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).