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Anxiety Disorders

Anxiety Disorders. Fundamental Features of Anxiety Disorders. Fear and Threat Effortful Avoidance Compulsions or Rituals Detachment Experiential Avoidance

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Anxiety Disorders

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  1. Anxiety Disorders

  2. Fundamental Features of Anxiety Disorders • Fear and Threat • Effortful Avoidance • Compulsions or Rituals • Detachment • Experiential Avoidance • A person is unwilling to remain in contact with particular private experiences (e.g., bodily sensations, emotions, thoughts, memories, images, behavioral predispositions) and takes steps to alter the form or frequency of these experiences or the contexts that occasion them, even when these forms of avoidance cause behavioral harm

  3. Multidimensional Construct • Three Categories • Subjective Distress (Cognitive Symptoms) • Worry about specific events harm/danger • Broader constellation of anxious cognitions • Physiological Responses • Sympathetic nervous system • Tachycardia • Tremulousness • Dizziness • Lightheadedness • Parathesias • Dyspnea • Avoidance or Escape Behaviors

  4. Anxiety symptom baserates • 1/3 of nonclinical populations have had symptoms of a panic attack at some time in their lifetimes • 90% of nonclinical populations have had obsessive thoughts no different from OCD

  5. Types of Anxiety Disorders • Panic Disorder (w/o Agoraphobia) • Agoraphobia without panic • Social Anxiety Disorder • Specific Phobia • Obsessive Compulsive Disorder • Posttraumatic Stress Disorder • Acute Stress Disorder • Generalized Anxiety Disorder • Other Anxiety Conditions secondary to medical conditions

  6. Medical Conditions and Other Etiologies • Mitral valve prolapse • Hypothyroidism • Cardiovascular problems • Vestibular abnormalities • Hyperthyroidism • Cushing’s Syndromes • Alcohol, caffeine, amphetamines, cannabis, cocaine, hallucinogens, inhalants, phencyclidine, sedatives, hypnotics, anxiolytics and a host of medications

  7. Comorbidity • ½ of patients with an anxiety disorder have had at least one other clinically significant anxiety or depressive disorder diagnosis • Panic Disorder with Agoraphobia had the highest comorbidity rates • GAD and Social Phobia had the highest rates as assignments to other disorders (e.g. depression or other anxiety disorders)

  8. Prevalence • Anxiety disorders are very prevalent second only to substance abuse (LT) and highest (past year) • 31% lifetime rate; 18.7% past year rate • Most common are social phobia and specific phobia • Women experience anxiety dx 2x rate of men • Exceptions are that social phobia is disproportionate but not as great • OCD rates are roughly comparable for men and women

  9. Diatheses • Evidence for heritability for the broad category of anxiety disorders and • Specific category for panic, agoraphobia, social phobia and OCD (less evidence for GAD and specific phobia) • Depression and anxiety may share common genetic factors • Modest support for genetic markers for AD, better evidence for genetic marker for temperament

  10. Personality • Children who were more inhibited at earlier ages evidenced more social inhibition as adults

  11. Theories • Mower’s Two Factor Theory • Exposure Therapy • Guidelines for Exposure • Identify the entire stimulus complex (including verbal processes) • Avoid small exposures that potentiate fear • Be attuned to escape behavior • When escape is blocked watch out for frustration/anger • Reconditioning of fear occurs more rapidly than the original conditioning

  12. Panic Disorder: Phenomenology • Misinterpretation of bodily sensations. Fear of physical sensations. • A panic attack appears at inappropriate or unexpected times with no apparent stimulus. • Intense fear and discomfort • Palpitations • Smothering • Dizziness • Losing Control • Fear of dying or going crazy • Peak within 10 minutes often within 1-5 minutes

  13. Physiology of Panic • Panic is an emergency response • If safe, look for explanation of symptoms • Sympathetic system either runs its course or the parasympathetic system takes our and stops the response • Cardiovascular effects • Respiratory effects • Sweat glands • Effect of overbreathing

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