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1. Define various anxiety disorders
2. Evaluate and diagnose various anxiety disorders
3. Identify common causes of various anxiety disorders
4. Distinguish between different anxiety disorders
5. Utilize effective treatment approaches and techniques
Table of Contents:
1. Definitions
2. Diagnosis
3. Causes
4. Types
5. Treatment
6. Resources
7. References
1. Definitions
“Anxiety disorder” is a general term including several different forms of
abnormal, pathological anxieties, fears, and phobias. For clinical purposes,
"fear", "anxiety" and "phobia" have distinct meanings. Anxiety is distinctive
from fear because fear occurs in the presence of an external threat. Anxiety
is a psychological and physiological state characterized by cognitive,
somatic, emotional, and behavioral components. These components combine
to create an unpleasant feeling that is typically associated with uneasiness,
fear, or worry. Additionally, fear is related to the specific behaviors of
escape and avoidance, whereas anxiety is the result of threats that are
perceived to be uncontrollable or unavoidable. Anxiety is a normal reaction
to stress. It may help a person to deal with a difficult situation, for example
at work or at school, by prompting one to cope with it (American Psychiatric
Association. 2000. Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, Text Revision. Washington DC: American Psychiatric
Association).
2. Diagnosis
Clinically, a phobia is defined in the Diagnostic and Statistical Manual of
Mental Disorders, 4th edition (DSM-IV-TR) as a "persistent or irrational
fear." Clinically, fear is defined as an emotional and physiological response
to a recognized external threat. Anxiety is an unpleasant emotional state, the
sources of which are less readily identified. Distinguishing among different
anxiety disorders is important, since accurate diagnosis is more likely to
result in effective treatment and a better prognosis. Some surveys have
indicate that as many as 18% of Americans may be affected by anxiety
disorders. Anxiety disorders are frequently accompanied by physiological
symptoms that may lead to fatigue or even exhaustion. Anxiety can be
accompanied by headache, sweating, muscle spasms, palpitations, and
hypertension. Clinical depression is frequently comorbid with anxiety
disorders. 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 (American Psychiatric
Association. 2000. Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, Text Revision. Washington DC: American Psychiatric
Association).
Thorough assessment is essential for the initial diagnosis of an anxiety
disorder, preferably using a standardized interview or questionnaire and a
mental status exam. A medical examination is recommended in order to
identify possible medical conditions that may produce anxiety symptoms. A
family history of anxiety disorders increases the likelihood of an anxiety
disorder. Clients with an anxiety disorder may exhibit symptoms of clinical
depression and vice-versa (American Psychiatric Association. 2000.
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
Revision. Washington DC: American Psychiatric Association).
3. Causes
Clinical and animal studies suggest a correlation between anxiety disorders
and difficulty in maintaining balance. A possible mechanism is malfunction
in the parabrachial nucleus, a structure in the brain that among other
functions, coordinates signals from the amygdala with input concerning
balance. The amygdala is involved in the emotion of fear. The basolateral
amygdala has been implicated in anxiety generation. A relationship between
anxiety and dendritic arborization of the amygdaloid neurons is well known.
SK2 potassium channels mediate inhibitory influence on action potentials
and reduces arborization. By over expressing SK2 in basolateral amygdala
anxiety was reduced and stress-induced corticosterone secretion at a
systemic level lowered, in a test model. Mutations in related SK3 are
suspected to be a possible underlying cause for several neurological
disorders, including anxiety. A low level of GABA, a neurotransmitter that
reduces over activity in the central nervous system, contributes to anxiety. A
number of anxiolytics achieve their effect by modulating the GABA
receptors (The role of GABA in anxiety disorders. J Clin Psychiatry. 2003.
PMID : 12662130).
Selective serotonin reuptake inhibitors, the drugs most commonly used to
treat depression, are also frequently considered as a first line treatment for
anxiety disorders. A recent study using functional brain imaging techniques
suggests that the effects of SSRIs in alleviating anxiety may result from a
direct action on GABA neurons rather than as a secondary consequence of
mood improvement (The role of GABA in anxiety disorders. J Clin
Psychiatry. 2003. PMID : 12662130).
It is estimated that approximately half of all patients receiving mental health
services for anxiety disorders such as panic disorder or social phobia are the
result of alcohol or benzodiazepine dependence. Sometimes anxiety preexisted
alcohol or benzodiazepine dependence but the alcohol or
benzodiazepine dependence act to keep the anxiety disorders going and
often progressively making them worse. Many people who are addicted to
alcohol or prescribed benzodiazepines when it is explained to them they
have a choice between ongoing ill mental health or quitting and recovering
from their symptoms decide on quitting alcohol and/or their
benzodiazepines. It was noted that every individual has an individual
sensitivity level to alcohol or sedative hypnotic drugs and what one person
can tolerate without ill health another will suffer very ill health and that even
moderate drinking can cause rebound anxiety syndromes and sleep
disorders. A person who is suffering the toxic effects of alcohol or
benzodiazepines will not benefit from other therapies or medications as they
do not address the root cause of the symptoms which is a "poisoned brain".
Recovery from benzodiazepines tends to take a lot longer than recovery
from alcohol but people can regain their previous good health. Symptoms
may temporarily worsen however, during alcohol withdrawal or
benzodiazepine withdrawal. There is some evidence that prolonged
exposure to organic solvents in the work environment may be associated
with anxiety disorders. Painting, varnishing and carpet laying are some of
the jobs in which significant exposure to organic solvents may occur.
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