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Future oriented mood state characterized by marked negative affect and apprehension about future danger or misfortune. Somatic symptoms of tension.
Present oriented mood state, immediate fight/flight response to danger or threat, strong avoidance/escape tendencies. Abrupt activation of sympathetic nervous system.
Characteristics of Anxiety disorders
- Pervasive and persistent symptoms of anxiety and fear.
- Excessive avoidance and escapist tendencies.
- Clinically signif. distress.
Define Panic Attack
- Abrupt experience of intense fear/discomfort, accompanied by several physical symptoms.
- -Situational bound (cued) panic
- -Unexpected (uncued) panic
- -Situationally predisposed panic
Biological Contributions to Anxiety and Panic
Diathesis-Stress: inherit vulnerabilities for anxiety and panic. Stress and life circumstances activate.
- Biological Causes:
- -Anxiety and Brain circuits-GABA, Nonadrenergic& Serotonergic systems
- -Corticotropin releasing factor (CRF) and the HPAC axis
- -Limbic (amygdala) and the septal-hippocampal systems
- Behavioral inhibition (BIS) and fight/flight (FF) systems
Psychological Contributions to anxiety and fear
- Freud- psychic reaction to danger, involves reactivation of an infantile fear situation.
- Behavioristic-result from classical and operant conditioning and modeling
- Psychological- early experiences w/ uncontrollability/unpredictability
- Social-stressful life events trigger, many stressors are familial and interpersonal
Integrative Model of Anxiety and Fear
Bio. vulnerability interacts with psychological, experiential, and social variables to produce an anxiety disorder.
- Common Processes:
- -Comorbidity common
- -1/2 patients have 2+ secondary diagnoses
- -Major depression most common secondary
- -Comorbidity suggests common factors across anxiety
- -anxiety and depression closely related
Generalized Anxiety Disorder (GAD)
- -Excessive uncontrollable anxious apprehension & worry, coupled w/strong persistent anxiety, somatic symps. such as muscle tens., fatigue, irritability. Persists for 6 mth or more.
- -Affects 4% of pop., Females outnumber, onset is often subtle begin in early childhood, runs in families.
- -Fail to process emotional component- thoughts/images
- -Psych. Interventions/ Cognitive-Behavioral therapy
Panic Disorder w or w/out Agoraphobia
- -Experience of unexpected panic attack, Anxiety/Worry of another attack, Agoraphobia, symptoms persist for 1+ months.
- -Affects 3.5% of pop., 2/3 are female, onset is acute and begin between 25-29.
Panic Disorder: Associated Features
- Assoc. Feat.:
- -Nocturnal panic attacks: 60% panic during non-REM sleep
- -Extreme avoidance, catastrophic misinterpretation of symptoms
- Med. Treat.:
- -SSRI's, Benzos, any to target serotonergic, nonadrenergic GABA systems.
- -Cognitive-behavior are highly effective
- -No long term advantage for combined treatment
- -Best long term outcome is Cognitive-Behavior alone.
Extreme and irrational fear of specific object or situation, markedly interferes w/ functioning, recognizes fears are irrational, but still avoids at all costs. Affects 11% of pop, most females, chronic, onset between 15-20.
Specific Phobias: Associated Features
- Causes: Bio. and Evolutionary vulnerability, direct conditioning, observational learning, info. transmission.
- Psychological Treatments: Cognitive-behavior therapy, structured and consistent graduated exposure.
Extreme and irrational shyness/fear, social/performance situations, marked interference w/functioning. Affects 13% of pop., females more, onset during adolescence w/peak at about 15.
Causes: Bio.& Evo. vulnerability. Direct conditioning, observational learning, info. transmission.
Medical Treatment: Tricyclic antidepressants, MAOI, SSRI.
Psych. Treatment: Exposure, rehearsal, role play in group--Highly effective.
- Exposure to traumatic event, experience extreme fear, helplessness or horror, continue to re-experience (nightmares, flashbacks), avoidance of reminders, emotional numbing, interpersonal probs. common, marked interference in functioning, Only 1 month or more past trauma.
- -Affects 7.8% of pop.
- -Most common for sexual assault victims, Accident victims, or Combat.
PTSD Associated Features
- Acute PTSD-1-3 months post trauma
- Chronic PTSD-After 3 months post trauma
- Delayed onset PTSD-After 6 months or more
- Acute stress disorder-Immediately post trauma
Causes: Intensity of trauma, Uncontrolability and unpredictability, Extent of or lack of social support, Direct conditioning and observational learning
- -Cognitive-behavioral treatment involving graduated or massed imaginal exposure (highly effective)
- - Increase positive coping skills and social support
- -Most persons display multiple obsessions (most w/cleaning, washing, checking rituals)
- -Affects 2.6% of pop., mostly female, tends to be chronic, onset in early adolescence or adulthood.
- -Causes: Parallel to anxiety disorders, Early life experiences and learning, Thought-Action fusion (the thought is like the action.
- -Clomipramine or other SSRI's (benefit about 60%)
- - Psychosurgery (cingulotomy)- used in extreme cases
- -Relapse is common
- Psychological Treatment:
- -Cognitive-behavioral therapy (most effective)-Involves exposure and response prevention
- -Combined treatments-Not better than CBT alone
-Meaning overly preoccupied with body or health, physical complaints w/out a medical condition.
- -Somatization disorder
- -Conversion disorder
- -Pain disorder
- -Body dysmorphic disorder
- -Severe anxiety over possibility of disease or contracting a disease/illness, strong conviction, med. reassurance does not help.
- -Onset at any age, runs chronic courses
- -Cognitive perceptual distortions (distort normal body sensations), familial history.
- -Challenge illness related misinterpretations
- -Provide substantial and sensitive reassurance
Distortion in perception of reality
Losing a sense of the external world
Define Dissociative Amnesia
Inability to recall anything, including identity/Failure to recall specific (traumatic) events.
Define Dissociative Fugue
- -Related to dissociative amnesia
- -Take off to new place
- -Unable to remember the past
- -Unable to remember how they arrived at new location
- -Often assume a new identity
The different identities of DID
The identity that keeps other identities together in DID.
The quick transition from one personality to another.
Sqeezing all the alters back into one identity.
Deliberately faking symptoms
Define Conversion Disorder
Physical malfunction of the body with no known cause.
Ex: New mom, one morning wakes up and arm is numb, can't pick up baby.
Define Body Dysmorphic Disorder
Preoccupation with imagined defect in appearance.