A N X I E T Y VICTORIA PEARSON

THERE ARE 14 DISORDERS CONTAINED IN THE DSM IV TR SECTION OF ANXIETY DISORDERS Panic Attack Agoraphobia Panic Disorder without Agoraphobia Panic Disorder with Agoraphobia Agoraphobia without history of Panic Disorder Specific Phobia Social Phobia Obsessive-Compulsive Disorder Posttraumatic Stress Disorder Acute Stress Disorder Generalized Anxiety Disorder Anxiety Disorder due to a General Medical Condition Substance-Induced Anxiety Disorder Anxiety Disorder not otherwise specified``

GENERAL FACTS ABOUT ANXIETY DISORDER Anxiety disorders are the most common mental illness in the US more than 23 million Americans are affected Anxiety Disorders are most common for women, affecting approximately 30% of the female population at some point in their lives. Initial Manifestations appear at age 20 to 35 years, but children and adolescents can be affected. High levels of Anxiety can exacerbate a wide variety of medical conditions (e.g., gastric ulcers, asthma, hypertension, and seizure d/o).

AN INNOCENT FAMILY BBQ OR IS THIS A SITUATION THAT COULD LEAD TO A SITUATIONAL PHOBIA?

PANIC ATTACK 1.Palpitations, pounding heart, or accelerated heart rate 2.Sweating 3.Trembling or shaking 4.Sensations of shortness of breath or smothering 5.Feeling of choking 6.Chest pain or discomfort 7.Nausea or abdominal distress 8.Feeling dizzy, unsteady, lightheaded, or faint. 9.Derealization (feelings of unreality) or depersonalization (being detached from oneself) 10.Fear of losing control or “going crazy” 11.Fear of dying 12.Paresthesias (numbness or tingling sensations) 13.Chills or hot flushes

GENERALIZED ANXIETY DISORDER (INCLUDES OVERANXIOUS DISORDER OF CHILDHOOD) DIAGNOSTIC CRITERIA Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). The anxiety and worry are associated with three (or more) of the following: 1.Restlessness or feeling keyed up or on edge 2.Being easily fatigued 3.Difficulty concentrating or mind going blank 4.Irritability 5.Muscle tension 6.Sleep disturbance

GAD INTERVIEWING ISSUES Very little is known about GAD’s natural history, etiology and predisposing factors. Some experts believe that GAD is not a specific disorder, but merely a residual category for the other specified Anxiety Disorders.

PANIC DISORDER Panic Disorder runs in families. About 20% of patients with Panic d/o identify 1 st degree relatives with Panic d/o. A Panic Attack usually occurs during an unusually stressful period. Caffeine produces Panic Attacks in 71% of patients with Panic d/o. Stopping caffeine reduces the frequency and intensity of Panic Attacks.

SOCIAL PHOBIA Is a marked and persistent fear of one or more social or performance situations in which embarrassment or humiliation may occur.

SPECIFIC PHOBIA DIAGNOSTIC CRITERIA A. Marked and persistent fear that is excessive or unreasonable, (e.g., flying, heights, animals, seeing blood, and injections). B. Exposure to phobic stimulus provokes an immediate anxiety response. C. The person recognizes that the fear is excessive or unreasonable. Note: In children this feature may be absent. D. The phobic situation is avoided or endured with intense anxiety or distress. E. Significant Interference with the person’s normal functioning. F. In individuals under age 18 years, the duration is at least 6 months. G. The anxiety, Panic Attacks, or phobic avoidance with specific object or situation are not better accounted for by another mental disorder

OPHIDIOPHOBIA OR OPHIOPHOBIA IS A PARTICULAR TYPE OF SPECIFIC PHOBIA, THE ABNORMAL FEAR OF SNAKES. FEAR OF SNAKES IS SOMETIMES CALLED BY A MORE GENERAL TERM, HERPETOPHOBIA, FEAR OF REPTILES AND/OR AMPHIBIANS. THIS IS A FEAR THAT THIS LADY OBVIOUSLY DOES NOT HAVE.SPECIFIC PHOBIASNAKESHERPETOPHOBIAREPTILESAMPHIBIANS

AGORAPHOBIA Anxiety about, or avoidance of places or situations from which escape might be difficult or embarrassing in which help may not be available in the event of a Panic Attack or Panic-Like symptoms.

POSTTRAUMATIC STRESS DISORDER DIAGNOSTIC CRITERIA The development of symptoms following exposure to an extreme traumatic stressor that involves actual or threatened death or serious injury, or witnessing an event that involves actual or threatened death, or injury

ANXIETY DISORDER DUE TO A GENERAL MEDICAL CONDITION DIAGNOSTIC CRITERIA Anxiety, Panic Attacks, or obsessions or compulsions are due to the physiological consequence of a general medical condition.

SUBSTANCE-INDUCED ANXIETY DISORDER The Anxiety symptoms are due to the direct physiological effects of a substance (i.e., drug abuse, medication, or toxin exposure)

INTERVIEWING ISSUES One of the most difficult task in interviewing is differentiating Anxiety from Depression, primarily because of the frequency of mixed anxiety and depressive symptoms Patients complaining of anxiety who have definite symptoms of depressive syndrome should be treated as having depression Patients with Anxiety disorder are usually seen in medical care or substance abuse treatment settings, but It is important to recognize anxiety syndromes in patients in these settings who are not complaining of it. In diagnosing an anxiety syndrome, there should be a presence of both psychological and physiological symptoms

ANXIETY DISORDER {NOT OTHERWISE SPECIFIED} It is all so important during an interview to distinguish between General Anxiety disorder and Anxiety disorder Not Otherwise Specified (NOS).

REFERENCES American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4 th ed.). Text Revision. Washington, DC: American Psychiatric Association. Butcher, J. N., Mineka, S., Hooley, J. M., (2004). Abnormal psychology (12 th ed.). Boston, MA: Pearson Education, Inc. Maxmen, J. S., Ward, N. G. (1995). Essential psychopathology and its treatment (2 nd ed.). Revised for DSM-IV. New York, NY: W.W. Norton & Company, Inc.