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Questions and Answers
What is the first-line treatment for specific phobias?
What is the first-line treatment for specific phobias?
Agoraphobia can occur in multiple situations.
Agoraphobia can occur in multiple situations.
True
What physiological symptom is often associated with Generalized Anxiety Disorder (GAD)?
What physiological symptom is often associated with Generalized Anxiety Disorder (GAD)?
Muscle tension
Match the following disorders with their characteristics:
Match the following disorders with their characteristics:
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People with social phobia fear being negatively evaluated in ______ situations.
People with social phobia fear being negatively evaluated in ______ situations.
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What treatment is most effective for Social Anxiety Disorder?
What treatment is most effective for Social Anxiety Disorder?
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The prevalence of Generalized Anxiety Disorder is higher in men than women.
The prevalence of Generalized Anxiety Disorder is higher in men than women.
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In GAD, excessive worry must be accompanied by at least one of five ______ symptoms.
In GAD, excessive worry must be accompanied by at least one of five ______ symptoms.
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What are some dysfunctional safety behaviors that can perpetuate concern regarding pain?
What are some dysfunctional safety behaviors that can perpetuate concern regarding pain?
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What are the conditions under which anxiety becomes a disorder?
What are the conditions under which anxiety becomes a disorder?
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What type of medication is typically used for comorbid anxiety and depression associated with pain?
What type of medication is typically used for comorbid anxiety and depression associated with pain?
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Factitious disorder involves external rewards for the person exhibiting the symptoms.
Factitious disorder involves external rewards for the person exhibiting the symptoms.
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What does HPA stand for?
What does HPA stand for?
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Panic attacks are triggered by actual danger.
Panic attacks are triggered by actual danger.
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Factitious disorder by proxy involves creating medical symptoms in someone else, often a _____ .
Factitious disorder by proxy involves creating medical symptoms in someone else, often a _____ .
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Which neurotransmitter is believed to be depleted in anxiety disorders?
Which neurotransmitter is believed to be depleted in anxiety disorders?
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What are the primary types of OCD?
What are the primary types of OCD?
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What age group experiences anxiety disorders in childhood?
What age group experiences anxiety disorders in childhood?
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OCD and anxiety disorders share the same underlying neurocircuitry.
OCD and anxiety disorders share the same underlying neurocircuitry.
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Panic disorder is characterized by _____ panic attacks.
Panic disorder is characterized by _____ panic attacks.
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What length of time must a patient typically engage in compulsive behavior to be diagnosed with OCD?
What length of time must a patient typically engage in compulsive behavior to be diagnosed with OCD?
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What is the prevalence of panic disorder in the general population?
What is the prevalence of panic disorder in the general population?
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Match the following OCD-spectrum disorders with their descriptions:
Match the following OCD-spectrum disorders with their descriptions:
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What is one common method for treating panic disorder?
What is one common method for treating panic disorder?
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Match the following types of phobias with their examples:
Match the following types of phobias with their examples:
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Anxiety disorders are often recognized and effectively treated.
Anxiety disorders are often recognized and effectively treated.
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Study Notes
Physiological Arousal
- Innate fear system is marked by HPA activation impacting the brain and body systems, essential for survival.
Stress, Fear, Panic, and Anxiety
- Stress is a response to perceived demands, when coping abilities are overwhelmed.
- Fear is a present-oriented response to actual danger, involving a surge in the sympathetic nervous system (fight/flight).
- Panic is a sudden rush of intense fear and physiological symptoms, an intense HPA activation response, often triggered by no objective danger (false alarm).
- Anxiety is a future-oriented apprehension about a possible threat, often accompanied by physical tension.
Anxiety Disorders
- Prevalence of anxiety disorders is high, making it the most prevalent mental health problem in North America.
- Lifetime prevalence is 24.9%, while 12-month prevalence is 16.4%.
- Prevalence varies across cultures, with higher rates in Europe and North America compared to Asia.
- Anxiety disorders are often chronic, cause significant personal impairment, and are risk factors for other disorders like depression, suicide, and substance abuse.
- Contribute to a significant economic burden for society.
Etiology of Anxiety Disorders
-
Biological Contributions:
- Genetic predisposition for negative affectivity or generalized anxiety.
- Biochemical factors include depleted GABA or dysfunctional GABA and serotonin systems.
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Brain Circuits: Fear network involving the amygdala, vmPFC, and hippocampus.
- Hyperresponsive amygdala leads to abnormal threat assessment and excessive HPA activation.
- Insufficient vmPFC function causes an inability to recall extinction information for safety cues.
- Abnormal hippocampal function results in difficulty distinguishing safe and dangerous cues, leading to increased contextual conditioning and insensitivity to cortisol.
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Environmental Contributors:
- Childhood experiences: 2.5-5% of children meet criteria for anxiety disorders, with subclinical anxiety being more widespread.
- Parenting styles: Overprotective, over-controlling, critical-hostile, and neglectful parenting can increase risk.
- Modeling: Parental anxiety can influence a child's own vulnerability.
- Peer influences: Anxiety is negatively associated with school popularity and peer victimization.
Barlow's Triple Vulnerability Model
- Genetic predisposition
- General Psychological Vulnerability: Belief that the world is often unsafe.
- Specific Psychological Vulnerability: Specific events shaping the form of the anxiety disorder.
Types of Anxiety Disorders
-
Panic Disorder:
- Characterized by recurrent, unexpected panic attacks, which are sudden rushes of intense fear and physiological symptoms peaking within minutes.
- Diagnosis requires at least 5 panic attack symptoms, anticipatory anxiety before attacks, worry about consequences afterward, and significant behavioral changes like situation avoidance.
- Subtypes: Cued, situationally predisposed, unexpected, and limited symptom attacks.
- Prevalence: 1 in 3 people experience a panic attack, but only 3% meet criteria for panic disorder.
- Biological contributions: Neurochemical disturbances, hypersensitivity to carbon dioxide.
- Cognitive contributions: Catastrophic misinterpretations of physical sensations (fear of fear).
- Treatments: CBT, including education, interoceptive exposure, and in vivo exposure.
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Specific Phobia:
- Characterized by marked, persistent fear that is excessive and unreasonable in response to a specific object or situation.
- Types: Animal, natural environment, blood-injury-injection, situational, and miscellaneous.
- Prevalence: 6.7% of the population meets diagnostic criteria.
- Biological contributions: Genetic vulnerabilities, biological preparedness, and evolutionary influence.
- Learning contributions: Two-factor learning theory (classical conditioning and operant conditioning), Rachman's three pathways (direct conditioning, vicarious conditioning, and informational transmission).
- Cognitive contributions: Influence how we interpret and experience fear.
- Treatments: Cognitive modification and in vivo exposure (graduated or virtual reality).
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Agoraphobia:
- Anxiety about being in places or situations where escape might be difficult or help may not be available.
- Situations are often avoided, entered only with a "safe person," or endured with marked distress.
- Controversy: Agoraphobia is often associated with panic disorder, but there is debate about whether it should be diagnosed independently.
Panic Disorder
- 46%-80% of people with panic disorder do not report symptoms
- Prevalence is 1.7%, and 61% of the variation can be attributed to genetics
- People with panic disorder are more likely to stay in safe zones and may become housebound
- People with panic disorder tend to be clingy and dependent due to their fear of the lack of safety, they often rely on one 'safe person'
- Panic disorders tend to have a chronic course and without treatment, do not usually remit
- CBT is the first-line treatment for panic disorder, which includes education, relaxation techniques, breathing instruction, in vivo exposure, and safety behaviour fading
- SSRIs are another treatment option
- Challenges and discrepancies exist between North American and European treatment models
Social Phobia / Social Anxiety Disorder (SAD)
- SAD is characterised by a marked and persistent fear of one or more social or performance situations
- People with SAD fear being negatively evaluated and doing something humiliating or embarrassing
- There is a performance subtype of SAD (e.g., singing in public)
- SAD is the fourth most prevalent disorder after depression, alcoholism, and specific phobias
- SAD has a high prevalence in North America, with 8.1% of Canadians experiencing this disorder, but lower prevalence in Europe (2.3%)
- The prevalence of SAD is consistent across children, adolescents, and adults
- The onset of SAD is typically around age 13 (coinciding with puberty and potential bullying) but can begin earlier
- SAD is more prevalent in women than men, but men are more likely to seek treatment
- Cultural influences can shape the presentation of SAD, with specific cultural syndromes like "Taijin kyofusho" (Japan, Korea) and "Hikikomori" (Japan)
- Individuals from Asian cultures (especially China and Korea) report higher levels of social anxiety but lower rates of SAD, likely due to societal acceptance of being shy and reserved, leading to less stigma
- People with SAD often experience social impairment, including avoidance, hikikomori, less social support, fewer friends, and loneliness
- SAD can impact education (e.g., choosing careers with limited interactions), and occupational functioning (e.g., underemployment)
- SAD is a risk factor for depression and substance abuse, especially with marijuana abuse/dependence (25% of people who use marijuana have SAD)
Biological Contributors to SAD
- Genetic factors contribute to a non-specific vulnerability to SAD
- Behavioural inhibition, an innate hypersensitivity to environmental change, is associated with heightened physiological reactions to angry and disgusted faces
Cognitive-Behavioural Contributors to SAD
- Attentive mothers are more likely to have children who overcome phobias/less likely to develop anxiety disorders
- Negative life events, self-beliefs, predictions, selective attention, judgemental biases, and safety behaviours can contribute to the development of SAD
Treatment for SAD
- SSRIs are a treatment option for SAD
- CBT is a central approach, including behavioural experiments to challenge negative beliefs and practice social situations
- Treatment outcomes for SAD are variable, with medication response taking 6-8 weeks, while CBT takes months. Relapse rates are 43% for medication and 17% for CBT
Generalised Anxiety Disorder (GAD)
- GAD is characterised by excessive and unreasonable worry, difficulty controlling worry, accompanied by at least one of five physiological symptoms
- One distinguishing symptom of GAD is muscle tension; other symptoms include restlessness, fatigue, difficulty concentrating, irritability, and sleep disturbance
- The content of worry in GAD often includes minor things and is excessive in relation to life experiences
- GAD has a prevalence of 0.9% in adolescents and 2.9% in adults
- GAD is more common in people of European descent and developed countries, and the diagnosis rate is influenced by the presence of mental health care
- GAD is slightly more common in women
- GAD often has an early onset with worry waxing and waning depending on underlying stress
- Small heritability coefficient of 0.33, similar to depression, suggesting shared biological susceptibility
Cognitive-Behavioural Models of GAD
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Cognitive Avoidance (Borkovec)
- People with GAD use cognitive strategies to avoid thinking about important things
- Less physiological reactivity/arousal than people with panic disorder, except for muscle tension
- They are worried but have less arousal than other anxiety disorders
- Worry involves more verbal than pictorial components
- Worries focus on the future, distracting from present events
- Verbalizing worry (e.g. 'What am I going to wear?') serves as a distraction from more serious events in life
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Intolerance of Uncertainty (Dugas)
- People with GAD have heightened anxiety in uncertain situations
- Erroneous beliefs about worry, believing it is useful
- Poor problem orientation, able to generate solutions but fear implementing them
- Emphasis on cognitive avoidance, using worry to avoid a deeper fear
- The 'Why Worry' questionnaire found that people with GAD believe worrying protects from future upset but has no protective function
- They also believe worrying helps with planning, but this actually leads to procrastination and prevents implementation of problem solutions
- Overpreparation is a common safety behaviour in GAD
Treatment for GAD
- Dugas & Robichaud’s CBT approach for GAD
- Worry discrimination is a key component:
- Type 1 (controllable) - problem solving exercises
- Type 2 (uncontrollable hypothetical situations) - focus on increasing tolerance for uncertainty
- Exposure to most feared outcome (e.g., visualizing a loved one getting into a car accident) to drain emotion and anxiety
- Cognitive therapy to challenge thoughts, reduce body vigilance, alter core health beliefs, and learn about normal sensations
- Behavioural therapy to replace avoidance and reassurance-seeking with adaptive coping skills
- Exposure therapy to practice distress tolerance and reduce anxiety sensitivity in controlled environments
Somatic Symptoms and Related Disorders
- Factitious disorder, malingering, and somatic symptom disorders are distinct diagnoses
- Somatic symptom disorders often present in non-psychiatric settings
- Patients with somatic symptom disorders may report a range of physical symptoms, often in the absence of objective medical findings
- These disorders can be challenging to diagnose due to the subjective nature of pain and physical symptoms
- The DSM-5 focuses on the presentation, interpretation, and impairment related to somatic symptoms rather than the symptoms themselves
- Comorbidity with PTSD and depression is common
Somatic Symptom Disorder (per se)
- Characterized by distressing somatic symptoms that disrupt daily life
- Excessive thoughts, feelings, and behaviours related to symptoms
- Disproportionate anxiety, excessive focus on health, and preoccupation with symptoms themselves
- Multiple vague symptoms and a chronic course that revolves around symptoms
- The predominant complaint is often pain, which becomes more intense with events
Clinical Picture of Somatic Symptom Disorder
- The suffering is genuine
- Often fuels avoidance behaviours
- Catastrophizing thoughts about symptoms
- High utilization of medical services
- Medical treatment does not usually alleviate symptoms
- Explanatory therapy (detailed explanations and reassurance) may be effective for mild cases
Prevalence, Onset, and Cultural Influences on Somatic Symptom Disorder:
- Prevalence is estimated at 5-7% in the general population
- Predictors of onset include body checking, catastrophizing beliefs about pain, negative affect, and activity avoidance
- Cultural differences in how people express somatic symptoms (e.g. idioms of distress)
Impairment in Somatic Symptom Disorder
- Significant work impairment, leading to job loss
- High rates of substance abuse (e.g., prescription opioids, cannabis, alcohol)
- Housebound and may assume the role of an invalid
Illness Anxiety Disorder (Hypochondriasis)
- Preoccupation with having a serious undiagnosed disease
- Minimal to no somatic symptoms
- High levels of anxiety and low threshold for perceiving sickness
- Excessive health-related behaviours, such as checking for symptoms, internet searches, and reassurance-seeking
- Clinical picture includes:
- Prevalence of 1-5% in general population
- Similar rates in males and females
- Chronic, fluctuating course (waxing and waning)
- Social and occupational impairment
Conversion Disorder (Functional Neurological Symptom Disorder)
- Characterized by one or more symptoms that alter voluntary motor or sensory function (e.g., paralysis, blindness)
- These symptoms are incompatible with recognised neurological or medical conditions
- Clinical picture includes:
- Rare in general population (30% of neurology referrals)
- 2:1 ratio of women to men
- Onset often under stress
- Prognosis is usually short duration, better, and may reoccur with stress
Aetiology of Conversion Disorder
- Associated with lower SES and less education/medical literacy
- Major life stress
- Common in those with religious beliefs
- Symptoms need to make sense within the person's context
- Social acceptance of symptoms
Aetiology of Somatic Symptom and Related Disorders
- Biological contributions:
- Presence of some biological symptoms
- Unrecognised medical conditions (e.g., Parkinson's, multiple sclerosis)
- Pain sensitivity
- Family aggregation (suggests possible genetic link, but overlaps with anxiety disorders) -Negative affectivity (e.g., neuroticism)
- Psychodynamic Perspective:
- Trauma or extreme stress
- Defence mechanisms (repression, conversion, symbolism)
- Quasi-resolution of conflict
- Cognitive-Behavioural Perspective:
- Learned through experiences related to illness
- Development of illness concerns
- Heightened vigilance
- Contemporary anxiety about stressful events prior to the onset of the disorder
- Focus on symptoms of anxiety
- Misinterpretation of symptoms, believing they are actually ill
- Dysfunctional beliefs and interpretations, including pain catastrophizing
- Neural matrix model, pain processing is genetically determined and can be modified through experience
- Cognitive activity that amplifies pain signals (e.g., catastrophizing) sensitizes neural mechanisms
- Anxiety can prospectively predict pain intensity
- Dysfunctional safety behaviours perpetuate concern (e.g., self-assessment, excessive guarding, reliance on analgesics)
- Reinforcement
Treatment for Somatic Symptom and Related Disorders
- Medication (SSRIs for comorbid anxiety and depression)
- Cognitive-behavioural therapy (CBT)
- Caution regarding dismissing concerns
- Education about the disorder
- Address triggering stress/trauma events
- Evaluate pain beliefs
- Promote activity resumption
- Self-management:
- Relaxation training
- Reduce reassurance-seeking
- Reduce social facilitation
- Treatment Alliance:
- Cognitive therapy to challenge thoughts, reduce body vigilance, alter core health beliefs, and learn about normal sensations
- Behavioural therapy to replace avoidance and reassurance-seeking with adaptive coping skills
- Exposure therapy to practice distress tolerance and reduce anxiety sensitivity in controlled environments
Factitious Disorder
- Intentional falsification of physical or psychological symptoms, or induction of injury or disease
- The individual presents as ill or injured to gain attention, despite no obvious external reward
- Clinical Picture:
- Unknown prevalence
- Intermittent episodes
- Onset often under stress
- Factitious disorder by proxy - the person creates medical symptoms in someone else, usually a child
- Rare
- Signs include:
- A child with a history of repeated hospitalizations
- Unusually strange sets of symptoms
- Worsening of symptoms reported by the parent, but not witnessed by hospital staff
- Child's condition and symptoms do not match diagnostic tests
- Child's condition improves in the hospital but recurs at home
- Lab samples do not match the child's blood
- Chemicals in child's blood, stool, or urine
- Child may die due to maltreatment by the parent
- Mothers are the most frequent abusers of their children in this context
Obsessive-Compulsive Spectrum Disorders
- Distinguish OCD spectrum disorders from anxiety disorders due to different neurocircuitry
- Anxiety disorders: amygdala-cortical connectivity (fear system)
- OCD: overactive fronto-striatal circuitry
- Primary types of OCD:
- Obsessive-Compulsive Disorder (OCD)
- Body Dysmorphic Disorder
- Hoarding Disorder
- Trichotillomania (compulsive hair pulling)
- Excoriation (compulsive skin-picking)
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Description
Test your knowledge on various anxiety disorders, including specific phobias, generalized anxiety disorder, and social anxiety disorder. This quiz covers treatment options, prevalence rates, and characteristic symptoms. Perfect for psychology students looking to deepen their understanding of anxiety-related conditions.
