly experience, witnessing the event as it occurred to others, learning that the traumatic event occurred to close family member/close friend, experiencing repeated/extreme exposure to aversive details of the traumatic events (first responders, police officers)

being detached from oneself

depersonalization

PTSD specifiers: Dissociative symptoms- symptoms meet ptsd criteria and in response to the stressor, experiences persistent or recurrent symptoms of either of the following: (2)

depersonalization, derealization

feelings of unreality

derealization

sympathetic (8)

dilates pupil, inhibits flow of saliva, accelerates heartbeat, dilates bronchi, inhibits peristalsis and secretion, conversion of glycogen to glucose, secretion of adrenaline and noradrenaline, inhibits bladder contraction

Hoarding disorder: A. persistent difficulty

discarding or parting with possessions, regardless of actual value

panic disorder criteria: C and D

disturbance not attributable to substance of medical condition, disturbance is not better explained by another mental disorder

DSM criteria for GAD: section E & F

disturbance not due to a substance or general medical condition, disturbance not better explained by another mental disorder

Onset of BDD: _______ ______ through _______'s

early adolescence through 20s

onset of GAD is typically in _______ _______ and tends to run in __________

early adulthood, families

OCD: differential diagnosis- obsessions and compulsions is not better accounted for by

eating disorder, trichotillomania, body dysmorphic disorder, substance use, hypochondriasis, paraphilia, MDD

Hoarding disorder more common in men or women???

equal

DSM criteria for panic disorder w/ agoraphobia: B. the individual fears or avoids these situations due to thoughts that ________ might be difficult or _____ might not be available in the event of developing panic-like symptoms or other incapacitation or embarrassing symptoms

escape, help

when anxiety becomes _________ it may fall under the classification of an ________ _______

excessive, anxiety disorder

skin picking disorder that leads to tissue damage

excoriation

exposure treatment for specific phobias- patient is ________ to the _______ _____ as part of the _________ process

exposed, phobic stimulus, therapeutic

OCD treatment: CBT =

exposure and response prevention - ERP

Acute stress disorder comes from

exposure to trauma

what is the behavior therapy treatment for specific phobias called

exposure treatment

CBT for specific phobias: __________ _______ uses the most _________ stimulus first

exposure treatment, fearful

benzodiazepines are ______ acting: leaving you calm and relaxed... issue is the ________ that is built up when used for ______ _______ or more

fast, tolerance, 6 months

some therapists have patients with specific phobias develop a __________ ________

fear hierarchy

example of systemic desensitization in class

fear of clowns- coulrophobia

what video did we watch in class that had to do with avoidance model for maintenance of the phobia

fear of dogs

examples of embarrassing symptoms for people with panic disorder w/ agoraphobia

fear of falling in the elderly, fear of incontinence

DSM criteria for panic disorder w/ agoraphobia: G. the ______, ______, or ______ causes clinically significant _______ or impairment in _______, _______, or other important areas of __________

fear, anxiety, avoidance, distress, social, occupational, functioning

differential diagnosis for GAD: the focus of the anxiety & worry is not confined to : (7)

feature of an axis I disorder e.g the anxiety or worry is not about having a panic attack - as in panic disorder, being embarrassed in public- as in social phobia, being away from homo or close relatives - as in separation anxiety disorder, gaining weight- as in anorexia nervosa, having multiple physical complaints- as in somatic symptom disorder, or having a serious illness- as in hypochondriasis, and the anxiety or worry do not occur exclusively during post-traumatic stress disorder

most with OCD are

female

do more females or males have specific phobias

females

prevalence for social anxiety is slightly greater in __________

females

GAD stats: _______ out number ______ approx. __:__

females, males, 2:1

systemic desensitization: some phobic patients cannot handle

flooding in any form

the anxiety disorders (6)

generalized anxiety disorder, panic disorder & agoraphobia, specific phobias, social anxiety disorder, separation anxiety disorder, selective mutism

specific phobia disorder: the second component of systemic desensitization is ___________ _______ to the feared objects or situations

gradual exposure

best treatment for excoriation

habit reversal training

physical symptoms of anxiety (4)

headaches, stomach aches, muscle tension, irritability

how can you moderate stress for someone with GAD? _____ individual find ____ _____

help, better balance

relapse rate for panic disorder is ________ following _____ ______

high, medication discontinuation (especially w/o therapy)

BDD: reaction to a _______ or _______ feature

horrible, grotesque

panic attacks cannot be due to a general medical condition e.g.,

hyperthyroidism

People with OCD attempt to

ignore, suppress, or neutralize obsessive thoughts, impulses, or images

exposure treatment (for phobias)- FLOODING. the key is keeping the patient

in the feared situation long enough that they can see that none of their worst fears are realized

with absent insight/delusional beliefs for BDD:

individual is completely convinced that the BDD beliefs are true

with poor insight for BDD:

individual thinks that the body dysmorphic disorder beliefs are probably true

social anxiety must markedly ________ with ones ability to _______, often ______ social situations or _____ them with great _______

interferes, function, avoid, endure, distress

cognitive behavioral theory of panic disorder: circle chart

internal/external trigger, panic, misinterpreting the symptoms, additional fear/anxiety, increase in symptoms (process repeats itself)

DSM- V clusters for trauma- stressor related disorders:

intrusion, avoidance, negative alterations in cognitions & mood, alterations in arousal & reactivity

acute stress disorder symptoms (5)

intrusive symptoms, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms

Pure obsessional OCD: Pure O -

intrusive thoughts/ images of killing ones family, fear of molesting child, worrying that they will assault or run over someone, repetitive thoughts that they have written/said something inappropriate, fear they are gay (when they are not), thoughts/images that are sacrilegious or blasphemous such as worshiping satan or having sex with jesus

normal anxiety vs. disorder: realistic fear of a threatening stimulus vs.

irrational fear or avoidance of an object, place, or situation that poses little or not threat of danger

Hoarding disorder: C. if living area is uncluttered,

it is only because of interventions of third parties

BDD course

lifelong

conditioned fear - generalization... conditioned fear response

lil albert

what is a fear hierarchy? (for people with specific phobias)

listing the relative unpleasantness of various types of exposure

exposure treatment does not use really stimulus...

literally using imagination and visualization, virtual reality

avoidance model contributes to ___________ of the __________

maintenance of the phobia

to be considered a phobia, the fear must be (3) ______ and ____,______ or _____, _____/______/____ in feared situations interfere significantly with ______ _____

marked and persistent, excessive or unreasonable, the avoidance/anxious anticipation/distress in the feared situations interferes significantly with persons life

OCD: obsessions or compulsions cause

marked distress, time consuming, or significantly interfere with persons normal routine - occupational functioning, or usually social activities or relationships

OCD relapse is common with

medication discontinuation

relapse rate for social anxiety disorder is high following

medication discontinuation

cognitive behavioral theory of panic disorder: says that sufferers tend to

misinterpret the physical signs of arousal as catastrophic & dangerous, this interpretation leads to further physical arousal and can lead to a vicious cycle

hoarding disorder: B. this difficulty is due to a perceived

need to save items and to distress associated with discarding item

DSM criteria for PTSD: D. ______ alterations in _______ and _____ associated with traumatic events, beginning or worsening after th traumatic events occurred, as evidenced by _______ of the following: 7

negative, cognitions, mood, 2 or more: inability to remember important aspect of event, persistent & exaggerated negative beliefs about oneself/others/world, persistent distorted cognitions about the cause/consequences of event that lead them to blame others/themselves, persistent negative emotional state, less interest in significant activities, detachment from others, inability to experience positive emotions

some people have __________ panic attacks

nocturnal

majority of people with OCD experience both

obsessions and compulsions

normal anxiety vs. disorder: difficulty following a traumatic event vs.

ongoing and recurring nightmares, flashbacks, or emotional numbing relating to traumatic event in your life that occurred several months or years ago

experience of extreme physical or mental anxiety and fear

panic

best long-term outcome is with cognitive behavior therapy ALONEE for what disorder

panic disorder

preoccupation with sexual urges or fantasies

paraphilia

numbing or tingling sensations

parethesias

newer antidepressants such as ____________- ______ and ________ -_____ are also being used to treat GAD

paxil, SSRI, Effexor, SNRI

for social anxiety disorder in children, the anxiety must occur in _________ settings and not just in interactions with _______

peer, adults

"as good as it gets"

people who have GAD have lived with their anxiety for a long time

DSM criteria: social anxiety disorder- specify if

performance only - the fear is restricted to speaking or performing in public

normal anxiety vs. disorder: making sure you are healthy and safe vs.

performing uncontrollable, repetitive actions, such as washing your hands repeatedly or checking things

(panic disorder) losing control, having a heart attack, going crazy

persistent concern or worry about additional panic attacks or their consequences

behavior therapy and phobias- exposure to the

phobic stimulus in a safe and controlled setting

Phobias: it is not ________ to simply be _______ about something

phobic, anxious

people with specific phobias will go to great lengths to avoid _________ objects, most recognize that the feat and avoidance are ___________, markedly ______ with ones ability to _________

phobic, unreasonable, interferes, function

anxiety is both a _______ and ____ state

physiological & psychological

what is often unhelpful for BDD?

plastic surgery

general anxiety disorder issue: _____ vs. ____

possible vs. probable

Body dysmorphic disorder: _________ with some _________ _______ in appearance by someone who actually looks reasonably ________

preoccupation, imagined defect, normal

coping strategies for specific phobia disorder (3)

prior to exposure - therapist teaches the patient cognitive strategies to cope, provides patient w/ a means of controlling fear, relaxation training

behavioral effects of social anxiety (7)

problems dating, habitual avoidance, fear based decision making, avoid meeting new people, avoid eye contact with stranger, decline to speak up in meetings, never eat in public

Obsessions are defined as:

recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate and cause marked anxiety or distress; but are no excessive worries about real-life problems

DSM criteria for panic disorder: A.

recurrent unexpected panic attacks are present

what does exposure treatment not involve

relaxation or gradual approach to the source of anxiety

specific phobia disorder: systemic desensitization - one is trained to substitute a ______ response for the _____ response in the prescence of the _________ _______

relaxation, fear, phobic stimulus

OCD: Symptoms related to performing tasks:

repeated hand washing, clearing of the throat, specific counting systems or counting steps, repetitive actions

normal anxiety vs. disorder: occasional case of nerves or jitters vs.

repeated, random panic attacks or persistent worry/anticipation of another panic attack

what is the process of extinction

repeatedly presenting CS with the US and the result is fear no longer elicited by the CS

compulsions are defined as:

repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or rigid rules

cognitive effects of social anxiety

self conscious thoughts, fear, thoughts of inadequacy, low self-esteem, mind games, negative thoughts about self, unrealistic demands of self

med treatment for panic disorder targets what? (3)

serotonergic, noradrenergic, and GABA

DSM 5 new criteria for trauma-stressor related disorders: (7)

sexual assault/recurring exposure, persistent distorted blame of self or others, persistent negative emotional state, aggression, reckless/self-destructive behavior, dissociative subtype, 6 or younger subtype

clinical description for GAD: (3) shift from _____ ____ to ____, worry about _____ ______ concerns, problems _______

shift from possible crisis to crisis, worry about minor everyday concerns, problems sleeping

most common location for imagined defects with BDD (3)

skin, hair, nose

extreme and irrational fear in social/performance situations

social anxiety

used to be social phobia, now called

social anxiety

to have panic disorder the attacks cannot be better accounted for by another mental disorder: (4)

social phobia, specific phobia, obsessive-compulsive disorder, PTSD

DSM criteria for panic disorder w/ agoraphobia: E. the feat or anxiety is out of proportion to the actual danger posed by the agoraphobic situations, and to the ________ _______

socioculture, context

extreme irrational fear of a specific object or situation

specific phobias

what affects about 11% of the general population

specific phobias

parasympathetic: (6)

stimulates flow of saliva, slows heartbeat, constricts bronchi, stimulates peristalsis and secretion, stimulates release of bile, contracts bladder

individuals with hoarding disorder usually begin acquiring things during their _______ years and often experience great _______ from _______ or ________ various items

teenage, pleasure, shopping, collecting

generalized anxiety disorder aka

the "basic" anxiety disorder

at each step in the progression (for treatment of a patient with specific phobia) (4)

the patient is desensitized to the phobia, using self-talk and relaxation, realize that nothing bad happens to them, fear gradually extinguishes

flight-or-fight response aka

the stress response mechanism

Person with OCD is aware that obsessional

thoughts, impulses, or images are a product of his/her own mind

removed from DSM-IV stuff for trauma- stressor related disorders (4)

trauma "requires intense fear, helplessness, or horror happen right after the trauma", unexpected death of family or close friend due to natural causes, acute/chronic specifiers, sense of "foreshortened" future

anxiety disorders are ______ and _______ related

trauma, stressor

agoraphobia =

treatment through exposure

hair pulling disease

trichotillomania

medication treatment for social anxiety disorder (2)

tricyclic antidepressants and monoamine oxidase inhibitors

stage process model for learning and phobias says that the fear can be

unlearned by simply reversing the process

after fear hierarchy is made, they would then present increasingly ___________ _______: (4)

unpleasant situations, poster of a snake, small snake in a box in the other room, snake in a clear box, touching the snake

change in the DSM 5 for stress-trauma related disorders. went from _____ _____ to ___

went from 3 clusters to 4

"your body was designed for the savannas of africa... not the streets and sidewalks of some urban metropolis and the rigors of modern life" - this is a major issue due to one of your body great fail-safe systems: the stress response mechanism, also called fight or flight response

why zebras don't get ulcers

DSM-5 Criteria: PTSD specifiers (2)

with dissociative symptoms, with delayed expression

specifiers for OCD - insight:

with good & fair, with poor insight

specify if.... for BDD: (3)

with good or fair insight, with poor insight, with absent insight/delusional beliefs

common benzodiazepines include (4)

xanax, librium, valium, ativan