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What distinguishes hoarding disorder from obsessive-compulsive disorder (OCD)?
Which treatment approach is considered more effective for hoarding disorder?
What is a common characteristic of individuals suffering from animal hoarding?
Which statement best represents the concept of ego-syntonic versus ego-dystonic in relation to hoarding?
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Which method is recommended for reducing acquisition in individuals with hoarding disorder?
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What is a key characteristic of hoarding disorder that differentiates it from other types of clutter-related issues?
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Which type of insight may a person with hoarding disorder exhibit?
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What are the most common items that individuals with hoarding disorder tend to accumulate?
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How is the course of hoarding disorder generally described?
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What is a possible risk associated with the living conditions of individuals with hoarding disorder?
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Which statement accurately reflects the prevalence of hoarding disorder?
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What is a common misconception regarding the treatment of hoarding disorder?
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What differentiates animal hoarding from other types of hoarding behavior?
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What is a key characteristic of body dysmorphic disorder (BDD)?
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Hoarding disorder is primarily defined by which of the following?
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What distinguishes ego-syntonic from ego-dystonic behaviors in disorders?
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What is a common treatment option for hoarding disorder that is often less effective?
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Which of the following best describes animal hoarding characteristics?
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What is the prevalence of body dysmorphic disorder in patients seeking cosmetic surgery?
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What age group is most commonly associated with the onset of body dysmorphic disorder?
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Which of the following statements about the consequences of hoarding disorder is false?
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Which factor may influence the higher prevalence of anxiety disorders in individuals with European backgrounds compared to other cultural groups in Canada?
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What is a significant cultural consideration when assessing anxiety disorders across different ethnic groups?
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Which demographic in Canada shows a marked higher risk of anxiety disorders according to cultural studies?
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In terms of social anxiety disorder prevalence, which country has the highest reported rate?
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Which statement about gender differences in anxiety disorders is accurate?
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What cognitive strategy do individuals with generalized anxiety disorder (GAD) commonly use to manage their anxiety?
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What is a notable impact of social anxiety disorder (SAD) on the social relationships of affected individuals?
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Which group demonstrates a higher prevalence of social anxiety disorder in community populations?
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What is a common cultural influence on social anxiety as observed in Asian cultures?
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At what age is generalized anxiety disorder (GAD) typically identified, based on the onset period?
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Which statement best describes the difference in treatment-seeking behavior between men and women regarding anxiety disorders?
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What co-occurring issue is often seen in individuals suffering from social anxiety disorder?
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Taijin kyofusho is a cultural phenomenon particularly associated with which aspect of anxiety?
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What is a major cognitive contribution to panic disorder related to the interpretation of physical sensations?
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Which of the following statements best represents the economic burden of social anxiety disorder on society?
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How does prevalence of social anxiety disorder differ between genders?
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Which cultural factor may influence the manifestation of social anxiety disorder?
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What percentage of individuals with social anxiety disorder is likely to also experience depression?
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Which of the following conditions is commonly comorbid with panic disorder?
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What is a significant behavioral change observed in individuals with panic disorder?
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What role do biological factors play in panic disorder according to recent studies?
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Which statement accurately reflects how cognitive interpretations influence fear?
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Which mechanism is hypothesized to contribute to the effectiveness of in vivo exposure therapy?
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What impact does the interaction between innate vulnerability and learning experiences have on individuals with phobias?
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Which of the following best describes the purpose of cognitive modification in treating anxiety disorders?
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How do safety behaviors influence an individual's belief about their fears during treatment?
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What is a primary characteristic of generalized anxiety disorder (GAD) as opposed to other anxiety disorders?
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Which cognitive-behavioral therapy technique is most effective in addressing anxiety disorders?
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Which genetic aspect is commonly associated with a predisposition to anxiety disorders?
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What is a noted outcome when treating anxiety disorders with cognitive-behavioral therapy?
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How do biological factors, particularly genetics, influence the manifestation of anxiety disorders?
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Which cognitive-behavioral therapy technique specifically helps patients challenge their negative thoughts about physical sensations?
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What characterizes the reinforcement of behaviors in individuals with chronic pain issues?
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In the context of psychological treatments for anxiety, which approach focuses on helping patients develop better coping strategies?
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What is a critical aspect of the clinical picture of Factitious Disorder by Proxy?
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Which of the following is NOT considered a part of cognitive-behavioral treatment for anxiety disorders?
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Which symptom is commonly associated with Generalized Anxiety Disorder (GAD)?
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What does the temporary relief gained from safety behaviors in anxiety treatments often lead to?
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What is a prevalent characteristic observed in children with Factitious Disorder by Proxy?
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What role do genetic factors potentially play in anxiety disorders?
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In managing chronic pain, what is one key treatment approach mentioned for returning individuals to work?
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What distinguishes cued panic attacks from unexpected panic attacks?
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Which cognitive interpretation is a common factor in panic disorder?
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What is a biological theory that explains the development of panic disorder?
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What symptom is NOT required for the diagnosis of panic disorder?
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Which factor is considered a significant aspect of the cognitive model regarding panic attacks?
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Which treatment is regarded as the first-line approach for panic disorder?
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Approximately what percentage of individuals may meet the criteria for panic disorder?
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What role does anticipatory anxiety play in panic disorder?
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Study Notes
Hoarding Disorder
- Persistent difficulty discarding possessions regardless of their actual value.
- Individuals perceive a need to save items and experience distress when discarding them.
- Accumulation of possessions clutters living areas and compromises their intended use.
- Clutter is characterized by disorganized piles of unrelated objects, often spilling beyond living spaces.
- Squalor often accompanies hoarding with dirt, filth, and unsanitary conditions.
- Vermin like mice can be present.
- Saving is intentional, with motivations such as perceived utility, sentimental attachment, responsibility for possessions, and fear of losing important information.
- Common hoarded items include newspapers, magazines, old clothing, bags, books, and mail/paperwork.
- Excessive Acquisition occurs in 80-90% of hoarders, who acquire items they don't need or lack space for.
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Clinical Picture
- Prevalence: up to 5% in Vancouver.
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Etiology
- Early onset: Some symptoms emerge by age 11-15, with significant impairment by the mid-20s.
- Culture: Similar across studied cultures.
- Age: Prevalence is similar across age groups, though more common in older people (average age 50).
- Chronic Course
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Substantial Impairment
- Inability to use living spaces.
- Danger to self (e.g., falling objects, eviction).
- Danger to others (e.g., fire).
- Interpersonal and social conflict.
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Hoarding vs. OCD
- Hoarding is ego-syntonic, aligning with an individual's values, identity, and beliefs.
- OCD is ego-dystonic, conflicting with an individual's values and beliefs.
- Hoarding lacks the rituals typical of OCD.
- Acquisition in hoarding is associated with positive emotions, while distress in hoarding arises only when discarding possessions.
- Only 18% of hoarders exhibit OCD symptoms.
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Treatment
- SSRIs and ERP (Exposure and Response Prevention) are generally ineffective.
- Forced removal of possessions is ineffective.
- Specialized CBT (Cognitive Behavioral Therapy) is most effective:
- Education about hoarding.
- Cognitive therapy for dysfunctional beliefs.
- Skills training for organizing and decision-making.
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Reducing Acquisition
- Encouraging individuals to question the need for items and their available space.
- Implementing sorting and discarding practice, with therapists guiding the process.
- Home visits can be helpful.
Animal Hoarding
- More common in older women and older individuals.
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Distinct Characteristics:
- Hoard at least 15 animals.
- Median number of animals is 39.
- Animals often suffer due to neglect.
- Individuals view animals as a source of love.
- Extremely debilitating.
- Poor insight, potentially indicating delusional disorder.
Body Dysmorphic Disorder (BDD)
- Preoccupation with a perceived physical defect that is not observable or appears slight to others.
- Most common site: face, especially facial dysmorphia (eyes, jaw).
- Can be extremely impairing.
- Repetitive behaviors related to the perceived defect are common.
- Muscle dysmorphia is a specific example, prevalent in men who perceive their bodies as too small or insufficiently muscular, often leading to excessive workout regimes and steroid abuse.
- "Safety behaviors," such as comparing oneself to others, controlling diet, adjusting clothing, and excessive mirror checking, are common in BDD.
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Clinical Picture
- Prevalence: 2.4%.
- 8% of cosmetic surgery patients.
- 15% of dermatology patients.
- 10% of oral surgery patients.
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Cosmetic Treatments
- 76% of individuals with BDD have sought cosmetic treatments.
- No benefit is typically derived from these treatments.
- 81% are dissatisfied with the results.
- Repeated surgeries are common.
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Clinical Course
- Onset: Mean age 16-17 years old.
- 66% onset before age 18.
- Chronic without treatment.
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Consequences
- Significant distress and impairment.
- Suicide risk: 44% of youth, 24% of adults.
- Housebound: 20% school dropout rate.
- Ideas of reference: People are staring because of the perceived defect.
Anxiety Disorders
- Prevalence varies across cultures:
- 12-month prevalence (DSM-IV):
- Europe: 8.4%
- USA: 22%
- Australia: 5.6%
- China: 13%
- Canada: 5.8% (PD, Agoraphobia, SAD only)
- Francophone: 3.85%, Anglophone: 4.89%
- 12-month prevalence (DSM-IV):
- More common in Europe, particularly those with Anglophone backgrounds.
- Potentially due to greater access to mental health care in wealthier countries.
- Research by Tiwari & Wang (2006) indicates that individuals of European descent have a higher risk of anxiety disorders compared to other groups in Canada.
- Findings consistent for both anxiety disorders and depression.
Issues with Research on Cultural Differences in Anxiety
- Defining "culture" and "ethnic heritage" remains challenging:
- Lack of a standardized definition.
- Distinction between ethnicity and culture.
- Difficulty controlling for generational status.
- Grouping of heritage groups can mask differences.
- Translation issues with emotion terms:
- E.g., Social anxiety disorder (SAD) may have different meanings across cultures.
- Generalized anxiety disorder (worry) appears to be universal.
Key Features of Anxiety Disorders
- Often chronic, leading to significant personal impairment.
- Increase risk for other disorders:
- 31% comorbid for another anxiety disorder.
- 50% also have depression.
- Increased risk of substance disorder.
- Potential links to suicide.
- Multiple health conditions.
- Significant economic burden on society.
Panic Disorder
- Panic attacks subside but feelings of anxiety can persist.
- A critical symptom is a sense of choking or inability to breathe.
- Diagnosis requires:
- At least 5 panic attack symptoms.
- Anticipatory anxiety before an attack.
- Worry about the consequences of an attack.
- Significant behavioral change:
- Situational avoidance of triggers.
- Avoiding internal sensations associated with panic attacks.
- Safety behaviors, such as carrying anti-anxiety medication.
Subtypes of Panic Attacks
- Cued (situationally bound).
- Situationally predisposed.
- Unexpected (required for panic disorder diagnosis).
- Limited symptom attacks.
Prevalence of Panic Disorder
- 1 in 3 people experience a panic attack.
- Only 3% meet the criteria for panic disorder.
Biological Contributions to Panic Disorder
- Biological challenge studies:
- Manipulations that increase CO2 levels.
- Lactic acid infusions.
- Carbon dioxide inhalation.
- Biological theories:
- Neurochemical disturbance:
- 30-40% genetically transmitted.
- E.g., Suffocation false alarm theory: Hypersensitivity to carbon dioxide detection (chemoreceptors).
- Neurochemical disturbance:
Cognitive Contributions to Panic Disorder
- In biological challenge studies, individuals informed that sensations are harmless are less likely to panic.
- Catastrophic misinterpretation of physical sensations (fear of fear):
- Association of bodily sensations with negative consequences spirals anxiety into panic.
- Example: Singing in public.
Prevalence of Panic Disorder
- Fourth most prevalent disorder after depression, alcoholism, and specific phobias.
- High prevalence in North America (8.1% of Canadians).
- Lower prevalence elsewhere (Europe = 2.3%).
- Prevalence is the same in children, adolescents, and adults.
Time Course of Panic Disorder
- Onset typically at age 13 (puberty), but can begin earlier.
Gender Differences in Panic Disorder
- More prevalent in women in community populations.
- Men are more likely to seek treatment.
Cultural influences on Panic Disorder
- Taijin kyofusho: Fear of offending others through behavior, body odor, or intense gaze (Japan, Korea).
- Hikikomori: Severe social withdrawal (failure to launch) (Japan).
- People from Asian cultures, particularly in China and Korea, report more social anxiety but have lower rates of social phobia.
- Society may be more accepting of shyness and reserve, resulting in less stigma and impairment.
Impairment Associated with Panic Disorder
- Social: Avoidant personality, hikikomori, reduced social support, fewer friends, loneliness.
- Education: May choose careers that limit social interaction.
- Occupational: Underemployment.
- Comorbidity:
- Risk factor for depression (often precedes depression).
- Substance abuse: Strong predictor of marijuana abuse/dependence.
- 25% of marijuana users have SAD.
Generalized Anxiety Disorder
- DSM-V considers GAD a form of depression.
- Possible link to an underactive GABA-benzodiazepine system.
- Cognitive-behavioral models:
- Maintaining factors: Cognitive avoidance (Borkovec).
- People with GAD use cognition to avoid thinking about important issues.
- Lower physiological reactivity and arousal except for muscle tension compared to those with panic disorder.
- Worry is often verbal rather than pictorial.
- Focus on future events serves as a distraction from fear.
- Maintaining factors: Cognitive avoidance (Borkovec).
Two-Step Learning Theory Problems
- The text presents issues with the two-step learning theory, stating that the conditioning event is often absent, and that individual differences in conditionability exist.
- Additionally, the theory doesn't explain the specificity of fears, as humans don't fear everything.
- An example is given, stating that people are inclined to develop fears of certain objects, for example, people do not typically have a fear of a bottle of water.
- Cognitive interpretations influence fear, highlighting the complexity of fear development.
Integrative Models
- Integrative models propose an interaction between innate vulnerability and learning experiences to explain the aetiology of fear and phobias.
- These models highlight the role of biological predispositions and genetics, along with evolutionary influences.
- Individuals with phobias tend to exhibit exaggerated threat perceptions, resulting from maladaptive thought processes related to the feared object or situation.
- This leads to avoidance and safety behaviors, further reinforcing fear.
Contemporary Models
- Contemporary models focus on safety behaviors, highlighting their deliberate nature as a means of preventing negative outcomes.
- Although unnecessary, these behaviours reinforce the belief in the feared threat, perpetuating the phobia.
First-Line Treatment
- The text emphasizes cognitive modification as a first-line treatment for managing phobias, with a goal of changing maladaptive thought processes.
- In vivo exposure, or real-life exposure, is another key component, employing a graduated or step-wise approach.
- Virtual reality exposure is presented as an alternative method for in vivo exposure.
Treatment Mechanisms
- Treatment mechanisms include reconsolidation, extinction learning, and cognitive change.
- Reconsolidation aims to reactivate the fear memory and store it with fewer emotional connections.
- Extinction learning, or inhibitory learning, involves developing a new memory store associated with the fear stimulus to weaken the original fear response.
- Cognitive change focuses on reducing selective attention to threat through safety learning, promoting a shift in focus away from the fear.
Back Pain
- Back pain can result in muscle atrophy due to avoiding activities to prevent pain.
- This can lead to reliance on analgesic medication, medical reassurance-seeking, and avoidance-constricted lifestyles.
- The text emphasizes the role of reinforcement in perpetuating these behaviors.
Treatment for Back Pain
- The text discusses medication, specifically SSRIs, for managing comorbid anxiety and depression associated with back pain.
- Cognitive-behavioural therapy emphasizes cautiousness in dismissing concerns, education regarding triggering events and pain beliefs, and promoting activity resumption.
- Self-management strategies include relaxation training, reducing reassurance-seeking, and minimizing social facilitation.
- The text highlights the effectiveness of treatment, with 62% of individuals returning to work after being off for more than 6 months.
Treatment Alliance
- The text highlights the importance of a strong treatment alliance between healthcare providers, family, and friends.
- Cognitive therapy plays a role in challenging negative thoughts, reducing body vigilance, and altering core health beliefs.
- Behavioral therapy focuses on replacing avoidance and reassurance-seeking with adaptive coping skills and problem-solving.
- Exposure therapy is a key component of behavioral therapy, allowing individuals to experience anxiety in a controlled environment to practice distress tolerance and reduce anxiety sensitivity.
Factitious Disorder
- Factitious disorder involves the falsification of physical or psychological symptoms, including the induction of injury or disease, with the sole aim of presenting as ill or injured.
- Notably, there is no obvious external reward for these actions.
Clinical Picture of Factitious Disorder
- The prevalence of factitious disorder remains unknown, with intermittent episodes being a characteristic of its course.
- Onset often occurs under stressful conditions.
- Factitious disorder by proxy, where individuals create medical symptoms in someone else (usually a child), is a rare but serious condition.
Signs of Factitious Disorder by Proxy
- The text highlights specific signs:
- A history of multiple hospitalizations for the child.
- A strange set of symptoms presented by the child.
- Worsening of symptoms reported by the mother but not witnessed by hospital staff.
- A discrepancy between reported condition and laboratory test results.
- The mother being the primary caregiver responsible for the child's health.
- More than one unusual illness or death of children in the family.
- Improvement of the child's condition during hospitalization but recurrence upon returning home.
- Blood in lab samples not matching the child's blood type.
- Signs of chemicals in the child's blood, stool, or urine.
- Potential death of the child due to maltreatment by the parent seeking attention.
Obsessive-Compulsive Spectrum Disorders
- The text explores the separation of obsessive-compulsive spectrum disorders from anxiety disorders.
Learning Objectives
- The following learning objectives are presented:
- Understanding why OCD-spectrum disorders are distinct from anxiety disorders.
- The impact of ethnicity and culture on mental health.
- The challenges of controlling for generational status in research studies.
- Recognizing biases associated with grouping heritage groups.
- Variations in anxiety disorder presentation across different cultural groups.
- The challenges of translating emotion terms across languages and cultural contexts.
- The universal nature of generalized anxiety disorder or worry.
Obsessive-Compulsive Spectrum Disorders: Features
- The text presents several key features of OCD-spectrum disorders:
- Often chronic.
- Cause significant personal impairment.
- Pose a risk for other disorders, such as depression, suicide, substance use, and other health conditions.
- Place an economic burden on society due to the impact on relationships, employment, and healthcare costs.
- Often under-recognized and under-treated, requiring increased awareness and resources for effective management.
Etiology of OCD-Spectrum Disorders
- The text explores the biological contributions to OCD-spectrum disorders:
Biological Contributions
- Genetics plays a role, but the predisposition is non-specific and generalized.
- Individuals with OCD-spectrum disorders often exhibit negative affectivity (formerly known as "neuroticism").
- Family studies are often confounded by environmental factors.
- Twin studies provide valuable insights by comparing concordance rates between monozygotic (MZ) and dizygotic (DZ) twins, uncovering potential genetic influences.
Panic Disorder
- Characterized by sudden intense fear and discomfort, with lingering anxiety after the panic subsides.
- Diagnosed with at least 5 symptoms, such as choking sensation, anticipatory anxiety, worry about attack consequences, significant behavioral changes due to attacks, and internal sensations like rapid heartbeat.
Subtypes of Panic Attacks
- Cued (situationally bound): triggered by specific situations or objects.
- Situationally predisposed: increased risk in specific situations, such as social anxiety.
- Unexpected: occur without a recognizable trigger.
- Limited symptom attacks: attacks that don't fully meet panic attack criteria.
Prevalence
- Approximately 1 in 3 people experience a panic attack at some point in their life.
- Around 3% of people meet the criteria for panic disorder.
Biological Contributions
- Biological challenge studies: manipulation of factors such as CO2 and lactic acid inducing panic attack-like physiological changes.
- Biological theorists: suggest a neurochemical disturbance, possibly a genetic predisposition for heightened sensitivity to bodily sensations. Genetic transmission is estimated at 30-40%.
- Suffocation false alarm theory: hypersensitivity to carbon dioxide levels detected by chemoreceptors.
Cognitive Contributions
- Catastrophic misinterpretations of bodily sensations contribute to a "fear of fear" response.
- Interpretation of bodily sensations as dangerous leads to increased anxiety and difficulty breathing.
Cognitive Model
- A cyclical process starts with triggers (internal or external) leading to perceived threats.
- These threats then trigger catastrophic misinterpretations, apprehension, and bodily sensations of anxiety.
- This cycle returns to perceived threats and continues.
Treatment
- Medications: may have potential side effects.
- Cognitive Behavioral Therapy (CBT): Often considered the first-line treatment approach, including education and recognizing panic attack signs.
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Description
This quiz explores the key characteristics and clinical aspects of hoarding disorder, including the emotional attachment to possessions and the cluttered living conditions it causes. Understand the prevalence, causes, and behaviors associated with this complex mental health issue.