Abnormal Psychology: Anxiety Disorders

• Midterm 2 covers chapters 5, 7, and 8, focusing on abnormal psychology, anxiety, trauma, dissociation, and mood disorders

Anxiety

• Anxiety is a future-oriented negative mood state marked by tension and feelings of unpredictability or uncontrollability
• Fear is an immediate alarm reaction to present danger, triggering a strong escape response
• Panic attacks involve a fear response occurring inappropriately, either expected (cued) or unexpected (uncued)

Causes of Anxiety

• Biological factors include specific brain circuits, neurotransmitter systems, the corticotropin-releasing factor (CRF) system, and the behavioral inhibition system (BIS), along with the fight/flight system (FFS)
• The integrated model, or triple vulnerability theory, suggests that the combination of generalized biological vulnerability (heritable negative affect), specific psychological vulnerability (e.g., physical sensations are dangerous), and generalized psychological vulnerability (sense of uncontrollability) contributes to anxiety disorders
• Comorbidity is the co-occurrence of multiple disorders in a single person

Generalized Anxiety Disorder (GAD)

• GAD is characterized by uncontrollable worry about everyday events
• Symptoms include muscle tension, fatigue, irritability, sleep issues, autonomic arousal, and constant worry
• Cognitive symptoms involve intolerance of uncertainty, positive beliefs about worry, poor problem-solving skills, and cognitive avoidance
• A possible genetic component can contribute to the development of GAD
• Treatments include benzodiazepines, antidepressants, and cognitive-behavioral therapy (CBT) to change negative thought patterns

Panic Disorder (PD) and Agoraphobia

• PD involves panic attacks and fear or avoidance of unsafe situations
• Agoraphobia involves fear and avoidance of situations where escape might be difficult or help unavailable if a panic attack occurs
• Agoraphobia can lead to substance abuse, avoidance behaviors, and interoceptive avoidance (avoiding internal cues)
• Causes include biological, psychological, and social factors, genetic vulnerability to stress, and learned alarms (conditioned responses to panic attack cues)
• Treatments include benzodiazepines, SSRIs, and SNRIs, as well as panic control treatment (PCT) involving cognitive and behavioral techniques, education, cognitive restructuring, and breathing exercises

Specific Phobias

• Specific phobias are irrational fears of specific objects or situations that interfere with functioning, such as situational, natural environment, animal, or blood-injection-injury phobias
• Traumatic experiences, vicarious learning, panic attacks, and socio-cultural factors can cause phobias
• Common phobias include snakes, heights, flying, and separation anxiety disorder, which can extend into adulthood
• Generalized biological vulnerability involves a preparedness to associate fear with dangerous stimuli
• Specific psychological vulnerability involves the belief that a specific object or situation is dangerous
• Generalized psychological vulnerability involves anxious apprehension
• Treatments include exposure-based exercises and virtual reality exposure therapy

Social Anxiety Disorder (Social Phobia)

• Social anxiety disorder involves fear of social situations where one might be judged, causing social inhibition and potential panic attacks
• Biological vulnerability to anxiety, social inhibition and conditioned panic attacks contribute to social anxiety disorder
• Treatments include CBT, virtual reality therapy, interpersonal psychotherapy (IPT), and SSRIs
• Selective mutism, a rare childhood disorder with a lack of speech in specific social settings, is classified as an anxiety disorder

Trauma and Dissociation (Chapter 7)

• Experiences resulting in emotional disorder include trauma (war), physical assault, accidents, natural disasters, and death
• These experiences can lead to PTSD or acute stress disorder with symptoms that include re-experiencing traumatic events (flashbacks, nightmares), avoidance, emotional numbing, and hyperarousal
• Risk factors include intensity/severity of trauma, lack of social support, and hippocampal damage
• Treatment involves exposure therapy (imaginal), cognitive therapy, EMDR, and SSRIs

Other Trauma-Related Disorders

• Adjustment disorder involves anxious or depressive reactions to life stress
• Attachment disorders in children are due to inadequate or abusive rearing
• Reactive attachment disorder involves a child seldom seeking or responding to caregivers
• Disinhibited social engagement disorder involves a child showing no inhibition approaching adults

Dissociative Disorders

• Depersonalization-derealization disorder involves detachment from body or mind and cognitive or perceptual deficits
• Dissociative amnesia involves an inability to recall information, either generalized (complete loss of identity) or localized (specific events)
• Dissociative fugue involves memory loss and unexpected travel, where the person may assume a new identity

Dissociative Identity Disorder

• Clinical features include multiple identities (alters) coexisting, amnesia, and fragmented identity as per DSM-5.
• One characteristic is that the host identity seeks treatment while switches occur between personalities
• Causes include childhood abuse (physical or sexual), PTSD subtype, heredity, sleep deprivation, and temporal lobe seizures
• Treatment includes long-term psychotherapy to reintegrate personalities, similar to PTSD treatment

Mood Disorders (Chapter 8)

• Mood disorders are characterized by deviations in mood, including major depressive episodes (severe depression with cognitive symptoms, altered sleep or appetite, loss of energy and anhedonia which is the inability to experience pleasure)
• Mania involves extreme pleasure, hyperactivity, rapid speech, and flight of ideas
• Hypomanic episodes are less severe than manic episodes

Depressive Disorders

• Major depressive disorder (MDD) involves the presence of depression and the absence of mania, and is recurrent
• Persistent depressive disorder (PDD) or dysthymia is chronic and less severe
• Specifiers include psychotic features, anxious distress, mixed features, melancholic features, atypical features, catatonic features, peripartum onset, and seasonal pattern (SAD), seasonal depression

Bipolar Disorders

• Bipolar I involves full manic episodes (at least 7 days) with possible major depressive episodes
• Bipolar II involves hypomanic episodes and major depressive episodes (no full manic episodes)
• Cyclothymic disorder involves milder mood swings (hypomania and mild depression) for at least two years

Bipolar Specifiers

• Rapid cycling specifier involves four or more manic or depressive episodes within a year
• Onset and duration vary by type
• Older adults experience high rates of depression in nursing homes

Causes of Mood Disorders

• Biological dimensions include familial and genetic influences with heritability at 37%
• Genes are implicated
• Sleep and circadian rhythms involve REM sleep abnormalities and disturbed sleep patterns
• Psychological dimensions include learned helplessness (sense of lack of control)
• There is also depressive attributional style (internal, stable, global)
• Negative cognitive styles and cognitive triad involve negative interpretations of events, cognitive errors, and negative thinking about self, world, and future

Treatment of Mood Disorders

• Medications include antidepressants (tricyclics, MAOIs, SSRIs)
• Lithium is a mood stabilizer used for bipolar disorder
• Electroconvulsive therapy (ECT) is effective for treatment-resistant depression
• Transcranial magnetic stimulation (TMS) is effective in treating depression
• Psychosocial treatments include cognitive therapy to correct negative thinking and interpersonal psychotherapy to resolve relationship problems (negotiation, impasse, resolution)

Suicide

• Risk factors for suicide include psychological autopsy which helps us understand multifaceted causes
• Family history (suicidal family member, depression which is genetic) is also a risk factor
• Low serotonin and impulsivity may increase the risk