Anxiety disorders

Anxiety disorders ICD-10 F40-F42 ICD-9 300 OMIM {{{OMIM}}} DiseasesDB {{{DiseasesDB}}} MedlinePlus {{{MedlinePlus}}} eMedicine {{{eMedicineSubj}}}/{{{eMedicineTopic}}} MeSH {{{MeshNumber}}}

Anxiety disorder is a blanket term covering several different forms of abnormal, pathological anxiety, fears, phobias and nervous conditions that may come on suddenly or gradually over a period of several years, and may impair or prevent the pursuing of normal daily routines.

Anxiety and fear are ubiquitous emotions. The terms anxiety and fear have specific scientific meanings, but common usage has made them interchangeable. For example, a phobia is a kind of anxiety that is also defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) as a "persistent or irrational fear." Fear is defined as an emotional and physiological response to a recognized external threat (eg, a runaway car or an impending crash in an airplane). Anxiety is an unpleasant emotional state, the sources of which are less readily identified. It is frequently accompanied by physiological symptoms that may lead to fatigue or even exhaustion. Because fear of recognized threats causes similar unpleasant mental and physical changes, patients use the terms fear and anxiety interchangeably. Thus, there is little need to strive to differentiate anxiety from fear. However, distinguishing among different anxiety disorders is important, since accurate diagnosis is more likely to result in effective treatment and a better prognosis.

Diagnosis

A good assessment is essential for the initial diagnosis of an anxiety disorder, preferably using a standardized interview or questionnaire procedure alongside expert evaluation and the views of the person themselves. There should be a medical examination in order to identify possible medical conditions that can cause the symptoms of anxiety. A family history of anxiety disorders is suggestive of the possibility of an anxiety disorder.

Types

Generalized anxiety disorder

Main article: General anxiety disorder

Generalized anxiety disorder is a common chronic disorder that affects twice as many women as men and can lead to considerable impairment (Brawman-Mintzer & Lydiard, 1996, 1997). As the name implies, generalized anxiety disorder is characterized by long-lasting anxiety that is not focused on any particular object or situation. In other words it is unspecific or free-floating. People with this disorder feel afraid of something but are unable to articulate the specific fear. They fret constantly and have a hard time controlling their worries. Because of persistent muscle tension and autonomic fear reactions, they may develop headaches, heart palpitations, dizziness, and insomnia. These physical complaints, combined with the intense, long-term anxiety, make it difficult to cope with normal daily activities.

Panic disorder

Main article: Panic disorder

In panic disorder, a person suffers brief attacks of intense terror and apprehension that cause trembling and shaking, dizziness, and difficulty breathing. One who is often plagued by sudden bouts of intense anxiety might be said to be afflicted by this disorder. The American Psychiatric Association (2000) defines a panic attack as fear or discomfort that arises abruptly and peaks in 10 minutes or less.

Although panic attacks sometimes seem to occur out of nowhere, they generally happen after frightening experiences, prolonged stress, or even exercise. Many people who have panic attacks (especially their first one) think they are having a heart attack and often end up at the doctor or ER. Even if the tests all come back normal the person will still worry, with the physical manifestations of anxiety only reinforcing their fear that something is wrong with their body. Extreme awareness of every little thing that happens or changes with their body can make for a stressful time.

Normal changes in heartbeat, such as when climbing a flight of stairs will be noticed by a panic sufferer and lead them to think something is wrong with their heart or they are about to have another panic attack. Some begin to worry excessively and even quit jobs or refuse to leave home to avoid future attacks. Panic disorder can be diagnosed when several apparently spontaneous attacks lead to a persistent concern about future attacks.

Agoraphobia

Main article: Agoraphobia

A common complication of panic disorder is agoraphobia -- anxiety about being in a place or situation where escape is difficult or embarrassing (Craske, 2000; Gorman, 2000).

Phobias

Main article: Phobia

This category involves a strong, irrational fear and avoidance of an object or situation. The person knows the fear is irrational, yet the anxiety remains. Phobic disorders differ from generalized anxiety disorders and panic disorders because there is a specific stimulus or situation that elicits a strong fear response. A person suffering from a phobia of spiders might feel so frightened by a spider that he or she would try to jump out of a speeding car to get away from one.

People with phobias have especially powerful imaginations, so they vividly anticipate terrifying consequences from encountering such feared objects as knives, bridges, blood, enclosed places, certain animals or situations. These individuals generally recognize that their fears are excessive and unreasonable but are generally unable to control their anxiety.

Social anxiety disorder

Main article: Social Anxiety Disorder

Social anxiety disorder is also known as social phobia. Individuals with this disorder experience intense fear of being negatively evaluated by others or of being publicly embarrassed because of impulsive acts. Almost everyone experiences "stage fright" when speaking or performing in front of a group. But people with social phobias become so anxious that performance is out of the question. In fact, their fear of public scrutiny and potential humiliaton becomes so pervasive that normal life can become impossible (den Boer 2000; Margolis & Swartz, 2001). Another social phobia is love-shyness, which most adversely affects certain men. Those afflicted find themselves unable to initiate intimate adult relationships (Gilmartin 1987).

Obsessive-compulsive disorder

Main article: Obsessive-compulsive disorder

Obsessive compulsive disorder is a type of anxiety disorder primarily characterized by obsessions and/or compulsions. Obsessions are distressing, repetitive, intrusive thoughts or images that the individual often realizes are senseless. Compulsions are repetitive behaviors that the person feels forced or compelled into doing, in order to relieve anxiety. The OCD thought pattern may be likened to superstitions: if X is done, Y won't happen--in spite of how unlikely it may be that doing X will actually prevent Y, if Y is even a real threat to begin with. A common example of this behavior would be obsessing that one's door is unlocked, which may lead to compulsive constant checking and rechecking of doors. Often the process seems much less logical. For example, the compulsion of walking in a certain pattern may be employed to alleviate the obsession that something bad is about to happen.

Post-traumatic stress disorder

Main article: Post-traumatic stress disorder

Post-traumatic stress disorder is an anxiety disorder which results from a traumatic experience, such as being involved in battle. The sufferer may experience flashbacks and other symptoms.

Treatment

Anxiety disorders are often debilitating chronic conditions, which can be present from an early age or begin suddenly after a triggering event. They are prone to flare up at times of high stress.

Many of these disorders can also be treated (with or without adjuctive pharmaceutical therapy) with the aid of a good counselor and behavioral therapies such as cognitive therapy.

Mainstream treatment for anxiety consists of the prescription of anxiolytic agents and/or referral to a cognitive-behavioral therapist. There are indications that a combination of the two can be more effective than either one alone.

A number of drugs are used to treat these disorders. These include benzodiazepines and antidepressants of most of the main classes (SSRI, TCAs, MAOIs), and possibly Quetiapine.

• Anxiety management
• CBT for anxiety disorders
• Relaxation therapy

Epidemiology

Main article: Epidemiology of anxiety disorders

The cost of anxiety disorders

The cost of anxiety disorders around the world is substantial

Main article: Economic costs of anxiety disorders

See also

• Anxiety Disorders Due to General Medical Condition
• Castration anxiety
• Death anxiety
• Seperation anxiety
• Fear of success
• Guilt
• Hypochondriasis
• Mathematics anxiety
• Performance anxiety
• Social anxiety
• Speech anxiety
• Test anxiety

References

The Numbers Count: Mental Disorders In America, 2006 (rev), National Institute of Mental Health, NIH Publication No. 06-4584 [1]

• Wells, A (1995). Cognitive Therapy of Anxiety Disorders. A practical manual & conceptual guide. Chichester : Wiley

External links

• Anxiety Disorder at NIMH
• About Panic/Anxiety Disorders
• Anxiety Disorders (for professionals) Anxiety Disorders, Dissociative Disorders, and Adjustment Disorders for professionals
• Anxiety Disorders Association of America Improving lives and providing hope through education, research, and treatment