Introduction to Anxiety DisordersAnxiety disorders involve extreme reactions to anxiety-inducing situations, including excessive worry, uneasiness, apprehension, or fear. Show
Learning Objectives Summarize the general characteristics, etiology, and treatment of anxiety disorders Key TakeawaysKey Points
Key Terms
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 diagnosed in between 4% and 10% of older adults; however, this figure is likely an underestimate of the true incidence due to the tendency of adults to minimize psychiatric problems and to focus on physical symptoms. 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 and stress: Anxiety disorders can arise in response to life stresses such as financial worries or chronic physical illness. 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). Generalized Anxiety DisorderGeneralized anxiety disorder is characterized by chronic anxiety that is excessive, uncontrollable, and often irrational. Learning Objectives Summarize the diagnostic criteria, etiology, and treatment of generalized anxiety disorder Key TakeawaysKey Points
Key Terms
Defining 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. Generalized anxiety disorder: One of the main characteristics of GAD is excessive, constant, often irrational worry that impedes the individual's normal daily functioning. DSM-5 Diagnostic CriteriaIn 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 (such as work or school performance). 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. Treatment 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. SSRIs as treatment for GAD: SSRIs (selective serotonin reuptake inhibitors) are a type of drug frequently used to treat disorders with symptoms of depression (e.g., major depressive disorder) and anxiety. 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. Panic Disorder and Panic AttacksA panic attack is a sudden period of intense anxiety; if these attacks occur often, they may indicate a panic disorder. Learning Objectives Summarize the diagnostic criteria, etiology, and treatment of panic disorder Key TakeawaysKey Points
Key Terms
Defining PanicA panic attack is 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). The physical symptoms of a panic attack: Some of the physical manifestations of a panic attack can include dizziness, shortness of breath, sweating, trembling, feelings of faintness, chest pain, or a fear of losing control. People with panic disorder experience recurrent (more than
one) and unexpected panic attacks, along with at least one month of persistent concern about additional panic attacks, worry over the consequences of the attacks, or self-defeating changes in behavior related to the attacks (such as withdrawing from social activities out of fear of having an attack) (APA, 2013). Since panic attacks can occur unexpectedly, they can become a cause of ongoing worry and avoidance. People with panic disorder may become so afraid of having panic attacks that they
experience what are known as anticipatory attacks—essentially panicking about potential panic attacks and entering a cycle of living in fear of fear. DSM-5 Diagnostic Criteria In the DSM-5, panic attacks themselves are not mental disorders; instead, they are listed as specifiers for other mental disorders, such as anxiety disorders. Panic attacks are differentiated as being either expected or unexpected; the categories from the previous DSM-IV-TR (situationally bound/cued, situationally predisposed, or unexpected/uncued) have been removed. 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). The exact genes and gene functions involved in this disorder, however, are not well understood (APA, 2013). Neurobiological theories of panic disorder suggest that a region of the brain called the locus coeruleus may play a role in this disorder. Located in the brainstem, the locus coeruleus is the brain’s major source of norepinephrine, a neurotransmitter that triggers the body’s fight-or-flight response. Activation of the locus coeruleus is associated with
anxiety and fear, and research with nonhuman primates has shown that stimulating the locus coeruleus either electrically or through drugs produces panic-like symptoms (Charney et al., 1990). Such findings have led to the theory that panic disorder may be caused by abnormal norepinephrine activity in the locus coeruleus (Bremner, Krystal, Southwick, & Charney, 1996). 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. Learning Objectives Summarize the diagnostic criteria, etiology, and treatment of social phobia Key TakeawaysKey Points
Key Terms
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 (APA, 2013). 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). Social anxiety disorder: Worry and fear of social situations in which one may be negatively judged is a defining feature of social anxiety disorder. (credit: Freddie Peña) DSM-5 Diagnostic CriteriaIn 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 another 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. Specific PhobiaSpecific phobias involve excessive, distressing, and persistent fear or anxiety about a specific object or situation. Learning Objectives Summarize the diagnostic criteria, etiology, treatment, and most common categories of specific phobias Key TakeawaysKey Points
Key Terms
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.
Spider phobia: Specific phobias can produce a wide variety of physical symptoms, such as nausea, increased heartbeat, dizziness, and sweaty palms. (Hope you don't have a phobia of spiders!) 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. Etiology At a low level, fear and anxiety are not bad things. In fact, the hormonal response to
anxiety has evolved as a benefit, since it helps humans react to dangers. Researchers in evolutionary medicine believe this adaptation allows humans to recognize a potential threat and act accordingly in order to ensure safety. Treatment There are various methods used to treat phobias. Systematic desensitization is a process in which patients seeking help slowly become accustomed to their phobia, and ultimately overcome it. Similar to this, 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. Licenses and AttributionsCC licensed content, Shared previously
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