What is a panic attack?
a discrete period in which there is a sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom
What are the symptoms of panic attacks (four or more are required)?
trembling or shaking
sensations of shortness of breath or smothering
feeling of choking
nausea or abdominal distress
feeling dizzy, unsteady, lightheaded, or faint
derealization or depersonalization
fear of losing control or going crazy
fear of dying
paresthesias (numbness or tingling)
chills or hot flushes
Symptoms of a panic attack usually come on _______ and peak within ________.
suddenly; ten minutes
What are the three characteristic types of panic attacks?
situationally bound (cued)
What is an unexpected (uncued) panic attack?
a panic attack for which the individual does not associate onset with an internal or external situational trigger
What is a situationally-bound (cued) panic attack?
a panic attack that almost invariably occurs immediately on exposure to, or in anticipation of, the situational cue or trigger
What is a situationally predisposed panic attack?
Similar to situationally-bound panic attacks, they are not invariably associated with the cue and do not necessarily occur immediately after the exposure.
What is the essential feature for agoraphobia?
anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having a panic attack or panic-like symptoms
Agoraphobic fears typically involve characteristic clusters of situations that include:
being outside the home alone
being in a crowd or standing in a line
being on a bridge
traveling in a bus, train, or automobile
What is criterion B for agoraphobia?
B. The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.
What is criterion C for agoraphobia?
not better accounted for by another mental disorder (social phobia, specific phobia, OCD, PTSD, or separation anxiety disorder)
What is the essential feature of specific phobia?
marked and persistent fear of clearly discernible, circumscribed objects or situations
What is criterion B for specific phobia?
B. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally-bound or situationally predisposed panic attack.
Note: in children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
What is criterion C for specific phobia?
C. The person recognizes that the fear is excessive or unreasonable (except in children).
What is criterion D for specific phobia?
D. The phobic situation (s) is/are avoided or else is endured with intense anxiety or distress.
What is criterion E for specific phobia?
E. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
What is criterion F for specific phobia?
F. In individuals under age 18, the duration is at least six months.
What is criterion G for specific phobia?
G. Not better accounted for by another mental disorder (OCD, PTSD, separation anxiety disorder, social phobia, panic disorder with agoraphobia, or agoraphobia without history of panic disorder)
What are the types of specific phobia?
natural environment type
Explain the animal subtype of specific phobia.
This subtype should be specified if the fear is cued by animals or insects. This subtype generally has a childhood onset.
What is the natural environment type of specific phobia?
This subtype should be specified if the fear is cued by objects in the natural environment, such as storms, heights, or water. This subtype generally has a childhood onset.
When would the blood-injection-injury subtype be applied to specific phobia?
This subtype should be specified if the fear is cued by seeing blood or an injury or by receiving an injection or other invasive medical procedure. This subtype is highly familial and is often characterized by a strong vasovagal response.
When should the situational subtype be used to describe specific phobia?
if the fear is cued by a specific situation
- like public transportation, tunnels, bridges, elevators, flying, driving, enclosed places
- has bimodal age-at-onset distribution (one peak in childhood, another peak in mid-20s)
- appears to be similar to panic disorder w/agoraphobia in sex ratios, familial aggregation pattern, and age at onset
When should the other subtype be applied to specific phobia?
when fear is cued by other stimuli
- fear of choking, vomiting, or contracting an illness
- "space" phobia (fear of falling down if away from structural supports like walls)
- children's fears of loud sounds or costumed characters
What is the frequency of specific phobia subtypes from most to least?
What are some predisposing factors to specific phobia?
unexpected panic attacks in the to-be-feared situation
observation of others undergoing trauma or demonstrating fearfulness
How can specific phobia be differentiated from panic disorder with agoraphobia?
individuals with specific phobia do not present with pervasive anxiety because their fear is limited to specific, circumscribed objects or situations
How can specific phobia be differentiated from social phobia?
the focus of the fears: social phobia might include not eating in a restaurant because of fear of negative evaluation from others, but specific phobia might include fear of choking while eating
How can specific phobia be differentiated from PTSD?
Avoidance with PTSD follows a life-threatening stressor and is accompanied by additional features (like reexperienceing the trauma and restricted affect).
How can specific phobia be differentiated from OCD?
In OCD, the avoidance is associated with the content of the obsession (like dirt or contamination).
How can specific phobia be differentiated from separation anxiety disorder?
In separation anxiety disorder, the avoidance behavior is exclusively limited to fears of separation from persons to whom the individual is attached.
What is the essential feature of social phobia?
a marked and persistent fear of social or performance situations in which embarrassment may occur
What is criterion B of social phobia?
exposure to the social or performance situation almost invariably provokes an immediate anxiety response (may take the form of a situationally-bound or situationally predisposed panic attack)
What is criterion C for social phobia?
adolescents and adults recognize that their fear is excessive or unreasonable (kids do not, necessarily)
What is criterion D for social phobia?
most often, the social or performance situation is avoided, although sometimes it is endured with dread
What is criterion E for social phobia?
avoidance, fear, or anxious anticipation of encountering the social or performance situation interferes significantly with the person's daily routine, occupational functioning, or social life, or if the person is markedly distressed about having the phobia
What is criterion F for social phobia?
in individuals younger than 18, symptoms must have persisted for at least six months to warrant diagnosis
What are criteria G and H for social phobia?
G. Not substance-induced/gen med, and not better accounted for by another mental disorder (like panic disorder, separation anxiety, body dysmorphic disorder, schizoid PD)
H. If a general medical condition or another mental disorder is present, the fear in criterion A is unrelated to it
What is the specifier for social phobia?
if the fears include most social situations (also consider the additional diagnosis of avoidant personality disorder)
How can social phobia be differentiated from panic disorder with agoraphobia?
PDw/A panic attacks are not limited to social situations. Social phobia is not diagnosed when the only social fear is of being seen while having a panic attack.
How can social phobia and agoraphobia be differentiated?
in agoraphobia, the fear or anxiety is not always related to social situations (being on a bridge or in an elevator, for example)
How can social phobia be differentiated from generalized anxiety disorder?
fears and anxiety in generalized anxiety disorder occur even when not being socially evaluated
How can social phobia be differentiated from schizoid personality disorder?
with social phobia, individuals have a capacity for and interest in social relationships with familiar people
How can social phobia be differentiated from avoidant personality disorder?
Avoidant personality disorder may be a more sever form of generalized social phobia.
What is the essential feature of obsessive-compulsive disorder?
recurrent obsessions or compulsions
What four criteria define obsessions with regard to OCD?
recurrent and persistent thoughts, impulses, or images that are experiences, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
the thoughts, impulses, or images are not simply excessive worries about real-life problems
the preson attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not thought insertion)
What two criteria define compulsions with regard to OCD?
repetitive behaviors or mental acts (praying, counting, repeating, etc.) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly
the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way or are clearly excessive
What is criterion B for OCD?
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.
What is criterion C for OCD?
C. The obsessions or compulsions cause marked distress, are time consuming (more than one hour a day), or significantly interfere with the person's normal routine, occupational/academic functioning, or usual social activities/relationships.
What is criterion D for OCD?
if another Axis I disorder is present, the content of the obsessions/compulsions is not restricted to it
What is criterion E for OCD?
not due to substances or general medical condition
What is the specifier for OCD?
with poor insight
if, for most of the time during the current episode, the person does not recognize that the obsessions and compulsions are excessive or unreasonable
How can OCD be differentiated from generalized anxiety disorder?
GAD worries are distinguished from obsessions by the fact that the person experiences them as excessive concerns about real-life circumstances.
How can OCD be distinguished from obsessive-compulvive personality disorder?
OCPD is not actually characterized by presence of obsessions or compulsions, but rather a pervasive preoccupation with perfection, control, and orderliness.
What is the essential feature of PTSD?
the development of characteristic symptoms following exposure to an extreme traumatic stressor:
- involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity
- witnessing an event that involves death, injury, or a threat to the physical integrity of another person
- learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate
What is the A2 criterion for PTSD?
the person's response to the event must involve intense fear, helplessness, or horror (in children, the response to the event must include disorganized or agitated behavior)
What is criterion B for PTSD?
B. The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperienceing of the traumatic event.
What are the five subsections of PTSD criterion B and how many are necessary?
recurrent and intrusive distressing recollections of the event
recurrent distressing dreams of the event
acting or feeling as if the traumatic event were recurring
intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
only one is required
What is criterion C for PTSD?
persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness
What are the seven characteristics of PTSD criterion C and how many are required for diagnosis?
efforts to avoid thoughts, feelings, or conversations associated with the trauma
efforts to avoid activities, places, or people that arouse recollections of the trauma
inability to recall an important aspect of the trauma
markedly diminished interest or participation in significant activities
feeling of detachment or estrangement from others
restricted range of affect
sense of foreshortened future (does not expect to have career, normal lifespan, etc.)
three or more are required
What is criterion D for PTSD?
persistent symptoms of increased arousal
What are the five symptoms of increased arousal (criterion D), and how many are needed for diagnosis of PTSD?
difficulty falling or staying asleep
irritability or outbursts of anger
exaggerated startle response
two or more are required for diagnosis
What is criterion E for PTSD?
the full symptom picture must be present for more than one month
What is criterion F for PTSD?
the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
What are the three specifiers for PTSD?
acute (symptom duration less than three months)
chronic (symptom duration more than three months)
with delayed onset (symptom onset is at least six months after the stressor)
How can PTSD be differentiated from adjustment disorder?
In adjustment disorder, the stressor does not need to be severe. If the stressor is severe but all the criteria for PTSD are not met, adjustment disorder can also be diagnosed.
How can PTSD be differentiated from acute stress disorder?
The symptom pattern in acute stress disorder must occur and resolve within four weeks of the traumatic event.
How can PTSD be differentiated from OCD?
the thoughts in OCD are inappropriate and are not related to an experienced traumatic event
What is the essential feature of acute stress disorder?
the development of characteristic anxiety, dissociative, and other symptoms that occurs within one month after exposure to an extreme traumatic stressor
What are the two necessary characteristics for the A criterion of acute stress disorder?
the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
the person's response involved intense fear, helplessness, or horror
Criterion B of acute stress disorder states that, "either while experiencing or after experiencing the distressing event, the individual has three or more of the following dissociative symptoms." What are these symptoms?
a subjective sense of numbing, detachment, or absence of emotional responsiveness
a reduction in awareness of his or her surroundings (being in a daze)
What is criterion C for acute stress disorder?
C. The traumatic event is persistently reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience, or distress on exposure to reminders of the traumatic event.
What is criterion D for acute stress disorder?
D. Marked avoidance of stimuli that arouse recollections of the trauma (thoughts, feelings, conversations, activities, places, people)
What is criterion E of acute stress disorder?
E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).
What is criterion F for acute stress disorder?
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or imairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.
What are criteria G and H for acute stress disorder?
G. The disturbance lasts a minimum of two days and a maximum of four weeks and occurs within four weeks of the traumatic event.
H. Not substance/general med, and not better accounted for my brief psychotic disorder, not an exacerbation of a preexisting Axis I or Axis II disorder.
How can acute stress disorder and adjustment disorder be differentiated?
adjustment disorder is considered when individuals have an extreme stressor but do not meet the full criteria for acute stress disorder
What is the essential feature of generalized anxiety disorder?
excessive anxiety and worry (apprehensive expectation), occurring more days than not for a period of at least six months, about a number of events or activities
What is criterion B for generalized anxiety disorder?
B. The person finds it difficult to control the worry.
Criterion C of generalized anxiety disorder states that the anxiety and worry are associated with three or more othe following six xymptoms. What are these six symptoms?
restlessness or feeling keyed up or on edge
being easily fatigued
difficulty concentrating or mind going blank
sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
Criterion D of generalized anxiety disorder states that the focus of anxiety and worry is not confined to features of an axis I disorder. Give some examples.
worry about having panic attack (panic disorder)
being embarrassed in public (social phobia)
being contaminated (OCD)
being away from home or relatives (separation anxiety disorder)
gaining weight (anorexia nervosa)
having multiple physical complaints (somatization disorder)
having a serious illness (hypochondriasis)
worry/anxiety occurring exclusively during PTSD
What are criteria E and F for generalized anxiety disorder?
E. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
F. Not due to substance/gen med, and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder.