Key Terms

• Fear

  • Immediate, present-oriented

  • Sympathetic nervous system activation

• Anxiety

  • Apprehensive, future-oriented

  • Somatic symptoms: muscle tension, restlessness, elevated heart rate

• Panic attack: abrupt experience of intense fear

  • Physical symptoms: heart palpitations, chest pain, dizziness, sweating, chills or heat sensations, etc.

  • Cognitive symptoms: Fear of losing control, dying, or going crazy

  • Two types of panic attacks: expected and unexpected

Diagnostic Criteria

• The DSM – 5 diagnostic criteria for panic attack — 4 (or more) of the following symptoms occur:

  1. Palpitations, pounding heart, or accelerated heart rate

  2. Sweating

  3. Trembling or shaking

  4. Feeling of choking

  5. Chest pain or discomfort

  6. Nausea or abdominal distress

  7. Feeling dizzy, unsteady, light-headed or faint

  8. Chills or heat sensations

  9. Paresthesias

  10. Derealization

  11. Fear of losing control or going crazy

  12. Fear of dying

Biological Contributions

• Increased physiological vulnerability

  • Polygenetic influences

    • Corticotropin releasing factor (CRF)

      • Affects the HPA axis

  • Brain circuits and neurotransmitters

    • GABA

    • Noradrenergic

    • Serotonergic systems

• Limbic system

  • Behavioral inhibition system (BIS)

    • Received danger signals from:

      • Brain stem

      • Septal-hippocampal system

  • Fight/flight (FFS) system

    • Panic circuit

    • Alarm and escape response

• Brain circuits are shaped by environment

  • Example: teenage cigarette smoking – teenage smoking is linked to increased risk for developing anxiety and panic

  • Interactive relationship with somatic symptoms

Psychological Contributions of Anxiety

• Freud

  • Anxiety = psychic reaction to danger

  • Reactivation of infantile fear situation

• Behaviorists

  • Classical and operant conditioning: symptoms are a result of learned associations

  • Modeling: anxious behavior

• Beliefs about control over environment

Social Contributions to Anxiety

• Biological vulnerabilities triggered by stressful life events

  • Family

  • Interpersonal

  • Occupational

  • Educational

An Integrated Model of Anxiety

• Triple vulnerability

  • Generalized biological vulnerability

    • Diathesis

  • Generalized psychological vulnerability

    • Beliefs/perceptions

  • Specific psychological vulnerability

    • Learning/modeling

Comorbidity of Anxiety

• High rates of comorbidity

  • 55% to 76%

• Commonalities

  • Features

  • Vulnerabilities

• Links with physical disorders

Suicide

• Suicide attempt rates

  • Similar to major depression

  • 20% of panic patients attempt suicide

• Increases for all anxiety disorders