Anxiety Disorders (Ch.

18, 19, 20)

 Anxiety provides the motivation for achievement, a necessary force for survival.
 Anxiety is often used interchangeably with the word stress, but they are not the same.
 Stress is an external pressure that is brought to bear on an individual.
 Anxiety is the subjective emotional response to a stressor.
 Anxiety may be differentiated from fear in that the former is an emotional process, whereas fear
is cognitive.
 Anxiety is a feeling of apprehension manifested by feelings of impending doom, dread, and
uneasiness that is evoked by some perceived threat to the individual.
 Mild to moderate helps focus on immediate details and may enhance ability to deal with
anxiety-producing behavior.
 High anxiety narrows perceptions, decreased the level of functioning, and may lead to
inappropriate behavior, illness, or somatic complaints.
 Historical perspectives
o Anxiety was once identified by its physiological symptoms, focusing largely on the
cardiovascular system.
o Freud was first to associate anxiety with neurotic behaviors.
o For many years, they were viewed as purely physical.
 How much anxiety is too much? When it interferes with important areas of functioning. A
disorder exists when there is an excessive reaction to the anxiety over a sustained period of time
and there is excessive use of defense mechanisms (these are unconscious).
 Anxiety disorders are most common type of psychiatric illnesses and are usually comorbid
conditions. More common in men than women. Family predispositions exist.

Panic Attacks

 Sudden onset
 Physical symptoms of anxiety
 Dread/doom/fear of death
 Panic Disorder
o History of panic attacks
o Intense apprehension, fear, terror
o Four symptoms of a panic attack must be present (page 454 for symptoms)
o Depression common
o Women more likely than men
 Comorbidity
o More somatic complaints than general populations
o Patients with panic disorders have more: vertigo, cardiac disease, GI disorders, asthma
than general population.
o Patients with MI, mitral valve prolapse, complex partial seizures, migraine headaches,
hypoglycemia and HTN have a greater incidence of panic disorder (internalized feelings)
Generalized Anxiety Disorder (GAD)

 Chronic, unrealistic, excessive anxiety and worry.

 Occurring more days than not.
 At least 6 months duration
 Presence of three of the following: restlessness, edginess, fatigue, tension, sleep disturbance.
 Anxiety and worry that interfere with normal social and occupational functioning.
 5% WILL experience this
 Onset gradual
 Comorbid psychiatric disorders, mild depressive symptoms
 Assessment: fatigue, diarrhea, absence of panic attacks, pain with muscle tension, never relaxed
looking, increased motor tension, inability to relax, hypervigilance, insomnia, upset stomach,
frequent urination.
 Does not have panic attacks.
 Etiology
o Psychodynamic theory – inability of ego to intervene when conflict present between id
and superego.
o Cognitive theory – cognitive views are faulty
o Biological aspects
 Genetics – twin studies
 Neuroanatomical – limbic/hippocampus/amygdala
 Biochemical – blood lactate
 Neurochemical (GABA) – mentions norepinephrine for panic disorder.

Phobias

 Agoraphobia without history of panic disorder

 Social phobia: persistent fear of one or more social or performance situations.
 Specific phobia
o Animal
o Natural environment
o Blood-injection-injury
o Situational
o Other
 Treatment
o Identify triggers
o Distraction techniques
o Positive self-talk: I will get through this!
o Cognitive behavioral therapy (CBT)
o Exposure therapy – gradual exposure
o Systematic desensitization – relaxation while imaging
o Implosion therapy – aka flooding – maximum exposure to fears.