Understanding Anxiety Disorders

• Anxiety disorders are a group of mental disorders characterized by excessive fear, anxiety, and related behavioral disturbances

Key Objectives

• Recognize the symptoms of different anxiety disorders
• Distinguish between disorders through differential diagnosis
• Understand the etiology and maintenance factors of anxiety disorders
• Learn major theoretical perspectives on anxiety disorders
• Know the treatment options available for anxiety disorders

Concepts Related to HPA Activation

• Stress is a response to perceived demands exceeding coping abilities
• Fear is a present-oriented response to actual danger that triggers a fight/flight response
• Panic is a sudden, intense fear response without objective danger
• Anxiety is a future-oriented apprehension of possible threats that manifests as physical tension

Defining Anxiety as a Disorder

• Anxiety becomes a disorder when it reaches a certain level of intensity, frequency, and excessiveness
• Exaggerated threat perception is a sign that anxiety has become a disorder
• Anxiety can be classified as a disorder when it causes distress and/or impairment in daily life

Prevalence and Impact

• Anxiety disorders (ADs) are among the most prevalent mental health issues
• Anxiety disorders are often chronic, long-lasting conditions that can significantly impair a person's quality of life
• Comorbidity: Anxiety disorders are often linked with depression, suicide risk, and substance use
• There can be Cultural Differences in the prevalence of anxiety disorders, which varies by country

Risk Factors

• Genetics: The heritability of ADs ranges from 12-26% for monozygotic (MZ) twins
• Biochemical: GABA, serotonin, norepinephrine, and CRF (which triggers the HPA axis) play a role in anxiety disorders
• Brain Circuits: Dysfunction in the amygdala, ventromedial prefrontal cortex, and hippocampus may contribute to anxiety disorders

Environmental Contributors

• Overprotective, neglectful, or critical parenting styles will influence the development of anxiety disorders
• Vicarious learning, such as modeling parental anxiety, can contribute to the development of anxiety disorders
• Peer influences like bullying and exclusion can be risk factors for anxiety disorders

Panic Disorder

• Recurrent, unexpected panic attacks are key features to discern this disorder
• Physical Symptoms include a racing heart, dizziness, nausea, sweating, and chills
• Psychological Symptoms include derealization, depersonalization, and a fear of "going crazy" or dying
• Diagnosis includes anticipatory anxiety, behavioral changes, and safety behaviors
• Treatment involves CBT (interoceptive exposure, in vivo exposure) and medication (SSRIs)

Agoraphobia

• Agoraphobia is defined as the fear of places where escape may be difficult
• Common Avoidances include public transport and crowded places
• Heritability is estimated to be ~61%
• Treatment includes CBT with exposure therapy

Specific Phobias

• Types include animal, natural environment, blood-injury-injection, situational, and other phobias
• Causes include genetics, classical/operant conditioning, and vicarious learning
• Treatment includes cognitive modification and in vivo exposure therapy

Social Anxiety Disorder (SAD)

• SAD is defined by a fear of social situations due to potential embarrassment
• Prevalence: Approximately 8.1% of individuals in Canada experience SAD
• Risk Factors include behavioral inhibition, negative life experiences, and negative self-beliefs
• Treatment for SAD typically involves CBT and SSRIs

Generalized Anxiety Disorder (GAD)

• The symptoms are excessive worry, physical tension, and difficulty concentrating
• Risk Factors include genetics, intolerance of uncertainty, and avoidance of emotions
• Treatment includes CBT (problem-solving, exposure to feared outcomes)

Somatic Symptom & Related Disorders

• Somatic Symptom Disorder includes distress about physical symptoms despite having no medical cause
• Illness Anxiety Disorder includes the fear of serious illness despite having minimal symptoms
• Conversion Disorder includes neurological symptoms without medical basis
• Factitious Disorder includes faking symptoms for attention (without external gain)
• Malingering includes faking symptoms for external rewards
• Psychological causes include negative affectivity and cognitive misinterpretation of bodily sensations
• Biological causes include some symptoms with genetic or neurological bases
• Treatment includes CBT, education, and reducing reassurance-seeking

Obsessive-Compulsive & Related Disorders

• Obsessive-Compulsive Disorder (OCD) is defined by obsessions (unwanted intrusive thoughts)
• Compulsions are repetitive behaviors or rituals
• Common Themes include contamination, checking, symmetry, and unacceptable thoughts
• Treatment includes CBT (Exposure & Response Prevention), SSRIs, and Deep Brain Stimulation (in severe cases)

Other OCD-Spectrum Disorders

• Body Dysmorphic Disorder (BDD) involves an obsession with perceived physical flaws
• Hoarding Disorder involves difficulty discarding items, leading to excessive accumulation
• Trichotillomania involves compulsive hair-pulling
• Excoriation (Skin-Picking) Disorder involves compulsive picking at the skin

Trauma & Stressor-Related Disorders

• Post-Traumatic Stress Disorder (PTSD) - Key Symptoms include intrusive thoughts (flashbacks, nightmares)
• Individuals should avoid trauma-related cues
• Negative alterations in mood (guilt, detachment)
• Hyperarousal (hypervigilance, irritability)
• Risk Factors include genetics, pre-existing mental health issues, and trauma severity
• Treatment includes CBT (Prolonged Exposure, Cognitive Processing Therapy) and SSRIs

Acute Stress Disorder (ASD)

• ASD includes short-term PTSD-like symptoms (3 days to 1 month)
• Treatment includes early intervention with CBT

Complex PTSD

• Complex PTSD include associations with prolonged trauma (e.g., childhood abuse)

• Symptoms include PTSD, emotional dysregulation, negative self-concept, and interpersonal problems

• Treatment includes trauma-focused CBT and social support systems

Dissociative Disorders

• Depersonalization/Derealization Disorder involves feeling detached from self/environment
• Dissociative Amnesia involves memory loss for personal events
• Dissociative Identity Disorder (DID) - Presence of multiple personality states
• Causes & Controversies include the trauma-based theories - DID as a coping mechanism for extreme trauma
• Socio-cognitive model - DID is influenced by suggestibility and media portrayal
• Treatment includes CBT, trauma processing, reducing dissociative behaviors