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Anxiety disorders

Anxiety Disorders & Obsessive-Compulsive and Related Disorders

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Anxiety disorders

  1. 1. Anxiety Disorders & Obsessive-Compulsive and Related Disorders MAP106 – Advanced Abnormal Psychology
  2. 2. Anxiety Disorders
  3. 3. Definition of Terms Anxiety • A negative mood state characterized by mostly symptoms of physical tension and apprehension about the future • Subjective sense of unease, a set of behaviors, or a physiological response originating in the brain and reflected in elevated heart rate and muscle tension Fear • An immediate alarm reaction to danger. Panic • It is a sudden experience of an overwhelming reaction when there is nothing to be afraid of. Panic Attack • Abrupt experience of intense fear or acute discomfort accompanied by physical symptoms such as heart palpitations, chest pain, shortness of breath, and possible dizziness. • It can be cued or uncued
  4. 4. Causes of Anxiety Disorders Biological • Low levels of gamma- aminobutyric acid (GABA) • Behavioral Inhibition System: activated by signals from the brain stem that may help signal danger. • Fight/Flight System Psychological • Psychic reaction to danger surrounding the reactivation of infantile fearful situation • An early product of classical conditioning, modeling, or other forms of learning • Lack of sense of control Social • Stressful life events may trigger our vulnerabilities
  5. 5. Generalized Anxiety Disorder • At least 6 months of excessive anxiety and worry (apprehensive expectation) that is ongoing more days than not • Characterized by the following: • Muscle tension • Mental Agitation • Susceptibility to fatigue • Some irritability • Difficulty sleeping STATISTICS: • 3.1% of the population • 5.7% at some point during course of lifetime • 1.1% of adolescents • During early adulthood, it is thought of as a response to a life stressor. • Prevalent in older adults. • More common among females
  6. 6. Generalized Anxiety Disorder CAUSES: • Low cardiac vagal tone • The vagus nerve innervates the heart and decreases its activity • People with GAD are also known as “autonomic restrictors” • High sensitivity to threat • Allocate attention more readily to sources of threat • Learning that the world is dangerous and out of control that they might not be able to cope. • Evidence of an intense cognitive processing on the frontal lobes in the left hemisphere as indicated by EEG waves. TREATMENT: • Benzodiazepines • Impairments in motor and cognitive functioning • Psychological Dependence • Some research suggests antidepressants like Paxil and Effexor • Cognitive-Behavioral Therapy • Patients evoke worry and confront threatening images and thoughts head on. • To counteract and control worry • Meditation and mindfulness • Teaches the clients to be tolerant of feelings of anxiety • CBT + Zoloft was found to be better
  7. 7. Panic Disorder with or without Agoraphobia • Experiencing severe, unexpected panic attacks that they may think they’re dying or losing control. • Must also develop anxiety over the possibility of having another panic attack or about its implications or consequences. • Must persist for at least 1 month • AGORAPHOBIA: fear/avoidance of situations where escape is impossible. • Must persist for at least 6 months • INTROCEPTIVE AVOIDANCE: avoidance of internal physical sensations STATISTICS: • Can be found in 2.7% of the population for a year. • May occur at some point during lifetime at 4.7% • Two-thirds are women • The onset is between midteens through 40s. • Asian and African countries have lowest rates • White Americans have a higher prevalence.
  8. 8. Panic Disorder with or without Agoraphobia CAUSES: • Learned Alarms • Interpretation of normal physical sensations in a catastrophic way • Early object loss and/or separation anxiety • TREATMENT: • SSRIs • Sexual dysfunctions • Xanax • Physical and psychological dependence • Exposure-based Treatment • Patient can gradually face feared situations and learn that there is nothing to fear. • Therapist help structure exercises that the clients will be provided with psychological coping mechanisms in completing the exercises. • May be combined with relaxation or breathing retraining • Panic Control Treatment • Cognitive Therapy
  9. 9. Specific Phobia • Irrational fear of a specific object or situation that can interfere individual functioning that persists for at least 6 months. • Blood-injection-injury • Situational • Natural Environment • Animal • Others STATISTICS: • Occurs in majority of people. • Most cases tend to be among females. • The median age of onset is 7 years old. • Hispanics are more likely to report.
  10. 10. Specific Phobia CAUSES: • Direct experience • Experiencing false alarms • Vicarious experience • Being told about the danger TREATMENT: • Structured and consistent exposure-based exercises
  11. 11. Separation Anxiety Disorder • Developmentally inappropriate and excessive fear or anxiety associated with separation from home or primary caregivers • CHILDREN: at least 4 weeks • ADULTS: at least 6 months TREATMENT: • CBT • Incorporation of parents
  12. 12. Social Anxiety Disorder (Social Phobia) • Marked fear or anxiety focused on one or more social/performance situations lasting for at least 6 months. • People suffering from this tends to focus on the possibility of embarrassing themselves STATISTICS: • 12.1% of the population • In a given 1-year period, the prevalence is 6.8% • 50:50 sex ratio • Common among White Americans compared with the minorities
  13. 13. Social Anxiety Disorder (Social Phobia) CAUSES: • Biological predisposition to being socially inhibited • Experience of an unexpected panic attack in social situation (becoming conditioned) • Real experience of social trauma (i. e., bullying). TREATMENT: • Cognitive Therapy • Emphasize real-life experiences to disprove automatic perceptions of danger • Interpersonal Psychotherapy • D-cycloserine (DCS) + CBT • The drug may facilitate the extinction of anxiety by modifying the neurotransmitter flow in the glutamate system.
  14. 14. Selective Mutism • Lack of speech in one or more settings in which speaking is socially expected that must occur for more than one month and cannot be limited to the first month of school TREATMENT: • Play socializing games that encourages verbal participation • Modeling • Stimulus Fading • Shaping
  15. 15. Obsessive-Compulsive and Related Disorders Obsessions • Intrusive, nonsensical thoughts, images, or urges that an individual tries to resist or eliminate. Compulsions • Thoughts or actions that are used to suppress the obsessions and provide relief
  16. 16. Obsessive-Compulsive Disorder • Recurrent obsessions or compulsions that causes significant distress • WITH GOOD INSIGHT: if the client is able to recognize that obsessive- compulsive beliefs are not true • Subtypes: • Symmetry • Forbidden thoughts • Cleaning/Contamination • Hoarding STATISTICS: • Lifetime prevalence of 1.6 to 2.3% • The range of onset is from childhood to 30s (median is 19 years of age). • Men develops earlier compared to women. • Has a chronic course • Cultural implication in Arab countries
  17. 17. Obsessive-Compulsive Disorder CAUSES: • Thought-Action Fusion • Equating thoughts with the specific actions or activity represented by the thoughts. • Leads to an attitude of excessive responsibility that may result to guilt TREATMENT: • Clomipramine/SSRIs • Exposure and Ritual Prevention • Rituals are actively prevented and the client is systematically and gradually exposed to feared thought/situation • Cingulotomy • Deep Brain Stimulation
  18. 18. Body Dysmorphic Disorder • Preoccupation with imagined or minor physical defect in appearance. • Their compulsive behavior may involve looking in mirrors to check physical features. • WITH MUSCLE DYSMORPHIA: preoccupation with the thought of one’s physique being too small or insufficiently muscular. • Most may seek plastic surgeons or dermatologists STATISTICS: • Difficult to be estimated due to its tendency to be kept as a secret. • Onset is from adolescence through the 20s
  19. 19. Body Dysmorphic Disorder CAUSES: • Displacement as a defense mechanism • Unconscious conflict becomes anxiety provoking to be admitted into consciousness that a person displaces into another body part TREATMENT: • Clomipramine • Fluvoxamine • Exposure and Response Prevention • CBT
  20. 20. Hoarding Disorder • Excessive acquisition of things • Difficulty to discard • Living with excessive clutter under conditions best characterized by gross disorganization STATISTICS: • The average age for seeking treatment is approximately 50.
  21. 21. Hoarding Disorder CAUSES: • Strong emotional attachment to possessions • Marked deficits in deciding whether a possession is worth keeping or not. TREATMENT: • CBT • Teach the clients to assign any value to reduce anxiety about throwing away items that are valued
  22. 22. Trichotillomania & Excoriation • TRICHOTILLOMANIA: urge to pull hair from everywhere • EXCORIATION: repetitive and compulsive picking of the skin resulting to tissue damage TREATMENT: • Habit Reversal Training • Clients are carefully taught of being aware with their behavior and make them substitute a different behavior that are reasonably pleasurable, but harmless