Chapter 6 Panic, Anxiety, Obsessions, and Their Disorders

Chapter 6 Panic, Anxiety, Obsessions, and Their Disorders
ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 6 Panic, Anxiety, Obsessions, and Their Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Anxiety Disorders Lifetime prevalence in US: 25-29%
Term “neurosis” dropped from DSM (1980) In touch with reality Neuroticism: personality trait. Proneness or disposition to experience negative mood states that is a common risk factor for both anxiety and mood disorders OCD no longer an anxiety disorder © Pearson Education, Inc. All rights reserved.

Fear and Anxiety Response Patterns
What is the difference between fear and anxiety? It is difficult to completely distinguish between fear and anxiety Anxiety: general fear about possible future danger Fear: alarm response that occurs due to immediate danger © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

It is difficult to completely distinguish between fear and anxiety
Anxiety: general fear about possible future danger Fear: alarm response that occurs due to immediate danger Preparedness theory (survival purposes) © Pearson Education, Inc. All rights reserved.

Fear and Anxiety Response Patterns
Historically, distinction centered on whether source of danger is obvious Obvious danger leads to fear Less obvious danger leads to anxiety It is difficult to completely distinguish between fear and anxiety. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Fear and Anxiety Response Patterns
Fear or panic Activation of “fight-or-flight” response Fear with no external cause is known as (spontaneous or uncued) panic attack and includes sense of impending doom, including: fear of dying, going crazy or losing control Fear or panic is basic emotion that involves activation of “fight-or-flight” response of the autonomic nervous system Fear with no external cause is known as panic attack and includes sense of impending doom © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Fear and Anxiety Response Patterns
General feeling of apprehension about possible danger Future-oriented and diffuse Cognitive/subjective, physiological, and behavioral components Anxiety is more oriented to the future and more diffuse than fear © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Overview of the Anxiety Disorders and Their Commonalities
Unrealistic, irrational fears or anxieties Disabling intensity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The DSM-5 recognizes five primary types of anxiety disorders. How many of these can you identify? Specific phobia Social anxiety disorder (social phobia) Panic disorder Agoraphobia Generalized anxiety disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Social anxiety disorder (social phobia) Panic disorder Agoraphobia
Specific phobia Social anxiety disorder (social phobia) Panic disorder Agoraphobia Generalized anxiety disorder © Pearson Education, Inc. All rights reserved.

Basic biological causes Basic psychological causes Effective treatments All have genetic component and this may be nonspecific to a disorder People with these disorders are all high in neuroticism Classical conditioning plays a role in all of these disorders. People who feel no control over their situation are at greater risk for anxiety disorders Graduated exposure to fears is a common treatment. All (except specific phobias) respond to antianxiety and antidepression drugs © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

All have genetic component and this may be nonspecific to a disorder
People with these disorders are all high in neuroticism Classical conditioning plays a role in all of these disorders. People who feel no control over their situation are at greater risk for anxiety disorders Graduated exposure to fears is a common treatment. All (except specific phobias) respond to antianxiety and antidepression drugs © Pearson Education, Inc. All rights reserved.

Specific Phobias Specific phobia Strong and persistent fear recognized as excessive or unreasonable Triggered by a specific object or situation © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Subtypes identified in DSM-5
Specific Phobias Subtypes identified in DSM-5 Animal Natural environment Blood-injection-injury Situational Other © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Prevalence, Age of Onset, and Gender Differences
Social phobia: common mental disorder Lifetime prevalence rate of about 12% More common in women (60%) than men Blood-injection-injury phobia occurs in about 3-4% of population Age of onset for different phobias varies widely © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychological Causal Factors
Psychological Causes Psychoanalytic viewpoint: defense against anxiety stemming from represses id impulses Learned behavior/classical conditioning Vicarious conditioning Individual differences in learning Evolutionary preparedness Psychoanalytic viewpoint: defense against anxiety stemming from repressed id impulses © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Biological Causal Factors
Genetics Temperament Monozygotic twins are more likely to share phobias than dizygotic twins Behaviorally inhibited temperament is linked to higher vulnerability to phobias Genetics Monozygotic twins are more likely to share phobias than dizygotic twins Temperament Behaviorally inhibited temperament is linked to higher vulnerability to phobias © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatments Exposure therapy Cognitive techniques combinations
Participant modeling Virtual reality components Cognitive techniques combinations Exposure therapy is the treatment of choice for specific phobias Can involve participant modeling or virtual reality components Can also be combined with cognitive techniques © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Medication treatments are ineffective by themselves when dealing with any of the specific phobias. However, d-cycloserine (facilitates extinction of conditioned fear in animals) may enhance the effectiveness of small amounts of exposure therapy for fear of heights in a virtual reality environments. By itself, it has no effect. © Pearson Education, Inc. All rights reserved.

Social Phobias Social phobia Disabling fears of one or more specific social situations Fear of exposure to scrutiny and potential negative evaluation of others and to humiliation or embarrassment Aka Social anxiety disorder Fear of exposure to scrutiny and potential negative evaluation of others and to humiliation or embarrassment © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Common mental disorder Lifetime prevalence around 12% Somewhat more common in women than men Typically begin during adolescence or early adulthood Many have comorbid disorders such as other anxiety disorders or depression Approximately 1/3 abuse alcohol to reduce anxiety and face fear Tend to have lower SES and lower employment rates Very persistent disorder. Only 37% recovered spontaneously in the 12-year period © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Social Phobia Approximately 1/3 abuse alcohol to reduce anxiety and face fear Tend to have lower SES and lower employment rates Very persistent disorder. Only 37% recovered spontaneously in the 12-year period © Pearson Education, Inc. All rights reserved.

Learned behavior Evolutionary factors Perceptions of uncontrollability and unpredictability Cognitive biases toward “danger schemas” Learned behavior Classical conditioning that is direct or vicarious in nature Evolutionary factors Predisposition based on social hierarchies Perceptions of uncontrollability and unpredictability Cognitive biases toward “danger schemas” in social situations © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Classical conditioning that is direct or vicarious in nature (56-58%)
Learned behavior Classical conditioning that is direct or vicarious in nature (56-58%) Evolutionary factors Predisposition based on social hierarchies. Greater activation of the amygdala in response to negative facial expressions (angry faces) Perceptions of uncontrollability and unpredictability Cognitive biases toward “danger schemas” (expect to be rejected or being negatively evaluated) in social situations that they will behave in awkward and unacceptable fashion, resulting in rejection and loss of status © Pearson Education, Inc. All rights reserved.

Genetics Temperament Twin studies suggest about 30% of variance in liability to social phobia is due to genetic factors Behavioral inhibition (shares characteristics with neuroticism and introversion) correlates with social phobia Genetics Twin studies suggest about 30% of variance in liability to social phobia is due to genetic factors Temperament Behavioral inhibition correlates with social phobia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatments for social phobias
Cognitive therapy Behavior therapy Medications Treatments for social phobias include: Cognitive therapy Cognitive restructuring to change distorted automatic thoughts Behavior therapy Exposure to social situations that evoke fear Medications Antidepressants Relapse rate with medication is higher than with therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatments for social phobias include:
Cognitive therapy Cognitive restructuring to change distorted automatic thoughts. More effective than medications. Behavior therapy Exposure to social situations that evoke fear. If added d-cycloserine, treatment gains occur more quickly and are more substantial Medications Antidepressants (MAOIs and SSRIs) Relapse rate with medication is higher than with therapy © Pearson Education, Inc. All rights reserved.

Recurrent, unexpected attacks and worry about additional attacks
Panic Disorder Occurrence of panic attacks seems to come “out of the blue” Recurrent, unexpected attacks and worry about additional attacks Attacks are brief but intense Must be abrupt onset of 4 out of 13 symptoms (10 physical, 3 cognitive) See page 178 Characterized by the occurrence of panic attacks that often seem to come “out of the blue” Recurrent, unexpected attacks and worry about additional attacks 13 possible symptoms of panic attacks, 10 of which are physical and 3 of which are cognitive Attacks are brief but intense © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Agoraphobia Can you define agoraphobia?
Anxiety about being in places from which escape might be difficult or embarrassing: Crowds Theaters Malls Cars, buses, trains, planes Standing in line Elevators Other similar situations Frequent complaint of people with panic disorder but a distinct disorder in DSM-5 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Anxiety about being in places from which escape might be difficult or embarrassing:
Crowds Theaters Malls Panic disorder without agoraphobia more common than panic disorder with agoraphobia © Pearson Education, Inc. All rights reserved.

4.7% of adult population have had panic disorder at some time in their lives Twice as prevalent in women as men Average age of onset is 23–34 years Panic disorder without agoraphobia more common than panic disorder with agoraphobia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Comorbidity with Other Disorders
83% of people with panic disorder have at least one comorbid disorder 50–70% will experience serious depression at some point in their lives Panic disorder associated with suicidal ideation and suicide attempts independent of comorbidity Panic disorder associated with suicidal ideation and suicide attempts independent of comorbidity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Timing of a First Panic Attack
First attack frequently follows feelings of distress or highly stressful life circumstance Many adults who experience single panic attack do not develop panic disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Genetics: 33-43% genetic factors Biochemical agents: norepinephrine, caffeine, etc Neural regions: amygdala, hippocampus, etc Panic disorder has a moderate heritable component: 33% to 43% due to genetic factors There is a broad range of biochemical panic provocation agents There are also several areas of the brain implicated in panic attacks © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 6.1: A Biological Theory of Panic, Anxiety, and Agoraphobia
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Comprehensive learning theory of panic disorder Cognitive theory of panic Anxiety sensitivity and perceived control Safety behaviors and persistence of panic Cognitive biases and maintenance of panic Comprehensive learning theory of panic disorder Cognitive theory of panic Anxiety sensitivity and perceived control Safety behaviors and the persistence of panic Cognitive biases and the maintenance of panic © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 6.2: The Panic Circle
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatments Medications Anxiolytics Antidepressants
Behavioral treatments Cognitive-behavioral treatments Medications Anxiolytics Antidepressants © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Generalized Anxiety Disorder
Chronic or excessive worry about multiple events and activities Occurs more days than not for 6-month period © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Each year 3% of population experiences GAD Lifetime prevalence is 5.7% Twice as common in women as in men 60–80% report having been anxious nearly all their lives 60-80% report having been anxious nearly all their lives, so age of onset is difficult to determine © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Conflict between id and ego Perceptions of uncontrollability and unpredictability Worry positive or negative Automatic attentional bias toward threatening information in environment According to the psychoanalytic viewpoint, the disorder results from conflict between the id and the ego Sense of mastery can help © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Genetics Neurotransmitters CRH It is modestly heritable The neurotransmitters GABA, serotonin, and perhaps norepinephrine all play a role in anxiety CRH also plays a role Neurobiological factors implicated in panic disorders and GAD are not the same © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

GAD Biological Causal Factors
It is modestly heritable (15-20%) The neurotransmitters GABA, serotonin, and perhaps norepinephrine all play a role in anxiety CRH also plays a role Neurobiological factors implicated in panic disorders and GAD are not the same © Pearson Education, Inc. All rights reserved.

True or false? Neurobiological factors implicated in panic disorders and GAD are the same. False Neurobiological factors implicated in panic disorders and GAD are not the same © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive-behavioral therapy
Treatments Anxiolytic drugs Buspirone Cognitive-behavioral therapy Anxiolytic drugs are commonly used and misused Buspirone seems effective and nonaddictive Cognitive-behavioral therapy has become increasingly effective © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Obsessive-Compulsive Disorder
Occurrence of unwanted and intrusive obsessive or distressing images Usually accompanied by compulsive behaviors New category of disorders in DSM-5: obsessive-compulsive and related disorders Usually accompanied by compulsive behaviors performed to neutralize obsessive thoughts or images and/or prevent some dreaded event or situation New category of disorders in DSM-5: obsessive-compulsive and related disorders Usually accompanied by compulsive behaviors performed to neutralize obsessive thoughts or images and/or prevent some dreaded event or situation © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Obsessive-Compulsive Disorder
Obsessions Contamination fears Fears of harming oneself or others Lack of symmetry Pathological doubt Compulsions Cleaning Checking Repeating Ordering/arranging Counting © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

One-year prevalence is 1.2% Lifetime prevalence is 2.3% OCD affects both genders about equally Typically begins in adolescence or early adulthood Lifetime prevalence is some studies is as high as 3% Divorced (or separated) and unemployed individuals overrepresented Also not uncommon in children: more frequent in boys than girls and greater in severity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

OCD Lifetime prevalence is some studies is as high as 3%
Divorced (or separated) and unemployed individuals overrepresented Also not uncommon in children: more frequent in boys than girls and greater in severity © Pearson Education, Inc. All rights reserved.

Frequently co-occurs with other anxiety disorders and mood disorders Also co-occurs with body dysmorphic disorder Depression very common comorbid disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Mowrer developed the two-process theory of avoidance learning Neutral stimuli become associated with fearful thoughts via classical conditioning eliciting anxiety Examples: touching doorknob, shaking hands Obsessions with contamination and dirt appear to have evolutionary roots Attempting to suppress unwanted thoughts may increase those thoughts Cognitive biases toward material relevant to one’s obsessive concerns © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Attempting to suppress unwanted thoughts may increase those thoughts
Obsessions with contamination and dirt appear to have evolutionary roots Attempting to suppress unwanted thoughts may increase those thoughts Cognitive biases (attracted) toward material relevant to one’s obsessive concerns. Have difficulty blocking negative, irrelevant input or distracting information © Pearson Education, Inc. All rights reserved.

Genetics Brain function abnormalities Serotonin OCD appears moderately heritable Abnormalities in brain function may include: Slight structural abnormalities in the caudate nucleus high metabolic levels in other parts of the brain Serotonin is strongly implicated in OCD © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Abnormalities in brain function may include:
Slight structural abnormalities in the caudate nucleus (part of the basal ganglia) high metabolic levels in other parts of the brain (orbital frontal cortex, cingulate cortex/gyrus, globus pallidus, substantia nigra, and thalamus) Serotonin is strongly implicated in OCD. Increased Se activity and increased sensitivity of some brain structures to Se. Anafranil (clomipramine) a tricyclic and Prozac effective in the tx of OCD bu unclear the dysfunction of serotonergic system. © Pearson Education, Inc. All rights reserved.

Treatments Exposure and response prevention Medications that affect neurotransmitter serotonin Exposure and response prevention may be most effective approach to obsessive-compulsive disorder Exposure to anxiety-producing obsession, prevention of compulsion typically used Gradually move through hierarchy of stimuli Medications that affect neurotransmitter serotonin have also been found helpful © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Exposure and response prevention may be most effective approach to obsessive-compulsive disorder
Exposure to anxiety-producing obsession, prevention of compulsion typically used Gradually move through hierarchy of stimuli Medications that affect neurotransmitter serotonin have also been found helpful © Pearson Education, Inc. All rights reserved.

Body Dysmorphic Disorder
BDD Obsessed with perceived or imagined flaw in appearance Causes clinically significant distress May focus on any body part Moved from somatoform disorders to OCD disorders because of its commonalities with OCD Most common locations of complaints are skin, hair, nose, eyes, breasts/chest/nipples, stomach, face size/shape Causes of BDD still being researched. There is some heritability and some issues with self-schema © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

BDD has been moved from somatoform disorders to OCD disorders because of its commonalities with OCD
Most common locations of complaints are skin, hair, nose, eyes, breasts/chest/nipples, stomach, face size/shape Causes of BDD still being researched. There is some heritability and some issues with self-schema © Pearson Education, Inc. All rights reserved.

General population prevalence is 1–2% People with depression prevalence is 8% BDD affects both genders about equally Typically begins in adolescence Very common to also have diagnosis of depression Suicide attempts and ideations are also common © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive-behavioral therapy
Treatments Antidepressants Cognitive-behavioral therapy Therapy emphasizing exposure and response prevention appears to be effective © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Hoarding Hoarding Disorder
Acquire and fail to discard limited value possessions (10-40% of OCD sufferers) Prevalence may be 3-5% of gen. population Disorganization in living space interferes with daily life Poorer prognosis for treatment than OCD Occurs in approximately 10–40% of people with OCD Prevalence may be 3–5% of general population © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Trichotillomania Moved from impulse-control disorders to OCD-related disorders in DSM-5 Not much is known about the disorder Urge to pull out hair from any body location Preceded by tension and followed by pleasure Must cause clinically significant distress Trichotillomania moved from impulse-control disorders to OCD-related disorders in DSM-5 Not much is known about the disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Sociocultural Causal Factors For All Anxiety Disorders
Anxiety is a universal emotion Expression and rates of anxiety expressed differently across cultures Examples: Yoruba, Koro, etc Anxiety is a universal emotion, but anxiety disorders are expressed differently across cultures Ataque de nervios is common in the Caribbean Different countries have very different rates of anxiety disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cultural Differences in Sources of Worry
How would you describe these sources of worry? Yoruba culture of Nigeria Koro in China Taijin kyofusho in Japan In the Yoruba culture of Nigeria, sources of anxiety are different than in the U.S. Creating and maintaining a large family Fertility Dreams that may indicate bewitchment Somatic complaints that are atypical in Western society In China, Koro is an anxiety that a body part is retracting into the body or shrinking Certain anxiety disorders may have evolved to fit certain cultural patterns The Japanese disorder taijin kyofusho is somewhat like social phobia in Western culture, but fear is about offending or embarrassing others, not self © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

In the Yoruba culture of Nigeria, sources of anxiety are different than in the U.S.
Creating and maintaining a large family Fertility Dreams that may indicate bewitchment Somatic complaints that are atypical in Western society In China, Koro is an anxiety that a body part is retracting into the body or shrinking Certain anxiety disorders may have evolved to fit certain cultural patterns The Japanese disorder taijin kyofusho is somewhat like social phobia in Western culture, but fear is about offending or embarrassing others, not self

Unresolved Issue Which type of treatment is best for anxiety and obsessive-compulsive disorders? Many people do not know what treatment options are available to them Many therapists are not trained in specialized treatments for these classes of disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Best tx for Anxiety Disorders and OCD
Many people do not know what treatment options are available to them Many therapists are not trained in specialized treatments for these classes of disorders © Pearson Education, Inc. All rights reserved.

Chapter 6 Panic, Anxiety, Obsessions, and Their Disorders

Similar presentations

Presentation on theme: "Chapter 6 Panic, Anxiety, Obsessions, and Their Disorders"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Chapter 6 Panic, Anxiety, Obsessions, and Their Disorders

Similar presentations

Presentation on theme: "Chapter 6 Panic, Anxiety, Obsessions, and Their Disorders"— Presentation transcript:

Similar presentations

About project

Feedback