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Chapter 5 Practice Exam Questions

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 5:Anxiety Disorders LEARNING GOALS 1. Be able to describe the clinical features of the anxiety disorders, and how they tend to co-occur with each other. 2. Be able to describe how gender and culture influence the prevalence of anxiety disorders. 3. Be able to recognize commonalities in etiology and treatment across the anxiety disorders. 4. Be able to describe etiological factors and treatment approaches that are specific to each of the anxiety disorders. Summary Clinical Descriptions of theAnxiety Disorders ● As a class, anxiety disorders are the most common type of mental illness. ● DSM-IV-TR lists seven principal diagnoses: specific phobia, social phobia, panic disorder (with and without agoraphobia), generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and acute stress disorder. Anxiety is common to all the anxiety disorders, but phobias and panic also involve fear as a clinical feature. ● Phobias are intense, unreasonable fears that interfere with functionality. Social phobia is fear of unknown people or social scrutiny. Specific phobias include fears of animals, heights, enclosed spaces, and blood, injury, or injections. ● Apatient with panic disorder has recurrent, inexplicable attacks of intense fear. Panic attacks alone are not sufficient for the diagnosis; a person must be worried about the potential of having another attack. Panic attacks sometimes lead to fear and avoidance of being in places where escape would be difficult if another attack were to occur, known as agoraphobia. ● In generalized anxiety disorder, the person is beset with virtually constant tension, apprehension, and worry which lasts for at least 6 months. ● People with obsessive-compulsive disorder have intrusive, unwanted thoughts and feel pressured to engage in rituals to avoid overwhelming levels of anxiety. ● Post-traumatic stress disorder is diagnosed in some people who have experienced a traumatic event that would evoke extreme distress in most people. It is marked by symptoms of reexperiencing the trauma, arousal, and emotional numbing. Acute stress disorder is defined by similar symptoms, but lasts less than one month. Gender and Sociocultural Factors in theAnxiety Disorders ● Anxiety disorders are much more common among women than men. ● The focus of anxiety, the prevalence of anxiety disorders, and the specific symptoms expressed may be shaped by culture. Common Risk Factors across theAnxiety Disorders ● The psychoanalytic view of anxiety disorders is that they are a defense against repressed conflicts. ● Genes increase risk for a broad range of anxiety disorders. Beyond this general risk for anxiety disorders, there may be more specific heritability for certain anxiety disorders. Beyond genetic diatheses, other factors that appear to be involved in a range of anxiety disorders include elevated activity in the fear circuit, poor regulation of several neurotransmitter systems (GABA, serotonin, and norepinephrine), lack of perceived control, a tendency to pay closer attention to signs of potential danger, and negative life events. CommonAspects of Treatment for theAnxiety Disorders ● Behavior therapists focus on exposure to what is feared. Systematic desensitization and modeling may be used as parts of exposure therapy. For some disorders, including social phobia, GAD, OCD and panic disorder, cognitive components may also be helpful in therapy. ● Antidepressants and benzodiazapenes are most commonly used for anxiety disorders, but new research also has begun to focus on medications like the anticonvulsant medication gabapentin (Neurontin). The effects of medications are often not as powerful as those seen for psychotherapy. There are some concerns that benzodiazapenes are subject to abuse, and discontinuing medications usually leads to relapse. Etiology and Treatment of SpecificAnxiety Disorders ● Behavioral models of phobias typically emphasize two stages of conditioning. The first stage involves classical conditioning, in which a formerly innocuous object is paired with a feared object. This could be accomplished through direct exposure, modeling, or cognition. Fears of objects with evolutionary significance may be more easily conditioned. The second stage involves avoidance. Because not all people with negative experiences develop phobias, diatheses must be important. Exposure treatment for specific phobia tends to work quickly and effectively. Social phobia is harder to treat and addiing cognitive components to behavioral treatments may help. ● Neurobiological models of panic disorder have focused on the locus ceruleus, the brain center responsible for norepinephrine release. Many different drugs have been found to trigger panic attacks in laboratory studies among people with a history of panic attacks. The key trigger is probably not a shift in a given neurotransmitter, but rather, how a person interprets changes in their body. Behavioral theories of panic attacks have posited that the attacks are classically conditioned to internal bodily sensations. Cognitive theories suggest that such sensations are more frightening due to catastrophic misinterpretation of somatic cues. CBT treatment appears more effective than medication treatment of panic disorder. ● Cognitive behavioral theories hold that GAD results from distorted cognitive processes. One model suggests that worry actually helps people avoid more intense emotions. Neurobiological approaches focus on the neurotransmitter GABA, which may be deficient in those with the disorder. Relaxation and cognitive approaches may be helpful, as is the use of medication. ● OCD symptoms have been robustly linked to activity in the orbitofrontal cortex, the caudate, and the anterior cingulate. In behavioral accounts, compulsions are considered avoidance responses that are reinforced because they provide relief. Checking behaviors may be intensified by doubts about memories. Obsessions may be intensified by attempts to inhibit unwanted thoughts, in part because people with OCD seem to feel that thinking about something is as bad as doing it. ERP is a well-validated approach that involves exposure. The SRI, clomipramine, also appears helpful, as do other antidepressant medications. ● Research and theory on the causes of post-traumatic stress disorder focus on risk factors such as hippocampal volume, the severity of the event, dissociation, and other psychological factors that may influence the ability to cope with stress, such as social support and intelligence. Psychological treatment involves exposure, but often, imaginal exposure is used. 1. The difference between anxiety and fear is that a. anxiety is a response to immediate danger, while fear is defined as apprehension over an anticipated problem. b. anxiety is immediate and fear is anticipated. c. anxiety is apprehension over an anticipated problem, while fear is defined as a response to immediate danger. d. anxiety is always adaptive, whereas fear is not. Answer: C Type: Factual Page: 122 2. Dylan is walking through the jungles ofAfrica, and he suddenly comes across a ferocious tiger. Which of the following reactions is most adaptive in this scenario? a. anxiety b. anger c. panic d. fear Answer: D Type:Applied: Page: 122 3. To improve performance on laboratory tests, it is best for participants to a. experience a great deal of anxiety. b. experience a small degree of anxiety. c. experience no anxiety. d. experience a small amount of anxiety as well as fear. Answer: B Type: Factual Page: 122 4. Which of the following statements is true? a. Hannah’s performance on her algebra test will improve if she experiences a small degree of anxiety. b. Hannah’s performance on her algebra test will worsen if she experiences any anxiety. c. Hannah’s performance on her algebra test will improve if she experiences a fair amount of anxiety before and during the test. d. Anxiety is not related to performance on tests. Answer:AType: Factual Page: 122 5. As a group, anxiety disorders a. are unlikely to be cormorbid. b. are one of the least costly psychiatric disorders to society. c. cause little interpersonal problems. d. are the most common type of psychiatric diagnosis. Answer: D Type: Factual Page: 122 6. Mario was diagnosed with both post-traumatic stress disorder and dysthymic disorder. This is an example of a. an inability to distinguish depressive symptoms from anxiety symptoms. b. an error by the diagnostician, since twoAxis I disorders cannot be diagnosed in the same person. c. the importance of having a multiaxial diagnostic system. d. comorbidity, a common occurrence in psychiatric diagnosis. Answer: D Type: Factual Page: 123 7. Margaret and Ed have different fears. Margaret is afraid of snakes, whereas Ed is afraid of dogs. Their fears are similar in that a. both serve the same adaptive purpose. b. both require aversive learning consequences for their development. c. neither respond well to treatment. d. All of the above choices are correct. Answer:AType:Applied Page: 122 8. Why are anxiety disorders often comorbid with other kinds of diseases? a. The disorders involve similar neural pathways. b. Prolonged anxiety leads to other problems. c. Clinicians misdiagnose disorders. d. Their symptoms overlap. Answer: B Type: Factual Page: 124 9. Ted is fearful of interactions with others and avoids eating in public. Ted most likely has a. specific phobia. b. panic disorder with agoraphobia. c. social phobia. d. paranoia. Answer: C Type: Factual Page: 124 10. An individual diagnosed with a social phobia a. exhibits paranoid symptoms, believing others are plotting to hurt him or her. b. is unable to speak in the presence of other people. c. is terrified of being in public places and may become housebound. d. becomes extremely anxious when in certain situations which involve activities done in the presence of other people. Answer: D Type: Factual Page: 124 11. Julie has a social phobia. Given this information, it would not be surprising if she also met DSM-IV criteria for a. schizophrenia. b. borderline personality disorder. c. avoidant personality disorder. d. obsessive compulsive personality disorder. Answer: C Type: Factual Page: 124 12. Which of the following terms have been proposed as a more appropriate label for a social phobia? a. social disorder b. social anxiety disorder c. social phobia disorder d. avoidant personality disorder Answer: B Type: Factual Page: 124 13. Why has the term “social anxiety disorder” been proposed as a more appropriate label for social phobia? a. Social phobias tend to be more pervasive and cause more interference with daily routines than other phobias. b. Asocial phobia was termed “social anxiety disorder” in the DSM-III. c. Many people with social phobias also meet criteria forAvoidant Personality Disorder. d. Social phobias cause minimal impairment and tend to be of short duration. Answer:AType: Factual Page: 124 14. Ted is fearful of most social situations, whereas Andreas is only fearful of giving speeches. Given this, one could infer a. that Ted’s fear began at an earlier age. b. that Ted may be more likely to abuse alcohol. c. thatAndrea has less impairment. d. All of the above choices are correct. Answer: D Type:Applied Page: 124-125 15. In the question above, Ted would be diagnosed with ____________ whileAndreas would be diagnosed with _________. a. social phobia, specific type; social phobia, generalized type b. social phobia, generalized type; social phobia, specific type c. agoraphobia, social type; social phobia, specific type d. agoraphobia, social type; generalized anxiety disorder Answer: B Type:Applied Page: 125 16. Depersonalization and derealization are common symptoms for which disorder? a. obsessive-compulsive disorder b. specific phobia c. social phobia d. panic disorder Answer: D Type: Factual Page: 125 17. Which of the following is an example of a cued panic attack? a. One that occurs during sleep. b. One that occurs in the therapist's office, under control and as part of treatment. c. One that occurs in specific situations, such as when the person is driving. d. One that occurs without warning while watching T.V. Answer: C Type: Factual Page: 125 18.Agoraphobia is characterized by a fear of a. being in unfamiliar places. b. being embarrassed by saying or doing something foolish in front of others. c. strangers misinterpreting their symptoms as a heart attack. d. having a panic attack in places in which escape would be difficult or embarrassing. Answer: D Type: Factual Page: 126 19. Edna does not currently have panic disorder. However, she cannot leave her house and required home sessions when she began therapy. It is likely a. Edna has agoraphobia, does not meet criteria for panic disorder. b. Edna does not have agoraphobia. c. Edna is faking her symptoms. d. that Edna has more severe panic but is able to cope with the symptoms. Answer:AType:Applied Page: 126 20. Why are agoraphobia and panic disorder discussed together? a. Panic disorder often leads to agoraphobia. b. Panic disorder is a primary characteristic of agoraphobia. c. The two terms are synonymous. d. Their etiology and treatment is very similar. Answer:AType: Factual Page: 126 21. Panic attacks a. occur only in people with panic disorder, by definition. b. can occur in people who do not have panic disorder. c. occur in greatest frequency among people diagnosed schizophrenic. d. occur primarily in people with agoraphobia. Answer: B Type: Factual Page: 126 22. Tom has symptoms of chronic muscle tension, occasional rapid heart rate, dizziness, and difficulty falling asleep. In addition to these symptoms, if he has GeneralizedAnxiety Disorder, he also has a. chronic worry. b. depersonalization. c. derealization. d. interpersonal stress. Answer:AType:Applied Page: 127 23. The worries of people with GAD a. are generally limited to physiological concerns. b. are similar to worries of most people. c. typically are driven by another Axis I disorder. d. All of the above are true. Answer: B Type: Factual Page: 127 24. Intrusive, irrational and unwanted thoughts are called a. irrational beliefs. b. generalized anxiety. c. obsessions. d. compulsions. Answer: C Type: Factual Page: 127 25. Oscar feels the urge to turn a light switch on and off 12 times before leaving a room. This would be referred to as a. an irrational belief. b. generalized anxiety. c. an obsession. d. a compulsion. Answer: D Type:Applied Page: 127 26. Which of the following is a compulsion? a.Apersistent fear of getting dirty. b. Having persistent doubts about whether the stove was turned off that morning. c. Persistent checking for one's keys. d. Persistent thoughts about harming one’s spouse. Answer: C Type:Applied Page: 127 27. Which of the following is an obsession? a. Repeatedly checking that the water is turned off. b. Humming a tune over and over. c. Having a recurring fear that one is giving others illnesses when they actually are not. d. Having excessive worry over finances. Answer: C Type:Applied Page: 127 28. What diagnosis is most appropriate for Nicole? She is constantly concerned with symmetry, often spending hours arranging items in her room so that the room appears even on the left and right. She also feels that when she eats, the items on the plate must be arranged symmetrically. All of this effort interferes with her work. a. obsessive-compulsive disorder b. specific phobia c. generalized anxiety disorder d. specific phobia Answer:AType:Applied Page: 127-128 29. Sharon, a five-year-old girl, developed the following symptoms after being sexually molested: difficulty sleeping, nightmares, a tendency to be easily startled, and bedwetting. Which of the following would be the most likely diagnosis for Sharon? a. generalized anxiety disorder b. adjustment disorder c. depressive disorder d. posttraumatic stress disorder Answer: D Type:Applied Page: 129 30. Symptoms of PTSD are grouped into which of the following major categories? a. reexperiencing of traumatic event, avoidance of stimuli associated with event and anxiety b. hypervigilance, avoidance of stimuli associated with event and exaggerated startle response c. avoidance of stimuli associated with event, symptoms of increased arousal and symptoms of suicidality d. reexperiencing of traumatic event, avoidance of stimuli associated with event and symptoms of increased arousal Answer: D Type: Factual Page: 129 31. Iris was in an automobile accident. She goes to a psychologist one week after the accident. If she is experiencing nightmares, flashbacks, headache, and is ruminating about the accident, she will likely receive which diagnosis? a. acute stress disorder b. generalized anxiety disorder c. posttraumatic stress disorder d. anxiety disorder not otherwise specified Answer:AType:Applied Page: 130 32. Comorbidity a. is more the rule than the exception with anxiety disorders. b. occurs in less than 1/6 of people with anxiety disorders. c. is associated with less severity and better outcomes. d. All of the above are true. Answer:AType: Factual Page: 130 33. The most common disorder comorbid with anxiety disorders is a. borderline personality disorder. b. obsessive compulsive disorder. c. avoidant personality disorder. d. depression. Answer: D Type: Factual Page: 130 34. Women are more likely to be diagnosed with anxiety disorders because they are more a. likely to face their fears directly. b. physiologically vulnerable. c. willing to report their symptoms. d. exposed to social discrimination. Answer: C Type: Factual Page: 131 35. Research shows that compared with men, women a. are at least twice as likely to be diagnosed with an anxiety disorder. b. are less likely to develop PTSD after exposure to a trauma. c. are less likely to report their symptoms. d. are more likely to be diagnosed with OCD. Answer:AType: Factual: Page: 131 36. According to the text, which of the following is NOT a theory as to why women are more likely to develop anxiety disorders than men? a. Women may be more likely to report their symptoms. b. Women tend to be more nervous than men in general. c. Men may be raised to believe more in personal control over situations. d. Men may experience more social pressure than women to face fears. Answer: B Type: Factual Page: 131 37. In relation to objects of anxiety, different cultures appear to a. have the same prevalence of a given disorder. b. play little role in what people fear. c. influence what people come to fear. d. fear the same objects, but these fears manifest themselves in different ways depending on the culture. Answer C Type: Factual Page: 131-132 38. If you lived in Taiwan or Japan, you would a. be more likely to have an anxiety disorder. b. be less likely to have an anxiety disorder. c. be more likely to have kayak-angst. d. never receive a formal psychiatric diagnosis. Answer: B Type: Factual Page: 131-132 39. Heritability estimates tend to be the highest for a. panic disorder. b. GAD. c. PTSD. d. arachnophobia. Answer:AType: Factual Page: 133 40. Individuals with anxiety disorders a. have weak fear circuits. b. have fear circuits that do not activate correctly when they are fearful or anxious. c. have an overactive fear circuit. d. have an underactive amygdala. Answer: C Type: Factual Page: 133 41. Josie has panic disorder. She is being shown pictures of sad and angry faces as part of an experiment. Herbie does not have an anxiety disorder. He is also being shown pictures of sad and angry faces. The researchers studying Josie and Herbie’s brain while they look at the pictures will most likely note that a. Josie’s amygdala is less active than Herbie’s. b. Josie’s fear circuit is less elevated than Herbie’s. c. Herbie’s fear circuit is more elevated than Josie’s. d. Herbie’s amygdala is less active than Josie’s. Answer: D Type:Applied Page: 133 42. Dana’s baby, Sophie, participated in a study that indicated that Sophie had high levels of behavioral inhibition. Compared with babies who demonstrated low levels of behavioral inhibition, Sophie is likely to develop a. panic disorder. b. social phobia. c. OCD. d. agoraphobia. Answer: B Type:Applied Page: 134 43. Behavioral inhibition is defined as a. the tendency to experience neuroticism. b. the inability to inhibit one’s behavioral reactions. c. the tendency to become agitated and cry when faced with novel stimuli. d. the inability to regulate symptoms of anxiety. Answer: C Type: Factual Page: 134 44. Infants with become agitated and cry when faced with novel toys or people and are more likely to show anxiety as they get older. a. neuroticism b. depersonalization c. prepared learning d. behavioral inhibition Answer: D Type: Factual Page: 134 45. Neuroticism is best defined as a. depression. b. anxiety. c. the tendency to react to events with negative affect. d. the tendency towards pessimism. Answer: C Type: Factual Page: 134 46. Lola is low in neuroticism. Compared with people who have high levels of neuroticism, Lola a. is more likely to experience anxiety and depression. b. is less likely to develop an anxiety disorder. c. is probably characterized by a tendency to react to events with negative affect. d. is more likely to have OCD. Answer: B Type:Applied Page: 134 47. Which of the following puts people at greater risk for developing anxiety disorders? a. having a perception that they have no control over
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