Agoraphobia Literally means fear of the market Complication of panic disorder person begins to fear and avoid places associated with the occurrence of panic attacks open spaces stores malls cars elevators etc In severe cases the person may become completely homebound Panic with agoraphobia considerably more difficult to treat Effective treatment for agoraphobia graded exposure hierarchy Example graded exposure hierarchy case study Driving on interstate rush hour alone Driving on interstate 7pm alone rd Driving on 23 Street alone Driving on 23rd Street with friend Driving around block alone Driving around block with friend Backing down driveway Sitting in driver s seat with engine running Sitting in driver s seat with key in ignition engine off Specific Phobia e g snakes spiders other animal heights water blood needles 1 Marked and persistent fear excessive cued by presence or anticipation of specific object or situation 2 Exposure consistently produces anxiety possibly panic 3 Person recognizes fear excessive otherwise psychosis 4 The feared situation is avoided 5 The anxiety and or avoidance causes impairment in function Specific Phobia Lifetime Prevalence 12 5 Natl Comorbidity Survey Hypothesized causes of specific phobia Biological model preparedness hypothesis also genetic vulnerability Psychodynamic model phobic object is symbol of inner conflict Behavioral model classical conditioning Cognitive observational learning Treatments Exposure 90 cure rate No drug treatments even come close not widely used d cycloserine promotes formation of new memories faster therapy Social Phobia Two sub types performance linked e g public speaking social anxiety disorder pervasive social anx Estimated prevalence 12 lifetime Treatment 1 cognitive behavior therapy CBT 50 60 response can get higher 2 Nardil MAO inhibitor 80 response Risk of hypertensive crisis aged foods like cheese sausage wine Emsam new MAO inhibitor patch 3 SSRI 40 55 response 4 beta blocker very effective for performance linked sub type Generalized Anxiety Disorder GAD Diagnostic criterion excessive worry for 6 months Other symptoms restlessness fatigue insomnia irritability concentration difficulties muscle tension 90 GAD patients have another Axis I diagnosis Treatment 1 SSRI s average 30 reduction of symptoms 2 Benzodiazepines 30 50 reduction 3 CBT 40 50 reduction Obsessive Compulsive Disorder OCD Obsession recurrent intrusive thought impulse or image that causes anxiety and cannot be dismissed or put out of one s mind Common themes aggression contamination religious blasphemy pathological doubt loss sexuality symmetry Compulsion repetitive action ritual person feels compelled to do For diagnosis either obsessions or compulsions both not required Lifetime Prevalence 2 Moderate genetic loading for OCD 40 50 heritability Neurobiology anterior cingulate error detection orbitofrontal cortex basal ganglia attention fixation Strep infection link autoimmune response OCD Treatment 1 Exposure Ritual Prevention Foa 86 success largest study 2 Anafranil 48 success 3 SSRI 40 success