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Part 2- L6.docx

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University of Otago
Gareth Treharne

Part 2- L6 Anxiety disorders DSM5 - There are over 19 disorders that involve anxiety - Panic disorder- Repeated panic attacks - Specific phobia- excessive fear of a specific stimulus - Social phobia- fear of social performance or scrutiny - Obsessive compulsive disorder- intrusive thoughts - Post-traumatic stress disorder- stress reaction to trauma o Physiology is more aroused o Re-experiencing things that have happened - Generalised anxiety disorder- excessive worrying Simple phobias Aetiology - Freud/ Psychoanalytic model o defence against the anxiety experienced when impulses formed by the id are repressed o resulting in a displacement of the repressed feelings onto the object or situation with which it is symbolically associated o childhood trauma or conflict o E.g. Hans was a 5-year-old boy who was afraid of horses, and avoided leaving the house for fear of being bitten by one. He also developed a specific fear of the blinkers and muzzles on horses’ faces. Freud considered his fears to relate to the Oedipus complex (see Chapter 2), and that he was having sexual fantasies about his mother and feared his father’s retaliation. He therefore displaced the fear of his father onto horses who reminded him of his father - Behavioural model o result from conditioning experiences o inappropriately feared object or situation was associated with the experience of fear at some time in the past o Less able to explain why they are maintained over long periods o once a phobic response is established through classical conditioning processes, the affected individual tends to avoid the feared stimulus  Prevents the classical conditioning process of extinction  Avoidance itself produces feelings of relief - A cognitive behavioural model o Retained the conditioning processes but added a number of other processes  Acquisition of phobias × Familiarity × Observations/info from others expressing high fear  Maintenance × Socially or verbally transmitted information × Rehearsal and overestimation of the possible adverse outcomes - Biological/evolutionary model o preparedness theory o some phobias or fears are more o Easily acquired as a result of their evolutionary usefulness than others  Beneficial to have a fear of potentially dangerous stimuli such as snakes o hardwired, or biologically prepared, to react fearfully to stimuli that were once threatening to prehistoric man o Because of their biological significance, they are non-cognitive o resist extinction o Fear of these stimuli is easily acquired - Genetic o agoraphobia, social phobia and animal phobias  more strongly correlated in 23 MZ twins than in 38 DZ twins  0.47 for common phobic fear of small animals  0.30 for agoraphobic fear Treatment - Behavioural treatments o exposure to the feared stimulus either directly (flooding) or in a series of hierarchical stages (systematic desensitization)  teaching people skills such as:  Relaxation  Cognitive strategies to counter negative expectations and fear - Pharmacological treatments o Little benefit o Many major reviews of the pharmacological treatment of anxiety do not even address the pharmacological treatment of specific phobias. Paruresis - Does not fit the mould offered in the DSM5 o Is not in DSM 4 or 5 o Not afraid of a specific stimulus therefore is not a specific phobia - Fear of urinating in public - Space where people may come. - Think that whatever the other person is thinking about it must be about you. - Will not want to travel because unsure if there is a secure toilet - Features o Disruption of micturition (weeing) o Is defined by public or social settings  Public is idiosyncratically (characteristically) defined  Exposure you’re afraid of is others hearing, seeing, smelling or knowing you’re weeing o Fear other will perceive self as unusual or inadequate o Avoidance  Social activities  Delayed micturition  Restricting fluids - 600 members of paruresis o 38% wouldn't travel o 38% wouldn't go on a date. - Make major life decision around paruresis i.e. o University o Going to lectures o Work - Associations o Elevated interpersonal/performance anxiety o Comorbidity  Many are depressed × ¼ are depressed  1/3 had another social phobia  At least ½ have other psychopathology o Family history  16% have family members with paruresis o Secondary disorder  Kidney infections are common.  Stuttering
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