Generalised Anxiety Disorder (GAD) is distinguished from other anxiety disorders primarily by:
A: Intense fear triggered by specific objects or situations
B: Persistent, excessive, and uncontrollable worry about a wide range of topics
C: Recurrent unexpected panic attacks with physical symptoms
D: Anxiety specifically in social or performance situations
Correct: Persistent, excessive, and uncontrollable worry about a wide range of topics
GAD is characterised by chronic, free-floating worry that is difficult to control and spans multiple domains of life (health, finances, relationships, everyday matters). Unlike panic disorder or phobias, the anxiety in GAD is not tied to a specific trigger. The worry is accompanied by physical symptoms such as muscle tension, fatigue, and sleep disturbance.
A patient reports recurrent episodes of sudden, intense fear peaking within minutes, accompanied by heart palpitations, shortness of breath, and a fear of dying — with no identifiable trigger. Which diagnosis best fits?
A: Specific phobia
B: Agoraphobia
C: Panic disorder
D: Generalised Anxiety Disorder
Correct: Panic disorder
Panic disorder is defined by recurrent unexpected panic attacks — sudden surges of intense fear with physical symptoms (palpitations, chest pain, dizziness, shortness of breath) — combined with persistent concern about future attacks or significant changes in behaviour to avoid them. The "unexpected" nature distinguishes panic disorder from situation-bound attacks seen in phobias.
According to Clark's cognitive model of panic disorder, panic attacks are maintained by catastrophic misinterpretations of benign bodily sensations.
Answer: True
David Clark's (1986) cognitive model proposes that panic disorder is driven by a vicious cycle: physical sensations (e.g., mild heart rate increase) are catastrophically misinterpreted as signs of imminent danger (e.g., heart attack), triggering anxiety that amplifies the physical sensations, which are then misinterpreted further. This model underpins cognitive therapy for panic, which targets these misinterpretations directly.
Which of the following best describes the two-factor theory (Mowrer, 1960) of phobia acquisition and maintenance?
A: Phobias are inherited genetically and reinforced by social modelling
B: Fear is acquired through classical conditioning and maintained through operant conditioning (avoidance)
C: Phobias develop through cognitive distortions and are maintained by negative self-talk
D: Fear is acquired through observational learning and maintained through attention bias
Correct: Fear is acquired through classical conditioning and maintained through operant conditioning (avoidance)
Mowrer's two-factor theory proposes that phobias are first acquired via classical conditioning (a neutral stimulus becomes associated with fear) and then maintained via operant conditioning — specifically negative reinforcement. Avoidance of the feared stimulus reduces anxiety in the short term, which reinforces the avoidance behaviour and prevents extinction of the fear response.
OCD was reclassified in the DSM-5 into its own chapter ("Obsessive-Compulsive and Related Disorders") rather than remaining within anxiety disorders. What is the primary rationale for this change?
A: OCD does not involve anxiety
B: OCD shares distinct phenomenology, neurobiology, and treatment with related disorders such as hoarding and body dysmorphic disorder
C: OCD responds exclusively to medication rather than psychological therapy
D: The anxiety in OCD is indistinguishable from GAD
Correct: OCD shares distinct phenomenology, neurobiology, and treatment with related disorders such as hoarding and body dysmorphic disorder
The DSM-5 created a separate OCD spectrum chapter based on evidence that OCD shares features — including intrusive thoughts, repetitive behaviours, and specific neural circuits (cortico-striato-thalamo-cortical loops) — with related conditions such as body dysmorphic disorder, hoarding disorder, and trichotillomania. This grouping better reflects their shared aetiology and treatment profiles (particularly ERP and SRIs) compared to anxiety disorders.
Exposure and Response Prevention (ERP) is considered the gold-standard psychological treatment for OCD.
Answer: True
ERP involves systematically exposing the patient to feared stimuli (e.g., contamination) while preventing the compulsive response (e.g., handwashing). Over repeated trials, anxiety habituates and the person learns that the feared outcome does not occur. Multiple meta-analyses support ERP as the most effective psychological treatment for OCD, typically combined with SRIs (e.g., fluvoxamine, sertraline) in moderate-to-severe cases.
Which neurotransmitter system is most centrally implicated in the biological models of anxiety disorders?
A: Dopamine
B: GABA and noradrenaline
C: Acetylcholine
D: Glutamate exclusively
Correct: GABA and noradrenaline
GABA (gamma-aminobutyric acid), the main inhibitory neurotransmitter, plays a central role — benzodiazepines reduce anxiety by enhancing GABAergic inhibition. Noradrenaline (norepinephrine) is also implicated: the locus coeruleus, a major noradrenergic nucleus, is activated during fear responses. Serotonin is additionally implicated (SSRIs are first-line pharmacological treatments), and the amygdala is a key structure in threat processing across anxiety disorders.
Anxiety Disorders
Generalised Anxiety Disorder (GAD) is distinguished from other anxiety disorders primarily by:
About this quiz
Anxiety disorders are the most prevalent class of mental disorders worldwide. They share a core feature — excessive fear or anxiety — but differ in what triggers that response and how it manifests. Understanding the distinctions between GAD, panic disorder, specific phobias, social anxiety disorder, and OCD is essential for both diagnosis and treatment planning.
This quiz covers the defining features of the major anxiety disorders, their underlying cognitive and biological models, and the evidence-based treatments most commonly used in clinical practice.