Generalized Anxiety Disorders

Generalized Anxiety Disorder (GAD) Clinical description Criteria to base diagnosis * duration/how long it's been a problem * thoughts/Cognitions * emotions * behaviors * Physiological Symptoms Dsm Criteria For GAD "excessive anxiety. and worry occurring more. days. than not for at least le months loout several events/activities difficulty Controlling worry at least 3 of the following: - difficulty Concentrating on other things; blank mind muscle tension restlessness; keyed up or on edge - fatigue - irritability difficulty sleeping Significant distress or impairment not limited to one specific issue GAD: Statistics the basic anxiety disorder "about 3.1% of population in a given year; 5.7% meet criteria at some point in their life Similar rates around the wond Usually seek out primary physician first • 2/3 female, developed Countries Onset in early adulthood (m-3ly), typically after Stressor "earlier and more gradual onset than other anxiety d/o's once developed, Chronic course GAD: Causes GMD tends to run in families-general biological vulnerability (30%) inherited tendency to become anxious, not GAD nervousness, low frustration tolerance muscle tension consistently distinguishes GAD from normal, non-anxious people • Unconscious mental processes - more readily focus attention on threat than non-anxious people "Sensitivity to threat developed in stressful events that seemed dangerous or uncontrollable (generalized psychological vulnerability) Chronic worriers GAD: Comorbidity • 90% of those with GAD have a second dx -42% diagnosis of major depression or dysthymia also social of specific phobias, 18 GAD Treatment • benzodiazepines (minor tranquilizers) Short term relief, modest effects not studied longitudinally Side effects: impaired motor and cogn. fx psychological and physical dependence antidepressants: more Support •psychological treatments (benau+CBT) Same Short term benefits as meds better long-term, reduces use of meds CBT Superior to psychoanalytic +x (72% vs. 31% "good autcome") Panic Disorder with of w/o Agoraphobia Panic attack: a discrete period of intense fear or discomfort in which 4 or more of the following Symptoms develop abruptly and peak within 10 minutes *palpations, pounding heart, increased heart rate * Sweating * trembling, shaking * Sensation of shortness of breath or Smothering * feeling of choking * Chest pains or discomfort * nausea or alodominal distress * feeling dizzy, unsteady, light-headed, or faint Chills or heat Sensations * paresthesias (numbness or tingling Sensations) * derealization (feeling of unreality) or depersonalization (being detached from one-serf) * fear of losing control or "going crazy" * fear of dying • 8-12% of pop. experience panic attacks at some point, only 3.5% develop disorder agoraphobia ("fear of the marketplace") - anxiety about being in places or situations from which escape might be difficult or embarrassing (in the event of a panic attack) * will avoid, feel discomfort, or need "safety person" Criteria For Panic Disorder w/ Agoraphobia • both of the following: "recurrent unexpected panic attacks at least one of the attacks was followed by Imo. (or more) of one or more of the following: * persistent concern of having additional attacks * worry about the implications of the attack or its consequences (eg..heart attack, dying) *Significant change in behavior related to attacks presence of agoraphobia not due to effects of substance or medical conditions panic attacks not better accounted by another d/o lifetime prevalence rate: 1.5 to 3.5% meet criteria in a given lyr period 4.7% at some point in their life age of onset: mid-teens through - 40 years Children 2/3 are female Cultural more acceptable for women to repart fear and avoid Situations males may not seek treatment as much *cope on their own (e.g., alcohol) Causes biological genetic predisposition to stress "Stressful situations may trigger emergency alarm reaction generalized psychological vulnerability life stress Susceptible to becoming anxious over a future panic attack. tendency to believe and expect the worse •Specific psychological vulnerability "Interpret normal cues in catastrophic ways: become associated with panic * internal - rapid heart rate during exercise * external-Shopping at walmart Panic Disorder With and Without Agoraphobia • treatment: medication/biological benzodiazepines Serotonin Specific reuptake inhibitors (SSRIs) Treatment: Psychological • exposure-based "gradual: Slowly face fears using hierarchy virtual reality muscle relaxation and breathing exercises approx 70% of pts improve w/ combined tx (aloove). panic control treatment (PCT)