ANXIETY DISORDERS and its types, diagnosis and treatment.pdf

Anxiety disorders are mental health conditions marked by persistent and excessive fear, worry, or nervousness that interfere with daily life and functioning. Unlike normal anxiety, these disorders involve intense emotional and physical symptoms such as restlessness, rapid heartbeat, difficulty concentrating, and avoidance of feared situations. Common types include specific phobia, social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD). They can arise from psychological, biological, and environmental factors and are treatable through approaches like cognitive behavioral therapy (CBT), exposure therapy, and medications.

1. ANXIETY DISORDERS
What is Anxiety?
• Anxiety refers to a sense of agitation
or nervousness which is often focused
on an upcoming potential danger.
• Anxiety is a feeling of worry,
nervousness, or unease about
something with an uncertain
outcome.
• It often involves both emotional and
physical symptoms, such as tension,
restlessness, rapid heartbeat, or even
difficulty concentrating
Anxiety Disorder
• Anxiety disorder is a mental health
condition characterized by persistent
and excessive feelings of worry, fear,
or anxiety.
• Unlike occasional anxiety that
everyone experiences, anxiety
disorders involve prolonged and
intense symptoms that can interfere
with daily life, work, and
relationships.
• These emotions or the efforts to avoid
experiencing them can create high
level of distress, which can interfere
with normal functioning.
Common symptoms include
• Persistent worrying or fear
• Avoidance of anxiety-inducing
situations
• Restlessness or feeling on edge
• Difficulty concentrating
• Physical symptoms like increased
heart rate, sweating, trembling, or
fatigue
Types of Anxiety Disorders
1. Specific Phobia
2. Social Anxiety Disorder(Social
Phobia)
3. Panic Disorder
4. Generalized Anxiety Disorder
5. Obsessive Compulsive Disorder
(OCD)
A. Specific Phobia
• A person is diagnose having a specific
phobia if he or she shows strong and
persistent fear that is triggered by the
presence of a specific object or
situation .
• People with specific phobias
recognize that their fear is somewhat
excessive or unreasonable although
occasionally they may not have this
insight.
• A specific phobia is an intense and
irrational fear of a particular object,
situation, or activity that poses little to
no actual danger.
• This fear leads to significant anxiety
and avoidance behavior.
• People with specific phobias often go
to great lengths to avoid the feared
object or situation, which can
interfere with their daily life and
activities.
Diagnostic Criteria
Marked fear or anxiety about a specific object
or situation (e.g.; flying, heights, animal,
seeing blood etc.)
1.The phobic object or situation almost
always provokes immediate fear or anxiety

2. 2.The phobic object or situation is actively
avoided or endured with intense fear or
anxiety
3.The fear, anxiety or avoidance is persistent
typically lasting for 6 months or more
4.The fear, anxiety or avoidance causes
clinically significant distress or impairment
in social, occupational or other important
areas of functioning
5.The disturbance is not better explained by
the symptoms of another mental disorder,
including fear, anxiety, avoidance of situation
associated with panic like symptoms or other
incapacitating symptoms, objects or
situations related to obsessions, reminder of
traumatic events, separation from home or
social situations
Prevalence, Age of onset, gender differences
• Among people with one specific
phobia, over 75% have at least one
other specific fear that is excessive
• More common in women than men
• National comorbidity survey –
Replication revealed a lifetime
prevalence rate of about 12%
Psychological Causal factors
• Vicarious conditioning
• Individual differences in learning
Biological Causal factors
• Genetic and temperamental variables
affect the speed and strength of
conditioning
• Behaviorally inhibited toddlers ( who
are excessively timid, shy , easily
distressed etc.) at 21 months of age
were at higher risk of developing
multiple specific phobia by 7 to 8
years of age
Treatments
• Exposure therapy – controlled
exposure to the stimuli or situations
that elicit phobic fear
• Medications
B. Social Anxiety Disorder
• Social Anxiety Disorder (SAD), also
known as social phobia, is a mental health
condition characterized by an intense and
persistent fear of being judged,
embarrassed, or humiliated in social or
performance situations.
• People with social anxiety disorder often
worry excessively about how they are
perceived by others and fear negative
evaluation.
• This can lead to significant distress and
avoidance of social interactions or
activities.
• Characterized by disabling fears of one or
more specific social situations ( such as
public speaking, eating or writing in
public)
• People with social phobia either avoid
these situations or endure them with great
distress.
• Intense fear of public speaking is the
single most common type of social
phobia

Diagnostic Criteria
1. Marked fear or anxiety about one or
more social situations in which the
individual is exposed to possible
scrutiny by others. Examples include
social interactions, being observed,
and performing in front of others.
2. The individual fears that they will act
in a way or show anxiety symptoms
that will be negatively evaluated (e.g.,

3. humiliating or embarrassing; leading
to rejection or offending others).
3. Social situations almost always
provoke fear or anxiety. In children,
the fear or anxiety may be expressed
by crying, tantrums, freezing,
clinging, shrinking, or failing to speak
in social situations.
4. The social situations are avoided or
endured with intense fear or anxiety.
5. The fear or anxiety is out of
proportion to the actual threat posed
by the social situation and to the
sociocultural context.
6. The fear, anxiety, or avoidance is
persistent, typically lasting for 6
months or more.
7. The fear, anxiety, or avoidance causes
clinically significant distress or
impairment in social, occupational, or
other important areas of functioning.
8. The fear, anxiety, or avoidance is not
attributable to the physiological
effects of a substance (e.g., a drug of
abuse, a medication) or another
medical condition.
9. The disturbance is not better
explained by the symptoms of another
mental disorder, such as panic
disorder, body dysmorphic disorder,
or autism spectrum disorder.
Specify if: Performance only: if the fear is
restricted to speaking or performing in
public.
Prevalence, Age of onset, gender differences
• About 12% of population will qualify for
a diagnosis at some point in other lives
• More common in women
• Most often originated in childhood, or
later during early or middle adolescence
or by early adulthood
Psychological Causal factors
• Social phobias as a learned behavior
• Traumatic experience
• Social fears or phobias in an evolutionary
context – fears of members of one’s own
species
Biological causal factors
• Genetic and temperamental factors
• Behaviorally inhibited infants who
are easily distressed by unfamiliar
stimuli and who are shy and avoidant
more likely to become fearful during
childhood
Treatments
• CBT
• Medications ( Monoamine oxidase
inhibitors (MAIOS), selective
serotonin reuptake inhibitors (SSRI))
C. Panic Disorder
• Panic disorder is a type of anxiety
disorder characterized by recurrent
and unexpected panic attacks.
• A panic attack is a sudden episode of
intense fear or discomfort that reaches
a peak within minutes and includes a
variety of physical and cognitive
symptoms.
• Characterized by the occurrence of
panic attacks that often come “out of
the blue “
• Panic attacks are fairly brief but
intense with symptoms developing
abruptly and usually reaching peak
intensity within 10 minutes
• Panic attacks are often “unexpected”
or “uncued” in the sense they do not
appear to be provoked by identifiable
aspects of the immediate situation

4. Diagnostic Criteria
1.Recurrent unexpected panic attacks; A
panic Attack Is an abrupt surge of intense fear
or intense Discomfort that reaches a peak
within minutes And during which time four
(or more) of the following symptoms occur ;
• Palpitations, pounding heart
• Sweating
• Trembling or shaking
• Feelings of choking
• Chest pain nausea
• Feeling of dizzy, unsteady, or faint
• Fear of dying
• Sensation of shortness of breath
2. At least one of the attacks has been
followed by 1 month or more of one or both
of the following
• Persistent concern or worry about
additional panic attacks or their
consequences
• A significant maladaptive change in
behavior related to attacks
3. Disturbance is not attributable to the
physiological effects of a substance
4. The disturbance is not better explained by
another mental disorder
Prevalence, Age of onset, gender differences
• Approx. 4.7% of adult population had
panic disorder
• Average age of onset is 23 to 34 years
• More in women
Biological causal factors
• Genetics
• Biochemical abnormalities – panic
attacks are alarm reactions caused by
biochemical dysfunction
Psychological Causal factors
• Comprehensive learning theory of
panic disorder
• Cognitive theory of panic
Treatments
• Medications(antianxiety
medications)
• CBT
D. Generalized Anxiety Disorder
(GAD)
• Generalized Anxiety Disorder (GAD)
is a mental health condition
characterized by persistent and
excessive worry about various
aspects of daily life.
• People with GAD often experience
anxiety that is difficult to control and
can interfere with their daily
activities, work, and relationships.
• The worry is usually out of proportion
to the actual events and can be present
most days for at least six months.
Diagnostic criteria
1. Excessive anxiety and worry
occurring more days than not for at
least 6 months , about a number of
events or activities ( such as work or
school performance)
2. The individual fails it difficult to
control the worry
3. The anxiety and worry are associated
with three or more of the following
symptoms these symptoms have been
present for more days than not for the
past 6 months
• Restlessness
• Being easily fatigued
• Difficulty in concentrating or mind
going blank

5. • Irritability
• Muscle tension
• Sleep disturbance
4. The anxiety, worry or physical
symptoms cause clinically significant
distress or impairment in social,
occupational or other important areas
of functioning
5. The disturbance is not attributable to
the physiological effects of a
substance or other medical condition
6. The disturbance is not better
explained by another mental disorder

Prevalence, Age of onset, gender differences
• Approx. 3% of population suffers
from it in any 1 year period & 5.7 %
at some point in their lives
• GAD is approx. Twice as common in
women as in men
• Age of onset is often difficult to
determine because 60 to 80 % of
people with GAD
Psychological causal factors
• Psychoanalytic view point – GAD
results from an unconscious conflict
between ego and Id impulses
• Perception of uncontrollability and
unpredictability

Biological causal factors
• Genetics
• Neurotransmitter and neurohormonal
abnormalities
• Neurobiological differences between
anxiety and panic
Treatments
• Medications
• Cognitive behavioral treatment

E. Obsessive – Compulsive
Disorder (OCD)
• Defined by the occurrence of
unwanted and intrusive Obsessive
thoughts or distressing images
• These are usually accompanied by
compulsive behaviors performed to
undo or neutralize the obsessive
thoughts or Images as a way of
preventing some dreaded event or
Situation
• People who have obsessions actively
try to resist or suppress Them or to
neutralize them with some other
though Or action
• Compulsions can involve either overt
repetitive behaviors that are
performed as lengthy rituals
Diagnostic Criteria
1.Presence of obsessions , compulsions or
both obsessions are defined by ;
Obsessions are defined by:
• Recurrent and persistent thoughts, urges,
or images that are experienced as
intrusive and unwanted, causing marked
anxiety or distress.
• The individual attempts to ignore or
suppress these thoughts, urges, or images,
or to neutralize them with some other
thought or action (i.e., by performing a
compulsion).
Compulsions are defined by:
• Repetitive behaviors (e.g., hand washing,
ordering, checking) or mental acts (e.g.,
praying, counting, repeating words
silently) that the individual feels driven to

6. perform in response to an obsession or
according to rigid rules.
• The behaviors or mental acts are aimed at
preventing or reducing anxiety or
distress, or preventing some dreaded
event or situation; however, these
behaviors or mental acts are not
connected in a realistic way with what
they are designed to neutralize or prevent,
or are clearly excessive.
2. Obsessions or compulsions are time
consuming ( takes more than 1 hr per day) or
cause clinically significant distress or
impairment in social, occupational or other
important areas of functioning
3. Obsessive compulsive symptoms are not
attributable to the physiological effects of a
substance or another mental condition

Prevalence, Age of onset, gender differences
• Avg 1 year prevalence rate of OCD in the
National Comorbidity Survey
Replication study was 1.2% and average
lifetime prevalence was 2.3%
• Childhood or early adolescent of onset
• More in boys than in girls

Psychological Causal factors
• OCD as a learned behavior
• OCD and preparedness
Biological causal factors
• Genetics
• Neurotransmitter abnormalities
Treatments
• CBT
• Medications