Anxiety, Obsessive- Compulsive, and Related Disorders Chapter 27 of the required textbook DR. ARNEL BANAGA SALGADO, Ed.D., D.Sc., RN, MA, B.Sc, Cert.Ed, MAT (Psychology)

7/9/2016

Learning Objectives 1.Identify the different levels of anxiety 2.List the different psychodynamic factors that contribute to the development of anxiety disorders. 3.Assess clients with anxiety disorders 4.Design a Nursing Care Plan appropriate for clients with anxiety disorders.

Anxiety Disorders Anxiety Disorders Introduction – Anxiety is an emotional response to anticipation of danger, the source of which is largely unknown or unrecognized. – Anxiety is a necessary force for survival. It is not the same as stress or fear (cognitive).

Historical Aspects Freud was the first to associate anxiety with neurotic behaviors. For many years, anxiety disorders were viewed as purely psychological or purely biological in nature.

Epidemiological Statistics Anxiety disorders are the most common of all psychiatric illnesses. They are more common in women than men. Minority children and children from low socioeconomic environments are at risk. A familial predisposition probably exists.

How Much Is Too Much? When anxiety is out of proportion to the situation that is creating it When anxiety interferes with social, occupational, or other important areas of functioning

1. Mild Associated with the tension of everyday life The person is alert, the perceptual field is increased, and learning is facilitated Physiological responses are within normal limits The effect is positive algado.com Anxiety exists on a continuum

2. Moderate Focus is on immediate concerns The perceptual field is narrowed Low-level sympathetic arousal occurs Tension and fear are experienced 3. Severe Focus is on specific details and behavior is directed toward relieving anxiety The perceptual field is significantly reduced, and learning cannot occur The SNS is aroused Severe emotional distressed is aroused

4. Panic Disorder – Characterized by recurrent panic attacks the onset of which is unpredictable and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort – May or may not be accompanied by agoraphobia.

Application of Nursing Process Application of Nursing Process Symptoms of Panic Attack – Sweating, trembling, shaking – Shortness of breath, chest pain or discomfort – Nausea or abdominal distress – Dizziness, chills, or hot flashes – Numbness or tingling sensations – Derealization or depersonalization – Fear of losing control or “going crazy” – Fear of dying

Generalized Anxiety Disorder – Characterized by chronic, unrealistic, and excessive anxiety and worry Application of Nursing Process Application of Nursing Process

Predisposing Factors Predisposing Factors Panic and Generalized Anxiety Disorders – Psychodynamic theory Ego unable to intervene between id and superego Overuse or ineffective use of ego defense mechanisms results in maladaptive responses to anxiety. S. Freud

Phobias Phobias Agoraphobia – Fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of panic-like symptoms or other incapacitating symptoms – Examples: Traveling in public transportation Being in open spaces Being in shops, theaters, or cinemas Standing in line or being in a crowd Being outside of the home alone in other situations

Social Anxiety Disorder (Social Phobia) – Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others Phobias (cont.) Phobias (cont.)

Specific Phobia – Fear of specific objects or situations that could conceivably cause harm but the person’s reaction to them is excessive, unreasonable, and inappropriate. – Exposure to the phobic object produces overwhelming symptoms of panic, including palpitations, sweating, dizziness, and difficulty breathing. Phobias (cont.) Phobias (cont.)

Specific Phobia (cont.) – Type specifiers Animal Natural environment type Blood-injection-injury type Situational type Other type Phobias (cont.) Phobias (cont.)

Predisposing Factors to Phobias – Psychoanalytical theory: Unconscious fears may be expressed in a symbolic manner as phobia. S. Freud Phobias (cont.) Phobias (cont.)

Life Experiences – Early experiences may set the stage for phobic reactions later in life. Phobias (cont.) Phobias (cont.)

Substance-Induced Anxiety Disorder May be associated with intoxication or withdrawal from any of the following substances: – Alcohol, sedatives, hypnotics, or anxiolytics – Amphetamines or cocaine – Hallucinogens – Caffeine – Cannabis – Others

Obsessive-Compulsive Disorder (OCD) Assessment Data Recurrent obsessions or compulsions that are severe enough to be time-consuming or to cause marked distress or significant impairment

Obsessive-Compulsive Disorder (OCD) (cont.) Obsessive-Compulsive Disorder (OCD) (cont.) Obsessions R ecurrent thoughts, impulses, or images experienced as intrusive and stressful, and unable to be expunged by logic or reasoning

Compulsions R epetitive ritualistic behavior or thoughts, the purpose of which is to prevent or reduce distress or to prevent some dreaded event or situation. Obsessive-Compulsive Disorder (OCD) (cont.) Obsessive-Compulsive Disorder (OCD) (cont.)

Body Dysmorphic Disorder Assessment – Characterized by the exaggerated belief that the body is deformed or defective in some specific way – If true defect is present, the person’s concern is unrealistically exaggerated and grossly excessive. – Symptoms of depression and obsessive- compulsive personality are common.

Assessment – The recurrent pulling out of one’s own hair that results in noticeable hair loss. – Preceded by increasing tension and results in sense of release or gratification – The disorder is not common but occurs more often in women than in men. Trichotillomania (Hair-Pulling Disorder)

Assessment – There is persistent difficulty discarding or parting with possessions, regardless of their actual value. – When there is a need for continual acquiring of items, the symptom is identified by the DSM-5 as “with excessive acquisition.” – Virtually all surfaces within the home are covered with clutter. Hoarding Disorder

Predisposing Factors to OCD and Related Disorders – Psychoanalytic Theory Clients with OCD have weak, underdeveloped egos. Aggressive impulses are channeled into thoughts and behaviors that prevent the feelings of aggression from surfacing and producing intense anxiety fraught with guilt. S. Freud

Diagnosis/Outcome Identification Nursing diagnoses commonly associated with anxiety, OCD, and related disorders: – Panic anxiety (panic disorder and GAD) – Powerlessness (panic disorder and GAD) – Fear (phobias) – Social isolation (agoraphobia)

Ineffective coping (OCD) Ineffective role performance (OCD) Disturbed body image (body dysmorphic disorder) Ineffective impulse control (trichotillomania) Diagnosis/Outcome Identification (cont.)

Outcomes The Client: – Is able to recognize signs of escalating anxiety and intervene before reaching panic level (panic and GAD) – Is able to maintain anxiety at a manageable level and make independent decisions about life situations (panic and GAD)

The Client: – Functions adaptively in the presence of the phobic object or situation without experiencing panic anxiety (phobic disorder) – Verbalizes a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety (phobic disorder) Outcomes (cont.)

The Client: – Is able to maintain anxiety at a manageable level without resorting to the use of ritualistic behavior (OCD) – Demonstrates more adaptive coping strategies for dealing with anxiety than ritualistic behaviors (OCD) Outcomes (cont.)

The Client: – Verbalizes a realistic perception of his or her appearance and expresses feelings that reflect a positive body image (body dysmorphic disorder) – Verbalizes and demonstrates more adaptive strategies for coping with stressful situations (trichotillomania) Outcomes (cont.)

Planning/Implementation Interventions for individuals experiencing panic disorder or GAD are aimed at: – Relief of acute panic symptoms – Helping the client to take control of his or her own life situation and accept those situations over which he or she has no control

– Nursing interventions for the client with phobias are aimed at: Decreasing the fear and increasing the ability to function in the presence of the phobic stimulus or situation without experiencing panic anxiety Planning/Implementation (cont.)

Treatment Modalities Treatment Modalities Individual Psychotherapy Cognitive Therapy Behavior Therapy – Systematic desensitization – Implosion therapy