Anxiety Stress or Related Disorders
Anxiety, Panic & Other Stressor Related Disorders
Anxiety disorders are among the most common psychiatric conditions and can often appear in ways that resemble physical health problems. While anxiety is a natural and expected human emotion, psychiatric providers must be able to differentiate normal, situational anxiety from pathological anxiety that reflects an underlying brain-based disorder. When
anxiety reaches a pathological level, it typically requires clinical treatment and therapeutic intervention, as it will not resolve on its own.
Normal emotion of anxiety:
- Anxiety is one of the most common human emotions.
- Anxiety lies on a spectrum that could extend from the absence of anxiety at one end to pathological levels that produce significant symptoms of psychiatric disorder at the other.
- Anxiety can be considered a healthy reaction to life stressors that acts as a motivator to deal with events and emotions.
4. Anxiety can be pathological if it is disproportionate to events, if it is sustained over a significant time frame, if it significantly impairs functioning, or if it is apparently unrelated to any identifiable event or situation in a person’s life.
5. High pathological levels of anxiety interfere with perceptions, memory, judgment, and motor responses.
ANXIETY DISORDERS
PANIC DISORDER
Panic disorder involves sudden, intense episodes of fear or terror that arise unexpectedly. These attacks often come with a strong sense of impending doom and can be overwhelming for the individual experiencing them.
- Attacks occur without warning and in the absence of any real danger.
- Attacks build to a peak of intensity within a short, self-limiting time, usually within 10 minutes of onset.
- It is more common in women than in men.
- After first attack, persistent concern over having another attack, worry over the consequences of initial attack, or a significant behavioral change related to attack
- With high somatic sensations, clients are often sensitive to new somatic experiences or perceptions.
- Frequently intolerant of or concerned with common side effects of medication treatments
- Discouraged or ashamed about “failure” to control emotions and over concern about dying when no other pathology identified
- In two-thirds of cases, major depression occurs first, followed by panic disorder symptoms.
- In one-third of cases, panic disorder symptoms lead to major depression symptoms
AGORAPHOBIA
Agoraphobia is characterized by the avoidance of places or situations where escape might be difficult or embarrassing, or where help may not be readily available if anxiety or a panic-like episode occurs. Up to half of individuals diagnosed with agoraphobia report that panic attacks or panic disorder developed before the onset of their agoraphobic symptoms.
- Anxiousness usually leads to avoidant behavior that impairs a person’s ability to travel, to work, or to carry out tasks of daily living.
- Differential diagnosis is assisted by the awareness that people with agoraphobia feel better and report less significant concerns with anxiety when accompanied by a trusted companion.
- When people meet criteria for agoraphobia and panic or other anxiety disorder, both diagnoses should be assigned
SOCIAL ANXIETY (PHOBIA) DISORDER
Social anxiety disorder involves a significant and persistent fear of social or performance situations where a person may feel embarrassed or judged. The anxiety experienced can be intense enough to trigger a situationally bound panic attack. The condition affects an estimated 3% to 13% of the U.S. population, with similar rates among men and women.
Monitor for the following:
- Some degree of social anxiety is common and normative in adolescence.
- Social phobia should be diagnosed only if symptoms persist for longer than 6 months.
- Onset is in the mid-teens, often following stressful or humiliating experience, and tends to remit with age.
- Differential diagnosis is assisted by awareness that people with social phobia do not feel better or experience decreased anxiety when accompanied by a trusted companion.
- Common descriptive features: Hypersensitivity to criticism. Negative self-evaluations. Sensitivity to rejection. Low self-esteem. Inferiority feelings. Lack of assertiveness.
GENERALIZED ANXIETY DISORDER (GAD)
- In GAD, unwarranted worry, apprehension, or anxiety about events or activities occurs more days than not for a period of at least 6 months.
- They find it hard to control the anxiety.
- There is no clear link exists to life events or stressors.
OBSESSIVE–COMPULSIVE AND RELATED DISORDERS:
- Obsessive–Compulsive Disorder
- Body Dysmorphic Disorder
- Hoarding Disorder
- Trichotillomania (Hair Pulling Disorder)
- Worry and anxiety often interfere with activities of daily living.
- The nature and focus of worry change frequently.
- There is a pattern of waxing and waning of symptoms.
- Excoriation (Skin-Picking Disorder)
- Substance- or Medication-Induced Obsessive–Compulsive and Related Disorder
OBSESSIVE–COMPULSIVE DISORDER (OCD)
- OCD is the manifestation of anxiety-provoking obsessions or compulsions that function to reduce the person’s subjective anxiety level.
- Obsession is defined as recurrent and persistent thoughts, impulses, or images that are experienced and cause anxiety and distress
- Experienced as intrusive and inappropriate
- Ego-dystonic experience that makes a person feel the content of obsession is foreign to his or her belief structure and not the kind of common thought, impulse, or image he or she usually experiences
- Compulsion is defined as repetitive behaviors or mental actions that a person feels driven to perform in response to an obsession.
DISSOCIATIVE DISORDERS:
Dissociative amnesia, depersonalization or derealization, and dissociative identity disorder (DID)
- Dissociation is a defense mechanism that protects a person from overwhelming anxiety by emotionally separating. Dissociation causes gaps or interruption in the person’s memory
- Depersonalization or derealization: A persistent feeling of oneself not being real, or the environment not being real; reality testing remains intact. Depersonalization and derealization are generally perceived as uncomfortable.
Etiology of depersonalization and derealization can be physical or psychological:
- Physical causes are seizures, migraine headaches, psychedelic drugs, and alcohol.
- Psychological causes are severe anxiety and traumatic stress.
Dissociative identity disorder (DID) is characterized by two or more distinct personality states which alters.
- It is a personality state that generally split off from one another, leading to gaps in recall of everyday events.
- Symptoms causes significant distress and impaired functioning.
- Comorbidity with PTSD.
- Etiology is a history of severe physical or sexual trauma, or both, in childhood.
BODY DYSMORPHIC DISORDER
- Preoccupation with one or more perceived defects or flaws in physical appearance
- Engages in repetitive behaviors such as checking mirror, reassurance-seeking, etc. in response to appearance concerns
- Preoccupation causes considerable distress
- Insight ranges from good, to poor, and to absent (fixed delusion)
HOARDING DISORDER
- Constant difficulty discarding possessions, regardless of actual value
- Experiences marked distress in response to pressure to discard items
- Results in accumulation of possessions that compromise living space or ability to function, including maintaining a safe environment for self or
- others
- Insight ranges from good, to poor, and to absent (fixed delusion)
TRICHOTILLOMANIA
- Recurrent pulling out of one’s hair despite repeated attempts to stop
- Causing significant distress or impairment in functioning
- Hair-pulling is not an attempt to improve a perceived defect or flaw
EXCORIATION DISORDER
- Recurrent skin picking that results in lesions despite attempts to stop
- Results in significant distress or impairment
- Behavior not better explained by physiologic response to substance (e.g., methamphetamine use) or intentional attempt at self-harm
TRAUMA AND STRESSOR RELATED DISORDERS
- Reactive Attachment Disorder
- Disinhibited Social Engagement Disorder
- Post-Traumatic Stress Disorder
- Acute Stress Disorder
- Dissociative Identity Disorder
- Dissociative Amnesia
- Depersonalization or Derealization Disorder
If you’re among the many individuals living with anxiety, we’re here to help. Contact our office today supporting our patients is our top priority. (240) 504-2871
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