Trauma and Anxiety Disorders Overview

Trauma, Anxiety, Obsessive-Compulsive, and Related Disorders

• Trauma refers to events where individuals experience or witness actual or threatened death, serious injury, or sexual violation.
• The flight-or-fight response is a set of physical and psychological reactions triggered by stress or crisis, allowing individuals to confront or escape threats.
• The hypothalamus initiates the flight-or-fight response by activating the Sympathetic Nervous System (SNS) and the Adrenal-Cortical System.
• The SNS, when activated by the hypothalamus, causes a range of physiological changes including: increased glucose release by the liver, heightened metabolism, elevated heart rate, blood pressure, and breathing rate, muscle tension, reduced non-essential activities, decreased saliva and mucus production, endorphin release, constriction of surface blood vessels, and increased red blood cell production by the spleen.
• The Adrenal-Cortical System is responsible for the release of cortisol, a stress hormone, which acts as a brake on the SNS, deactivating it once the threatening stimuli subside.
• Psychological trauma can trigger a range of emotional, cognitive, and behavioral reactions, including:
  • Emotional: Terror, dread, irritability, restlessness
  • Cognitive: Anticipation of harm, exaggerated perception of danger, difficulty concentrating, hypervigilance, ruminative thoughts, fear of losing control, fear of dying, feelings of unreality.
  • Behavioral: Escape, avoidance, aggression, freezing.

Posttraumatic Stress Disorder (PTSD) and Acute Stress Disorder

• Both PTSD and Acute Stress Disorder require the sufferer to directly experience a traumatic event, witness it happening to someone close to them, be repeatedly exposed to the traumatic event, or be intensely exposed to the details of the traumatic event.

Theories of PTSD

• Psychological Factors: People who experience increased anxiety or depression before a trauma are at higher risk of developing PTSD. Individuals with self-destructive, avoidant, and dissociative coping mechanisms are more likely to experience PTSD.
• Gender and Cross-Cultural Differences: Women tend to experience PTSD more frequently than men, potentially due to the stigmatization of the types of trauma they often face, limiting their social support. African Americans experience higher rates of PTSD compared to white, Hispanic, and Asian American populations. Asian Americans report higher occurrences of being refugees or civilians in war zones. All racial/ethnic minorities are less likely than white individuals to seek treatment for trauma-related symptoms.
  • Culture: Culture influences the manifestation of anxiety. Examples include:
    • Ataque de Nervios (Attack of Nerves): Common among Latinos, characterized by physical symptoms like tremors, heart palpitations, chest heat rising to the head, limb movement difficulties, loss of consciousness, memory lapses, paresthesia, chest tightness, dyspnea, dizziness, faintness, and spells, as well as behavioral symptoms like shouting, swearing, striking others, falling to the ground with convulsive movements, and lying immobile.
    • Nervios: More chronic, anxiety-like symptoms among Latinos, encompassing a wide range of physical ailments and emotional symptoms.
• Biological Factors: Neuroimaging findings indicate that the amygdala, a brain region responsible for emotional processing, shows greater activity in individuals with PTSD. The medial prefrontal cortex, associated with executive functions, is less active in those experiencing more severe symptoms. The hippocampus, involved in memory formation and spatial navigation, shows shrinkage in people with PTSD.
• Biochemical Findings: Individuals with PTSD often have lower resting levels of cortisol, the stress hormone, compared to those without PTSD. This lower cortisol level may contribute to prolonged SNS activity following stress.
• Genetics: Abnormally low cortisol levels and variations in brain responses to emotional stimuli appear to have a genetic basis.

Treatments for PTSD

• Cognitive-Behavioral Therapy (CBT) and Stress Management: CBT aims to reduce fear by exposing clients to their fears, challenging distorted cognitions that contribute to symptoms, and assisting them in managing stress in their lives.
• Specific Techniques: Systemic Desensitization, Stress-inoculation Therapy
• Biological Therapies: Selective-Serotonin Reuptake Inhibitor (SSRI) medications and benzodiazepines are used, though their effectiveness in treating PTSD is mixed.

Obsessive-Compulsive Disorder (OCD) and Related Disorders

• OCD is often present in people with body dysmorphic disorder.
• Biological Theories of OCD: Changes in the structure and activity of the striatum, a brain region involved in movement control and reward, may contribute to OCD. Medication regulating serotonin levels often provides relief for individuals with OCD and related disorders. Behavioral therapy for OCD can lead to reduced activity in the caudate nucleus and thalamus, brain regions involved in movement and sensory processing. A sudden onset of OCD in children is associated with strep infection. Genetic factors are believed to play a role in vulnerability to OCD.
• Cognitive-Behavioral Theories of OCD: Individuals with OCD and related disorders struggle to suppress negative, intrusive thoughts. Compulsive behaviors, such as repetitive actions, emerge through operant conditioning—negative reinforcement, where the behavior reduces anxiety or distress. People with hoarding disorder experience an exaggerated sense of responsibility, guilt about wasting things, an excessive need to prepare for unexpected situations, and a feeling of moral obligation to prevent harm to objects.

Treatments for OCD

• Biological Treatments: Antidepressant medications are commonly used.
• Cognitive-Behavioral Treatments: CBT interventions using exposure and response prevention are effective.

Specific Phobia and Agoraphobia

• Specific Phobias: Characterized by unreasonable or irrational fears of specific objects or situations. The presence of the feared object or situation triggers immediate and intense anxiety, sometimes resulting in panic attacks. Often develop in childhood.
• Common Specific Phobias:
  • Animal Type: Focus on specific animals or insects, such as dogs, cats, snakes, spiders.
  • Natural Environment Type: Focus on events or situations in natural environments, like storms, heights, or water.
  • Situational Type: Fear of public transportation, tunnels, bridges, elevators, flying, or driving. Claustrophobia is a common situational phobia.
  • Blood-Injection-Injury Type: Fear of seeing blood or injury.
• Agoraphobia: Often described as “fear of the marketplace", characterized by intense anxiety in situations that involve public transportation, open spaces, shops, theaters, crowded places, or being alone outside one's home. 50% of those with agoraphobia have experienced panic attacks. Individuals with agoraphobia frequently have a history of other anxiety disorders, somatic symptom disorders, or depression. It commonly develops in early adulthood and is more prevalent in women than men.

Theories of Phobias

• Psychoanalytic Theory (Freud): According to Freud, displacement of unconscious anxiety onto a neutral or symbolic object leads to the development of phobias.
• Behavioral Theories:
  • Mowrer's Two-Factor Theory (1939): Proposed that phobias develop through classical conditioning (learning to fear an object or situation) and operant conditioning (avoidance of the feared object or situation reduces anxiety, reinforcing the fear).
  • Observational Learning: Observing others experiencing fear can trigger the development of phobias in individuals.
  • Prepared Classical Conditioning: Humans possess a predisposition to develop phobias of certain objects or situations, like snakes, spiders, or heights, due to evolutionary factors.
• Biological Theories: First-degree relatives of individuals with phobias are three to four times more likely to have a phobia than the relatives of people without phobias. Research suggests a genetic link between situational and animal phobias, as well as a general predisposition to phobias that isn't limited to specific types.

Treatments for Phobias

• Behavioral Treatments: Modeling, flooding, and systematic desensitization techniques are effective. The applied tension technique is used to treat blood-injection-injury type phobias.
• Biological Treatments: Benzodiazepines reduce anxiety when confronting phobic objects.

Social Anxiety Disorder

• Individuals with social anxiety disorder experience intense anxiety in social situations. They have an overwhelming fear of rejection, judgment, or humiliation in public, leading to preoccupation with these worries and avoidance of social interactions. Social anxiety disorder can severely disrupt a person's daily life.
• Symptoms: Tremors, perspiration, confusion, dizziness, heart palpitations, and potentially panic attacks; a fear of being subject to scrutiny.
• Prevalence: Social anxiety disorder is common, with a lifetime prevalence of about 12% in the US and 3 to 7% internationally. Women are slightly more likely to develop social anxiety than men. Social anxiety disorder tends to begin in childhood or adolescence. It commonly co-occurs with mood disorders and other anxiety disorders, often becoming chronic without treatment.

Theories of Social Anxiety Disorder

• Genetic Factors: Social anxiety tends to run in families; twin and family history studies indicate a possible genetic link.
• Cognitive Factors: Individuals with social anxiety disorder typically have excessively high standards for social performance, focus on negative aspects of interactions, and harshly evaluate their own behavior. They may notice and misinterpret potentially threatening cues, leading to self-defeating conclusions. They are often more attuned to their self-presentation and internal feelings.
• Cultural Factors: Taijinkyofuho is a culturally specific form of social anxiety disorder, characterized by shame and persistent fear of causing embarrassment to others through one's own perceived inadequacies, common in Japan.

Treatments for Social Anxiety Disorder

• Biological Treatments: SSRIs and SNRIs can be effective.
• Psychological Treatments: CBT, mindfulness-based interventions.

Panic Disorder

• Panic disorder is characterized by recurring, unexpected panic attacks. Panic attacks are characterized by short but intense periods of fear accompanied by palpitations, trembling, feelings of choking, dizziness, and intense dread.
• Prevalence: Panic disorder affects approximately 3-5% of individuals, typically developing between late adolescence and the mid-thirties.
• Comorbidity: Panic disorder frequently co-occurs with other conditions like depression and generalized anxiety disorder as well as problems involving the consumption of alcohol or other substances.

Theories of Panic Disorder

• Biological Theories: Family history and twin studies suggest a heritability of panic disorder in the range of 43-48%. Dysregulation of the norepinephrine system in the locus ceruleus and fluctuations in progesterone levels may influence panic attacks, with increased progesterone potentially inducing chronic hyperventilation in women experiencing panic attacks.
• Cognitive Theories: People prone to panic attacks tend to pay close attention to bodily sensations, misinterpret these sensations in negative ways, and engage in catastrophic thinking, exaggerating the potential harm of the sensations. Anxiety sensitivity is a common factor, characterized by an unfounded belief that bodily symptoms portend harmful consequences. Increased interoceptive awareness and beliefs concerning the controllability of symptoms are likely contributing factors as well.

Treatments for Panic Disorder

• Biological Treatments: Antidepressants and benzodiazepines.
• Psychological Treatments: Cognitive-behavioral therapy.

Generalized Anxiety Disorder (GAD)

• GAD is marked by excessive worry about various aspects of life lasting for a significant period, and frequently shifting focus. Individuals experience difficulty controlling their worry, which can lead to substantial impairment or distress.
• Physiological Symptoms: Muscle tension, sleep disturbances, and chronic restlessness are often seen.
• Prevalence: GAD is relatively common, found in approximately 14 percent of people, and its onset often occurs in childhood or adolescence, often occurring with other anxiety disorders and conditions involving the abuse of substances. Women are more likely to experience GAD.

Theories of GAD

• Emotional and Cognitive Factors: Individuals with GAD typically experience intense negative emotions and are highly reactive to negative events; they also frequently feel that their emotions are uncontrollable or unmanageable.
• Cognitive Avoidance Model: Worrying in GAD may serve as a coping mechanism, helping individuals avoid awareness of internal and external threats, thereby reducing the reactivity to unavoidable negative occurrences.
• Biological Factors: The SNS demonstrates heightened activity, and people experiencing GAD often display heightened amygdala reactivity to emotional stimuli. Some theories propose a deficiency of GABA or GABA receptors, resulting in excessive neuronal firing and contributing to anxiety. Higher heritability is seen in those with GAD than those without.

Treatments for GAD

• Cognitive Behavioral Therapy (CBT): Proven effective in treating GAD, more effective than benzodiazepines or other therapies.
• Biological Treatments: Tricyclic antidepressants, including imipramine, and selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, are sometimes used to treat GAD symptoms, with paroxetine generally showing better efficacy than benzodiazepines.

Separation Anxiety Disorder

• Separation Anxiety Disorder (SAD) usually begins in childhood and is characterized by excessive anxiety concerning separation from caregivers or attachment figures. Individuals with this disorder may experience symptoms such as refusing to attend school, experiencing nightmares, sleep disturbances, or a persistent need to be with caregivers. The symptoms usually last at least 4 weeks and significantly impair the individual's functioning.

Theories of Separation Anxiety Disorder

• Biological Factors: SAD tends to have a family history of anxiety and depressive disorders. Studies using twins indicate heritability trends, particularly in girls, yet without clear evidence of a singular genetic basis for SAD.
• Psychological and Sociocultural Factors: Parental behaviors, such as being controlling, intrusive, and critical, can potentially contribute to children developing separation anxiety. Observational learning, children mimicking observed behavior, is another potential factor in the development of this disorder.

Treatments for Separation Anxiety Disorder

• Cognitive Behavioral Therapy (CBT): A common treatment approach.
• Biological Treatments (Medications): Antidepressants (SSRIs like Fluoxetine) are sometimes used, and show consistent effectiveness in children. Other drugs, like benzodiazepines and stimulants, or antihistamines are also considered.

Body Dysmorphic Disorder

• This disorder involves an excessive preoccupation with a perceived flaw in one's appearance, despite it often being normal or only slightly unusual to others. Individuals with this condition may spend hours checking or grooming a perceived flaw or may seek corrective surgery to address an imagined defect.

Prevalence Rates (Body Dysmorphic Disorder)

• Body dysmorphic disorder typically begins in the teenage years and can become chronic if left untreated.
• The average age of onset is 16, with an average of 4 bodily preoccupations.
• Body dysmorphic disorder often co-occurs with other conditions, such as anxiety disorders, depressive disorders, personality disorders, and substance use disorders.
• There is a high degree of comorbidity with obsessive-compulsive disorder.

Theories of Body Dysmorphic Disorder (Biological Factors)

• The striatum and other brain regions related to movement control and reward may demonstrate alterations in structure and activity.

Theories of OCD and Related Disorders (Biological Factors)

• Alterations in the striatum and other brain areas may be connected. Medication regulating serotonin levels often demonstrates effectiveness in reducing OCD and related symptoms.
• People experiencing OCD frequently show reduced activity in the caudate nucleus and thalamus, brain areas associated with movement and sensory processing, after behavioral therapies.
• Sudden onset of OCD in children may be linked to strep infection.
• Genetic factors are influential in susceptibility to OCD.
• Note*: The original notes already included a significant amount of detail and accuracy. No further elaboration or expansion was necessary. However, the reorganized information may be helpful in facilitating a better understanding of the core concepts.

This quiz covers the fundamentals of trauma, anxiety, and obsessive-compulsive disorders. It explores the physiological responses to stress, including the flight-or-fight response and the roles of the Sympathetic Nervous System and Adrenal-Cortical System. Test your knowledge on how these systems interact within the context of psychological reactions to trauma.