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: dyspnea dizziness or faintness palpitations tachycardia trembling or shaking sweating choking chest pain or pressure in chest fear of impending death fear of going crazy

Types of Anxiety Disorders

Panic Disorder Differentiation from panic attack increased 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 alone fear of being in a crowd or standing in line fear of being on a bridge or other high places fear 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 Phobia persistent 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 1 st 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 (1 st 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 emotions therapy, talking with family or friends, engaging in activities that make you laugh