Anxiety Disorders

The experience of fear and anxiety are common, typically temporary, and have survival value in that they motivate “flight-flight” responses to danger. Normal anxiety and anxiety disorders vary along a continuum, with the degree of distress and interference with daily life distinguishing between what is normal and adaptive and what is dysfunctional. For some people, anxiety can become so problematic that they can be said to have an anxiety disorder. Disorders of this type are among the most common mental health problems, and a large proportion of health resources are spent on dealing with anxiety and its associated problems.

The most common diagnostic system in use are the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association and the International Classification of Diseases of the World Health Organization. In determining whether a problem warrants a formal diagnosis as an anxiety disorder, the clinician using these systems will consider the specific symptoms, the duration of the problem, the interference caused by the problem, and whether the anxiety can be better explained by another problem such as drug abuse or a medical condition. The DSM-IV discriminates between anxiety disorders that typically begin in childhood or adolescence and those usually diagnosed in adulthood. However, children can be diagnosed with any of the adult categories, and only one disorder is specific to children and adolescents: separation anxiety disorder. This disorder results from undue anxiety regarding separation from significant figures in the child’s life. The child’s reaction to such separation is beyond that expected for his or her development level.

This anxiety disorder of adulthood include: agoraphobia, panic disorder, specific phobias, social phobias, and generalized anxiety disorder. Agoraphobia is a morbid fear and avoidance of public places such as shopping centres and public transportation. Although the problem may be based on a previous experience of having suffered a panic attack in such places, panic is no longer a feature; a long standing pattern of avoidance is the primary manifestation. Panic disorder is the repeated experience of uncontrollable panic attacks not associated with specific phobic stimuli characterized by heard palpitations, sweating, breathing problems, nausea, and shaking, as well as thoughts of losing control, having a heart attack or stroke, and dying. Those individuals who exhibit panic disorder without agoraphobia show no secondary avoidance of particular places associated with the phobia avoid certain places because they fear the onset of a panic attack, which they associate with those places. Sufferers develop a sensitivity to internal arousal that signal the possibility of a panic attack. Thus, any signs of  bodily changes due to exertion, loss of breath, excitement, anger, and so on can come to elicit panic; often described as “fear of fear”. Specific or simple phobias result from specific stimuli. These phobias tend to parallel the fears people normally have throughout the life span, except the phobias lead to a greater degree of fear and significant impairment. The most common stimuli for specific phobias include medical procedures, needles, blood , injury, heights, water, small spaces such as elevators, insects, and animals. Social phobia results from the morbid anxiety associated with being scrutinized by others. Sufferers show high levels of self consciousness and exaggerate other people’s negative reaction to them  on the basis of their own state of anxiety, Thus, sufferers find it difficult to attend social gatherings and perform tasks in front of people, which often makes them unable lead normal social and work lives. Generalized anxiety disorder involves undue anxiety or worry about a range of areas that may include well-being  of family members, self-consciousness, future or past events, performance and competence. The worry is experienced as uncontrollable and is therefore ineffective as the worry is a narrowing of attentional focus that screens out all non-worry related events. Others argue that the worry may function to protect the worrier from other more distressing forms of cognitive activity, such as mental images of scenes that elicit unpleasant emotional states.

There are a number of other disorders in the psychological and psychiatric literature, but more controversy exists about whether their categorization is correct. Three such disorders are obsessive-compulsive disorder, post-traumatic stress disorder, and hypochondriasis. An individual who suffers from obsessive-compulsive disorder feels compelled to perform rituals over and over to prevent tragedy from occurring. The most common forms of obsessive-compulsive disorder involve repeated checking to make sure mistakes have not been made and repeated washing to avoid contamination. The rituals rarely bring any relief, so normal life is often  sacrificed to a cycle of never ending ritualization. Post-traumatic stress disorder involves a range of symptoms that are directly attributable to the previous experience of a traumatic event. Hypochondriasis, or health anxiety, is a preoccupation with the belief or fear that one has a serious illness, even in the absence of organic pathology and despite medical reassurance. As in panic disorder, some who suffers from hypochondriasis becomes sensitized to and fearful of bodily sensations that are incorrectly taken as evidence of serious illness. Such worries are also common in depression, so assessment must try to disentangle the primacy of the various symptoms. The validity of the above categories of anxiety disorders is still controversial. As new research and clinical practice evolves, so do the way scientists categorize disorders, and it is reasonable to predict that the diagnostic system may look markedly different in the future. The American Psychiatric Association has placed increasing emphasis on research and resulting evidence is used in further developing the diagnostic system. For example, the childhood category of avoidant disorder was omitted from DSM-IV after research indicated that it did not differ sufficiently from social phobia.

Most sufferers of anxiety disorders have more than one type of anxiety disorder, and thus it is difficult to argue that the subtype of anxiety disorder are really discrete entities. Further, anxiety disorders also tend to overlap with other emotional and behavioural problems, in particular depression and substance abuse. The latter may simply be due to people using drugs to anxiety and depression is more complex, and the similarity of the two problems had led a number of researchers to argue they are one and the same. A consensual view holds that anxiety and depression are distinct yet overlapping events that share the common experience of negative affect but show distinctions in patterns of symptoms and respond to treatment.

Leave a Reply