Abnormal psych CHAPTER 6
panic attack
A severe, intense fear response that appears to come out of the blue; it has many physical and cognitive symptoms such as fear of dying or losing control
® What is a panic attack?
A severe, intense fear response that appears to come out of the blue; it has many physical and cognitive symptoms such as fear of dying or losing control
® What treatment technique is considered the most effective?
Exposure therapy § Type of behavior therapy that involves controlled exposure to the stimuli or situations that elicit phobic fear
limited symptom attack
Is a milder, less comprehensive form of panic attack, with fewer than four panic related symptoms being experienced
® Which subtype has a unique physiological response?
o Blood-injection because it gets your heart beat up but then in drops and the blood pressure drops as well
prepared learning
The view that people are biologically prepared through evolution to more readily acquire fears of certain objects or situations that may once have posed a threat to our early ancestors. For example, people more readily develop fears of snakes and spiders if they are paired with aversive events, that they develop fears of knives or guns.
® What is the biological basis for that effectiveness of exposure therapy?
Action of the amygdala
How do animal displacement activities relate to OCD
A lot of animals engage in displacement activities during situations that involve conflict or high arousal. Displacement activities (grooming or nesting) look similar to the compulsions in OCD. In OCD, people often engage in grooming (excessive hand washing) or cleaning rituals to deal with obsessive thoughts caused by anxiety. Both displacement activities and the compulsions in OCD are brought about by distress/anxiety and are seen as similar, so it's thought that the 2 might be related.
anxiety sensitivity
A personality trait involving a high level of belief that certain bodily symptoms may have harmful consequences.
participant modeling
A procedure for changing behavior in which effective styles of behavior are demonstrated step-by-step and analyzed by a therapist for an individual, who then practices the modeled behavior
danger schemas
Anxious people tend to preferentially allocate their attention toward threatening cues when both threat and nonthreat cues are present in the environment
® SOCIAL PHOBIA..Prevalence, age of onset, and gender differences
Approximately 12 percent of the population meets the diagnostic criteria for social anxiety at some point in their lives. More common among women Typically, beings during adolescence or early adulthood
preparedness
Developed to explain why certain associations are learned more readily than others
cognitive restructuring
Cognitive-behavioral therapy techniques that aim to change a person's negative or unrealistic thoughts and attribution
compulsion anxiety
Compulsions are repetitive rule-bound behaviors that the individual feels must be performed in order to ward off distressing situations.
derealization
Experience in which the external world is perceived as distorted and lacking a stable and palpable existence
® Comorbidity with other disorders (GAD)
GAD often co-occurs with other disorders, especially other anxiety and mood disorders such as panic disorder, social anxiety, specific phobia, PTSD and major depressive disorder
serotonin transporter gene
Gene most commonly associated with depression. Little (s) makes you more prompt to having fear condition. Associated with neuroticism and fear conditioning and anxiety.
anticipatory anxiety
Happens when people experience increased anxiety and stress when they think about an event that will happen in the future.
® What is panic disorder?
Is defined and characterized by the occurrence of panic attacks that often seem to come "out of the blue'
® How did social phobias evolve?
It has been proposed that social fears and phobia evolved as a by-product of dominance hierarchies that are a common social arrangement among animals such as primates
Taijin Kyofusho
Japanese disorder related to the Western diagnosis of social anxiety disorder. They are concerned about doing something that will embarrass of offend others.
exteroceptive conditioning
Modifying the perception of environmental stimuli acting on the body
® Comorbidity with other disorders (OCD)
OCD frequently co-occurs with other anxiety disorders, most commonly social anxiety, panic disorder, GAD and PTSD
vicarious classical conditioning
Occurs when a conditioned reflex is developed because there is an association between the conditioned stimulus and the unconditioned stimulus of reflexive response
obsession
Persistent and recurrent intrusive thoughts, images, or impulses that a person experiences as disturbing and inappropriate but has difficulty suppressing.
behavioral inhibition
Personality type that shows a tendency toward distress and nervousness in new situations.
® What causes social phobia, according to the different perspectives?
Psychological causal factors § Social anxiety as learned behavior · Seems to originate from simple instances of direct or vicarious classical conditioning such as experiencing or witnessing a perceived social defeat or humiliation § Social fears and phobia in an evolutionary context · Involve fears of members of one's own species · It has been proposed that social fears and phobia evolved as a by-product of dominance hierarchies that are a common social arrangement among animals such as primates § Perceptions of uncontrollability and unpredictability · Being exposed to uncontrollable and unpredictable stressful events may play an important role in the development of social anxiety § Cognitive biases · Cognitive factors also play a role in the onset and maintenance of social anxiety · People with social anxiety tend to expect that other people will reject or negatively evaluate them. they argued that this leads to a sense of vulnerability when they are around people who might pose a threat Biological causal factors § The most important temperamental variable is behavioral inhibition, which shares characteristics with both neuroticism and introversion
® What is generalized anxiety disorder?
Some people worry about different aspects of life and when that worry becomes chronic, excessive and unreasonable, generalized anxiety disorder may be diagnosed
depersonalization
Temporary loss of sense of one's own self and one's own reality
nocturnal panic attack
These attacks can potentially contribute to sleep disturbances and leave you feeling tired throughout the day
interoceptive conditioning
This term refers to a learning process that is similar to classic conditioning. It involves two conditioned stimuli and one unconditioned response.
automatic thoughts
Thoughts that are instantaneous, habitual, and nonconscious.
® What is a specific phobia?
o A phobia is a persistent and disproportionate fear of some specific object or situation that presents little or no actual danger and yet leads to a great deal of avoidance of these feared situations. o Specific phobia is when a person experiences a fear or panic response not only when they encounter the object or situation that they fear, but also in response to even the possibility of encountering their phobic situation o Is present if a person shows strong and persistent fear that is triggered by the presence of a specific object or situation and leads to significant distress and/or impairment in a person's ability to function
® Criteria for generalized anxiety disorder
o A. excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities o B. the individual finds it difficult to control the worry o C. the anxiety and worry are associated with three (or more) of the following six symptoms § Restlessness or feeling keyed up or on edge § Being easily fatigue § Difficulty concentrating or mind going blank § Irritability § Muscle tension § Sleep disturbance o D. the anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning o E. the disturbance is not attributable to the physiological effects of a substance or another medical condition o F. the disturbance is not better explained by another mental disorder
® Criteria for Social phobia
o A. marked fear and anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions, being observed and performing in front of others o B. the individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated o C. the social situations almost always provoke fear or anxiety o D. the social situations are avoided or endured with intense fear or anxiety o E. the fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context o F. the fear, anxiety or avoidance is persistent, typically lasting for 6 months or more o G. the fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning o H. the fear, anxiety or avoidance is not attributable to the physiological effects of a substance or another medical condition o I. the fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder o J. if another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive
® Criteria for Specific Phobia
o A. marked fear or anxiety about a specific object or situation o B. the phobic object or situation almost always provokes immediate fear or anxiety o C. the phobic object or situation is actively avoided or endured with intense fear or anxiety o D. the fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context o E. the fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more o F. the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning o G. the disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms; object or situations related to obsessions; reminders of traumatic events; separation from home or attachment figures; or social situations
® Criteria for agoraphobia?
o A. marked fear or anxiety about two (or more) of the following five situations: § Using public transportation § Being in open spaces § Being in enclosed places § Standing in line or being in a crow § Being outside of the home alone o B. the individuals fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms o C. the agoraphobic situations almost always provoke fear or anxiety o D. the agoraphobic situations are actively avoided, require the presence of a companion, or an endured with intense fear or anxiety o E. the fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context o F. the fear, anxiety or avoidance is persistent, typically lasting for 6 months or more o G. the fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning o H. if another medical condition is present, the fear, anxiety or avoidance is clearly excessive o I. the fear, anxiety and avoidance is not better explained by the symptoms of another medical disorder
® Criteria for body dysmorphic disorder
o A. preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others o B. at some point during the course of the disorder, the individual has performed repetitive behaviors in response to the appearance concerns o C. the preoccupation causes clinically significant distress or impairment in social, occupation or other important areas of functioning o D. the appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder
® Criteria for OCD
o A. presence of obsessions, compulsions or both o B. the obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupation or other important areas of functioning o C. the obsessive-compulsive symptoms ae not attributable to the physiological effects of a substance o D. the disturbance is not better explained by the symptoms of another mental disorder
® Criteria for panic disorder
o A. recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur: § Palpitations, pounding heart, or accelerated heart rate § Sweating § Trembling and shaking § Sensations of shortness of breath or smothering § Feelings of choking § Chest pain or discomfort § Nausea or abdominal distress § Feeling dizzy, unsteady, light-headed or faint § Chills or heat sensations § Paresthesia (numbness or tingling sensations) § Derealization 9feelings of unreality) or depersonalization (being detached from oneself) § Fear of losing control or 'going crazy" § Fear of dying o B. at least one of the attacks has been followed by 1 month (or more) of one or both of the following: § Persistent concern or worry about additional panic attacks or their consequences § A significant maladaptive change in behavior related to the attacks o C. the disturbance is not attributable to the physiological effects of a substance or another medical condition o D. the disturbance is not better explained by another mental disorder
® What are the subtypes of specific phobia?
o Animal § Snakes, spiders, digs, insects, birds o Natural environment § Storms, heights, water o Blood-injection-injury § Seeing blood or an injury, receiving an injection, seeing a person in a wheelchair o Situational § Public transportation, tunnels, bridges, elevators, flying, driving, enclosed spaces o Other § Choking, vomiting, "space phobia" (fear of falling down if away from walls or other support)
® What is Freud's definition of the term neurosis?
o Anxiety causes emotional disturbance o Used 'neurosis' to refer to both symptoms and process § Unconscious conflict - anxiety § Person tries to cope by using defense mechanisms § Ineffective or overly intense defense - symptoms
® What is the difference between anxiety and fear?
o Anxiety involves a general feeling of apprehension about possible future danger, whereas fear is an alarm reaction that occurs in response to immediate danger. Fear § Fear is a basic emotion that involves activation of the fight-or-flight response of the autonomic nervous system. § Fear's adaptive value as a primitive alarm response to imminent danger is that it allows us to escape § When the fear response occurs in the absence of any obvious external danger, the person has had a spontaneous or uncued panic attack § Panic and fear have three components: · Cognitive/subjective components · Physiological components · Behavioral components Anxiety § The anxiety response pattern is a complex blend of unpleasant emotions and cognitions that is both oriented to the future and much more diffuse than fear § At the cognitive/subjective level, anxiety involves negative mood, worry about possible future threats or danger, self-preoccupation, and a sense of being unable to predict the future threat or to control it if it occurs. § At a physiological level, anxiety creates a state of tension and chronic overarousal § At a behavioral level, it may create a strong tendency to avoid situations where danger might be encountered, but the immediate behavioral urge to flee is not present with anxiety as it is with fear
® Prevalence, age of onset, and gender differences for body dysmorphic disorder
o Approximately 2 percent of people in the community meet diagnostic criteria for BDD, as do approximately 20 percent of people seeking rhinoplasty o Approximately equal in women and men, but the focus on body parts differs in women and men o The age of onset is usually in adolescence, when many people start to become preoccupied with their appearance
® Prevalence, age of onset, and gender differences for OCD
o Approximately 2 to 3 percent of people meet criteria for OCD at some point in their lifetime, and approximately 1 percent meet criteria in a given year o Over 90 percent of treatment-seeking people with OCD experience both obsessions and compulsions o Divorced and unemployed people are somewhat overrepresented among people with OCD o Little or no gender difference
® Prevalence, age of onset, and gender differences generalized anxiety disorder
o Approximately 3 percent of population suffers from GAD in any 1-year period and 5.7 percent at some point in their lives o Tends to be chronic o After age 50, symptoms of the disorder seem to decrease for many people o GAD is approximately twice as common in women than in men o Age of onset is hard to determine because 60 to 80 percent of people with GAD remember having been anxious nearly all their lives o GAD often develops in older adults
® Prevalence, age of onset, and gender differences of panic disorder and agoraphobia
o Approximately 4.7 percent of the adult population has had panic disorder with our without agoraphobia at some time in their lives, with panic disorder without agoraphobia being more common o Panic disorder with or without agoraphobia typically beings in the 20s to the 40s, but sometimes beings in the late teen years o Once panic disorder develops, it tends to have a chronic and disabling course, although intensity of symptoms often waxes and wanes over time
® Treatment for agoraphobia
o Behavioral and cognitive-behavioral treatments § Prolonged exposure to feared situations § Panic control treatment (PCT) targets both agoraphobic disorder and panic attacks § clients are first educated about the nature of their anxiety and panic and how the capacity to experience both is adaptive. Then, the clinician will teach the client breathing exercises. After, clients are taught the logical errors and learn to subject their own automatic thoughts to a logical reanalysis. Lastly, they are exposed to feared situation to build up tolerance. o Medications § People with panic disorder are prescribed anxiolytics from the benzodiazepine category such as alprazolam or clonazepam § Antidepressants also work for panic disorder and agoraphobia
® Treatments for OCD
o Behavioral and cognitive-behavioral treatments § The most effective treatment for OCD is a behavioral treatment called exposure and response prevention. § The exposure component involves having individuals with OCCD repeatedly expose themselves to stimuli that provoke their obsessions. § The response prevention component requires that they then refrain from engaging in the rituals that they ordinarily would perform to reduce their anxiety or distress o Medications § OCD seems to respond best to medications that affect the serotonin system § These medications reduce the intensity of OCD symptoms
® What causes panic disorder, according to the different perspectives?
o Biological causal factors § Genetic factors · Panic has a moderate heritable component · Some studies have suggested that this heritability is at least partly specific for panic disorder § Panic and the brain · One relatively early prominent theory about the neurobiology of panic attacks implicated the locus coeruleus in the brain stem and a particular neurotransmitter - norepinephrine - that is centrally involved in brain activity in this area · Increased activity in the amygdala plays a more central role in panic attacks than does activity in the locus coeruleus · The amygdala is a collection of nuclei in front of the hippocampus in the limbic system of the brain that is critically involved in the emotion of fear. § Biomedical abnormalities · People with panic disorder are much more likely to experience a panic attack when they are exposed to biological challenge procedures than are normal people or people with psychiatric disorders. · Such procedures produce panic attacks in panic disorder clients at a much higher rate than inn normal patients · There is a broad range of these so-called panic provocation procedures and some of them are associated with quite different and even mutually exclusive neurobiological processes. o Psychological causal factors § Cognitive theory of panic · Proposes that people with panic disorder are hypersensitive to their bodily sensations and are very prone to giving them the most dire interpretations possible § Comprehensive learning theory of panic disorder · Initial panic attacks become associated with initially neutral internal and external cues through an interoceptive conditioning process, which leads anxiety to become conditioned to the CSs and the more intense the panic attack, the more robust the conditioning that will occur. § Anxiety sensitivity and perceived control · anxiety sensitivity is a personality trait involving a high level of belief that certain bodily symptoms may have harmful consequences. · People with anxiety sensitivity are more prone to developing panic attacks and perhaps panic disorder § Safety behaviors and the persistence of panic · People suffering from constant panic attacks may think they are having a heart attack, but they never do. This catastrophic thought would have been proved wrong so many times that it would finally go away. Evidence suggests that such disconfirmation does not occur because people with panic disorder frequently engage in safety behaviors before or during the attack. They tend to attribute the lack of catastrophe to their having engaged in this safety behavior rather than to the idea that panic attacks actually don't lead to heart attacks § Cognitive biases and the maintenance of panic · People with panic disorder are biased in the way they process threatening information.
® What causes it, according to the different paradigms? (body dysmorphic disorder)
o Causal factors: a biopsychosocial approach to BDD § One twin study found that overconcern with a perceived or slight defect in physical appearance is a moderately heritable trait § BDD seems to be occurring in a sociocultural context that places great value on attractiveness and beauty, and people who develop BDD often hold attractiveness as their primary value
® Treatment for Social phobia
o Cognitive and behavioral therapies § Prolonged and graduated exposure to the feared situation has proven to be very effective treatment § Cognitive restructuring: the therapist attempts to help clients with social anxiety identify their underlying negative, automatic thoughts. After helping the clients understand that such automatic thoughts often involve cognitive distortions, the therapist helps the clients change these inner thoughts and beliefs through logical reanalysis. o Medication § The most effective and widely used medications are several categories of antidepressants
® Treatments for generalized anxiety disorder
o Cognitive-behavioral treatment § CBT for generalized anxiety disorder has become increasingly effective as clinical researchers have refined the techniques used § It involves a combination of behavioral techniques, such as training in applied muscle relaxation, and cognitive restructuring techniques aimed to reducing distorted cognitions and information-processing biases associated with GAD as well as reducing catastrophizing about minor events o Medications § medications from the benzodiazepine category such as Xanax or Klonopin are used and misused for tension relief, reduction of other somatic symptoms § Their effects on worry and other psychological symptoms are not as great and relaxation
What is agoraphobia?
o In agoraphobia the most commonly feared and avoided situations include streets and crowded places such as shopping malls, movie theaters and stores. Standing in line can be particularly difficult. o Sometimes, agoraphobia develops as a complication of having panic attacks in one or more such situations o Concerned that they may have a panic attack or get sick, people with agoraphobia are anxious about being in places or situations from which escape would be difficult or embarrassing, or in which immediate help would be unavailable if something bad happened
® What factors can affect a person's vulnerability to a conditioned phobia?
o Individual differences in life experiences strongly affect whether conditioned fears or phobias actually develop o Some life experiences may serve as risk factors and make certain people more vulnerable to phobias than others, whereas other experiences may serve as protective factors for the development of phobias. o If it is uncontrollable and inescapable makes the person more vulnerable to develop a phobia
® What is social phobia?
o Is characterized by disabling fears of one or more specific social situations o In these situations, a person fears that she or he may be exposed to the scrutiny and potential negative evaluation of others or that she or he may act in an embarrassing or humiliating manner. o Because of their fear, they avoid these situations or endure them with great distress o Intense fear of public speaking is the single most common type of social anxiety o dSM-5 identifies two types oof social anxiety; one of which centers on performance situations and one of which is more general and includes nonperformance situations
OCD
o Is defined by the occurrence of both obsessive thoughts and compulsive behaviors performed in an attempt to neutralize such thoughts o Obsessions are persistent and recurrent intrusive thoughts, images or impulses that are experienced as disturbing, inappropriate and uncontrollable. People who have such obsessions actively try to resist or suppress them or to neutralize them with some other thought or action. o Compulsions involve overt repetitive behaviors that are performed as lengthy rituals. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive
® The DSM-5 moved some of these disorders to new categories; be sure to understand where they were moved and the logic behind this.
o OCD isn't considered an anxiety disorder anymore o New category called "obsessive-compulsive and related disorders" o One reason for moving OCD into the new category was that anxiety is not generally used as an indicator of OCD severity o Anxiety occurs in a wide range of disorders, so the presence of some anxiety is not a valid reason to regard OCD as an anxiety disorder o Another reason is that the neurobiological underpinning of OCD appears to be rather different from those of other anxiety disorders o Other anxiety disorders respond to a wide range of medication treatments than does OCD, which seems to respond selectively to SSRIs
® Comorbidity with other disorders (BDD)
o People with BDD very commonly have a depressive diagnosis o People with BDD, like those with OCD, have prominent obsessions, and they engage in a variety of ritualistic behaviors such as reassurance seeking, mirror checking, comparing themselves to others, and camouflage o OCD and BDD overlap in potential causes o Some researchers have found similarities between BDD and eating disorders, especially anorexia nervosa.
® What causes it, according to the different paradigms? (OCD)
o Psychological causal factors § OCD as learned behavior · The dominant behavior or learning view of obsessive-compulsive disorder is derived from Mowrer's two-process theory of avoidance learning. · Neutral stimuli become associated with frightening thoughts or experiences through classical conditioning and come to elicit anxiety § OCD and preparedness · The fact that many people with OCD have obsessions and compulsions focused on dirt, contamination and other potentially dangerous situations had led many researchers to conclude that these features of the disorder likely have deep evolutionary roots § The effects of attempting to suppress obsessive thoughts · When most people attempt to suppress unwanted thoughts they sometimes experience a paradoxical increase in those thoughts later § Appraisals of responsibility for intrusive thoughts · People with OCD often seem to have an inflated sense of responsibility. In turn, in some vulnerable people, this inflated sense of responsibility can be associated with beliefs that simply having a thought about doing something is morally equivalent to actually having done it, or that thinking about the behavior increases the chances of actually doing so § Cognitive biases and distortions · Cognitive factors have also been implicated in OCD. More specifically, people with OCD have an attentional bias toward disturbing material relevant to their obsessive concerns, much as occurs in the other anxiety disorders o Biological causal factors § Genetic factors · Moderately high concordance rate for OCD for monozygotic twins and a lower rate for dizygotic twins § OCD and the brain · Abnormalities occur primarily in certain cortical and subcortical structures such as the basal ganglia § Neurotransmitter abnormalities · Increased serotonin and increased sensitivity of some brain structures to serotonin are involved in OCD symptoms
® How do phobias develop, according to the different paradigms?
o Psychological causal factors § Psychoanalytic viewpoint · Phobias represent a defense against anxiety that stems from repressed impulses from the id § Phobias as learned behavior · The fear response can readily be conditioned to previously neutral stimuli when these stimuli are paired with traumatic or painful events · Vicarious conditioning o Direct traumatic conditioning in which a person has a terrifying experience in the presence of a neutral object or situation is not the only way that people can learn irrational, phobic fears. · Individual differences in learning o Individual differences in life experiences strongly affect whether conditioned fears or phobias actually develop o Some life experiences may serve as risk factors and make certain people more vulnerable to phobias than others, whereas other experiences may serve as protective factors for the development of phobias. · Evolutionary preparedness for learning certain fears and phobias o Prepared learning occurs because, over the course of evolution, those primates and humans who rapidly acquired fears of certain objects or situations that posed real threats to our early ancestors may have enjoyed a selective disadvantage. o Biological causal factors § Genetic and temperamental variables also affect the speed and strength of conditioning of fear
® What causes GAD, according to the different paradigms?
o Psychological causal factors § The psychoanalytic viewpoint · Generalized or free-floating anxiety results from an unconscious conflict between ego and id impulses that is not adequately dealt with because the person's defense mechanisms have either broken down or have never developed. · Freud believed that it was primarily sexual and aggressive impulses that had been either blocked from expression or punished upon expression that led to free-floating anxiety § Perceptions of uncontrollability and unpredictability · Uncontrollable and unpredictable aversive events are much more stressful than controllable and predictable aversive events, so it creates more fear and anxiety § A sense of mastery: the possibility of immunizing against anxiety · A person's history of control over important aspects of his or her environment is another significant experiential variable strongly affecting reactions to anxiety-provoking situations § The reinforcing properties of worry · The worry process is considered the central feature of GAD · Several of the benefits that people with GAD most commonly think derive from worrying are as follows: o Superstitious avoidance of catastrophe o Avoidance of deeper emotional topics o Coping and preparation · These positive beliefs about worry play a key role in maintaining high levels of anxiety and worry § The negative consequences of worry · People who worry about something tend to have more negative intrusive thoughts than people who do not worry · Attempts to control thoughts and worry may paradoxically lead to increased experience of intrusive thoughts and enhanced perception of being unable to control them § Cognitive biases for threatening information · They process threatening information in a biased way, perhaps because they have prominent danger schemas · Anxious people tend to preferentially allocate their attention toward threatening cues when both threat and nonthreat cues are present in thee environment o Biological causal factors § Genetic factors · Risk for GAD does seem to run in families and has a heritability of approximately 30% § Neurotransmitter and neurohormonal abnormalities · A functional deficiency in GABA o It appears that highly anxious people have a kind of functional deficiency GABA, which ordinarily plays an important role in the way our brain inhibits anxiety in stressful situations · The corticotropin-releasing hormone system and anxiety o An anxiety-producing hormone called corticotropin-releasing hormone (CRH) has also been strongly implicated as playing an important role in generalized anxiety § Neurobiological differences between anxiety and panic · Generalized anxiety is a more diffuse emotional state than acute fear or phobia that involves arousal and a preparation for possible impeding threat; and the brain area, neurotransmitters, and hormones that seem most strongly implicated are the limbic system, GABA and CRH
® Prevalence, Age of Onset, and Gender differences
o Specific phobias are common, occurring in about 12 percent of people at some point in their lifetime o More common in women that in men, but ratio varies depending on the type of phobia o Animal phobias and blood-injection-injury phobia start in childhood o Other phobias like claustrophobia and driving phobia tend to begin in adolescence or early adulthood
® Treatments for body dysmorphic disorder
o The treatments that are effective for BDD are closely related to those used in the effective treatment of OCD. o Antidepressant medications from the SSRI category often produce moderate improvement in patients with BDD o A form of cognitive-behavioral treatment emphasizing exposure and response prevention has been shown to produce marked improvement in 50 to 80 percent of treated patients
® Comorbidity with other disorders
o The vast majority of people with panic disorder have at least one comorbid disorder, most often generalized anxiety disorder, social anxiety, specific phobia, PTSD, depression and substance-use disorders o Depression is common among those with panic disorder
® What is body dysmorphic disorder?
o Was classified as a somatoform disorder in DSM-IV-TR because it involves preoccupation with certain aspects of the body o People with BDD are obsessed with some perceived or imagined flaw or flaws in their appearance to the point they firmly believe they are disfigured or ugly o This preoccupation is so intense that it causes clinically significant distress and impairment in social and occupational functioning