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Chapter 6

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 6: Anxiety Disorders Anxiety: unpleasant feeling of fear and apprehension - even in normal people, very few of us go without experiencing some measure of anxiety or fear Anxiety Disorders: Phobia- fear and avoidance of objects or situations that dont present any real danger Panic disorder- recurrent panic attacks (dizziness, rapid heart rate, trembling, terror and feelings of impending doom; sometimes accompanied by agoraphobia (fear of being in public places) Generalized anxiety disorder (GAD)- persistent uncontrollable worry, often about minor things Obsessive-compulsive disorder- uncontrollable thoughts/impulses/obsessions & repetitive bhvrs Post-traumatic stress disorder (PTSD)- aftermath of a traumatic experience (experiences arousal, avoidance of stimuli associated with the event, and anxiety recalling the event) Acute stress disorder- same symptoms as PTSD but only lasts for 4 weeks or less - often, someone with one anxiety disorder meets the diagnostic criteria for another disorder, with the possible exception of OCD - this comorbidity among anxiety disorders arises for 2 reasons: Symptoms of the various anxiety disorders are not entirely disorder specific (perspiration, fast heart rate are among the diagnostic criteria for panic disorder, phobias, and PTSD) Etiological factors that give rise to various anxiety disorders are probably applicable to more than 1 disorder - high rate of childhood maltreatment, has been linked to greater symptom severity and poorer quality of life and function in people seeking treatment for generalized social anxiety disorder - physical or sexual abuse during childhood increases a person's risk for developing several disorders As a group, anxiety disorders are the most common psychological disorders (in Alberta, 1/5 had some form of anxiety disorder) - on year and lifetime prevalence rates for total anxiety disorders include 10.6% and 16.6% - anxiety disorders have an early age of onset, typically during childhood more common in women than men across all age groups more common in women of 15-24 years of age common among university students (1 year prevelance of almost 12%) social anxiety disorder is the most common type of anxiety with a lifetime prevalence of 8.1%, PTSD could be a rival with a lifetime prevalence of 9.2% - majority of Canadians who met criteria for anxiety disorders reported it interefered with home, school, work, and social life - those with anxiety disorders were less likely to seek help from any mental health service, relative to mood disorders - +80% of college students with anxiety disorders did not seek treatment Anxiety disorders are comorbid with many other conditions (social phobia is comorbid with other anxiety disorders, substance abuse, depressive disorder, and bipolar disorder. Comorbidity is strongest with the depressive disorders - strong link between anxiety disorders and chronic pain, especially musculoskeletal pain Anxiety and depression show a strong relationship to each other at both genotypic and phenotypic levels and are 3 elements of a general negative affectivity factor - Found that social phobia plays a role in promoting depression in Japanese study - growing body of evidence suggests that PTSD and GAD have more in common with major depression than with the other evidences - may suggest a problem with DSM taxonomy - PTSD will be revised in DSM-5, but GAD and major depression have distinguishable environmental factors and temporal presentations - Clark and Watson proposed a tripartite model to account for the symptom overlap and diagnostic comorbidity between anxiety and depression. --> Model points that anxiety and depression share a common component of negative affect, but they can be differentiated by high physiological hyper arousal associated with anxiety and by low positive effect associated with depression - Watson et al. believe that these disorders should be collapsed together into overarching superclass of emotional disorders, with three subclasses 1) distress disorders - major depression, dysthymic disorder, GAD, and PTSD 2) fear disorders - panic disorder, agoraphobia, social phobia, and specific phobia 3) bipolar disorders - bipolar I, bipolar II and cyclothymia - Maser believed that there should be an umbrella category of Social Anxiety Disorder, that would include social anxiety disorder, avoidant personality disorder, selective mutism, seperation anxiety disorder, and school phobia --> reasoning behind this is that all disorders may be treated with SSRIs or bognitive behaviour therapy, many of the systems overlap, and each disorder has comorbidities similar to the others - the DSM-5 has special group for dealing with the anxiety disorder classifications - current work is focused on role of amygdala, found in the temporal love - Functional MRI & PET studies of PTSD, SAD, & specific phobia examined responses across 3 conditions: Negative emotion, Positive emotion and Neutral conditions - individuals have more activity in two areas associated with negative emotional responces - the amygdala and insula - individual who experienced traffic accident after getting part of amygdala removed to treat epilepsy still got PTSD - concluded that right amygdala is implicated in PTSD PHOBIAS - phobia: disrupting, fear mediated avoidance that is out of proportion to the real danger imposed and is accompanied with sufficient distress (social or occupational) to disrupt one's life - many specific fears do not cause enough hardship to compel an individual to seek treatment - eg. will not come into contact with snakes very often - Suffix is derived from the Greek god Phobos, who frightened his enemies - psychologists tend to focus on diff aspects of phobia based on the paradigms they adopt - eg. psychoanalysts believe that content of phobia has important symbolic value, while behaviourists would ignore the content and instead focus on its function (means of how they were acquired, how they might be reduced) Common phobias: Claustrophobia- fear of closed spaces Agoraphobia- fear of public places Acrophobia-fear of heights Exotic phobias: Ergasiophobia- fear of working Pnigophobia- fear of choking Taphephobia- fear of being buried alive mysophobia - fear of conttamination and dirt that plagues many people (Howie Mandel) Specific phobias: Unwarranted fear caused by the presence or anticipation of a specific object or situation DSM-IV-TR subdivides these phobias according to the sources of the fear: Blood Injuries Injections Situations (planes, elevators, enclosed spaces) Animals Natural environment (heights, water) Empirical research suggests that fears can be grouped into 1 of 5 factors: Agoraphobia Fears of heights or water Threat fears (blood/needles, storms/thunder) Fears of being observed Speaking fears Lifetime prevalence is almost 1 in 10 The mean age of onset was around 10 years old Mean duration was 20 years Only 8% received treatment for their specific phobia or phobias Most common specific phobia subtypes in order are: 1. Animal phobias (insects, snakes, and birds) 2. Heights 3. Being in closed spaces 4. Flying 5. Being in or on water 6. Going to the dentist 7. Seeing blood or getting an injection 8. Storms, thunder, or lightening Specific fear can vary cross culturally:
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