What is Anxiety Disorders?
Complex patterns of 4 types of reactions to perceive threat
What is Somatic Anxiety Disorder like?
Increased heart rate and respiration,muscle tension, shaking,dry mouth.
What is Emotional Anxiety Disorder like?
Fear,terror, irritability, restlessness and dread.
What are the four types of Anxiety Disorders?
- Somatic-(results in body tension)
- Emotional-(results in fear irritability)
- Behavioral-(results in escaping or avoidance)
- Cognitive-(results in anticipating loss of focus)
What is a specific phobia and it's symptoms?
Persistent irrational fear of an object or situation.
- >Exposure provokes immediate anxiety.
- >Recognition that fear is excessive.
- >Avoids and Endures with intense distress.
- >Produces marks distress or interferes with normal functioning.
What are the most typical types of phobias?
- >Natural Environment (storms, heights, water)
- >Situation (driving, elevators,tunnels,bridges, planes)
- >Blood (needles-shots, seeing blood)
What is the lifetime prevalence in Anxiety Disorders?
What is the course of anxiety disorders?
Course begins in childhood, stable/persistent, and 90% do not seek treatment.
Comorbidity in Anxiety disorders?
- >other anxiety
- >major depression
- >oppositional defiant disorder
What is flooding in regards to anxiety disorders?
exposed to the object of their fear directly and they are made to confront it.
What is Implosion therapy in regards to anxiety disorders?
Never brought in direct contact with the object or situation they fear, they imagine the situation instead.
What is Social Phobia and it's symptoms?
Fear of social situations.
- >Exposure provokes immediate anxiety
- >Recognition that fear is excessive or unreasonable
- >Avoids or endured with intense distress
- >Produces marked distress or interferes with normal functioning
What are the most typical types of social phobias?
Public speaking, big parties, public restrooms
What is the lifetime prevalence of Social Phobia in the US and Internationally?
- >12% in US
- >3% Internationally
What course does Social Phobia run?
- >Starts in adolescence/early preschool;associated with humiliation
- >prevalence increases with age
- >Relatively stable
What is the comorbidity in regards to Social Phobia?
- >Another Anxiety Disorder
- >Avoidant Personality Disorder
- >Drug/Alcohol abuse
What is General Anxiety Disorder and it's symptoms?
Excessive worry and anxiety, occurring most day for at least 6 months.
- >Unable to control the worry
- >Anxiety/worry is free floating(not specific)
- >Anxiety/Worry is 1 or more than below:
- ---Easily Fatigued
- ---Cannot concentrate
- ---Muscle tension
- ---Sleep disturbance
What is the lifetime prevalence of General Anxiety Disorder in Men and Woman?
What is the course of Generalized Anxiety Disorder?
Onset in child/adolescent; chronic
What is the comorbidity in Generalized Anxiety disorder and their percentages?
- Other Anxiety Disorders(50%)
- Mood Disorder(70%)
- Substance abuse(33%)
What is Obsessive Compulsive Disorder?
Characterized by either obsessions:
- Recurrent and persistent
- thoughts, impulses or images that are intrusive, inappropriate and causes
- marked anxiety or distress.
- Repetitive behaviors or
- mental acts performed in a rigid, ritualistic manner in order to reduce
- distress or prevent an imagined dreaded event from occurring.
What are the most common compulsions and obsessions for OCD?
Most common obsessions:
- > Germs or contamination
- > Fear or harm to self or others
- > Concerns with symmetry, excessive moralization
- or religiosity.
- Compulsions>Washing, counting
- >repeating words silently
- >checking, touching, arranging.
What is the lifetime prevalence in OCD?
What is the course of OCD in males and females?
- Males-6-15 yrs
- Females-20-29 yrs
Chronic if untreated,highly debilitating
What is the comorbidity and percentages in regards to OCD?
- --Generalized Anxiety Disorder
- --Panic Attacks
- --Substance abuse
- >60%-80% of cases occur with at least another disorder
- >50% with multiple
What is Panic Disorder and it's symptoms?
Recurrent and unexpected panic attacks
- >Persistent concern or worry about panic attacks; significant change in behavior as a
- --Heart palpitations --Sweating
- --Shortness of breath --Shaking
- --Chest Pain --Nausea
- --Feeling of Choking --Dizziness
- --Fear of losing control -- Derealization
- --Fear of dying --Chills/Hotflashes
- --Paresthesia(sense of tickling,prick,tingling)
What is Agoraphobia and it's symptoms?
anxiety re-being in situations where escape would be difficult to or unable to get help if they become anxious
>Avoid situations,endure with distress, require presence of loved ones
What is Panic Disorder and Agoraphobia?
28% of adults have occasional panic attacks
What is the lifetime prevalence of P&Agora?
- 3-5%(PD most common in women)
- 1/3 to 1/2 of people with Panic Disorder will develop Agoraphobia
What is the course of Panic &Agoraphobia?
Late Adolescence/early adulthood onset, chronic
What is comorbidity with Panic and Agoraphobia?
- Generalized Anxiety Disorder
- Alcohol abuse
- Increased risk for suicide attempts
What is Post Traumatic Stress Syndrome and its symptoms?
Exposure to traumatic event or witness being harmed or other being harmed.
- >Rexperiencing traumatic event
- >persistent avoidance and numbing and arousal(hyper-vigilant)
- >Causes significant impairment in functioning
What is the treatment for Post traumatic Stress Syndrome?
Bring down arousal
What are the Biological theories of causes of Anxiety Disorders?
- >Genetics-higher concordance rate in monozygotic twins vs. dizygotic twins
- ---Current thinking--emotional/behavioral reactivity to stimuli is inherited rather than specific anxiety disorder
>Neurotransmitters--deregulation of GABA(mellow out) and NE(energy) serotonin and CCK implicated in different anxiety disorders.
- >Brain Circuits-deregulated(OCD,PD,PTSD)
- >Hypothalamic-Pituitary-Adrenal (fight or flight)--system gets deregulated so hypothalamus does not stop secreting CRH
- --Increases stress hormone in blood stream
What are the Behavioral theories causes of anxiety disorders?
- >Classical Conditioning-(Pavlov) associations between teddy bear and feeling terrible
- >Operant conditioning-negative reinforcement (taking town away) escape/avoidance
- >Observational learning-models, fear of water because mom was
What are the Cognitive theories causes of anxiety disorders?
- >Interceptive awareness-increases attention to bodily sensations(ovulations/stomach pains)
- >Anxiety sensitivity-belief that body symptoms have harmful consequences(muscle twitches because too much coffee)
- >Distortions--catastrophizing,polarizing,should and control fallacies
- >Maladaptive assumptions-assume the worse,without problem solving
- >Difficulties turning off upset thoughts and give permission to let things go (grad school applications)
How to treat anxiety disorder?
- >Excessive escape and avoidance behavior(deal with issue now)
- >Emergency physiological reacts to perceive threats(over active car alarm)
- >Sense of lack of control(deep breathing)
- >Distorted info processing(hyper-vigilance for threat,cognitive avoidance,taking antennae for fear down)
What factors increase a person's vulnerability to PTSD?
Severity, duration and proximity to traumatic event; availability of social support, anxiety or depression, styles of coping (self-destructive, avoidant or dissociation); women are more likely to develop; culture differences;genetic factors.
What is the conditioned avoidance response and how does it relate to phobias?
- Associating places and situations with the anxiety;avoiding those places/situations.
- Negative reinforcement avoidance of feared object is reinforced by the reduction of anxiety...they avoid the object so much that when they encounter it, they experience very high levels of anxiety.They avoid is because they'll have lower levels of anxiety.
What is prepared classical conditioning, and how does it help explain the development certain phobias?
Some phobias make more sense than other; such as fearing snakes over flowers-we are programmed to fear certain things for evolutionary purposes.
What is the case of Agnes(Agoraphobia)?
What is the case of Paul(PTSD)?
What is the difference between implosion therapy and flooding?
Implosion therapy, a much higher anxiety is evoked;scenes are exaggerated by therapist to introduce worst of persons fears.
- ---Flooding: If the patient has a fear of teddy bears, the patient is put in a room full of teddy bears.
- ---Implosion therapy:tell client to imagine being in a room full of teddy bears.
What is Secondary gain?
- An external motivator/benefit to the symptom. unconscious and psychological.
- ---EX.Missing work, avoid military duty,financial compensation, avoid jail sentence.
What does Case Studies book indicate is a "critical predictor" of later development of PTSD?
- >elevated arousal and fear
- --disassociate from the trauma
- ----more disassociation, the more PTSD
What factors are associated with worse prognosis?
Human-made disasters (war,terrorist attack,torture)more likely to lead to PTSD than natural disasters(hurricane, tsunami,tornado)
What is articulation of affect?
- >expressing sympathy, compliments feelings
- >Learning empathy
- >Giving and receiving compliments
What treatment is suggested for young children with PTSD?
Anxiety management training(AMT) exposure-based therapy(EBT)and systematic desensitization(asked to imagine himself in situations similar to his traumatic experience) and play therapy(playing out the event while feeling safe-like Paul with his lego buildings)
What are four questions that are asked to determine where along the continuum(from normal to abnormal) anxiety symptoms fall?
How realistic is it? How severe is it? How persistent is it? How problematic or impairing is it?
Which anxiety disorder is most likely to not comorbid with another disorder?
What are the most common obsession people with OCD have?
Germs and contamination, fear of harm to self or others,concerns with symmetry,excessive moralization or religiosity.
What do the letters FEAR stand for in CBT for anxiety disorders?
- Feeling frightened(identifying physiological symptoms of anxiety)
- Expecting bad things to happen(recognizing cognitive symptoms of anxiety)
- Attitudes and actions that can help
- Results and rewards(operant conditioning)
What is amenorrhea?
Absence of at least 3 consecutive menstrual cycles
What is Anorexia Nervosa and it's symptoms?
- Loss of appetite,
- >Refusal to maintain body weight at or above minimal normal(less than 85%)(<15% according to book)
- >Intense fear of gaining weight/becoming fat
- >Body image disturbance, under influence of body shape on self-evaluation or denial of the seriousness of low weight
- >Post-Menarche,amenorrhea(absence of at least 3 consecutive periods)
What are Anorexia Nervosa subtypes?
- Restricting(don't eat) and binge eating/purging
- >Purging-vomiting,abuse laxatives, enemas,diuretics
- >Non-purging-fasting,compulsive exercising,diet pills
What is the lifetime prevalence in Anorexia Nervosa and it's course?
1-2%(90-95% women)(Caucasian women more likely than african american women)
What is the comorbidity in Anorexia Nervosa?
greater than 70% anxiety, depression, OCD,PTSD, borderline
What are the complications of Anorexia Nervosa?
- --Lanugos(fine hair) --gastritic,
- --hair loss --bradycardia(slow HR)
- --arrhythmia(irregular HR) --hypothermia
- --osteoporosis/osteopenia --kidney prob.
- --fertility problems
What is bulimia nervosa and its subtypes?
Ox hunger,normal or slightly overweight. Recurrent inappropriate compensatory behavior in order to prevent weight gain.
- --recurrent episodes of binge eating
- --Eating within 2 hr, large amount of food than most(junk food)
- Subtypes-Restricting(don't eat) and binge eating/purging
- ---Binge eating compensatory behaviors occur greater than or equal to 2 times a week for 3 months.
- --Self-evaluation is influenced by body shape and weight.
What is the lifetime prevalence of Bulimia Nervosa and its life course?
3-5%(women more than men) Wrestling,boxing,jockeys.
What is the comorbidity of Bulimia Nervosa?
Mood disorders, anxiety,substance abuse, borderline OD
What are the complications with bulimia nervosa?
Tooth decay, electrolyte imbalance, intestinal dysfunction, dehydration, fatigue, swollen glands, kidney problems, fertility problems.
What are eating disorders not specified, its prevalence?
- Meet some, not all for Anorexia,Bulimia or binge eating disorder
- >meet anorexia except amenorrhea(missing 3 consecutive periods)
- >Meet anorexia except less than 85% body weight
- >Chewing and spit out food
- >Can be as severe as anorexia or bulimia
What is the Multi-Model approach for Eating disorders?
- Different professions work together to prevent splitting(putting one provider against the other)
- ---Medical profession(vital signs)
- ---Psychologist(emotional issue)
- ---Dietician(meal planning)
What is psychotherapy for Bulimia?
- Cognitive Behavioral Therapy(CBT)
- --highly effective treatment
- >>Rationale-cognitive distortions and loss of control center to Bulimia
- >>Focus on challenging faulty cognitions(food and weight) developing coping strategies for dealing with stress, feeling
- >>Learning to constructively express anger and learn assertiveness skill(exploding doormat)
- >>enhance body image
What is exposure and response prevention in eating disorders?
eat high fear food and prevent use of compensatory methods(inpatient and intensive outpatient treatment)
What is Psychotherapy (2 phases) for Anorexia and other treatments?
- 1: restore body weight and save life--behavioral interventions to promote weight gain
- 2: Long term, work on long-standing adjustments and family difficulties
- Cognitive Behavioral Treatment
- -limited research shows positive effects
- -family therapy-especially for younger patients
What is the psychopharmacology for anorexia?
- no well controlled studies, no meds approved for treatments.
- -Therapeutic target-restore weight,decrease anxiety and obsessive compulsive delusions.
- -Atypical antipsychotics-zyprexa, risperdal(decrease pre-meal anxiety and agitation,improves weight gain and maintenance.
- -antidepressant-clomipramine(anafranil)OCD fluoxetine(Prozac)
What is the psychopharmacology for Bulimia?
- more solid research indicates short term effectiveness of SSRI
- --Fluoxetine(Prozac)-best studied,high dosage(60 mg/day)more effective in reducing symptoms
- --Psychopharmacology+Psychotherapy better than meds alone
What are the treatment outcomes 10 years later for Eating disorders?
- -40% fully recovered
- -35% better, some ED symptoms
- -25% chronically ill(anorexia and bordering PD represented in this group)
- Worse for Anorexia.
- --Bulimia are ego dystonic(at odd with person's self image are more amenable to change(cheating)
- --Anorexia-symptoms are ego syntonic(in line with person's self-image are less amenable to change(perfectionist)
What is the mortality rate of anorexia?
5-8%, some estimates higher 3rd highest mortality rate.
What are partial-syndrome eating disorders?
syndromes on the less severe end of the continuum of eating disorders that dont meet the full criteria for AN of BN. May binge once a week every week but not multiple times every week. May not be underweight by 15%, but highly concerned with weight.
What sports tend to have a higher prevalence of eating disorders?
those in which weight is an important factor in competitiveness-gymnastics,ice skating,dancing,horse racing, wrestling,bodybuilding
According to Minuchin,what are the 5 characteristics?
- -Overinvested in child's compliance and achievement
- -overcontrolling , not allow the expression of feelings, especially negative,
- -child is high achieving
- -always trying to please parents by being perfect.
What is the case of Karen Carpenter?
What is the case of Christina Ricci?
What is the case of Princess Diana?
According to Case studies book what makes Bulimia hard to treat?
Is it secretive in nature, so when it is often well entrenched before help is sought. has a high dropout rate for treatment.
What are the major points of Jenna Rudo-Sterns lecture?