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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