Fear, Anxiety & Related Disorders — Lectures 1-8
Inhoud
From Anxiety to Disorder.......................................................................................................................2
Specific Phobia.......................................................................................................................................8
Social Anxiety Disorder (SAD)...............................................................................................................10
Panic Disorder and Agoraphobia..........................................................................................................15
Post-Traumatic Stress Disorder (PTSD).................................................................................................24
Generalised Anxiety Disorder (GAD).....................................................................................................28
Obsessive Compulsive Disorder (OCD).................................................................................................34
Transdiagnostics and Enhancement.....................................................................................................38
1
,From Anxiety to Disorder
Distinguishing Fear from Anxiety
—> Both are common and (evolutionary) useful.
Fear = a state of immediate alarm in response to a serious, known threat to one’s
well-being.
Anxiety = a state of alarm in response to a vague sense of threat or danger,
meaning you are uncertain if it will actually happen and what the outcome will be
(example: relationship worries).
Both have the same physiological features: increase in respiration, perspiration,
muscle tension, etc.
Fear
- An emotional response to perceived threat
- Adaptive and has evolutionary meaning; every animal is afraid of things
- Humans are biologically predisposed; fear is hardwired and it acts fast
- Involves activation of the sympathetic nervous system
- “Fight or flight” phenomenon; freezing isn’t as helpful in most situations
(sometimes it is; rabbit example)
o Adrenaline speeds up the heart and makes us breathe deeply —>
oxygen rich blood to muscles —> muscle tension —> fight or flight.
o Can result in hyperventilating through changing your breathing pattern
for more air in the lungs.
- Fear can either be lifesaving or turn into a phobia which is problematic.
Trauma can create powerful associations/links in the brain. Phobia: overreact
to something that you know isn’t dangerous.
o Specific phobia: there are ways to avoid/ignore the triggers and cope.
As long as we can live with it, we have no big motivation to do
something about it. However, it can impact life; you can endanger
yourself and others. Example: flight reaction while you’re with your kids
and you leave them behind.
When does anxiety develop into a disorder?
- Normal anxiety is adaptive. It’s an inborn response to threat or to the absence
of people or objects that signify safety that can result in cognitive (worry) and
somatic (racing heart, sweating, shaking, freezing, etc.) symptoms.
- Pathologic anxiety is anxiety that is excessive, it impairs function.
DSM-V:
- Unreasonably strong or permanent
- Arises without sufficient reason; the trigger isn’t dangerous enough to elicit
such anxiety
- Cannot be controlled or endured
- Causes suffering and constrains in life
- Some diagnosis cause more suffering (ex. spider phobia) than others (ex.
plane phobia)
- Typical symptom patterns are present (e.g. fight/flight)
2
,Diagnostic process for anxiety problem
Somatic underlying disease can also be triggered by medicine.
An example of an underlying mental disease could be schizophrenia.
In the DSM-IV social anxiety disorder was called social phobia. In the DSM-V, the
“fear” term was changed into an “anxiety” term because SAD symptoms are more in
line with those of other anxiety disorders: worry beforehand, post-event processing
and evaluation.
Avoidance
All anxiety disorders have this in common. Avoidance doesn’t just mean running
away, it can also be rather hidden.
Patients try to alleviate the unpleasant feeling of anxiety by:
- Avoiding the trigger
- Developing a safety behaviour (i.e. having someone else accompany the
(agoraphobia) or wearing a lot of makeup to cover up blushing)
o Using a substance or medication
o GP’s have to be very careful with just giving out some medicine for
people who suffer from anxiety. Mental and later on physical
dependence is developed really easily.
- Alcohol dependence is correlated with SAD.
- Reassurance is a big thing in all anxiety disorders!
3
, Clinical characteristics of adult anxiety disorders
Disorder Gender Diffuse/ Avoidance Spontaneous Comments
Specific Behaviour Panic Attacks
GAD W>M Diffuse +— — - Worry
If you can’t - High
define what comorbidity
you’re afraid of, with other
it’s harder to anxieties and
avoid; more depression
subtle.
Panic Disorder W > M Diffuse + ++ Ca. 65% have
both disorders,
and 30% panic
disorder only,
Agoraphobia W>M Diffuse +++ ++ 5%
If you agoraphobia
most common understand only
combination what triggers
the anxiety, you
can also
understand the
kind of
(avoidance)
behaviour.
SAD W = M in Both possible ++ Rare Subtypes:
children specific type
Specific could Panic attacks responds better
W > M from be “being afraid occur, just not to treatment.
puberty to give a talk” spontaneous;
onwards (also usually
has to do with triggered by for
masculinity & example giving
asking for help) a presentation.
Specific W>M Specific +++ —
Phobia
PTSD ? Specific + Rare Highly comorbid
Probably 50-50. More vague
Self-medication
plays major
role; veterans
come to
institutions for
some type of
substance
abuse, many
afterwards find
out it’s PTSD.
OCD: Ca. 50%
- Washing W>M Both ++ — washing
More easy to compulsions,
avoid germs 35% checking
4
Inhoud
From Anxiety to Disorder.......................................................................................................................2
Specific Phobia.......................................................................................................................................8
Social Anxiety Disorder (SAD)...............................................................................................................10
Panic Disorder and Agoraphobia..........................................................................................................15
Post-Traumatic Stress Disorder (PTSD).................................................................................................24
Generalised Anxiety Disorder (GAD).....................................................................................................28
Obsessive Compulsive Disorder (OCD).................................................................................................34
Transdiagnostics and Enhancement.....................................................................................................38
1
,From Anxiety to Disorder
Distinguishing Fear from Anxiety
—> Both are common and (evolutionary) useful.
Fear = a state of immediate alarm in response to a serious, known threat to one’s
well-being.
Anxiety = a state of alarm in response to a vague sense of threat or danger,
meaning you are uncertain if it will actually happen and what the outcome will be
(example: relationship worries).
Both have the same physiological features: increase in respiration, perspiration,
muscle tension, etc.
Fear
- An emotional response to perceived threat
- Adaptive and has evolutionary meaning; every animal is afraid of things
- Humans are biologically predisposed; fear is hardwired and it acts fast
- Involves activation of the sympathetic nervous system
- “Fight or flight” phenomenon; freezing isn’t as helpful in most situations
(sometimes it is; rabbit example)
o Adrenaline speeds up the heart and makes us breathe deeply —>
oxygen rich blood to muscles —> muscle tension —> fight or flight.
o Can result in hyperventilating through changing your breathing pattern
for more air in the lungs.
- Fear can either be lifesaving or turn into a phobia which is problematic.
Trauma can create powerful associations/links in the brain. Phobia: overreact
to something that you know isn’t dangerous.
o Specific phobia: there are ways to avoid/ignore the triggers and cope.
As long as we can live with it, we have no big motivation to do
something about it. However, it can impact life; you can endanger
yourself and others. Example: flight reaction while you’re with your kids
and you leave them behind.
When does anxiety develop into a disorder?
- Normal anxiety is adaptive. It’s an inborn response to threat or to the absence
of people or objects that signify safety that can result in cognitive (worry) and
somatic (racing heart, sweating, shaking, freezing, etc.) symptoms.
- Pathologic anxiety is anxiety that is excessive, it impairs function.
DSM-V:
- Unreasonably strong or permanent
- Arises without sufficient reason; the trigger isn’t dangerous enough to elicit
such anxiety
- Cannot be controlled or endured
- Causes suffering and constrains in life
- Some diagnosis cause more suffering (ex. spider phobia) than others (ex.
plane phobia)
- Typical symptom patterns are present (e.g. fight/flight)
2
,Diagnostic process for anxiety problem
Somatic underlying disease can also be triggered by medicine.
An example of an underlying mental disease could be schizophrenia.
In the DSM-IV social anxiety disorder was called social phobia. In the DSM-V, the
“fear” term was changed into an “anxiety” term because SAD symptoms are more in
line with those of other anxiety disorders: worry beforehand, post-event processing
and evaluation.
Avoidance
All anxiety disorders have this in common. Avoidance doesn’t just mean running
away, it can also be rather hidden.
Patients try to alleviate the unpleasant feeling of anxiety by:
- Avoiding the trigger
- Developing a safety behaviour (i.e. having someone else accompany the
(agoraphobia) or wearing a lot of makeup to cover up blushing)
o Using a substance or medication
o GP’s have to be very careful with just giving out some medicine for
people who suffer from anxiety. Mental and later on physical
dependence is developed really easily.
- Alcohol dependence is correlated with SAD.
- Reassurance is a big thing in all anxiety disorders!
3
, Clinical characteristics of adult anxiety disorders
Disorder Gender Diffuse/ Avoidance Spontaneous Comments
Specific Behaviour Panic Attacks
GAD W>M Diffuse +— — - Worry
If you can’t - High
define what comorbidity
you’re afraid of, with other
it’s harder to anxieties and
avoid; more depression
subtle.
Panic Disorder W > M Diffuse + ++ Ca. 65% have
both disorders,
and 30% panic
disorder only,
Agoraphobia W>M Diffuse +++ ++ 5%
If you agoraphobia
most common understand only
combination what triggers
the anxiety, you
can also
understand the
kind of
(avoidance)
behaviour.
SAD W = M in Both possible ++ Rare Subtypes:
children specific type
Specific could Panic attacks responds better
W > M from be “being afraid occur, just not to treatment.
puberty to give a talk” spontaneous;
onwards (also usually
has to do with triggered by for
masculinity & example giving
asking for help) a presentation.
Specific W>M Specific +++ —
Phobia
PTSD ? Specific + Rare Highly comorbid
Probably 50-50. More vague
Self-medication
plays major
role; veterans
come to
institutions for
some type of
substance
abuse, many
afterwards find
out it’s PTSD.
OCD: Ca. 50%
- Washing W>M Both ++ — washing
More easy to compulsions,
avoid germs 35% checking
4
