Basic Statistics for the Behavioral Sciences
Chapter Five
Anxiety Disorders and Obsessive-Compulsive Spectrum Disorders
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Understanding Anxiety Disorders
Anxiety:
A feeling of uneasiness or apprehension; a fundamental human emotion
Anxiety disorders:
Fear or anxiety symptoms that interfere with an individual’s day-to-day functioning
Anxiety is anticipatory: waiting for a dreaded event to occu
Fear is a most intense emotion experienced in response to a threatening situation
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Understanding Anxiety Disorders (cont’d.)
Panic attacks:
Intense fear accompanied by pounding heart, trembling, shortness of
eath, fear of losing control, and fear of dying
Panic attacks may be experienced without an anxiety disorde
*
Understanding Anxiety Disorders (cont’d.)
Figure 5-1 Prevalence of Anxiety Disorders in the United States Anxiety disorders are the most common mental conditions in the United States.
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Understanding Anxiety Disorders (cont’d.)
Four anxiety disorders covered in this chapter:
Phobias
Panic disorde
Agorophobia
Generalized anxiety disorder (GAD)
Obsessive-compulsive spectrum disorders also discussed due to similarities with anxiety disorders
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Understanding Disorders from Multipath Perspective
Figure 5-2 Multipath Model of Anxiety Disorders The dimensions interact with one another and combine in different ways to result in a specific anxiety disorder. The importance and influence of each dimension varies from individual to individual.
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Biological Dimension
Two main biological factors:
Brain function
Amygdala
Hippocampus
Prefrontal cortex
Genetic influences
Modest contribution to anxiety disorders
Interact with other multipath factors
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Biological Dimension (cont’d.)
Figure 5-3 Neuroanatomical Basis for Panic and Other Anxiety Disorders The fear network in the
ain is centered in the amygdala and interacts with the hippocampus and areas of the prefrontal cortex. Antianxiety medications appear to desensitize the fear network. Some psychotherapies also affect
ain functioning related to anxiety.
*
Biological Dimension (cont’d.)
Biological, psychological, and social factors interact with one another
Interplay between genetic and environmental influences
Environmental variables affect gene expression
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Psychological Dimension
Cognitive-behavioral theories focus on cognitive processes (negative, catastrophic, or i
ational thoughts)
Anxiety sensitivity (a personality variable) may be a risk facto
Psychological variables such as one’s sense of control may also be involved
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Social and Sociocultural Dimensions
Daily environmental stress
Traumatic events
Social support network
Gende
Acculturation factors among minority groups
Discrimination and prejudice
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Phobias
Phobia:
Strong, persistent, unwa
anted fear of a specific object or situation
Extreme anxiety or panic is expressed when phobic stimulus is encountered
Most common mental disorder in United States
Comes from Greek word for fea
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Phobias (cont’d.)
Social phobia:
Intense fear of being scrutinized or doing something emba
assing or humiliating in the presence of others
“Threat cues” and “safety behaviors”
Generalized type versus performance type
Can be chronic and disabling
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Phobias (cont’d.)
Specific phobia:
Extreme fear of a specific object or situation; exposure to stimulus nearly always produces intense anxiety or panic attack
Five types (DSM-V):
Animal
Natural environmental
Blood/injection or injury
Situational
Othe
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Phobias (cont’d.)
Agorophobia:
Intense fear of at least two of the following
Being outside of the home alone
Traveling in public transportation
Being in open spaces
Being in stores or theatres
Standing in line or being in a crowd
These situations are feared because escape or help may not be readily available
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Etiology of Phobias
Figure 5-5 Multipath Model of Phobias The dimensions interact with one another and combine in different ways to result in a phobia.
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Etiology of Phobias (cont’d.)
Biological dimension:
Genetics or biological preparedness
Psychological dimension:
Classical conditioning
Observational learning or modeling
Negative information
Cognitive-behavioral
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Etiology of Phobias (cont’d.)
Social dimension:
Family interaction patterns
Peer victimization
Sociocultural dimension:
Gende
Child-rearing practices
Discrimination and prejudice
Culturally distinctive phobias
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Treatment of Phobias
Biochemical:
Neurobiological abnormalities can be normalized with medication
Norepinephrine, serotonin, and dopamine
Antidepressants, benzodiazepines, and SSRIs
Side effects of medications
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Treatment of Phobias (cont’d.)
Behavioral:
Exposure therapy:
Gradually introduce increasingly difficult encounters with feared situation
Systematic desensitization:
Uses muscle relaxation to reduce anxiety
Cognitive restructuring:
Unrealistic thoughts are altered
Modeling:
Patient observes a model coping with, or responding appropriately to, the feared situation
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Panic Disorde
Panic disorder:
Recu
ent unexpected panic attacks in combination with:
Apprehension over having another attack or wo
ying about consequences of having an attack
Changes in behavior or activities designed to avoid another panic attack
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Panic Disorder (cont’d.)
Three types of panic attacks:
Situationally bound
Situationally predisposed
Unexpected or uncued
All three types may be present in individuals with panic disorde
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Etiology of Panic Disorde
Figure 5-6 Multipath Model for Panic Disorder The dimensions interact with one another and combine in different ways to result in a panic disorder.
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Etiology of Panic Disorder (cont’d.)
Biological dimension:
Modest heritability rate of 32%
Brain structures (e.g., amygdala) and neurotransmitters (e.g.. serotonin) involved
Psychological dimension:
Interoceptive sensitivity
Cognitive behavioral: stresses individual’s interpretation of unpleasant bodily sensations as indicators of impending disaste
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Etiology of Panic Disorder (cont’d.)
Social and sociocultural dimensions:
Distu
ed childhood
Separation anxiety
Family conflicts
School problems
Loss of loved one
Major life changes occu
ing prior to attacks
Culture plays a role
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Treatment of Panic Disorde
Both medication and cognitive therapies have been effective
Biochemical:
Benzodiazepines, antidepressants, and SSRIs
Cognitive-behavioral:
80% reported to achieve and maintain panic-free status
Improve quality of life
Extinction of fea
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Generalized Anxiety Disorder (GAD)
Persistent high levels of anxiety and excessive wo
y over many life circumstances; symptoms must be present for at least three months
Develops gradually, beginning in childhood and adolescence
Somatic symptoms:
Muscle tension, restlessness, sleep difficulties, poor concentration, and avoidance of situations associated with wo
y
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Generalized Anxiety Disorder (GAD) (cont’d.)
Two-thirds have como
id disorders
Most frequently diagnosed anxiety disorder worldwide
Twice as common in women as in men
Must consider cultural context
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Etiology of GAD
Figure 5-8 Multipath Model for GAD The dimensions interact with one another and combine in different ways to result in generalized anxiety disorder (GAD).
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Etiology of GAD (cont’d.)
Biological dimension:
Small but significant heritability facto
May disrupt prefrontal cortex modulation of amygdala
Psychological dimension:
Cognitive theories: dysfunctional thinking and beliefs
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Etiology of GAD (cont’d.)
Social and sociocultural dimensions:
Poverty
Poor housing
Prejudice
Discrimination
Traumatic events
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Treatment of Generalized Anxiety Disorde
Biochemical treatment:
Benzodiazepines, but problems of dependence
Tricyclic and SSRI antidepressants are medications of choice due to less risk or dependence
Newer antianxiety medication: buspirone
Cognitive-behavioral therapy:
Only consistently validated psychological treatment
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Obsessive-Compulsive (OC) Spectrum Disorders
Have much in common with anxiety disorders
Include:
Obsessive-compulsive disorde
Body dysmorphic disorde
Hair-pulling disorde
Skin-picking disorde
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Obsessive-Compulsive Disorde
Characterized by:
Obsessions:
Intrusive, repetitive thoughts or images that produce anxiety (e.g., contamination, orderliness, uncertainty)
Compulsions:
The need to perform acts or dwell on thoughts to reduce anxiety (e.g., repetitive behaviors, mental acts)
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Obsessive-Compulsive Disorder (cont’d.)
Associated thoughts and actions that are out of character and not under voluntary control
Recognition that thoughts and impulses are senseless, but no control
In a given year, about 1% of U.S. adult population suffers from OCD
May be underdiagnosed
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Obsessive-Compulsive Disorder (cont’d.)
Four identified types:
Harm-related, sexual, aggressive, and/or religious obsession with checking compulsions
Symmetry obsessions with compulsions to a
ange things or repeat behaviors
Contamination obsessions with cleaning compulsions
Hoarding and saving compulsions
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Obsessive-Compulsive Disorder (cont’d.)
INSERT Video Obsessive-Compulsive Disorde
Obsessive-Compulsive Disorder Children talking about their experienced with obsessive-compulsive disorder.
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Body Dysmorphic Disorder (BDD)
Involves preoccupation with a perceived physical defect in a normal-appearing person or excessive concern over a slight physical defect
Comes from Greek word for abnormal shape
Produces marked clinical distress
Chronic and difficult to treat
Underdiagnosed
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Body Dysmorphic Disorder (BDD) (cont’d.)
Compulsive behaviors:
Frequent mi
or checking
Excessive grooming
Seeking constant reassurance
Common concerns:
Bodily features (e.g., lack of hair, size of nose)
Muscle dysphoria: believing that one’s body is too small or insufficiently muscula
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Hair-Pulling and Skin-Picking Disorders
Hair-pulling disorder (trichotillomania):
Involves hair-pulling that causes significant distress and results in hair loss
4% of population may be affected
Four times higher prevalence in women
Skin-picking disorder:
Recu
ent picking of the skin and resultant skin lesions
Three quarters are females
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Etiology of OC Spectrum Disorders
Figure 5-11 Multipath Model for OCD The dimensions interact with one another and combine in different ways to result in obsessive-compulsive disorde
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Etiology of OC Spectrum Disorders (cont’d.)
Biological dimension:
Brain structure:
O
ital frontal cortex
Genetic factors:
May account for half of variance in hoarding
Biochemical abnormalities:
Serotonin deficiency
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Etiology of OC Spectrum Disorders (cont’d.)
Figure 5-12 O
ital Frontal Cortex Untreated patients with obsessive-compulsive disorder show a high metabolism rate in this area of the
ain. Certain medications reduce metabolic rates to “normal” levels and also reduce obsessive-compulsive symptoms. What would it mean if similar results are found with psychotherapy?
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Etiology of OC Spectrum Disorders (cont’d.)
Psychological dimension:
Behavioral perspective:
Obsessive-compulsive behaviors develop because they reduce anxiety
Cognitive characteristics:
Threat estimation
Control
Intolerance of uncertainty
Probability bias
Morality bias
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Etiology of OC Spectrum Disorders (cont’d.)
Social and sociocultural dimensions:
Family variables
Controlling, overly critical parenting styles
Low parental warmth
Discouragement of autonomy
Culture may affect how symptoms are expressed
Minorities are unde
epresented in clinical studies
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Basic Statistics for the Behavioral Sciences
Chapter Five
Anxiety Disorders and Obsessive-Compulsive Spectrum Disorders
*
Understanding Anxiety Disorders
Anxiety:
A feeling of uneasiness or apprehension; a fundamental human emotion
Anxiety disorders:
Fear or anxiety symptoms that interfere with an individual’s day-to-day functioning
Anxiety is anticipatory: waiting for a dreaded event to occu
Fear is a most intense emotion experienced in response to a threatening situation
*
Understanding Anxiety Disorders (cont’d.)
Panic attacks:
Intense fear accompanied by pounding heart, trembling, shortness of
eath, fear of losing control, and fear of dying
Panic attacks may be experienced without an anxiety disorde
*
Understanding Anxiety Disorders (cont’d.)
Figure 5-1 Prevalence of Anxiety Disorders in the United States Anxiety disorders are the most common mental conditions in the United States.
*
Understanding Anxiety Disorders (cont’d.)
Four anxiety disorders covered in this chapter:
Phobias
Panic disorde
Agorophobia
Generalized anxiety disorder (GAD)
Obsessive-compulsive spectrum disorders also discussed due to similarities with anxiety disorders
*
Understanding Disorders from Multipath Perspective
Figure 5-2 Multipath Model of Anxiety Disorders The dimensions interact with one another and combine in different ways to result in a specific anxiety disorder. The importance and influence of each dimension varies from individual to individual.
*
Biological Dimension
Two main biological factors:
Brain function
Amygdala
Hippocampus
Prefrontal cortex
Genetic influences
Modest contribution to anxiety disorders
Interact with other multipath factors
*
Biological Dimension (cont’d.)
Figure 5-3 Neuroanatomical Basis for Panic and Other Anxiety Disorders The fear network in the
ain is centered in the amygdala and interacts with the hippocampus and areas of the prefrontal cortex. Antianxiety medications appear to desensitize the fear network. Some psychotherapies also affect
ain functioning related to anxiety.
*
Biological Dimension (cont’d.)
Biological, psychological, and social factors interact with one another
Interplay between genetic and environmental influences
Environmental variables affect