Understanding Anxiety; Types and Symptoms

• Anxiety involves feelings of apprehension, uneasiness, uncertainty, or dread from a real or perceived threat, stemming from fear of the unknown.
• Anxiety involves decreased amounts of the neurotransmitters serotonin, norepinephrine, and GABA.

Levels of Anxiety

• Mild anxiety presents with slight discomfort, restlessness, irritability, and mild tension-relieving behaviors like nail-biting or fidgeting.
• Moderate anxiety includes tension, pounding heart, increased pulse and respiratory rates, perspiration, and mild somatic symptoms like gastric discomfort or headaches.
• Severe anxiety impairs learning and problem-solving, may cause confusion, with behavior becoming automatic and aimed at reducing anxiety. Somatic symptoms include headaches, nausea, dizziness, insomnia, trembling, hyperventilation, and feelings of impending doom.
• Panic involves an inability to process the environment, loss of touch with reality, pacing, shouting, hallucinations (false sensory perceptions), and erratic, uncoordinated physical behavior.

Defense Mechanisms

• Altruism involves unconsciously acting for the well-being of others to feel caring.
• Compensation is when counterbalancing perceived deficiencies by emphasizing strengths.
• Conversion unconsciously transforms anxiety into a physical symptom without an organic cause.
• Denial involves escaping unpleasant thoughts, feelings, wishes, or needs by ignoring their existence.
• Displacement transfers emotions from a particular person, object, or situation to a non-threatening one.
• Dissociation disrupts consciousness, memory, identity, or perception to compartmentalize uncomfortable aspects of oneself.
• Identification means attributing the characteristics of another person or group to oneself.
• Intellectualization analyzes events with remote, cold facts instead of passion, omitting feeling and emotion.
• Projection unconsciously rejects emotionally unacceptable features and attributes them to others.
• Rationalization involves justifying illogical ideas, actions, or feelings with acceptable explanations.
• Reaction formation controls unacceptable feelings by developing the opposite emotion or behavior.
• Regression reverts to earlier, more primitive behavior patterns.
• Repression unconsciously excludes unpleasant experiences from awareness.
• Splitting is the inability to integrate positive and negative qualities into a cohesive image.
• Sublimation transforms negative impulses into less damaging or productive ones.
• Suppression is a conscious decision to delay addressing a disturbing situation.
• Undoing involves compensating for a regrettable act or communication.

Panic Disorder (DSM-5 Criteria)

• Requires recurrent, unexpected panic attacks with an abrupt surge of intense fear or discomfort, peaking within minutes.
• During a panic attack, four or more symptoms such as palpitations, sweating, trembling, shortness of breath, choking, chest pain, nausea, dizziness, chills or heat sensations, paresthesias, derealization/depersonalization, and fear of losing control or dying must be present.
• At least one attack is followed by one month or more of persistent concern about further attacks or significant maladaptive behavior changes to avoid attacks.
• The disturbance is not due to substance use or a medical condition.
• The disturbance is not better explained by another mental disorder.

Generalized Anxiety Disorder (DSM-5 Criteria)

• Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities.
• Difficulty controlling the worry.
• Anxiety and worry are associated with three or more symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and/or sleep disturbance. Only one symptom is required for children.
• Anxiety, worry, or physical symptoms cause clinical distress or impairment in functioning.
• The disturbance is not attributable to the physiological effects of a substance or another medical condition.
• The disturbance is not better explained by another mental disorder.

Obsessive-Compulsive Disorder (DSM-5 Criteria)

• The presence of obsessions, compulsions, or both.
• Obsessions are recurrent, persistent, intrusive, unwanted thoughts, urges, or images that cause marked anxiety or distress.
• Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession, aimed at reducing anxiety or preventing a dreaded event, but are unrealistic or excessive.
• Obsessions or compulsions are time-consuming (over 1 hour per day) or cause clinically significant distress or impairment.
• Symptoms are not attributable to a substance or medical condition.
• Symptoms are not better explained by a different mental disorder.

Trichotillomania (DSM-5 Criteria)

• Recurrent pulling out of one's hair, resulting in hair loss.
• Repeated attempts to decrease or stop hair pulling.
• Hair pulling causes clinically significant distress or impairment.
• Hair loss is not attributable to another medical condition.
• Hair pulling is not better explained by the symptoms of another mental disorder such as body dysmorphic disorder.

Treatment of Anxiety Disorders

• Antidepressants like SSRIs, SNRIs, tricyclics, and MAOIs
• Anxiolytics like Buspirone (Buspar)
• Beta-Adrenergic Antagonists like Propranolol

Benzodiazepines

• Used to treat anxiety and aid sleep, targeting GABA.
• Increases GABA to calm and relax patients with severe anxiety or panic.
• Should be used with caution for patients with substance use disorders.
• They are central nervous system depressants.
• Can cause sedation and are controlled substances.

Therapeutic Rapport

• Creating a safe space for open communication, discussing difficult experiences, and establishing shared goals.
• Involves a non-judgmental approach that is non-stigmatizing, impartial, and normalizing.
• Builds trust to disclose distressing events and facilitate open communication.

Cognitive Behavioral Therapy

• Breaks the anxiety cycle by addressing the connections between thoughts, feelings, and behaviors.

Exposure Therapy

• Gradual exposure involves confronting feared objects or situations in a controlled manner.
• Emotional processing includes questioning and reevaluating fears.
• Preventing avoidance involves resisting avoidance behaviors.
• Sustained exposure involves attempting gradual exposure long enough to learn there aren't any consequences.

Exposure Therapy Techniques

• Graded exposure involves gradually exposing someone to their fear.
• Flooding involves direct exposure to the anxiety-provoking object or situation.
• Prolonged exposure therapy carefully exposes someone to traumatic memories to help manage PTSD symptoms.
• Systematic desensitization exposes someone to stimuli that become increasingly anxiety-provoking.

EMDR(Eye Movement Desensitization and Reprocessing)

• Used to treat PTSD, anxiety, depression, and phobias.