* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Document
Mental disorder wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Cognitive behavioral therapy wikipedia , lookup
Veterans benefits for post-traumatic stress disorder in the United States wikipedia , lookup
Selective mutism wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Spectrum disorder wikipedia , lookup
Conduct disorder wikipedia , lookup
Obsessive–compulsive personality disorder wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Conversion disorder wikipedia , lookup
Asperger syndrome wikipedia , lookup
Depression in childhood and adolescence wikipedia , lookup
History of mental disorders wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Child psychopathology wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Diagnosis of Asperger syndrome wikipedia , lookup
Externalizing disorders wikipedia , lookup
Posttraumatic stress disorder wikipedia , lookup
Intrusive thought wikipedia , lookup
Obsessive–compulsive disorder wikipedia , lookup
Test anxiety wikipedia , lookup
Social anxiety disorder wikipedia , lookup
Psychological trauma wikipedia , lookup
Anxiety disorder wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Claustrophobia wikipedia , lookup
Treatments for combat-related PTSD wikipedia , lookup
Panic disorder wikipedia , lookup
Welcome to Unit 5: Anxiety Disorders Class Business Grading **Conditional enrollment** Readings: • Chapter 4 • Chapter 7, pages 263-270 and 284-292 • The Numbers Count Reminders: • Writing and APA Style • http://owl.english.purdue.edu/owl/resource/560/01/ Anxiety What is anxiety? Anxiety Anxiety: A state characterized by negative affect, bodily tension, arousal and apprehension about the future. Is anxiety always a bad thing? Fear Fear: Distress about a specific dangerous object or situation. It is caused by need for immediate action and is usually shortlived. Protects us by triggering the “fight or flight” response. Anxiety Disorders All anxiety disorders can be thought of as extremely exaggerated versions of normal feelings such as fear, anxiety and panic. Case Study: Neal Neal is a 32 year-old IT specialist. He reports that for the past 18 months he constantly feels keyed-up, and unable to relax. He worries about everything, from his health, to the economy, to whether he is a good enough husband. He feels emotionally and physically exhausted. Even though he is worn out, he can’t sleep. He often spends hours in bed at night ruminating about possible disasters or things he might have done to offend people at work. He is having problems focusing at work, and is afraid he is going to be fired because of it. Generalized Anxiety Disorder (GAD) DSM-IV Criteria: Excessive anxiety & worry most days for at least 6 months, related to numerous areas of life. Difficult to control the worry. 3 or more symptoms: • • • • • Restlessness/feeling “keyed up” Easily fatigued Problems concentrating, mind going blank Muscle tension Sleep problems Prevalence of GAD Past-year prevalence is about 2%. Lifetime prevalence is about 5%. More common in women than men. Rate is 2x higher in very low income groups. Course of GAD Gradual onset typically in late teens or early adulthood. Tends to be persistent if not treated. Etiology of GAD Mildly heritable. May be related to chronic activation of the behavioral inhibition system (BIS). The BIS causes us to freeze, feel anxious and nervously evaluate the environment to find the threat. “Kindling Effect”: Groups of neurons that fire often have lower activation thresholds, and fire more easily in the future. Fear leads to fear. Treatment of GAD Cognitive-Behavioral Therapy (CBT): Superior to medication, long lasting effects. Learn to identify and control anxious thoughts. Progressive muscle relaxation. Case Study: Ally Ally is a 42 year-old preschool teacher. In the last year she has been experiencing “spells” that last about 10 minutes. She gets short of breath, her heart races, she feels dizzy, her fingers and toes tingle and she experiences fear that she is losing her mind. They “come out of the blue.” She went to the emergency room during her last spell because she thought she was having a heart attack. The doctor said she was healthy, and referred her to see a therapist. Panic Attacks DSM-IV Criteria: Discrete period of intense fear/discomfort with four or more symptoms that develop quickly and peak within ten minutes. • • • • • • • • • • • • Heart palpitations/racing heart Sweating Trembling/shaking Shortness of breath/feeling like choking Chest pain Nausea Dizziness, lightheadedness Derealization (feelings of unreality) or depersonalization (being detached from oneself) Fear of losing control/going crazy Fear of dying Numbness/tingling Chills or hot flushes Agoraphobia Literally “fear of the marketplace.” Agoraphobia is fear and avoidance of situations where it would be perceived to be unsafe to have a panic attack. Panic Disorder DSM-IV Criteria: Recurrent unexpected panic attacks. At least 1 attack followed by 1 month of at least 1 symptom: Persistent concern about having other attacks. Worry about implications/consequences of attack. Significant change in behavior related to the attacks. Prevalence of Panic Disorder Lifetime Prevalence is 3.5% 12-month prevalence is 2.3% More common in women, especially with agoraphobia. Men likely to cope with alcohol. Prevalence similar across U.S. ethnic groups. Course of Panic Disorder Onset in early adulthood, mean age is 25-29. Panic attacks don’t usually occur before puberty. Etiology of Panic Disorder Due to an interaction of psychological and biological factors. Some people are genetically predisposed to panic—they have an easily triggered “fight or flight response”. Seem to be more likely to catastrophically interpret bodily sensations. Etiology of Panic Disorder Upon the experience of such panic, psychological factors determine whether they expect subsequent attacks. Agoraphobia is socially or culturally determined after someone has a panic attack. Treatment of Panic Disorder Psychological Treatment: Panic Control Therapy Highly effective (80-100% panic free after 12 weeks!) Purposeful induction of panic. Cognitive therapy. Breathing exercises, progressive muscle relaxation. Gradual exposure to agoraphobic situations. Case Study: Lucy Lucy is a 19 year-old college student. Two months ago, she was raped by her ex-boyfriend in a car after a football game. Since the rape, she can’t stop thinking about what happened. She has nightmares about it, and sometimes feels as though she is in the back of the car again. Whenever she sees a car like the one her ex-boyfriend drives she experiences paralyzing fear. She finds that he is having trouble sleeping, and constantly feels on edge, like she needs to be scanning the room for men who might try to harm her. PTSD Criteria Exposure to a traumatic event where: Person saw, experienced or was confronted with events that involved actual or threatened death or serious injury, or a threat to physical integrity of self or others. AND Person felt fear, helplessness or horror. PTSD Criteria The event is repeatedly re-experienced in 1 or more ways: Intrusive memories, thoughts, images Nightmares Re-living the experience Intense physical or physiological distress when exposed to cues that remind of event. PTSD Criteria Persistent avoidance of stimuli associated with the trauma. Numbing of general responsiveness Persistent increased arousal (problems sleeping, irritability/anger, hypervigilance, exaggerated startle response, etc.) All symptoms must last more than 1 month. PTSD About 8% of people will experience PTSD. Most cases are due to combat or sexual assault. PTSD may last from months to a lifetime. Etiology of PTSD Trauma. May be a genetic vulnerability to anxiety that risk for PTSD. This vulnerability is more important when the trauma is less severe. Treatment of PTSD Psychotherapy is most effective treatment. Therapy generally focuses on reliving and describing traumatic events and experiencing feelings about it. Case Study: Mike Mike is a 39 year-old landscaper. He often worries about the possibility that his wife and children will be killed in a car accident. He can’t help thinking horrible thoughts about it, often imagining how their dead bodies would look. Whenever he has these thoughts, he recites three “Hail Mary” prayers and performs a discreet finger tapping ritual. If he does not say the prayers perfectly or tap his fingers evenly and without error he has to start over, or else his family may be killed. Sometimes, if the thoughts are especially bad, he also has to recite all of the prime numbers backward from 100, 100 times. He often spends hours each day doing these rituals. OCD Criteria Characterized by obsessions or compulsions (often both). Causes distress, is time-consuming (1 hr/day or more), or interferes with daily functioning. Obsessions Obsessions are nonsensical thoughts, images or urges that the person tries to resists or eliminate. Contamination Impulses Sexual ideas Somatic (bodily) concerns Need for symmetry Compulsions Compulsions are thoughts or actions used to suppress obsessions and provide relief from them. Also can be due to rigid internal rules, often to prevent a dreaded event. May be behaviors (like hand-washing, checking) or mental (like counting, praying etc.) Demographics Lifetime prevalence about 3%. More common in adult women, but in kids more common in boys. Age of onset is adolescence to mid-20’s. Onset is usually gradual but may be sudden after a trauma (such as rape). Typically a chronic disorder. Etiology of OCD Certain people more likely to be anxious. People with OCD more likely to have anxious relatives. Early experiences teaches certain thoughts are dangerous/unacceptable. Seems to be related to fundamentalist religious beliefs. Psychosocial Treatment of OCD Exposure and response-prevention Based on the idea of “reality testing.” Questions or comments?