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