Anxiety Disorders

How to distinguish between fear & anxiety :

fear – a feeling that arises from a concrete, real danger.

anxiety – a feeling that arises from an ambiguous, unspecific cause. (disproportionate to danger)

FYI:

Anxiety disorders generally develop during adolescence and/or early childhood.

Women are more likely than men to present for treatment.

Panic Attack – not a disorder in and of itself

sudden spontaneous episodes of overwhelming panic

panic attack is a symptom of many anxiety disorders

Signs & Symptoms of Panic Attack:

dyspneadizziness or faintnesspalpitationstachycardiatrembling or shakingsweatingchokingchest pain or pressure in chestfear of impending death fear of going crazy

Types of Anxiety Disorders

Panic Disorder

Differentiation from panic attackincreased frequency & redundancy of

attacks

at least four panic attack symptoms develop abruptly, crescendo within 10 minutes & typically last another 10 minutes

cont.

Two Main Subtypes of Panic Disorder

1. panic disorder without agoraphobia

2. panic disorder with agoraphobia

Agoraphobia

severe & pervasive anxiety

about being in situations from which escape

might be difficult

Agoraphobia cont.

usually (but not always) a secondary occurrence of unexpected, reoccurring panic attacks

individuals may begin to avoid places or situations in anticipation of a dreaded, spontaneous attack

often require presence of companion in order to avoid anxiety

Fears typically consistent with agoraphobia include:

fear of being outside home alonefear of being in a crowd or standing in linefear of being on a bridge or other high placesfear of traveling on bus, train, air plane, or in automobile

fears stem from primary fear of being “trapped” and unable to get back to safe place

Social Phobiapersistent fear of one or more

social or performance situations

Social phobia cont.

fears he/she will act in way (or show anxiety) that will be humiliating or embarrassing, i.e. –

fear of fainting, losing control of bowel or bladder function

fear of having one’s mind go blank when faced with dreaded social situation

Social phobia cont.

exposure to feared social situation invariable provokes anxiety, which may take form of situationally bound panic attack

children may express fear by crying or tantrum-like behavior

adults either avoid dreaded social situation or tolerate it with great discomfort

typically begins in childhood or adolescence

often associated with traits of shyness & social inhibition

public humiliation, severe embarrassment may initiate a social phobia

once established, complete remissions are uncommon without treatment

Social phobia cont.

Post-Traumatic Stress Disorder

(PTSD)

traumatic experience triggers recurring

anxiety

PTSD cont.

anxiety & behavioral disturbances that develop during or shortly following extreme trauma & lasts more than 1 month

historically identified in soldiers “shell shock” or “combat fatigue” syndrome

other traumatic events: rape, physical assault, near-death experience, witnessing a murder, disasters, etc.

Key Features of PTSD

symptoms of hyperarousal & generalized anxiety

emotional detachment from people & activities

avoidance of situations that elicit memories of trauma

persistent, intrusive recollections of event via flashbacks, dreams, and/or thoughts

PTSD cont.

post-traumatic stress symptoms persist for more than 1 month & are associated with functional impairment

about 50% of cases remit within 6 months

Acute Stress Disorder

Acute Stress Disorder cont.

follows traumatic event but symptoms may last from only 2 days to one month

psychological trauma initially keeps individual from pursuing necessary help (medical or legal assistance)

Generalized Anxiety Disorder

(GAD)

excessive anxiety & worry that

occurs more days than not

GAD cont.

accompanying symptoms: muscle tension, easy fatigability, poor concentration, insomnia, irritability, & restlessness

excessive worries pertain to many areas (work, relationships, money, potential misfortunes, etc.)

about 50% of cases begin in childhood

occurs more often in women

Obsessive-Compulsive Disorder

(OCD)

“Out, damned spot.”

Lady Macbeth’s unshakable conviction that

blood remains on her hands, even after

extensive cleaning.

OCD cont.

Obsessions – recurrent, intrusive thoughts, impulses, or images that are perceived as inappropriate, grotesque, or forbidden

Compulsions – repetitive behaviors or mental acts that reduce anxiety that accompany an obsession

Common Obsessive Themes

germ or body fluid contamination

doubts that important task was overlooked

worry that unintentional act inflicted harm on someone

unbending order or symmetry

compulsions play out as rituals that “neutralize” obsessive thoughts

OCD cont.

disorder equally common among men & women

typically begins in adolescence to young adult

course fluctuates

symptom exacerbations usually associated with stress

approximately 20% to 30% have tics

familial pattern among 1st degree relatives

OCD cont.

Physiological Responses to Anxiety

rapid heart beat

elevated blood pressure

increased perspiration

shortness of breath

“butterflies” in stomach, upset stomach

trembling (1st of lips, then extremities)

dizziness

Coping Mechanisms – Our Defense Against Anxiety

mechanisms against anxiety may be effective or ineffective

Ineffective Coping:

physical fights

abusing substances

social withdrawal

“acting-out” in inappropriate manner

Effective Coping:

use of physical activity walking, jogging, competitive sports,

strenuous work, etc.

stress-reduction techniques deep muscle relaxation, biofeedback,

meditation, visualization

expression of emotionstherapy, talking with family or friends,

engaging in activities that make you laugh