T5: Anxiety Disorders, OCD, and other related disorders

• Anxiety is a negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future.
• Fear is an immediate emotional reaction to current danger characterized by strong escapist action tendencies and, often, a surge in the sympathetic branch of the autonomic nervous system.
• Panic attack is defined as an abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms that usually include heart palpitations, chest pain, shortness of breath, and, possibly, dizziness.
• Panic attacks has two basic types: expected and unexpected.
• Depleted levels of gamma aminobutyric acid is associated with increased anxiety.
• The role of the corticotropin-releasing factor (CRF) system as central to the expression of anxiety (and depression) and the groups of genes that increase the likelihood that this system will be turned on.
• Behavioral Inhibition System (BIS) is brain circuit in the limbic system identified by Jeffrey Gray that seems heavily involved in anxiety.
• Generalized anxiety disorder is an excessive anxiety and worry (apprehensive expectation).
• In DSM-5, generalized anxiety disorder can be classified of at least 6 months of excessive anxiety and worry.
• Benzodiazepines are most prescribed for generalized anxiety.
• Panic disorder which individuals experience severe, unexpected panic attacks; they may think they’re dying or otherwise losing control.
• Agoraphobia is a fear and avoidance of situations in which a person feels unsafe or unable to escape to get home or to a hospital in the event of a developing panic symptoms or other physical symptoms, such as loss of bladder control.
• The term agoraphobia was coined in 1871 by Karl Westphal, a German physician, and, in the original Greek, refers to fear of the marketplace.
• Interoceptive Avoidance is a behavior involves removing oneself from situations or activities that might produce the physiological arousal that somehow resembles the beginnings of a panic attack.
• Panic control treatment (PCT) developed at one of our clinics concentrates on exposing patients with panic disorder to the cluster of interoceptive (physical) sensations that remind them of their panic attacks.
• A specific phobia is an irrational fear of a specific object or situation that markedly interferes with an individual’s ability to function.
• Four major subtypes of specific phobia are:

  • Blood-injection-injury type
  • Situational type
  • Natural environment type
  • Animal type
  • Other, phobias that do not fit any of the four major subtypes
• Phobias characterized by fear of public transportation or enclosed places are called situational phobias.
• Claustrophobia is a fear of small, enclosed places, is situational, as is a phobia of flying.
• Environment phobia is a fear of situations or events occurring in nature.
• Fears of animals and insects are called animal phobias.
• Separation anxiety disorder is characterized by children’s unrealistic and persistent worry that something will happen to their parents or other important people in their life or that something will happen to the children themselves that will separate them from their parents (for example, they will be lost, kidnapped, killed, or hurt in an accident).
• School phobia is a fear that is focused on something specific to the school situation; the child can leave the parents or other attachment figures to go somewhere other than school.
• Social anxiety disorder is an intense, persistent fear of being watched and judged by others. It is more than exaggerated shyness.
• Performance anxiety, which is a subtype of SAD, usually have no difficulty with social interaction, but when they must do something specific in front of people, anxiety takes over and they focus on the possibility that they will embarrass themselves.
• Selective mutism (SM) is a rare childhood disorder characterized by a lack of speech in one or more settings in which speaking is socially expected.
• In order to meet diagnostic criteria for SM, the lack of speech must occur for more than one month and cannot be limited to the first month of school
• Obsessive-compulsive disorder is a thought, image, or impulse that the client attempts to avoid as completely as someone with a snake phobia avoids snakes.
• Obsessions are intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist or eliminate.
• Compulsions are thoughts or actions used to suppress the obsessions and provide relief.
• Four major types of obsessions:

  • Symmetry obsessions
  • Forbidden thoughts or actions
  • Cleaning contamination
  • Hoarding
• The most effective approach of treating OCD is called exposure and ritual prevention (ERP), a process whereby the rituals are actively prevented, and the patient is systematically and gradually exposed to the feared thoughts or situations.
• Body dysmorphic disorder (BDD) is a preoccupation with some imagined defect in appearance by someone who actually looks reasonably normal. It has been referred as "imagined ugliness".
• Hoarding Disorder have characteristics of excessive acquisition of things, difficulty discarding anything, and living with excessive clutter under conditions best characterized as gross disorganization.
• Trichotillomania (Hair-Pulling Disorder) is the compulsive pulling out of one's hair from anywhere on the body, including the scalp, eyebrows, and arms.
• Excoriation Disorder (Skin Picking Disorder) is a repetitive and compulsive picking of the skin, leading to tissue damage.
• An approach called "habit reversal training" has the most evidence for success with hair-pulling and skin picking disorder. In this treatment, patients are carefully taught to be more aware of their repetitive behavior, particularly as it is just about to begin, and to then substitute a different behavior,