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Anxiety Disorder: Symptoms, Diagnostic Criteria N Treatment

Anxiety Disorder definition, symptoms, differential diagnosis and Psychotherapies

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Anxiety Disorder: Symptoms, Diagnostic Criteria N Treatment

  2. 2. ANXIETY DISORDERS As Anxiety disorders, as the term suggests, has an unrealistic, irrational fear or anxiety of disabling intensity at its core and its principal and most obvious manifestation. AGORAPHOBIA: Anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having an unexpected panic attacks or panic-like symptoms.  PANIC ATTACKS: A discrete period of intense fear or discomfort which developed abruptly and reached a peak within 10 minutes.
  4. 4. TYPES OF ANXIETY DISORDER • Panic disorder Panic disorder with agoraphobia or without agoraphobia • Phobic disorder Specific Phobias Social Phobias • • • • Generalized Anxiety Disorder (GAD) Obsessive Compulsive Disorder (OCD) Post-traumatic Stress Disorder (PTSD) Acute Stress Disorder (ASD)
  6. 6. PANIC DISORDER  Panic disorder defined as the occurrence of unexpected panic attacks. Panic disorder with agoraphobia characterized by both recurrent unexpected panic attacks and agoraphobia.  Panic disorder without agoraphobia characterized by recurrent unexpected panic attacks.  Symptoms: 1. persistent concern of having attack. 2. Worry about the implications of attack. 3. A significant change in behavior related to attack.
  7. 7. • COURSE AND PREVALENCE: • Age at onset for panic disorder varies but lay between late adolescence and mid-30s. • Lifetime prevalence of panic disorder reported to be high as 3.5% and one year prevalence rate are between 0.5% and 1.5%. • Duration: at least one month • Differential Diagnosis: Panic disorder is not diagnosed , if panic attacks are judged to be direct physiological consequence general medical condition or substance. In panic disorder avoidance is associated with anxiety of having a panic attack but in other disorders it is associated with concern about harmful consequence of feared object or situation. In Panic disorder with agoraphobia fear of having unexpected panic attack with avoidance of multiple situations and in specific phobia or social phobia it to specific situations.
  9. 9. PHOBIC DISORDER  A persistent and disproportionate fear of some specific object or situation that presents little or no actual danger to person. Specific phobias: is characterized by clinically significant anxiety provoked by exposure of specific feared object or situation, often leading to avoidance.  Specific types: Animal type: feared cued by animal or insect Natural Environment type: feared cued by object in natural environment like storm, water or height. Blood Injection type: fear cued by receiving injection or seeing blood. Situational type: fear cued by situation such as tunnels bridges, elevator. Other type: fear of choking, vomiting, contracting illness.
  10. 10. Course and Prevalence • Age onset for specific phobia lay between childhood to mid-20s. • In community samples current prevalence rate ranges from 4% to 8.8% and lifetime prevalence rates ranges from 7.2% to 11.3%. • Duration: at least 6 months. • Differential Diagnosis:      Social phobia. Post-traumatic stress disorder Obsessive Compulsive disorder Hypochondrias Anorexia Nervosa and Bulimia Nervosa
  11. 11. SOCIAL PHOBIA  Is characterized by clinically significant anxiety provoking by exposure to certain types of social or performance situation, which people exposed to unfamiliar people or to scrutiny by others. The individual fears that he or she will act in a way that will be humiliating or embarrassing. Duration: at least 6 months.
  12. 12. Course and Prevalence: It has an onset in the mid-teens.  Studies have reported a lifetime prevalence of social phobia ranging from 3% to 13%. DIFFERENTIAL DIAGNOSIS     Separation Anxiety disorder Generalized Anxiety disorder Schizoid Personality disorder performance anxiety, stage fright and shyness
  14. 14. OBSESSIVE COMPULSIVE DISORDER  Obsessive Compulsive Disorder characterized by obsessions(which cause marked anxiety) and by compulsions( which serve to neutralize anxiety) Obsession: are persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness.  Compulsions: are repetitive and rigid behavior or mental act that a person feels compelled to perform to reduce distress or anxiety. : Types  Verbal compulsion: compel them to repeat expressions, phrases.  Touching rituals: must touch or avoid touching certain items  Counting compulsion: driven to count the things they see around them.
  15. 15. Course and Prevalence  Community studies have estimated a lifetime prevalence of 2.5% and 1 year prevalence of 0.5%-2.1% in adults. OCD prevalence is similar in many different cultures.  Age onset is earlier in males than females: between age 6 and 15 for males and between age 20 and 29 years for females. Differential diagnosis: • OCD is not diagnosed if the content of thoughts or activities related to another mental disorder like Body Dysmorphic disorder or Specific phobia. • Major depressive disorder. • Generalized Anxiety disorder. • Hypochondrias. • Additional diagnosis of delusional disorder or psychotic disorder not otherwise
  17. 17. GENERALIZED ANXIETY DISORDER  Excessive anxiety and worry occurring more days than not for at least 6 months about number of events and activities.  Symptoms: • • • • • Restlessness or feeling keyed up or on edge Being easily fatigue Irritability & muscle tension Sleep disturbance Difficulty concentrating or mind going blank  Course and prevalence: • Onset occurring after age 20 years. • 1 year prevalence rate for GAD was 3% and lifetime rate was 5%.
  18. 18. Differential Diagnosis  GAD should be made only when the focus of the anxiety and worry is unrelated to other disorder like • Panic disorder • Obsessive Compulsive disorder • Hypochondrias • Separation Anxiety disorder • Post-traumatic Stress disorder.
  19. 19. Posttraumatic Stress Disorder  PTSD is characterized by the re-experiencing of an extremely traumatic event accompanied by the symptoms of increased arousal and by avoidance of stimuli associated with trauma.  Symptoms: • Nightmares • • • • • • • • Sleep disturbances Startle responses Anger outburst Regressive behavior Detachment Avoidance of trauma recollections Avoidance of talk of trauma Distress at exposure to similar stimuli
  20. 20. Course and Prevalence  PTSD can occur at any age, including childhood.  Community based studies reveal a lifetime prevalence for PTSD approximately 8% of adult population in United States.  Duration: Acute: duration of symptoms less than 3 months. Chronic: duration of symptoms last 3 months or longer. With Delayed onset: 6 months have passed between the traumatic event and the onset of symptoms.
  21. 21. Differential Diagnosis  Acute Stress disorder  Adjustment disorder  Flash backs in PTSD should also be distinguished from hallucinations, illusions and other perceptual disturbances.
  22. 22. ACUTE STRESS DISORDER  Acute Stress Disorder (ASD) is characterized by symptoms similar to those PSTD that occur immediately in the aftermath of an extremely traumatic event.  Symptoms: • Depersonalization. • Dissociative amnesia (inability to recall traumatic events). • Subjective sense of numbing, detachment or emotional responsiveness. • De realization.  Traumatic event is persistently re-experienced • • • • • Thoughts. Recurrent images. Flashback episode. Sense of reliving the experience. Distress on exposure to reminders of traumatic events.
  23. 23.  Marked symptoms of anxiety or increased arousal • difficulty in sleeping. • • • • • irritability poor concentration hyper vigilance motor restlessness exaggerated startle response  Course and Prevalence • Symptoms experienced during or immediately after the trauma, last for at least 2 days, and maximum 4 weeks and occur within 4 weeks of the traumatic event. • ASD in few available studies, rates ranging from 14% to 33% have been reported in individuals exposed to severe trauma.
  24. 24. Differential Diagnosis Distinguish from mental disorder due to general medical condition( e.g. head injury) and from Substance Induced disorder (e.g. related alcohol intoxication.  Major depressive disorder in diagnosed in addition to the diagnosis of Acute stress disorder.  PTSD  Adjustment Disorder
  25. 25. THEORIES ON ANXIETY DISORDER  The Psychodynamic Theory  The Humanistic- Existential Theory  The Behavioral Theory  The Neuroscience Theory  The Cognitive Theory  The Socio-cultural Theory
  26. 26. THE PSYCHODYNAMIC THEORY  The fundamental concept is that anxiety is at the root of neurosis.  Anxiety stemmed in the form of unacceptable ID impulses attempting to break through into consciousness and behavior. In all neurosis the relief of anxiety is sought through various defense mechanism.  For example, in panic attack, the cause that is id impulse moves closer to the boundaries of conscious mind, resulting in rapid building up of anxiety. The ego responds with desperate effort to repression, once the ego regain upper hand the impulse once again safely repressed.
  27. 27. THE HUMANISTIC-EXISTENTIAL THEORY  Humanistic- existential theorists describe anxiety as the outcome of the conflict between the individual and society.  According to humanists the source of neurosis is the discrepancy between the self concept and the ideal self.  If the way we perceive ourselves is very different from the way we would like to be, we feel incapable of meeting life’s challenges, and anxiety results.
  28. 28. THE BEHAVIORAL THEORY According to behaviorists avoidance is a response learned to relieve anxiety.  For example, Agoraphobia is a strategy to avoid panic attacks in public. Avoidance learning is a major source of anxiety and is two-stage process: 1) 2) Through respondent conditioning, a neutral stimulus becomes anxiety arousing. The avoidance response relieves anxiety through negative reinforcement and becomes habitual.  Another way of acquiring fear reactions is through modeling.
  29. 29. THE NEUROSCIENCE THEORY  Anxiety disorders appear to have genetic basis. In Norwegian study, the concordance rate for panic disorder in MZ twins was 31 percent, as opposed to 0 percent for D twins (Torgersen, 1983).  Abnormalities in the neurotransmitters gamma-amino butyric acid (GABA) and serotonin may have a particular role in susceptibility to generalized anxiety disorder. Serotonin is a major player in OCD and social phobia.
  30. 30. THE COGNITIVE THEORY  According to the cognitive theory, people with anxiety disorders misperceive or misinterpret internal and external stimuli.  Events that are not really threatening, and anxiety results. In the case of panic disorder, if a person upon experiencing unusual bodily sensations catastrophically, as a signal that he or she is about to pass out or have a heart attack, then panic could result.
  31. 31. THE SOCIO-CULTURAL THEORY According to socio-cultural theorists, phobic and GAD are more likely to develop in people who are confronted with societal pressure. Stressful changes have occurred in the society have also increased the prevalence of anxiety disorders.
  33. 33. PSYCHOLOGICAL TREATMENT FOR ANXIETY DISORDER • • • • • • • • • • Systematic Desensitization Flooding and Implosive Therapy Modeling Exposure Treatment Group Therapy Rational-emotive behavior therapy Self-instruction training Relaxation training Biofeedback training Crisis intervention therapy
  34. 34. • Do you become anxious when you face anything that reminds you of that traumatic event? • Are you afraid that you will be in a situation where you will not be able to escape? • Do you feel that you worry excessively about many things? • What is the differential diagnosis of panic disorder with agoraphobia with specific phobias? • How can anxiety disorder can be treated through systematic desensitization? • What is psychodynamic view regarding anxiety disorders?
  35. 35. REFERENCES Barlow. D. H & Durand. V. M., (2002). Abnormal Psychology An Integrative Approach. (3rd Ed). Published by Wadsworth Group , Belmont, USA. Bootzin. R. R., Accocella. J. R & Alloy. L. B., (1972). Abnormal Psychology Current Perspectives. (6th Ed). Published by McGraw-Hill-Inc, New York. Carson. R.C., Butcher J. N & Mineka. S., (2001). Abnormal Psychology and Modern Life. ( 11th Ed). Published by Pearson education, Inc. and Dorling Kindersley Publishing Inc. Comer. R. J., (1995). Abnormal Psychology. (2nd Ed). Published by W. H. Freeman and Company, USA. American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM–IV). Washington, DC: APA.