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CHAPT.

5 Anxiety, Obsessive-Compulsive Disorders


I) Anxiety

A sometimes vague and always unpleasant feeling of


fear and apprehension accompanied by physical
symptoms
Fear vs. Anxiety -

II) Generalized Anxiety Disorder

Chronic, prolonged, free-floating anxiety and dread.


- Not attached to a specific stimulus, and yet can
become attached to immediate events/stimuli - DSM:

2)

4 Types of Symptoms
Motor Tension

3)

Autonomic reactivity

4)

Apprehension about the future

5)

Hypervigilance

1)

B)

Common Disorder Most commonly diagnosed anxiety


disorder in
medical settings.
Lifetime prevalence

C)

III)

Onset

Panic Disorder (Cued and Uncued)


Sudden intense arousal. Symptoms may resemble a
heart attack.
Cued or uncued
Panic Disorder (PD) vs. Generalized Anxiety Disorder
(GAD)

IV)

Obsessive Compulsive Disorder (OCD)


Obsessions Intrusive, unwanted, repeated thoughts
Compulsions Repetitive acts/behavior performed to
reduce anxiety

Magical Thinking Thinking that defies logic


Patient believes -

Common forms of compulsions:


(1)
(2)
(3)
(4)
(5)

Counting
Ordering/organizing
Checking
Touching
Washing/cleaning
*Hoarding:

Onset:

Prevalence:

(a)

More common :

(b)

Less common:

OCD Spectrum Disorders Co-vary w/rates of OCD.

Phobias
Irrational unrealistic fear of an object or situation
May begin with real trauma
May begin with GAD

V)

Importance of avoidance:
When you avoid a feared stimulus Treatment:

A)

Specific Phobias
Subtypes:
1) Animal Type Animals or insects
2)

Natural Environment Type Objects in the natural


environment.

3)

Blood-Injection-Injury Type cued by seeing blood or


an injury; an injection or medical procedure may
include fainting.

4)

Situational Type Such as elevators, tunnels, bridges,


flying, driving, enclosed places.

5)

Other Type Cued by other stimuli fear of situations


that could lead to choking, vomiting or illness.

B)

Social Phobias - Fear & Embarrassment around others.


Basis: Fear of being observed and evaluated negatively
Most common social phobias:
a)
b)

Taijin Kyofusho Japanese Social Anxiety Disorder about


offending or embarrassing other people. The person with
TK must have one or more of the following: (Things they
do that would cause embarrassment for people around
them.)

C) Agoraphobia
Fear
Fear
Fear
Fear

of
of
of
of

open spaces
novel situations
the marketplace
losing control in public

Onset: 20s-40s

VI.
POST TRAUMATIC STRESS DISORDER (PTSD)
[Related to Trauma]
SubtypesAcute PTSD Sxs dev. within 6 months of trauma
Prognosis:
Delayed PTSD Sxs dev. after 6 months from
trauma
Prognosis:
Typical Symptoms: (Acute and Delayed)

Hyperarousal & vigilance


Flashbacks of event (cued or uncued)
Difficulty concentrating
Sleep problems
Psychic numbing dissociative states
Irritability
Intimacy problems
Substance abuse (dual diagnosis) often go
hand in hand
Avoidance of anything related to trauma
Increased arousal exaggerated startle
response
Health Effects:

Combat PTSD
- 12-20% of returning soldiers are diagnosed with
PTSD
- ~30% of wounded receive a diagnosis of PTSD
- Many do not seek help Delay in seeking help
Violence and PTSD

Treatment of PTSD

VI)

VULNERABILITY TO STRESS DISORDERS


A.

Biological and Genetic Factors


Cardiovascular Reactivity -

B.

C.

Personality

Background Factors
1.) History of poverty &/or early trauma or abuse
2.) Family history of psychological disorders
3.) History of divorce in the family prior to age 10
4.) History of family upheaval

D.

Social Support

E. Severity of Trauma

A)

TREATMENT OF ANXIETY DISORDERS

B)

Behavioral Anxiety is learned from the environment


1) Basis
Anxiety -> is learned (conditioned)
Avoidance -> negatively reinforces the behaviors
Anxiety ->

2)

Exposure Treatment

(a)

Systematic Desensitization gradual exposure to


source of anxiety

(i)

Reciprocal Inhibition underlying principle


- Two incompatible responses cannot co-exist
they reciprocally inhibit one another

(b)

Flooding

(c)

Virtual Reality Exposure (VRT)

(d)

Modeling Observe someone engage in the


desired behavior.
Most effective:

B)

Cognitive Address thoughts associated with anxiety

1)

Treatments
Cognitive restructuring
Thought-stopping

Cognitive rehearsal in anticipation of an anxietyprovoking


situation.
2)

Acceptance Commitment Therapy (ACT) 3rd


generation CBT?
a)Acceptance
b)

Mindfulness

c)Studies: ACT is effective for -

C)

Biological
1)

Drug Treatments:
Anxiolytics
More commonly used for:

Antidepressants SSRIs (Selective Serotonin


Reuptake Inhibitors)

More commonly used for:

Co-Morbidity Issues - If have 1 anxiety disorder, increases risk for


another
- Anxiety disorders run in families
- People with Anxiety disorders are more likely
to be depressed,
but not vice versa.