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Fear, Anxiety and Related Disorders
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Lecture notes of 55 pages for the course Fear, anxiety and other related disorders at RU (class notes)
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1Fear, Anxiety and Related Disorders
The exam will be 40 multiple-choice. We assume that you look up the diagnostic criteria
yourself and therefore they are not repeated in the lecture!
The exam will cover the issues discussed in the Main Lectures (Learning
objectives!) as well as the assigned readings.
Each question renders 1 point. The entire exam is worth 40 points BUT for each correct
sub-part you can get 0.25 points: Thus 0.25 for each correctly chosen answer and 0.25 for
each correctly NOT-chosen answer (e.g., A & B are the correct answer options and C & D
are not. If you choose A&B and NOT C&D you get the full point. If you choose, e.g., A,B&C
and NOT D you get 0.75 points. If you choose, e.g., A&C and NOT B&D you get 0.5 points. If
you choose, e.g., D and NOT A, B&C, you get 0.25 points, and if you choose, C&D, but NOT
A&B you get 0.0 points). In order to correct for the difficulty of the exam, all calculations will
be based on the score of the 5% best scoring students, not on the absolute score of 40
points.
1. From Anxiety to anxiety disorder: Theories
and Developmental aspects of anxiety
Learning objectives:
1. What is fear, what anxiety? What do they have in common, how do they
differ? What are the functions of fear and anxiety?
2. How is an anxiety disorder defined?
3. What is a fear reaction - what is a panic attack? What is the difference
between those two?
4. What is the prevalence and time course of an anxiety (related) disorder?
5. What do we know regarding biological risk factors of anxiety (related)
disorders?
6. What do we know regarding psychological risk factors of anxiety (related)
disorders?
7. What is the role of cognitive biases in the aetiology of anxiety (related)
disorders?
Anxiety is important for our survival, “rather safe than sorry”. Anxiety disorders are the most common
disorders, more common than affective disorders.
We all are primed for anxiety, there is an
evolutionary basis for it. Fear has a clear object,
there is a clear focus of what you're afraid of and
they usually trigger an immediate alarm
(freeze-fight-flight response). A threat to your
well-being.
Anxiety is linked to anticipatory anxiety, not being
entirely sure about what will happen. The most
common state linked to it is worry.
Anxiety is more of a human phenomenon than
fear. It is the shadow of intelligence, planning
ahead. Example: climate change.
, 2
Anxiety patients have to fight it
because of this evolutionary
value fear has. The fear
response is usually triggered
extremely fast. So fast that your
amygdala may notice a threat
before your visual cortex does.
But this speed can be a
disadvantage when it is a false
alarm like fear of public
speaking.
Exam question: We talk of fear if... if there is a clear object (correct answer)
…if there is a disorder… it would be phobia
…if we worry a lot… it would be anxiety
…if there is a fight or flight response… usually triggered by
fear but it can be in others too (ambiguous answer)
Anxiety disorders are really
dimensional and difficult to define.
Where we say it's too much is
subjective. (In OCD it is much
easier and qualitative). When it
impairs your life and is excessive
then we start to think of a possible
disorder.
DSM - Definition
Not unreasonable fear, but unreasonably strong.
Spiders can be dangerous. Disgust is clearly linked with
threat, people usually are disgusted by their fear.
, 3
A lot of drugs or
medications can trigger
anxiety. Schizophrenics
are usually very anxious.
(Panic disorder is
ambiguous and it's not
clear cut, it's anxiety but it
could be fear other than
the fact that there is no
real trigger).
Social anxiety has a lot of
anticipatory, constant
negative thinking and is
very repetitive and this
predicts trouble with
treatment.
Post-mortem processing, now called post-event processing: after getting home after a
party, thinking “I talked too much”, and the enjoyment of the evening goes away. This
post-event processing is why the name changed from social phobia to social anxiety. This
needs to be counteracted when planning the exposure therapy otherwise the treatment won’t
work. This is why success rates for social anxiety and GAD are not so good.
The most typical behavior of anxiety disorders, PTSD
and OCD. To prevent us from getting into danger. This
really impairs, and this behavior is the one that
changes your life the most. And it is the one that really
maintains the behavior. You don't realize that it is not
really necessary to avoid spiders. There are overt
behaviors but covert behaviors are in every patient
and they are called safety behaviors. These are safety
behaviors like carrying your phone always with you,
always making sure everything is tidy, being prepared,
avoiding words, certain clothing… and it must be
targeted and taken into account.
, 4
Every third person has a chance to develop a diagnosis.. Women’s numbers are higher. The
reason for this gender difference is that female animals are more likely to develop anxious
behavior when stressed. Also culturally, males are punished for being afraid, women are
allowed to.
Anxiety is the
earliest onset
mental disorder, it
starts very young.
Fear of loss,
strangers,
separation… They
can develop
phobias when they
are children. And
then later on
darkness,
monsters… when
children start to
wonder off.
Exposure therapy is the most powerful cognitive intervention. Most patients are afraid of
dying from a panic attack. They need to see the intervention as cognitive. You need to show
them that it will not kill them. Try your best to kill yourself with a panic attack and failing. No
safety behaviors.
Anxiety is linked to cognitive
development (humans rather than
animals), more likely in older kids.
A lot of shifting and switching from
one disorder to another.
What are the “causes” of anxiety?
Not so much trauma, in very few cases there is trauma (unless PTSD which is not an anxiety
disorder?).
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