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Panic Disorder With Agoraphobia
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Panic Disorder with Agoraphobia a case presentation vanessa villamia sochat abnormal psychology July 11, 2008
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Abnormal PsychologySummer Session II 2008Vanessa Sochat
Transcript of Panic Disorder With Agoraphobia
Panic Disorder with Agoraphobiaa case presentation
vanessa villamia sochat
abnormal psychology
July 11, 2008
Panic Disorder with Agoraphobia An Introduction
• WHO is our client?
• WHAT are his symptoms and diagnosis?
• WHY did he develop this disorder?
• HOW do we treat it?
Outline
WHO WHAT WHY HOW ?
Who is our client? John Donahue
DEMOGRAPHICS
• Forty five years ago • High school principal• Father of three
CLINICAL HISTORY
• First attack 15 years ago• Alcoholism• Anxiety Clinic
What does John think of his attacks?
WHO WHAT WHY HOW ?
An example of John’s typical panic attack
WHO WHAT WHY HOW ?
Symptoms of panic attack
Intense apprehension and terrorImpending doomLabored breathingHeart palpitationsNausea, chest painChoking and smotheringDizzinessSweatingTremblingDepersonalizationDerealization Fears of losing control, going crazy
Panic Disorder with Agoraphobia
“Anxiety about situations which would be embarrassing or difficult to escape if panic symptoms occurred”
What are his symptoms Diagnosis?
Symptoms of panic attack
Intense apprehension and terrorImpending doomLabored breathingHeart palpitationsNausea, chest painChoking and smotheringDizzinessSweatingTremblingDepersonalizationDerealization Fears of losing control, going crazy
Do John’s symptoms fit the disorder? recurrent unexpected panic attacks at least 1 of attacks followed by month of
concern about having another attack concern about consequences of attack change in behavior because of attacks
WHO WHAT WHY HOW ?
What is John’s official DSM-IV-TR diagnosis?
Axis I: 300.21 Panic disorder with agoraphobia
Axis II: No diagnosis on axis II
Axis III: None
Axis IV: Relocation to new state, job change, stressful
work schedule
Axis V: Global assessment of functioning = 58
DMS-IV-TR Diagnosis Based on:1)Anxiety about situations/events2)Avoidance of these situations/events3)Anxiety not better accounted for by another disorder!
WHO WHAT WHY HOW ?
Integrative Model of Causes and Maintenance of Panic Disorder
Genetic factorsSocial FactorsPhysiological FactorsCognition (personality)Life Events
Why did he develop this disorder?
Etiology of Panic Disorder with Agoraphobia
“Fear of Fear” Hypothesis
Genetic vulnerability to alarm reaction
Psychological problems on mother's side:* mother alcoholic, panic disorder with agoraphobia
anxious woman constantly concerned with her and her children's physiological symptoms, worried a lot
* maternal grandfather and two aunts abused alcohol * maternal grandmother and another aunt - panic disorder
* sister and younger brother, nothing
WHO WHAT WHY HOW ?
Why did he develop this disorder? Genetic factors
WHO WHAT WHY HOW ?
Why did he develop this disorder? social/environment factors
Stressful environment triggers vulnerability
Interoceptive conditioning (learned alarms)
Behavioral Factors
Physiological/biological Factors
WHO WHAT WHY HOW ?
Why did he develop this disorder? cognition
Safety behaviors and safety signals
24 access to anti anxiety medicationdriving to side of roadholding onto stationary objectsremaining near walls
Safety behaviors serve to maintain beliefs about the consequences of panic
Lack of control over environment
More attentive to signs of threat
WHO WHAT WHY HOW ?
Negative life eventNegative life event
AnxietyAnxiety
Somatic symptomsSomatic symptoms
First panic attackFirst panic attack
Fear symptomsFear symptoms
Panic disorderPanic disorder
Psychological and biological
vulnerability
Psychological and biological
vulnerability
Belief that symptoms dangerous
Belief that symptoms dangerous
Why did he develop this disorder? The big picture
GENETICSOCIAL/ENVIRONMENTAL
BEHAVIORALCOGNITIVE
Summary of maintaining factors panic disorder panic attack symptoms agoraphobic situations cognitions associated with panic attacks anticipatory anxiety safety behaviors and signals
WHO WHAT WHY HOW ?
Why does he still have it?
WHO WHAT WHY HOW ?
How do we treat it? In vivo exposure
Exposure treatmentCognitive behavioral treatment Panic Control Treatment (PCT)Situational exposure (with relaxation technique)
Situational (in vivo) exposure1) making list of situations that are avoided2) arranging the list in a hierarchical fashion from least to most avoided3) beginning with least difficult situations
WHO WHAT WHY HOW ?
How do we treat it? Course of treatment
OUTCOME: panic and medication free 6 months after final session
Why might women outnumber men?Why do men turn to substance abuse, and women to
avoidance?How might a psychoanalytical paradigm explain not
perceiving to have a sense of control?Medication?Why is remaining in feared situations important for in
vivo exposure?Public awareness of this disorder?How would you respond?Advantages and disadvantages of having spouse/friend?
WHO WHAT WHY HOW ?
Discussion
Works Cited
Brown, Timothy. Casebook in abnormal psychology. Thomson Higher Education, Belmont CA, 2007: 18-35.
Kring, Ann. Abnormal Psychology. John Wiley and Sons, United States, 20077: 121-155.
Panic Disorder and Agoraphobia. http://en.wikipedia.org/wiki/Agoraphobia
WHO WHAT WHY HOW ?
