Anxiety Disorder

Definition:

PSYCHOLOGICAL DISORDERS

deviant, distressful, and dysfunctional patterns of thoughts, feelings, or behaviors.

 Content

• DEFINING ANXIETY 
• GENERALIZED ANXIETY DISORDER 
• PANIC DISORDER & PANIC ATTACK 
• SOCIAL ANXIETY DISORDER (social phobia) 
• SPECIFIC PHOBIA

Introduction of anxiety disorder 

Anxiety disorders involve extreme reactions to anxiety-inducing situations, including excessive worry, uneasiness, apprehension, or fear.

• Defining anxiety

Anxiety is a normal human emotion that everyone experiences from time to time. People may feel anxious when facing problems, challenges, changes, or difficult decisions. Anxiety disorders, however, are dysfunctional responses to anxiety-inducing situations. The difference between normal anxiety and an anxiety disorder is that anxiety disorders cause such severe distress as to interfere with someone's ability to lead a normal life. "Anxiety disorder" refers to any of a number of specific disorders, including generalized anxiety disorder, phobia, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and social anxiety disorder.

Anxiety disorders are defined by excessive worry, apprehension, and fear about future events or situations, either real or imagined. Specifically, symptoms may include:

✓ Feelings of panic, fear, or uneasiness

✓ Ucontrollable and obsessive thoughts

✓ Flashbacks to traumatic events

✓ Problems sleeping

✓ Nightmares

✓ Shortness of breath

✓ Nausea

✓ Muscle tension

✓ Dizziness

✓ Heart palpitations

✓ Dry mouth

✓ Cold or sweaty hands ,Occasional sweat on the body

ETIOLOGY

Anxiety in and of itself is not a bad thing. In fact, the hormonal response involved in anxiety evolved to help humans react to danger .

it better prepares them to recognize threats and to act accordingly to ensure their safety. Such sensory information is processed by the amygdala,which communicates information about potential threats to the rest of the brain. However, anxiety becomes counterproductive and thus is deemed “disordered” when it is experienced with such intensity that it impedes social functioning

Anxiety disorders develop as the result of the interaction of genetic (inherited) and environmental factors. Neurologically speaking, increased amygdala reactivity is correlated with increased fear and anxiety responses.

Low GABA activity leads to anxiety, depression, insomnia, and mood disorders.(a neurotransmitter in the brain that reduces central nervous system activity) can contribute to anxiety, and serotonin, glutamate, and the 5-HT_2A receptor have also all been implicated in the development of anxiety disorders.

In addition to biological factors, anxiety disorders can also be caused by various life stresses, such as financial worries or chronic physical illness. 

Severe anxiety and depression can also be induced by sustained alcohol abuse; with prolonged sobriety these symptoms usually decrease. Even moderate sustained alcohol use may increase anxiety and depression levels in some individuals. Caffeine, alcohol, and benzodiazepine dependence can worsen or cause anxiety and panic attacks.

Treatment

Treatment options for anxiety disorders include lifestyle changes, therapy, and medication. The most common intervention is cognitive behavioral therapy (CBT), which aims to help the person identify and challenge their negative thoughts (cognitions) and change their reactions to anxiety-provoking situations (behaviors).

In terms of medication, SSRIs are most commonly recommended. Benzodiazepines are also sometimes indicated for short-term or “as-needed" use. MAOIS such as phenelzine and tranylcypromine are also considered effective and are especially useful in treatment-resistant cases, but dietary restrictions and medical interactions may limit their use.

• Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by chronic anxiety that is excessive, uncontrollable, often irrational, and disproportionate to the actual object of concern. People with GAD often characterize it as a feeling of "free-floating anxiety"— a term that Sigmund Freud used in his early work. Typically, the anxiety has no definite trigger or starting point, and as soon as the individual resolves one issue or source of worry another worry arises. People with GAD also tend to catastrophize, meaning they may assume the absolute worst in anxiety- inducing situations. Racing thoughts, inability to concentrate, and inability to focus are also characteristic of GAD. GAD is a particularly difficult disorder to live with; because the individual's anxiety is not tied to a specific situation or event, they experience little relief. This disorder can contribute to problems with sleep, work, and daily responsibilities and often impacts close relationships.

DSM-5 Diagnostic Criteria

But what Is DSM-5 ?

The DSM-5 and DSM-5-TR are medical reference books intended for experts and professionals. The content in these books is very technical, though people who aren’t medical professionals may still find it interesting or educational. Like me 

The Diagnostic and Statistical Manual of Mental Disorders, often known as the “DSM,” is a reference book on mental health and brain-related conditions and disorders. 

In order for GAD to be diagnosed, a person must experience excessive anxiety and worry more days than not-for at least 6 months and about a number of events or activities performance (such as work or school ). This excessive worry must interfere with some aspect of life, such as social, occupational, or daily functioning, and the person must have trouble controlling the anxiety.

The disturbance must not be attributed to the physiological effects of a substance (e.g., a drug or medication) or another medical condition, and must not be better explained by another medical disorder. At least 3 of the following symptoms must be experienced: restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating or mind going blank; irritability; muscle tension; and/or sleep disturbance

Etiology

In any given year, approximately 2.3% of American adults and 2% of European adults experience GAD. Although there have been few investigations into the disorder's heritability, a summary of available family and twin studies suggests that genetic factors play a moderate role in its development (Hettema et al., 2001). Specifically, about 30% of the variance for generalized anxiety disorder can been attributed to genes. Individuals with a genetic predisposition for GAD are more likely to develop the disorder, especially in response to a life stressor. Cognitive theories of GAD suggest that worry represents a mental strategy to avoid more powerful negative emotions

(Aikins &Craske, 2001),

perhaps stemming from earlier unpleasant or traumatic experiences. Indeed, one longitudinal study found that childhood maltreatment was strongly related to the development of this disorder during adulthood

(Moffitt et al., 2007) According to these theories, generalized anxiety may serve as a distraction from remembering painful childhood experiences. Long-term use of benzodiazepines can worsen underlying anxiety, with evidence that reduction in benzodiazepine use can in turn lead to a lessening of anxiety symptoms. Similarly, long-term alcohol use is associated with the development of anxiety disorders, with evidence that prolonged abstinence can in turn result in the remission of anxiety symptoms.

GAD is generally chronic, but it can be managed, or even eliminated, with the proper treatment. While there are many options for treating GAD, full recovery is only seen about 50% of the time, which indicates the need for further research into more effective treatment options.

Pharmaceutical treatments for GAD include selective serotonin reuptake inhibitors (SSRIs), which are more commonly used as antidepressants. SSRIs block the reabsorption of serotonin in the brain so that it can keep activating serotonin receptors, improving the individual's mood.

Two popular therapeutic programs used for treating GAD are applied relaxation, which focuses on muscle-relaxation techniques, and cognitive behavioral therapy (CBT), which focuses on ways to recognize and reduce worried thoughts. In a study comparing the two, it was found that CBT produced better post-treatment results. Other forms of therapy found to be effective in treating GAD include metacognitive therapy (MCT), which treats the "worrying about worrying" (or "meta-worrying") often found in GAD, and intolerance-of-uncertainty (IUT), which focuses on resolving people's difficulty dealing with uncertain situations. A particular challenge in treating GAD is its high comorbidity with other disorders, such as depression and substance abuse; it can be difficult in therapy to make progress with multiple issues simultaneously.

Introduction Panic Disorder and Panic Attacks

A panic attack is a sudden period of intense anxiety; if these attacks occur often, they may indicate a panic disorder

• Defining Panic

A panic attackis defined as a period of extreme fear or discomfort that develops abruptly and reaches a peak within 10 minutes. Its symptoms include accelerated heart rate, sweating, trembling, choking sensations, hot flashes or chills, dizziness or lightheadedness, fears of losing control or going crazy, and fears of dying

(APA, 2013). Sometimes panic attacks are expected, occurring in response to specific environmental triggers (such as being in a tunnel); other times, these episodes are unexpected and emerge randomly (such as when relaxing).

Panic disorder is very treatable; however, left untreated, it can significantly reduce quality of life. People with untreated panic disorder are at an increased risk for specific phobias, such as agoraphobia (a fear of leaving the house), and they often suffer from one or more additional mental-health conditions, such as depression or substance abuse.

DSM-5 Diagnostic Criteria

In the DSM-5, panic attacks themselves are not mental disorders; instead, they are listed as specifier for other mental disorders, such as anxiety disorders. Panic attacks are differentiated as being either expected or unexpected.

In order to be diagnosed with panic disorder, a person must experience unexpected, recurrent panic attacks. These panic attacks must also be accompanied by at least one month of a significant and related behavior change in relation to the attacks, a persistent concern or fear of more attacks, or a worry about the attacks' consequences. As is the case with other anxiety disorders, the panic attacks cannot result from the physiological effects of drugs and other substances, a medical condition, or another mental disorder. While the previous version of the DSM defined panic disorder as occurring either with or without agoraphobia, the new DSM-5 lists panic disorder and agoraphobia as two distinct disorders.

Etiology

Both genetic and environmental causes (often in combination) can cause panic disorder. Children are at a higher risk of developing panic disorder if their parents have the disorder (Biederman et al., 2001) and family and twins studies indicate that the heritability of panic disorder is around 43%  (Hettema, Neale, & Kendler, 2001) Although the genetic link is clear, 75% of those diagnosed with panic disorder do not have a close relative with the disorder-indicating the significance of environmental factors. 

Major life changes (such as moving out of the family home, getting married, starting a new job, or having a baby) often precede the onset of panic disorder by contributing to stress. Conditioning theories of panic disorder propose that panic attacks are classical- conditioning responses to subtle bodily sensations resembling those normally occurring when one is anxious or frightened (Bouton, Mineka, & Barlow, 2001)

Treatment

Although there is no known cure, panic disorder can be successfully treated in many cases using psychotherapy, medication, or a combination of both. Cognitive behavioral therapy (CBT) is the psychotherapeutic treatment of choice for panic disorder; several studies show that 85 to 90 percent of panic-disorder patients treated with CBT recover completely from their panic attacks within 12 weeks. The goal of cognitive behavioral therapy is to help a patient reorganize thinking processes and anxious thoughts regarding an experience that provokes panic. Psychotherapy can improve the effectiveness of medication, reduce the likelihood of relapse for someone who has discontinued medication, and offer help for people with panic disorder who do not respond at all to medication. Selective serotonin reuptake inhibitors (SSRIs) are first-line medication treatments for panic disorder; they are preferred over benzodiazapines due to concerns about the latter regarding tolerance, dependence, and abuse.

Social anxiety disorder (social phobia)

Social anxiety disorder is marked by intense fear and avoidance of social situations in which one might be negatively judged.

• Defining Social Anxiety

Social anxiety disorder (formerly called social phobia) is characterized by extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others. As with specific phobias, social anxiety disorder is common in the United States; a little over 12% of all Americans experience social anxiety disorder during their lifetime

(Kessler et al., 2005)

The heart of the anxiety in social anxiety disorder is the person's concern that they may act in a humiliating or embarrassing way, such as appearing foolish, showing symptoms of anxiety (such as blushing), or doing or saying something that might lead to rejection (such as offending others). The kinds of social situations that may cause distress include public speaking, having a conversation, meeting strangers, eating in restaurants, or using public restrooms. Although many people become anxious in social situations like public speaking, the fear, anxiety, and avoidance experienced in social anxiety disorder are highly distressing and lead to serious impairments in life.

Physical symptoms often accompanying social anxiety disorder include excessive blushing, excessive sweating, trembling, palpitations, and nausea. Stammering may be present, along with rapid speech. Panic attacks can also occur under intense fear and discomfort. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events.

Adults with this disorder are more likely to experience lower educational attainment and lower earnings

(Katzelnick et al., 2001) more likely to perform poorly at work and to be unemployed (Moitra, Beard, Weisberg, & Keller, 2011) and report greater dissatisfaction with their family lives, friends, leisure activities, and income (Stein & Kean, 2000)

When people with social anxiety disorder are unable to avoid situations that provoke anxiety, they typically perform safety behaviors. mental or behavioral acts that reduce anxiety in social situations by reducing the chance of negative social outcomes. Safety behaviors can include avoiding eye contact, rehearsing sentences before speaking, talking only briefly, and not talking about oneself .Although these behaviors are intended to prevent the person with social anxiety disorder from doing something awkward that might draw criticism, these actions often exacerbate the problem because they do not allow the individual to disconfirm their negative beliefs, often eliciting rejection and other negative reactions from others (Alden & Bieling, 1998)

DSM-5 Diagnostic Criteria

In order to be diagnosed with social anxiety disorder, a person must experience an intense fear in one or more social situations, marked specifically by the fear of embarrassment or humiliation. This anxiety or efforts to avoid the anxiety-inducing situation-must cause considerable distress and an impaired ability to function in at least some parts of social, occupational, academic, or daily life. Symptoms must last at least six months in order for a diagnosis to occur, and the symptoms must not be better accounted for by the effects of substance use, a medical condition, or anothe mental illness

Etiology

Research into the causes of social anxiety and social phobia is wide-ranging, encompassing multiple perspectives from neuroscience to sociology. Scientists have yet to pinpoint the exact causes. Studies suggest that genetics can play a part in combination with environmental factors. It has been shown that there is a two- to threefold greater risk of having social phobia if a first-degree relative also has the disorder; this could be due to genetics and/or due to children acquiring social fears and avoidance through observational learning

Treatment

The first-line treatment for social anxiety disorder is cognitive behavioral therapy (CBT), which has been shown to be effective in treating social phobias through both individual and group therapy. The cognitive and behavioral components seek to change thought patterns and physical reactions to anxiety-inducing situations. The attention given to social anxiety disorder has significantly increased since 1999, with the approval and marketing of several drugs for its treatment. Prescribed medications include several classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs). and monoamine oxidase inhibitors (MAOIs). Other commonly used medications include beta blockers and benzodiazepines.

Specific Phobia

Specific phobias involve excessive, distressing, and persistent fear or anxiety about a specific object or situation.

• Defining Phobias

A person diagnosed with a specific phobia (formerly known as a "simple phobia") experiences excessive, distressing, and persistent fear or anxiety about a specific object or situation (such as animals, enclosed spaces, elevators, or flying) (APA, 2013) Even though people realize their level of fear and anxiety in relation to the phobic stimulus is irrational, some people with a specific phobia may go to great lengths to avoid the phobic stimulus (the object or situation that triggers the fear and anxiety). Typically, the fear and anxiety a phobic stimulus elicits is disruptive to the person's life. For example, a man with a phobia of flying might refuse to accept a job that requires frequent air travel, thus negatively affecting his career. Between 5% and 12% of the population worldwide suffer from phobic disorders, making it the single largest category of anxiety disorders

When confronted with the object of their phobia, a person will generally enter a state of panic and experience a wide variety of physical symptoms, such as nausea, increased heartbeat, dizziness, and sweaty palms. For this reason, many people with phobias simply avoid the object of their phobia. Such avoidance can range from not wanting to be outside in a lightning storm to being unable to even look at a picture of lightning

DSM-5 Diagnostic Criteria

In order to be diagnosed with a specific phobia, a person must experience a marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). These symptoms must last for at least six months. Exposure to the object of the phobia nearly always elicits extremely distressing symptoms of anxiety, either immediately (“situationally bound") or after some time delay ("situationally predisposed"). The person either avoids the phobic situation(s) or else endures it with extreme distress. The avoidance and/or distress associated with the phobia must interfere significantly with the person's academic or social functioning. Like all anxiety disorders, the symptoms must not be better accounted for by another mental disorder or by substance use.

Etiology

Though the specific cause of phobias is unknown, they could be inherited; research has shown that if a person has a family member with a phobia, they are more likely to have one themselves. Phobias can also develop because of certain circumstances or occurrences, such as having been bitten by a snake, having seen someone else be bitten by a snake, having witnessed someone else being afraid of snakes, or having learned about someone being bitten by snake

Treatment

There are various methods used to treat phobias. 

Systematic desensitizationis a process in which patients seeking help slowly become accustomed to their phobia, and ultimately overcome it.

virtual reality therapy helps patients imagine encounters with the phobic object by simulating scenes that may not be possible or easy to find in the physical world. 

Cognitive behavioral therapy (CBT) allows the patient to challenge dysfunctional thoughts or beliefs by being mindful of their own feelings, with the aim that the patient will realize that their fear is irrational. Mainly used to treat post- traumatic stress disorder,

Eye-movement desensitization and reprocessing (EMDR) has been demonstrated as effective in easing phobia symptoms following a specific trauma, such as a fear of dogs following a dog bite.

Hypnotherapy can be used alone and in conjunction with systematic desensitization to treat phobias. Finally, antidepressant medications such as SSRIs or MAOIS may be helpful in some cases of phobia. Book