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PS280 Lecture Notes - Panic Disorder, Posttraumatic Stress Disorder, Etiology

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Kathy Foxall

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Anxiety Disorders
Include: panic disorder, generalized anxiety disorder (GAD), phobias, obsessive-
compulsive disorder, acute and post-traumatic stress disorders
Every healthy person experiences some anxiety at different times
Anxiety disorders 1/3 of costs for mental disorders in U.S.
Manifested in cognitive, behavioural, and somatic realms:
Cognitive – take place in a person’s thoughts
Behavioural – occur in a person’s action
Somatic – changes in a person’s physiological or biological reactions
awareness of illogical and self-defeating nature
“reasonable doses” of anxiety act as a safeguard to keep us from ignoring danger,
and anxiety appears to have an adaptive function
Anxiety disorder:
Anxiety itself is the major disturbance
The anxiety is manifested only in particular situations
Anxiety results from an attempt to master other symptoms
Panic disorder & GAD
both involve unfocused anxiety (free floating)
ofree floating – the affected individual is fearful and apprehensive but often
does not know exactly what he or she is afraid of
panic disorder includes episodes of intense fear with somatic symptoms
GAD chronic pathological worry
Panic disorder
5% of females, 2.3% males, (3.5%, M&F, lifetime prevalence) onset in
adolescence and mid 30's, chronic, symptoms fluctuate
1/4-1/3 American university students reported panic attack in last year
sudden symptoms, minutes - hours; usually less than 20 minutes:
oapprehension, feelings of impending doom
opounding heart
osweating, trembling

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oshortness of breath
ochoking sensation
ochest pain
ofeelings of unreality
ofear of dying
ofear loss of control
ochills/hot flashes
may be triggered by specific immediate circumstances
may seem to come out of the blue
many self-medicate
many develop agoraphobia; anxiety about leaving the home, fear attack in public
o1/3 – ½ of individuals diagnosed with a panic disorder also have
Most of these panic attacks are associated with an identifiable stimulus
Background/precipitating factors
childhood anxiety over separation from parents, family conflicts, school problems
may be precipitated by separation experiences, major life stresses
Generalized Anxiety Disorders (GAD)
persistent high levels of anxiety & excessive worry over many life circumstances
afflicted people are easily startled and are continually “on edge”
unable to discover the “real” source of their fears; they remain anxious and
occasionally experience even more attacks of anxiety
physiological reactions associated with GAD tend to be less extreme than those
that accompany panic disorder but also tend to be more persistent
symptoms include:
omuscle tension
opalpitations, trembling
osleep difficulties

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opoor concentration
opersistent apprehension
symptoms present for six months; chronic condition
Etiology of Panic Disorder & GAD
Psychodynamic perspective
internal, unconscious conflicts
sexual and aggressive impulses seeking expression
intense anxiety reaction when forbidden impulses seek expression
because this conflict is unconscious, the individual does not know the source of
the anxiety
Cognitive Behavioural Perspective
cognitions and conditioning
thoughts precede or contribute to panic attacks
cognitions influence severity of somatic symptoms
have excessive reaction to unpleasant somatic sensations (catastrophizing)
positive feedback loop that leads to panic attacks
people with high levels of anxiety sensitivity appear to have an overly active
degree of bodily vigilance, along with intense fear of and worry about bodily
attributes panic attacks to the individual’s interpretation of unpleasant bodily
sensations as indicators of an impending disaster
Biological Perspective
little evidence for biological contribution to generalized anxiety disorder
possible abnormality of benzodiazepine receptors in the brain
obenzodiazepines – a family of anti-anxiety drugs that include Valium and
Librium; have been successful in treating GAD
dysfunction of receptors (locus ceruleus) that monitor amount of oxygen in the
blood (controversial finding)
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