Anxiety Disorders

Introducing Anxiety

Anxiety is a negative psychological state characterised by bodily symptoms of physical tension and apprehension about the future.

Anxiety vs Anxiety Disorder

  • Duration
  • Intensity
  • Appropriateness of response
    • Disorder involves many false alarms - experiencing fear when there is nothing to be afraid of
  • Level of functional impairment and distress

Bodily Symptoms

  • Fight or Flight response
  • Sympathetic nervous system
  • Increased heart rate, increase blood pressure, sweating, goosebumps, hyperventilation, etc

Necessary Criteria for Classification

  • Excessive fear/overestimation of threat
  • Significant distress/impairment to daily life
  • Engagement in fear-avoiding or safety behaviours
  • Maintenance of anxiety symptoms (the behaviours above prevent fear extinguishing)

Panic Attacks

Intense abrupt experiences of fear accompanied by flight-or-fight symptoms are common in anxiety disorders. Panic attacks are split into cued (triggered) and uncued (unexpected) attacks.

Symptoms of Panic Attacks

  • Palpitations, accelerated heartrate
  • Sweating
  • Trembling/shaking
  • Sensations of shortness of breathing
  • Choking feeling
  • Chest pain/discomfort
  • Nausea/abdominal distress
  • Dizziness/Lightheaded
  • Derealisation
  • Fear of losing control
  • Fear of death
  • Numbness
  • Hot flushes/Chills

Types of Anxiety Disorder

Specific Phobia

Specific Phobia is an anxiety disorder marked by irrational/unreasonable fear upon exposure to specific objects/situations, that markedly affects an individual's ability to function.

Exposure to the object almost always invokes a panic attack.

Common Phobias

  • Animals; spiders, snakes, dogs, birds
  • Natural Environment; heights, water
  • Situational; planes, elevators
  • Blood-injury-injection; blood, needles
  • Other; vomiting, clowns

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Social Anxiety Disorder

Social Anxiety Disorder is characterised by marked and persistent intense fear in social situations.

More specifically, any social/performance situation in which humiliation or negative evaluation may occur. Exposure to these situations typically produces a panic attack.

Commonly Feared Situations

  • Public speaking
  • Parties, conferences, meetings
  • Talking on public transport
  • Using public toilets
  • Eating or drinking in public

"According to most studies, people's number one fear is public speaking. Number two is death. Death is number two. Does that sound right? This means to the average person, if you go to a funeral, you're better off in the casket than doing the eulogy"

- Seinfeld

Panic Disorder

Panic disorder is an anxiety disorder characterised by panic attacks.

Diagnostic Features:

  • Recurrent, unexpected panic attacks
  • (Persistent) Concern about having another panic attack
  • Fear or avoidance of potentially triggering situations, or those from which escape could be embarrassing/difficult

Causes

It's ultimately a fear of certain bodily sensations and their consequences (e.g. fear that elevated heart rate implies imminent heart attack), which gets activated in normal situations, causes anxiety and is a self-perpetuating loop.

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Obsessive-Compulsive Disorder

OCD is an anxiety disorder characterised by obsessions and compulsions.

Post-Traumatic Stress Disorder

PTSD develops after exposure to trauma; witnessing or experiencing actual/threatened injury/death which causes fear, helplessness or horror.

High PTSD-Causing Traumas

  • War
  • Torture
  • Rape
  • Assault

Symptoms

  • Re-experiencing symptoms (intrusive memories, nightmares)
  • Avoidance symptoms (unable to remember trauma, avoiding reminding situations, emotional numbing)
  • Hyperarousal (constant vigilance, insomnia)

Generalised Anxiety Disorder

GAD is characterised by excessive, irrational, disproportional and uncontrollable worry about every day activities.

Treatments

Pharmacological

  • SSRIs (e.g. Prozac) are the currently preferred drug, however frequent relapse occurs without continued use
  • Benzodiazepines are fast acting but addictive. They can become a safety behaviour.

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Psychological

Prevalence

  • Similar to MDD (comorbid - occur together frequently)
  • Lifetime prevalence ~20%
  • Point prevalence ~10%
  • Almost twice as common in females