Anxiety Disorders: Types, Symptoms and Treatment of Anxiety Disorders
Anxiety is defined as apprehension over an anticipated problem, whereas fear is defined as a reaction to immediate danger.
In order to be diagnosed as a disorder, the criteria specify that the anxiety or fear must be sufficient enough to interfere with daily functioning or cause marked distress to the individual.
Anxiety Disorders are the most common type of mental illness. They all share excessively high or frequent anxiety. Each type of disorder however is distinguished by a different set of symptoms related to anxiety or fear.
Symptoms of Anxiety Disorders:
Depending on the type of anxiety disorder, symptoms vary from person to person. However, some of the common symptoms of anxiety disorders are:
- Panic, fear, and uneasiness
- Uncontrollable, obsessive thoughts
- Repeated thoughts or flashbacks of traumatic experiences
- Ritualistic behaviours e.g. ticks, repeated hand washing
- Difficulty sleeping or sleep problems
- Cold or sweaty hands or feet
- Shortness of breath
- Muscle tension
- An inability to stay still and calm
- Dry mouth
- Tingling in hands or feet
- Feeling dizzy
Summary Of Major Anxiety Disorders:
DSM-IV-TR lists a number of major Anxiety Disorders.
These are as follows:
- Specific Phobia: The fear of objects or situations that is out of proportion to any real danger.
- Social Phobia: The fear of unfamiliar people, crowds or social scrutiny.
- Panic Disorder: The anxiety about recurrent panic attacks, which are often accompanied by agoraphobia i.e. fear of being in places or situations where panic attacks can occur.
- Generalized Anxiety Disorder: Worry that is uncontrollable for at least 6 months.
- Obsessive Compulsive Disorder (OCD): Obsessions which are uncontrollable thoughts, impulses, images or compulsions which are repetitive behaviours or mental acts.
- Post-traumatic Stress Disorder (PTSD): The aftermath of a traumatic experience in which a person re-experiences the traumatic event, avoids stimuli associated with the event and experiences increased arousal.
- Acute Stress Disorder or Complex PTSD: Symptoms are similar to those of post traumatic stress disorder but occur for less than 4 weeks after the traumatic event.
- Anxiety Disorder due to a general medical condition: When an individual experiences anxiety, panic or obsessive-compulsions as a direct consequence of a genral medical condition.
- Substance-indudced Anxiety Disorder: Characterised by prominent and persistent anxiety believed to be the direct consequence of the physiological experience of intoxication or withdrawal states.
Gender And Sociocultural Factors In Anxiety Disorders:
Anxiety Disorders are much more common among women than men. German Health interview and Examination Survey (de Graaf et al., 2002) indicated that women are at least twice as likely as men to be diagnosed with an anxiety disorder. Among people exposed to trauma, women are twice as likely to develop PTSD as are men (Breslau et al., 1999). However, OCD is the only anxiety disorder that is equally common in women and men.
People in every culture experience problems with anxiety disorders, however the focus of anxiety, the prevalence of anxiety disorders and the specific symptoms expressed may vary and be shaped by cultural factors.
Common Risk Factors Across Anxiety Disorders
Genes increase the risk for a broad range of anxiety disorders. Beyond this general risk for anxiety disorders, there may be more specific heritability for certain anxiety disorders.
Others factors that appear to be involved in a range of anxiety disorders include:
- Elevated activity in the fear circuit
- Poor regulation of several neuro-transmitter systems
- Negative life events
- Lack of perceived control
- Tendency to pay closer attention to signs of potential danger
Aetiology Of Specific Anxiety Disorders:
Behavioural Model of phobias stress two stages of conditioning. The first stage involves classical conditioning in which a previously innocuous object is paired with an object of fear. This can occur through direct exposure, modelling or cognition. Thus, Behaviourists believe that anxiety is explicable in terms of the individual having become classically conditioned to behaving in a particular way in response to external stimuli - the range of responses being broad in the case of GAD or Generalized Anxiety Disorder.
The Evolutionary Model suggests that fears of objects with evolutionary significance may be more sustained after conditioning. The second stage involves avoidance that is reinforced because it reduces anxiety.
Neurobiological Models of panic disorders focus on the brain regions responsible for norepinephrine release. Decreased levels of neurotransmitter gamma aminobutyric acid (GABA) have also been implicated in the aetiology of anxiety disorders. A receptor in the brain for benziodiazepines is linked to GABA. Thus, normal fear reactions result in firing of neurons in the brain resulting in anxiety. At the same time, the neural firing stimulates GABA system and this inhibits the neural activity which in turn reduces anxiety. However, GAD or Generalized Anxiety is due to a defective GABA system which results in anxiety not being controlled.
Cognitive theories: emphasise the lack of control of the individual over external stimuli which results from distorted cognitive processes. One model suggests that worry actually helps people avoid more intense emotions.
Research and theories on the causes of Post-traumatic disorder focus on risk factors such as small hippocampal volume, the severity of the event, dissociation and other factors that influence the ability to cope with stress such as intelligence and social support.
Psychological Treatment for Anxiety Disorders:
Exposure treatment for specific phobias tends to work quickly and well. Social phobia is harder to treat and adding cognitive components to behavioural treatments may help.
Relaxation and cognitive behavioural approaches may be helpful for GAD.
ERP is a well-validated approach for the treatment of OCD that involves exposure.
Psychological treatment of PTSD involves exposure, but often imaginal exposure is used.
Medications To Relieve Anxiety Disorders:
Anti-depressents and benzodiazopines are the most commonly used medications for anxiety disorders. However, there are concerns that benzodiazopines are subject to abuse.
Discontinuing medications usually leads to relapse. For this reason, cognitive behavioural therapy is considered a more helpful approach for most anxiety disorders.
One new approach involves providing D-cycloserine during exposure treatment for phobia.