Psych 380 1st Edition Lecture 10 Current Lecture Chapter 6 Anxiety Disorders I Clinical Descriptions of Anxiety Disorders II Common Risk Factors Across the Anxiety Disorders III Treatment of Anxiety Disorders Anxiety 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 phobias Phobias 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 life Avoidance Specific 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 phobias Social 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 being humiliated or embarrassed socially Onset often adolescence 33 also diagnosed with Avoidant Personality Disorder Overlap in genetic vulnerability for both disorders Panic Disorder Frequent panic attacks unrelated to specific situations Panic attack Sudden intense episode of apprehension terror feelings of impending doom Intense urge to flee Symptoms 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 dying Panic 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 phobia Panic 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 24 Panic 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 attacks Generalized Anxiety Disorder GAD Involves chronic excessive uncontrollable worry Lasts at least 6 months Interferes with daily life Often 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 way Comorbidity 80 of those with anxiety disorder meet criteria for another anxiety disorder Subthreshold symptoms do not meet full DSM very common Causes of comorbidity Symptoms overlap Social anxiety and agoraphobia might both involve a fear of crowds Etiological 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 depression Substance abuse Personality disorders Medical disorders e g coronary heart disease Gender and Sociocultural Factors Women are twice as likely as men to have anxiety disorder Women may be more likely to report symptoms Men more likely to be encouraged to face fears Women more likely to experience childhood sexual abuse Women show more biological stress reactivity Cultural factors Culturally specific syndromes Taijin kyofusho Japanese fear of offending or embarrassing others Kayak angst Inuit 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 inheritance