Anxiety Disorder

Presented by
Doon Psychotherapeutic Centre
 Classification of anxiety

• In ICD 10 F40-F48, neurotic , stress- related and

somatoform disorder have been classified into the
following types:
1. F40 Phobic anxiety disorder,
2. F41 Anxiety disorder
3. F42 Obsessive compulsive disorder
 What is Anxiety ?

• Anxiety is a medical condition that affects a person’s

mood, thoughts, behavior & body .

• Anxiety is often differentiated from fear is an

apprehension in response to an external danger while
in anxiety the danger is largely unknown (or
internal).
 Contributors/causes of anxiety

• Stress
• Life experience
• Brain chemistry
• Personality
• Physical illness
• Heredity
• Medications
• Substance abuse
 Symptoms of Anxiety

1. Physical symptoms
a- Motoric symptoms: tremors, restlessness, muscle
twitches, fearful facial expression
b- Autonomic and visceral symptoms: palpitations,
tachcardia, sweating, flushes, dysnoea, hyperventilation,
pain in chest, dry mouth, Dizziness, diarrhoea, mydriasis
2. Psychological symptoms
a- cognitive symptoms: poor concentration,
distractibility, hyperarousal, vigilance or scanning,
negative thoughts
b- Perceptual symptoms : derealisation,
depersonalisation
 Cont.

c )Affective symptoms: diffuse, unpleasant,

and vague sense of apprehension, fearfulness,
inability to relax, irritability ,feeling of
impending doom
d-) other symptoms: insomnia, increased
sensitivity to noise , exaggerated startle
response.
The term Anxiety Disorder refers to

• Generalized anxiety disorder (GAD)

• Obsessive – compulsive disorder (OCD)
• Panic disorder
• Posttraumatic Stress disorder (PTSD)
• Social anxiety disorder
• Phobia
(In today’s session we will cover GAD and Panic
disorder other will be covered in coming
sessions)
F41.0 Generalized Anxiety Disorder

• General anxiety disorder (GAD) is a broad term

covering several different forms of abnormal,
pathological anxiety, fears, phobias and nervous
conditions, which may have sudden onset or
may occur gradually over a period of several
years.
• GAD is an anxiety disorder marked by chronic,
exaggerated worrying and anxiety about
everyday life. The worry is so severe that it
interferes with their ability to live their lives.
 Cont.
• Excessive uncontrollable worry about everyday
things. This constant worry affects daily
functioning and can cause physical symptoms.
• GAD can occur with other anxiety disorders,
depressive disorders, or substance abuse.
 DSM V Diagnostic Criteria for
Generalized Anxiety Disorder
A. Excessive anxiety and worry (apprehensive
expectation), occurring more days than not for at
least 6 months, about a number of events or
activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or
more) of the following six symptoms (with at least
some symptoms having been present for more days
than not for the past 6 months);
Note: Only one item is required in children.
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or
staying asleep, or restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms
cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
E. The disturbance is not attributable to the
physiological effects of a substance (e.g., a
drug of abuse, a medication) or another
medical condition (e.g., hyperthyroidism).
 The disturbance is not better explained by
another mental disorder ., anxiety or worry
about having panic attacks in panic disorder,
negative evaluation in social anxiety disorder
[social phobia], contamination or other
obsessions in obsessive-compulsive disorder,
separation from attachment figures in separation
anxiety disorder, reminders of traumatic events
in posttraumatic stress disorder, gaining weight
in anorexia nervosa, physical complaints in
somatic symptom disorder, perceived appearance
flaws in body dysmorphic disorder, having a
serious illness in illness anxiety disorder, or the
content of delusional beliefs in schizophrenia or
delusional disorder
ICD 10 Criteria F41.1 Generalized
anxiety disorder
• The essential feature is anxiety, which is generalized and
persistent but not restricted to, or even strongly predominating
in, any particular environmental circumstances (i.e. it is "free-
floating"). As in other anxiety disorders the dominant
symptoms are highly variable, but complaints of continuous
feelings of nervousness, trembling, muscular tension,
sweating, lightheadedness, palpitations, dizziness, and
epigastria discomfort are common. Fears that the sufferer or a
relative will shortly become ill or have an accident are often
expressed, together with a variety of other worries and
forebodings. This disorder is more common in women, and
often related to chronic environmental stress. Its course is
variable but tends to be fluctuating and chronic.
 Diagnostic guidelines
• The sufferer must have primary symptoms of
anxiety most days for at least several weeks at a
time, and usually for several months. These
symptoms should usually involve elements of:
• (a)Apprehension (worries about future misfortunes,
feeling "on edge", difficulty in concentrating, etc.);
• (b)Motor tension (restless fidgeting, tension
headaches, trembling, inability to relax); and
• (c)Autonomic over activity (lightheadedness,
sweating, tachycardia or tachypnoea, epigastric
discomfort, dizziness, dry mouth, etc.).
 Associated Features Supporting
Diagnosis
Associated with
o muscle tension,
o There may be trembling,
o feeling shaky, and
o muscle aches or soreness
Also experience somatic symptoms (e.g.,
sweating, nausea, diarrhea) and an exaggerated
startle response
 F41.0 Panic Disorder
The abrupt onset of an episode of intense fear or
discomfort, which peaks in approximately 10
minutes, and includes at least four of the following
symptoms:
• A feeling of imminent danger or doom
• The need to escape
• Palpitations
• Sweating
• Trembling
• Shortness of breath or a smothering
• A feeling of choking
• Chest pain or discomfort
• Nausea or abdominal discomfort
• Dizziness or lightheadedness
• A sense of things being unreal,
• Depersonalization
• A fear of losing control or "going crazy"
• A fear of dying
• Tingling sensations
• Chills or hot flushes
 Types of panic disorder
• There are three types of Panic Attacks:
1. Unexpected - the attack "comes out of the blue"
without warning and for no discernable reason.
2. Situational - situations in which an individual
always has an attack, for example, upon entering a
tunnel.
3. Situationally Predisposed - situations in which an
individual is likely to have a Panic Attack, but does
not always have one. An example of this would be an
individual who sometimes has attacks while driving.
 Panic Disorder with or without
agoraphobia – DSM-IV criteria
• The person has experienced both :
• Recurrent, unexpected panic attacks
• One or more of the attacks has been followed by
either
1) Persistent concern about having another attack
2) Worry about the implications of the attack
3) Significant change in behaviour
• The presence (or absence of agoraphobia)
• Not due to a substance, medication or medical
condition
• Not better accounted for by another mental
disorder
Treatment
 Treatment

Cognitive-Behavioral Therapy
• Self-monitoring, relaxation training
• Focus on controlling worry.
Medication
Use medicine under registered medical perception
Self-Management
Changes in diet and nutrition.
Regular exercise.
Use relaxation strategies.
Learning new problem solving strategies.
Join support groups
 Self-help Strategies For GAD

: Learning about anxiety and GAD

: Identifying and recognizing worry
: Classifying your worries
. Worries about current problems (for example, “what if I
don’t have enough money to pay the bills?”, “what if I don’t
finish my report on time?)
. Worries about hypothetical situations (for example,
“what if the flight I’m taking next month crashes?”)
 To Cope with Anxiety,
Remember A-W-A-R-E

• The key to switching out of an anxiety state is to

accept it fully. Remaining in the present and
accepting your anxiety cause it to disappear.
• A: Accept the anxiety.
• W: Watch your anxiety.
• A: Act with the anxiety.
• R: Repeat the steps.
• E: Expect the best.
Tips for coping anxiety
7 SKILLS TO MANAGE ANXIETY
Case Discussion