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Block 2 Unit 1 Anxiety Disorders, Panic and Phobias

1) What are the primary types of anxiety according to DSM IV TR?

According to DSM IV TR, the primary types of anxiety disorders include:

• Panic disorder with or without agoraphobia
• Phobic disorders of the specific or social type
• Generalised anxiety disorder
• Obsessive compulsive disorder
• Post traumatic stress disorder

2) How many of the thirteen symptoms must be there for panic attack to be diagnosed?

A panic attack as a situation where a person suddenly behaves as if under severe stress, with symptoms like sweating, fainting, and breathing difficulties.

3) What is ‘fear of fear’?

'Fear of fear' refers to the apprehension of a panic attack, which can be a maintaining factor in panic disorder.

4) What are the relative merits and demerits of Benzodiazepine and SSRI in treating panic disorder?

• Benzodiazepines (like alprazolam or clonazepam) are often used to handle panic attacks, and they are effective as tranquilizers. However, they have the drawback of being addictive.
• SSRIs (Selective Serotonin Reuptake Inhibitors), which are antidepressants, have also been used effectively to treat panic attacks. They are not described as addictive in the text.

5) How many types of phobias have been identified by DSM?

According to DSM IV-TR, there are three types of phobias: Specific phobia, Social phobia, and Agoraphobia.

6) What are the subtypes of Specific phobia?

Specific phobias can be divided into subtypes, such as:

• Animal type
• Natural environment type (e.g., heights, water)
• Blood-injection-injury type
• Situational type (e.g., public transportation, enclosed spaces)
• Other type (e.g., choking, vomiting)

7) Distinguish between anxiety and fear.

Fear is a basic emotion associated with the perception of a real threatening situation and involves the "fight or flight" response. It includes cognition of a threatening object, subjective feelings of being in danger, physiological responses, and behavioural components such as running away.

Anxiety is a more general term that covers a range of disorders characterized by irrational fear of something or some situation. Anxiety disorders include panic disorder, phobic disorder, generalised anxiety disorder, obsessive compulsive disorder and post traumatic stress disorder. Anxiety is also a common reaction to stress.

8) Critically discuss the difference between normal and pathological anxiety.

Anxiety is a common reaction to stress, and it can be useful in certain situations. For example, it helps you to study for exams, or take care of a baby. However, pathological anxiety becomes a disorder when it is excessive, leading to a breakdown or avoidance.

Normal anxiety can be distinguished from pathological anxiety based on the degree of dysfunction it causes.

9) Discuss the symptoms and clinical features of different kinds of Panic disorder with case examples.

• A panic attack is characterized by a sudden onset of severe stress symptoms, such as sweating, fainting, and difficulty breathing. People experiencing a panic attack may feel like they are having a heart attack. The attacks usually subside after some time.
• An internal stimulus like an increased heart rate can trigger panic attacks because the sensation becomes associated with panic experiences.

10) What  is liability-stability dimension?

The liability-stability dimension refers to the idea that some individuals are temperamentally more prone to being easily aroused or "jumpy". This dimension is a function of the predisposition of autonomic activity, with those who are easily aroused having a greater chance of developing anxiety disorders later in life.

11) Discuss the aetiological factors of Panic disorder.

• The aetiology of panic disorder includes biological factors such as genetic factors and biochemical abnormalities in the brain.
• Psychosocial factors play a role by influencing an individual's perception of and reactions to internal or external cues that trigger attacks. This includes oversensitivity to internal stimuli such as an increased heart rate, and the interpretation of bodily sensations in a catastrophic way.
• Cognitive factors include a predisposition to interpret bodily sensations as catastrophic.

12) Discuss the treatment options of Panic disorder.

• Panic disorder can be treated with pharmacology, psychotherapy, or a combination of both.
• Tranquilizers from the benzodiazepine group (e.g., alprazolam, clonazepam) are often used, but they can be addictive.
• Antidepressants like tricyclics and SSRIs are also used effectively.
• Cognitive techniques can be employed to identify and challenge automatic thoughts and triggering cues. Cognitive techniques are considered more helpful than medicine for long-term maintenance.

13) Discuss the symptoms and clinical features of different kinds of Phobias with case examples.

• Phobias are characterised by an intense fear reaction when facing the phobic stimulus. The individual's attention becomes completely focused on the phobic object, causing them to experience intense fear and a desire to escape. The flight reaction is reinforced as it provides relief from the tension.
• Specific phobias involve irrational fear of specific objects, animals, or situations, such as claustrophobia (fear of enclosed spaces), acrophobia (fear of heights), haemophobia (fear of blood), ophidiophobia (fear of snakes), arachnophobia (fear of spiders), pyrophobia (fear of fire) and phobophobia (fear of phobias).
• Social phobias are characterised by persistent and irrational fears of social situations. People with social phobia struggle with situations where they might be evaluated and often find it difficult to interact with new people, speak in groups, or in public.

14) Discuss the aetiological factors of Phobias.

The aetiology of phobias include:

• Biological factors, including a predisposition to learn certain fears, known as preparedness.
• Learning theories which explain how phobias can be acquired through conditioning. A previously neutral stimulus (such as an elevator) that is paired with an aversive experience (like trauma) may result in the development of a phobia.
• Cognitive theories focus on how individuals have selective attention toward phobic objects and often have a belief that negative things are likely to happen.

15) Discuss the treatment options of Specific Phobia.

Anxiolytics and anti-depressants may be used for treating phobic disorders, but psychological treatments are more effective. Psychoanalytical, behavioural, or cognitive therapies may be employed.

16) Discuss the treatment options of Social Phobia.

• Treatment options for social phobia may include anxiolytics and anti-depressants, but psychological treatments are more effective.
• Cognitive therapies focus on exploring and correcting automatic thoughts and beliefs about the self and others.
• A combination of therapies can be used depending on the client’s needs.

Important Points

• Anxiety is imaginary; fear is response to a really possible event
• Real and pathological anxiety can be distinguished in terms of degree of dysfunction
• Sympathetic nervous system is activated during anxiety
• No specific neurobiological mechanism has been specified for panic attacks. 
• Panic attacks may be stimulated by internal cues
• The psychoanalytical model attributes phobias to unconscious conflict.
• Systematic desensitisation is used for treating phobic disorder