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IUPUI PSY 380 - Anxiety Disorders

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Lecture 10Current Lecture Chapter 6: Anxiety DisordersI. Clinical Descriptions of Anxiety DisordersII. Common Risk Factors Across the Anxiety DisordersIII. Treatment of Anxiety DisordersAnxiety vs. Fear Anxiety• Apprehension about a future threat Fear• Response to an immediate threat Both involve physiological arousal• Sympathetic nervous system Both can be adaptive• Fear triggers “fight or flight”May save life• Anxiety increases preparedness“U-shaped” curve (Yerkes & Dodson, 1908)Anxiety Disorders DSM-5 Anxiety Disorders• Specific phobias• Social anxiety disorder• Panic disorder • Agoraphobia• Generalized anxiety disorder Most common psychiatric disorders 28% report anxiety symptoms  Most common are phobiasPhobias Disruptive fear of a particular object or situation• Fear out of proportion to actual threat• Awareness that fear is excessive• Must be severe enough to cause distress or interfere with job or social lifeAvoidancePsych 380 1st EditionSpecific Phobia Disproportionate fear of a particular object or situation• Common examples: fear of flying, snakes, heights, etc. • Fear out of proportion to actual threat• Awareness that fear is excessive• Most specific phobias cluster around a few feared objects and situations • High comorbidity of specific phobiasSocial Anxiety Disorder Called Social Phobia in DSM-IV-TR• Causes more life disruption than other phobias More intense and extensive than shyness• Persistent, intense fear and avoidance of social situations• Fear of negative evaluation or scrutiny• Exposure to trigger (person, setting, memory) leads to anxiety about beinghumiliated or embarrassed socially• Onset often adolescence 33% also diagnosed with Avoidant Personality Disorder• Overlap in genetic vulnerability for both disordersPanic Disorder Frequent panic attacks unrelated to specific situations Panic attack• Sudden, intense episode of apprehension, terror, feelings of impending doomIntense urge to fleeSymptoms reach peak intensity within 10 minutes• Physical symptoms can include:Labored breathing, heart palpitations, nausea, upset stomach, chest pain, feelings of choking and smothering, dizziness, sweating, lightheadedness, chills, heat sensations, and trembling• Other symptoms may include:Depersonalization Derealization Fears of going crazy, losing control, or dyingPanic Disorder Uncued attacks• Occur unexpectedly without warning• Panic disorder diagnosis requires recurrent uncued attacks• Causes worry about future attacks  Cued attacks• Triggered by specific situations (e.g., seeing a snake)More likely a phobiaPanic Disorder Prevalence by Age and Sex Women are twice as likely as men to develop panic disorder. Panic disorder typically strikes in young adulthood. Roughly half of those with panic disorder develop it before age 24Panic disorder can develop into agoraphobia Agoraphobia: debilitating fear and avoidance of situations in which getting help or escape might be difficult in the event of having a panic attack Agoraphobia From the Greek word “agora” or marketplace Anxiety about inability to flee anxiety- provoking situations • E.g., crowds, stores, malls, churches, trains, bridges, tunnels, etc.• Causes significant impairment In DSM-IV-TR, was subtype of Panic Disorder• BUT, at least half of agoraphobics do not suffer panic attacksGeneralized Anxiety Disorder (GAD) Involves chronic, excessive, uncontrollable worry• Lasts at least 6 months• Interferes with daily lifeOften cannot decide on a solution or course of action Other symptoms:• Restlessness, poor concentration, tiring easily, restlessness, irritability, muscle tension Common worries:• Relationships, health, finances, daily hassles Often begins in adolescence or earlier• I’ve always been this wayComorbidity 80% of those with anxiety disorder meet criteria for another anxiety disorder• Subthreshold symptoms (do not meet full DSM) very common• Causes of comorbiditySymptoms overlap:Social anxiety and agoraphobia might both involve a fear of crowdsEtiological factors may increase risk for more than one disorder 75% of those with anxiety disorder meet criteria for another psychological disorder• Disorders commonly comorbid with anxiety:60% with anxiety also have depressionSubstance abusePersonality disordersMedical disorders, e.g. coronary heart diseaseGender and Sociocultural Factors Women are twice as likely as men to have anxiety disorder Women may be more likely to report symptomsMen more likely to be encouraged to face fearsWomen more likely to experience childhood sexual abuseWomen show more biological stress reactivityCultural factors• Culturally specific syndromesTaijin kyofushoJapanese fear of offending or embarrassing othersKayak-angstInuit disorder in seal hunters at sea similar to panic• Ratio of somatic to psychological symptoms appears similar across cultures (Kirmayer, 2001)Causes of anxiety disorders Conditioned fear or worry• Classical conditioning – phobia of wasps after bitten• Operant conditioning – reinforced for avoiding hospitals and doctors • Modeling – parent is afraid of storms Diatheses• Psychological– cognitive style/beliefs (catastrophizing, perfectionism)• Physiological – hot reactor, neurochemical imbalance, genetic


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