Anxiety Disorders

Overview

physiological and psychological symptoms are identical to normal fear and anxiety Þ disorders involve hypersensitivity

as always, it is only a disorder if there are associated functional problems

escape or avoidance behaviors are used to reduce episodic anxiety, but this perpetuates the disorder

although there are many classifications, there is much overlap, and a patient can manifest several of them

Types of Anxiety Disorders

(1) Generalized Anxiety Disorder (GAD)

manifests almost as a personality trait; there is a heightened basal sense of anxiety, worry (always on edge)
anxiety in GAD is unrelated to a specific stimulus (as occurs with panic attacks, phobias, etc)
GAD is a component of almost all other anxiety disorders (except specific phobias); therefore, before a diagnosis of GAD can be made, other anxiety disorder must first be ruled out

(2) Specific Phobia: an exaggerated fear of a specific stimulus; many different types:

animal type: lions, tigers, and bears, OH MY!

natural environment type: fears of heights, water, natural disasters

situational: airplanes, elevators, etc.

blood-injection-injury type: the ONLY phobic reaction that is associated with fainting

panic disorder fears fainting, but it never happens

i.e. it is normal to fear a free tiger, but someone with a specific phobia would fear a tiger in a cage

(3) Panic Disorder: recurrent panic attacks with the fear of another attack

must also have worry about the consequences of attack, OR significant change in behavior

Acute Phobic Reaction (Panic Attack): manifests as shortness of breath, palpitations, dizziness, sweating, etc.
panic disorder leads to avoidance of situations where a panic attack would have consequences

this leads to other disorders like agoraphobia

patient may also avoid situations of physical arousal like exercise and sex, fearing this will trigger a panic attack
the problem here is the fear of having another panic attack and the avoidance behavior associated with that

(4) Social Phobia:

specific social phobia: performance anxiety; fear of being embarrassed with people (i.e. public speaking)

generalized social phobia: anxiety isn’t just with strangers, interpersonal relationships such as dating, friendship, family are affected

(5) Obsessive-Compulsive Disorder (OCD): obsessions and compulsions are excessive or unreasonable

obsessions: thoughts, images, impulses that cause anxiety; obsessions are not normal worries, and are products of the patient’s mind; the patient knows this, but cannot help obsessing

compulsions: behaviors or mental acts to suppress or eliminate the obsession

Examples of OCD:

contamination:

obsession: dirt and germs

compulsion: frequent washing, may take several hours with a single washing

fear of harming:

obsession: patients feel they may harm themselves or someone else, having no desire to do so

compulsion: sit on hands for fear of hitting you; hide knives in the house so they cannot use them

unacceptable urges

obsession: i.e. they change the baby and fear they may have thoughts of molesting her

compulsion: avoid changing the baby to make sure they never have a chance at those thoughts

doubting:

obsession: did I lock the door?; did I leave the oven on?

compulsion: go back and check; may check several times

(6) Stress Disorder: person was exposed to a traumatic event; combat, natural disasters, assault, rape, abuse

they experienced or witnessed death or threat of death or serious injury

the response involved intense feelings of fear, helplessness, or horror

different from the others in that this is a fear of something that REALLY HAPPENED

Acute Stress Disorder:

dissociative experiences present during the event: numbing, detatchment, loss of emotional response; dazed, unaware of surroundings; dissociative amnesia

within one month Þ re-experiencing of the event (flashbacks, feelings, etc)

leads to avoidance of associated stimuli (i.e. place that it happened)

memory of the event may trigger anxiety

Post-Traumatic Stress Disorder: often related to childhood sexual abuse, combat vets

greater than one month in duration; may have a latency period of many years before symptoms

Some Comparisons

obsession: doubt about the present or future vs. depression: regret over past events

OCD: unrealistic fears vs GAD: realistic fears

obsession: doubts about possible things; patient has insight vs. delusion: certainty about bizarre things without insight

Comorbidity

anxiety disorders have a lot of overlap with the depressive disorders, but each have unique features

anxiety: hypervigilance, phobias (especially agoraphobia), worry, insomnia, motor tension; constant

depression: depressed mood, loss of interest/pleasure, hopelessness, weight change; episodic/recurrent