An anxiety disorder is diagnosed when there is a clear subjective experience of anxiety.
People with this disorder feel overwhelmed by anxiety that is considered irrational.
The DSM-IV-TR lists six subcategories of anxiety disorders: phobias, panic disorder, generalised anxiety disorder (GAD), obsessive-compulsive disorder, post-traumatic stress disorder, and acute stress disorder.
What is anxiety?
Anxiety is such a universal emotion that it would be maladaptive not to experience it, and although it is sometimes unpleasant, it serves us well.
In other words, anxiety can be seen as an adaptive response that puts us on alert to protect ourselves in dangerous or threatening situations.
Feeling anxious in a threatening situation that poses a realistic risk of harm is a natural and adaptive psychological response, and can be referred to as normal anxiety.
However, if our alarms are too sensitive, or if they are false and sound off frequently, we can become unnecessarily vigilant, overly tense, and confused. This maladaptive behaviour of the anxiety response is known as pathological anxiety.
Pathological anxiety is defined as anxiety about a situation or object that does not pose a realistic risk, anxiety that is disproportionately severe compared to the degree of realistic risk, or anxiety that persists even after the threatening factor that caused the anxiety has passed.
Anxiety disorders are defined as pathological anxiety that results in excessive psychological distress or severe difficulty adjusting to life.
Emotions underlying anxiety disorders
The emotional state of anxiety can occur in many psychopathological conditions and is a key aspect of anxiety disorders.
Furthermore, anxiety plays an important role in the study of normal psychological phenomena, as few people go a week without experiencing some degree of anxiety or fear.
However, the very short periods of anxiety that are problematic for normal people are rarely comparable in intensity or duration to those experienced by people with anxiety disorders and are not debilitating.
Anxiety disorders were all long considered neuroses.
The concept of neurosis was established through the clinical work of S. Freud with his patients, and as such, the diagnostic category of neurosis is closely associated with psychoanalytic theory: it ranges from the fear and avoidance behaviours complained of by phobics, to the irresistible urge to perform an action repeatedly, a symptom found in OCD, to the paralysis and other ‘neurological’ symptoms of conversion hysteria.
According to psychoanalytic theory, all neurotic states are assumed to reflect latent (unconscious) problems associated with repressed anxiety, even if the observed symptoms are different.
Example of a person with an anxiety disorder
The patient, a 24-year-old mechanical engineer, was very nervous before speaking, swallowing dry saliva, sweating, and fidgeting in his chair. He was very thirsty and repeatedly asked for water, which told us that he was in a state of nervousness.
He said he felt tense almost all the time, and seemed to worry about almost everything.
At work and when socialising with others, he felt that some great disaster was about to fall in front of him. His interpersonal relationships have been difficult for a long time and he has had to change jobs because of this.
Sub-disorders of anxiety disorders
Phobias are powerful, irrational fears that disrupt a person’s otherwise normal life.
The psychoanalytic view of phobias is that they are a defence against repressed conflicts.
Behavioural theories suggest that phobias are acquired through classical conditioning, in which harmless objects or situations are paired with inherently distressing ones; operant conditioning, in which avoidance behaviours are rewarded; imitation learning of other people’s fears and phobias; and cognitive conditioning, in which non-dramatic social mistakes are seen as dramatic.
However, not all people who have had these experiences develop phobias, and some people may have psychophysiological pathological predispositions, such as autonomic nervous system variability, that make them more prone to them.
Panic disorder is characterised by sudden, unpredictable and periodic intense panic attacks. Some people are afraid to leave the house due to panic attacks, which is called agoraphobia.
People with panic disorder typically worry a lot that they might have a serious physical or mental illness. Therefore, they fear and magnify their physical sensations and become overwhelmed by them.
Generalised anxiety disorder
Generalised anxiety disorder is sometimes referred to as free-floating anxiety, in which the sufferer’s life is virtually a continuous state of tension and anxiety.
Psychoanalytic theory considers the cause to be an unconscious conflict between the ego and the superego.
According to behaviourist theorists, this generalised anxiety, if properly assessed, can be attributed to specific anxiety-provoking situations and the anxiety can then be treated as a phobia.
A person with OCD feels compelled to perform routine behaviours in order to avoid being overwhelmed by anxiety, which can be overwhelming and selfish.
The person with this disorder becomes so incapacitated that it affects not only their life but also the lives of those close to them. Psychoanalytic theories attribute the disorder to powerful primal urges that are misplaced and under inadequate self-control.
Behaviourist theories view compulsive behaviour as a learned avoidance response. Obsessions can also be related to stress and are an attempt to resist unwanted thoughts.
5.4 Post-traumatic stress disorder
Post-traumatic stress disorder often occurs when a person experiences a traumatic event that has left them feeling extremely distressed. Characteristic symptoms of PTSD include re-experiencing symptoms, increased levels of arousal, and emotional numbness.
Biological causes of anxiety disorders
Research into the neurophysiological mechanisms of anxiety is still ongoing.
The discovery that benzodiazepine medications reduce anxiety has led to an increased focus on the neurotransmitter gamma-aminobutyric acid (GABA). Other neurotransmitters involved in anxiety include norepinephrine and glutamate.
In addition, there is increasing interest in the occipital lobe, which contains many benzodiazepine receptors, as an anatomical structure of the brain related to anxiety.
Comorbidity of anxiety disorders
People with one type of anxiety disorder may also meet the diagnostic criteria for another type of anxiety disorder. This phenomenon is called comorbidity.
Comorbidity occurs because the symptoms of each sub-disorder of an anxiety disorder are not unique to that disorder. For example, physical signs of anxiety are also included in the diagnostic categories of panic disorder, generalised anxiety disorder, and post-traumatic stress disorder.
Another reason for comorbidity is that the underlying concepts of what causes various anxiety disorders are not specific to any one disorder, but are widely applicable. For example, the feeling of being unable to control the stress of the moment is relevant to both phobias and generalised anxiety disorder. Therefore, the phenomenon of comorbidity can be attributed to common mechanisms in anxiety disorders.
Treatments for anxiety disorders
Psychoanalytic therapy seeks to release repression so that childhood conflicts can be resolved, meaning that it”s not advisable to directly alleviate overt problems.
Behavioural therapists, on the other hand, emphasize exposure using various procedures such as systematic desensitisation and imitation learning to reduce fear and avoidance behaviours.
Systematic desensitisation involves starting with a mild fear stimulus in a relaxed state and gradually exposing the person to a stronger fear stimulus, and is considered the most effective treatment for phobias.
Exposure therapy, which involves repeated exposure to a phobic stimulus to induce adaptation, is also commonly used to treat certain phobias.
There are two types of exposure therapy: in vivo exposure, which involves actually being exposed to the fearful stimulus, and imaginal exposure, which involves imagining the fearful stimulus.
There are also graded exposure, which involves gradual exposure to the fearful stimulus, and flooding, which involves being exposed to a strong fearful stimulus all at once.
Participant modelling is a method of treating phobias by observing others dealing with fearful stimuli without anxiety. Other methods include relaxation training, which teaches techniques to induce a state of physical relaxation that cannot coexist with anxiety.
Medication is another widely used treatment. Medications are easy to abuse and can cause side effects if taken long-term. In addition, the therapeutic effects achieved by using medication disappear when the medication is stopped.
Medications used for anxiety disorders include benzodiazepines, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and buspirone.
Panic attacks (PANIC ATTACK)
A sudden onset of intense fear or dysphoria with at least four of the following symptoms occurring suddenly and peaking within 10 minutes
(1) palpitations in the chest, heart palpitations, or increased heart rate
(3) Trembling or shaking
(4) Shortness of breath or a choking sensation
(5) choking sensation
(6) chest pain or discomfort
(7) Nausea or abdominal pain
(8) Feeling dizzy, unsteady, lightheaded, or like you’re going to pass out
(9) Loss of reality (derealisation) or depersonalisation
(10) Fear of loss of self-control or fear of going crazy
(11) Fear of death
(12) Paresthesia (numbness or tingling sensations)
(13) Chills or burning sensation in the face
(1) Anxiety about being in a place or situation that is difficult to avoid immediately (or embarrassing), or where it is difficult to get help in the event of an unexpected or situationally predisposing panic attack or panic-like symptoms. Agoraphobic fear typically occurs in characteristic situations, such as being out alone, in a crowd, in a queue, on a bridge, or during a bus, train, or car journey.
(2) Avoiding situations, tolerating significant discomfort or anxiety about having a panic attack or panic-like symptoms, or needing company.
(3) The avoidance due to anxiety or fear is not better explained by another mental disorder. Other mental disorders include social phobia, specific phobias, obsessive-compulsive disorder, post-traumatic stress disorder, and separation anxiety disorder.
What teens worry about
Teens with anxiety disorders worry about the same things as other teens, but more frequently and intensely.
In a study published in the journal of Abnormal Child Psychology in 2000, 119 children and adolescents who attended an anxiety clinic were asked what they worried about the most. These were their top responses.
Anxiety disorders in adolescence
When an anxiety disorder is left untreated, adolescents may exhibit the following symptoms.
First, an extreme dislike of going to school is sometimes seen in children with separation anxiety, social anxiety disorder, and generalised anxiety disorder, which can have serious academic and social consequences if not addressed immediately.
Second, individuals with social anxiety disorder, agoraphobia, and other anxiety disorders can separate themselves from others. Unfortunately, this deprives them of much-needed emotional and practical support.
Third, the tendency toward depression can be increased by avoiding activities that are fun or relaxing.
Fourth, some people with anxiety disorders develop an interest in alcohol or other drugs in a misguided effort to reduce their emotional difficulties.
Fifth, anxiety can be caused by or coexist with a number of physical illnesses, such as thyroid disease, hypoglycaemia, irritable bowel syndrome, pneumonia, and encephalitis.
The course of the disease can be sustained or exacerbated by anxiety.
If left untreated, anxiety disorders can interfere with daily activities, strain relationships with friends and family, and cause considerable difficulty and ongoing distress.
These feelings can eventually interfere with a young person’s important schoolwork.
Meanwhile, avoidance behaviours make it difficult for them to participate fully in this special time in their lives. Anxiety and fear can keep young people from flying at the very time when they should be spreading their wings.