Panic Attacks and Anxiety Disorders

Anxiety and Fear

• Anxiety involves a future-oriented mood, somatic symptoms of tension, apprehension about future danger or misfortune, and fear.
• Anxiety is characterized by a strong avoidance/escapist tendencies and a present-oriented mood state marked by negative affect.

Panic Attack

• A panic attack is an abrupt experience of intense fear or discomfort accompanied by several physical symptoms (e.g., breathlessness, chest pain).
• DSM-V subtypes of panic attacks include expected (cued) panic and unexpected (uncued) panic.

Psychological Contributions to Anxiety and Fear

• Anxiety began with Freud's concept of reactivation of an infantile fear situation.
• Anxiety is a psychic reaction to danger.
• Behavioral views suggest that anxiety and fear result from direct classical and operant conditioning and modeling.
• Psychological views propose that early experiences with uncontrollability and unpredictability contribute to anxiety.

Triple Vulnerability Theory

• Generalized biological vulnerability: anxiety is inherited.
• Generalized psychological vulnerability: lack of sense of control.
• Specific psychological vulnerability: early experiences.

Generalized Anxiety Disorder (GAD)

• Excessive uncontrollable anxious apprehension and worry about minor, everyday life events.
• GAD persists for 6 months or more.
• Somatic symptoms differ from panic (e.g., muscle tension, fatigue, irritability, difficulty sleeping).
• Persons with GAD are called "autonomic restrictors".

Panic Disorder and Agoraphobia

• Overview of Panic Disorder: experience of unexpected panic attack (i.e., a false alarm).
• Overview of Agoraphobia: fear and avoidance of situations in which a person feels unsafe or unable to escape in the event of a panic symptom.

Other Forms of Panic Disorder

• Ataques de nervios among Hispanic Americans and Caribbeans: shouting uncontrollably or bursting into tears.
• Kyol goeu or wind overload: too much wind or gas in the body is associated with panic attacks.

Specific Phobias

• Overview: extreme irrational fear of a specific object or situation.
• Persons will go to great lengths to avoid phobic objects, while recognizing that the fear and avoidance are unreasonable.

Separation Anxiety Disorder

• Unrealistic and persistent worry that something will happen to their caregiver or to the person themselves when they will be separated.
• Identified more closely with children and different from school phobia.

Social Phobia

• Overview: extreme and irrational fear/shyness in social and performance situations.
• Social Phobia: Associated Features and Treatment: selective mutism, lack of speech in one or more setting in which speaking is socially expected.

Posttraumatic Stress Disorder (PTSD)

• Overview: person continues to re-experience the event.
• Experience guilt symptoms, developmental regression, reckless or self-destructive behavior.
• Traumatic events: actual or threatened death, serious injury, sexual violence.

Psychological Treatment of PTSD

• Catharsis: psychoanalytic approach.
• CBT may include graduated or massed (e.g., flooding) imaginal exposure.

Subtypes and Associated Features of PTSD

• Delayed onset PTSD: onset of symptoms 6 months or more post-trauma.
• Acute stress disorder: diagnosis of PTSD immediately post-trauma (before 1 month).

Other Disorders

• Adjustment Disorder: anxious or depressive reaction to life stress that are milder than PTSD.
• Reactive Attachment Disorder: lack of responsiveness to caregiver, limited positive affect, additional heightened emotionality.
• Disinhibited Social Engagement Disorder: lack of selectivity in social interactions.