Anxiety Disorders Lesson 17 PDF

**[Lesson -17]** **[Anxiety Disorders I]** **[Topic 82-88]** **[Topic 82: *General Features 1248/394*]** ***Anxiety is defined as apprehension over an anticipated problem. Anxiety is the main feature of anxiety disorders.*** - ***Anxiety is manifested through e*xcessive fear and anxiety relat...

**[Lesson -17]** **[Anxiety Disorders I]** **[Topic 82-88]** **[Topic 82: *General Features 1248/394*]** ***Anxiety is defined as apprehension over an anticipated problem. Anxiety is the main feature of anxiety disorders.*** - ***Anxiety is manifested through e*xcessive fear and anxiety related behavioral disturbances** - **Many of the anxiety disorders develop in childhood and tend to persist if not treated** - **Anxiety disorders are diagnosed when there is no other alternate explanation of fear / anxiety** - **Anxiety disorder occurs more frequently in females as compared to males.** Any time you face what seems to be a serious threat to your well-being, you may react with the state of immediate alarm known as fear. Sometimes you cannot pinpoint a specific cause for your alarm, but still you feel tense and edgy, as if you expect something unpleasant to happen. The vague sense of being in danger is usually called anxiety, and it has the same features, the same increases in breathing, muscular tension, perspiration, and so forth, as fear. **Fear** **Anxiety** ------------------------------------------------------------- ------------------------------------ **Emotional response to real or perceived imminent threat** **Anticipation of future threat** **Autonomic arousal necessary for fight or flight** **Muscle tension** **Thoughts of immediate danger** **Preparation for future danger** **Escape behaviors** **Cautious or avoidant behaviors** All of us face some fear and anxiety, and differentiate it with pathological fear and anxiety 1. Normal Fear/Anxiety is consistent with developmental age. It is brief and for shorten span of time. As long as fearful stimulus disappears, the fear/anxiety also disappears. 2. On the contrary, pathological Fear / Anxiety is characterized by excessive or Persistent beyond developmentally appropriate periods, as in phobias, individual seems to be disproportionality afraid of even a snake toy. Such fear/anxiety often lasts for 6 months or more. **Types of Anxiety Disorders** **Following disorders fall under the category of anxiety disorders:** - **Separation anxiety disorder** - **Selective Mutism** - **Specific phobia** - **Social anxiety disorder** - **Panic disorder** - **Agoraphobia** - **Generalized anxiety disorder** - **Substance/medication-induced anxiety disorder** **[Topic 83: Separation Anxiety Disorder]** Individuals with separation anxiety disorder feel extreme anxiety, often panic, whenever they are separated from home or from key people/significant others in their lives. Children with separation anxiety disorder have great trouble traveling away from their family, and they often refuse to visit friends' houses, go on errands, or attend camp or school. Many cannot stay alone in a room and cling to their parents around the house. Some also have temper tantrums, cry, or plead to keep their parents from leaving them. The children may fear that they will get lost when separated from their parents or that the parents will meet with an accident or illness. As long as the children are near their parents, they may function quite normally. At the first hint of separation, however, the dramatic pattern of symptoms may be set in motion. Separation anxiety disorder is one of the most common psychological disorders among the young. In fact, for years, clinicians believed that the disorder is developed only by children or adolescents. DSM-5 determined that the disorder can also develop in adulthood, particularly after adults have experienced traumas such as the death of a spouse or child, a relationship break-up, separation caused by military service etc. Such individuals may become consumed with concern about the health, safety, or well-being of a significant other, their spouse, a surviving child, or another important person in their life. They may constantly and excessively try to be with the other individual, check on the other's whereabouts, protect the other person, and restrict the person's activities and travels. Their extreme anxiety and invasive demands cause them severe distress and can greatly damage their social and occupational lives. **Diagnostic Criteria:** A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following: 1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures. 2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death. 3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure. **[Topic 84: Diagnostic Criteria: (In continuation to the previous module)]** 4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation. 5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings. 6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure. 7. Repeated nightmares involving the theme of separation. 8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated. A. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults. B. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning. C. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder. **[Topic 85: Selective Mutism]** In selective mutism, children consistently fail to speak in certain social situations, but show no difficulty at all speaking in others child with this disorder may have no problem talking, laughing, or singing at home with family members, but will offer absolutely no words in other key situations, such as the classroom. Some go an entire school year without speaking a word to their teacher or classmates. Many have a special friend in the classroom to whom they will discreetly whisper important things to be communicated to the class, such as answers to a teacher's questions or the need to use the restroom. People who only see a selectively mute child at school often find it hard to believe that the child is an absolute chatterbox at home. Many researchers believe that selective mutism is an early version of social anxiety disorder, appearing in children before they have fully developed the cognitive capacities to worry about future embarrassment or anticipate potential judgment from others **Diagnostic Criteria:** A. Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations. B. The disturbance interferes with educational or occupational achievement or with social communication. C. The duration of the disturbance is at least 1 month (not limited to the first month of school). D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation. E. The disturbance is not better explained by a communication disorder (e.g., childhood onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder. **[Topic 86: Specific Phobia]** A specific phobia is a disproportionate fear caused by a specific object or situation, such as fear of flying, fear of snakes, and fear of heights. The person recognizes that the fear is excessive but still goes to great lengths to avoid the feared object or situation. The names for these fears consist of a Greek word for the feared object or situation followed by the suffix -phobia (derived from the name of the Greek god Phobos, who frightened his enemies). **Diagnostic Criteria:** A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). **Note:** In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging. B. The phobic object or situation almost always provokes immediate fear or anxiety. C. The phobic object or situation is actively avoided or endured with intense fear or anxiety. D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context. E. **Duration:** The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia): objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder). **Specify if:** While diagnosing we need to specify the specific type of phobia: - **Animal (e.g., spiders).** - **Natural environment (e.g., heights).** - **Blood-injection-injury (e.g., needles).** - **Situational (e.g., airplanes).** - **Other (e.g., situations that may lead to choking or vomiting: in children, (e.g., loud sounds).** **[Topic 87: Social Anxiety Disorder]** Social anxiety disorder is a persistent, unrealistically intense fear of social situations that might involve being scrutinized by, or even just exposed to, unfamiliar people. Although this disorder is labeled social phobia in the DSM-IV-TR, the term social anxiety disorder is proposed in the DSM-5 because the problems caused by it, tend to be much more pervasive and to interfere much more with normal activities than the problems caused by other phobias. People with social anxiety disorder usually try to avoid situations in which they might be evaluated, show signs of anxiety, or behave in embarrassing ways. The most common fears include public speaking, speaking up in meetings or classes, meeting new people, and talking to people in authority. Although this may sound like shyness, people with social anxiety disorder avoid more social situations, feel more discomfort socially, and experience these symptoms for longer periods of their life than people who are shy. They often fear that they will blush or sweat excessively. Speaking or performing in public, eating in public, using public restrooms, or engaging in virtually any activity in the presence of others can cause extreme anxiety. People with social anxiety disorder often work in occupations far below their talents because of their extreme social fears. Many would rather work in an unrewarding job with limited social demand than deal with social situations every day. **Diagnostic Criteria:** A. 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 (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). **Note:** In children, the anxiety must occur in peer settings and not just during interactions with adults. B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing: will lead to rejection or offend others). C. The social situations almost always provoke fear or anxiety. **Note:** In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations. D. The social situations are avoided or endured with intense fear or anxiety. E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context. F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. 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. I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder. J. If another medical condition (e.g., Parkinson's disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive. **While diagnosing we need to specify if it is:** Performance only: If the fear is restricted to speaking or performing in public. **Duration:** Duration of symptoms must be more than 6 months **[Topic 88: Agoraphobia]** Agoraphobia is defined by anxiety about situations in which it would be embarrassing or difficult to escape if anxiety symptoms occurred. Commonly feared situations include crowds and crowded places such as grocery stores, malls, and churches. Sometimes the situations are those that are difficult to escape from, such as trains, bridges, or long road trips. Many people with agoraphobia are virtually unable to leave their house, and even those who can leave do so only with great distress. Researches prove that The disorder also is twice as common among women as men and among poor people as wealthy people. Many people with agoraphobia have extreme and sudden explosions of fear, called panic attacks, when they enter public places, a problem that may have first set the stage for their development of agoraphobia. Such individuals may receive two diagnoses, agoraphobia and panic disorder, an anxiety disorder that will be discussed next, because their difficulties extend considerably beyond an excessive fear of venturing away from home into public places. **Diagnostic Criteria:** A. Marked fear or anxiety about two (or more) of the following five situations: 1. Using public transportation (e.g., automobiles, buses, trains, ships, planes). 2. Being in open spaces (e.g., parking lots, marketplaces, bridges). 3. Being in enclosed places (e.g., shops, theaters, cinemas). 4. Standing in line or being in a crowd. 5. Being outside of the home alone. B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence). C. The agoraphobic situations almost always provoke fear or anxiety. D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context. F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. If another medical condition (e.g., inflammatory bowel disease, Parkinson's disease) is present, the fear, anxiety, or avoidance is clearly excessive. I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder for example, the symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder): and are not related exclusively to obsessions (as in obsessive-compulsive disorder), perceived defects or flaws in physical appearance (as in body dysmorphic disorder), reminders of traumatic events (as in posttraumatic stress disorder), or fear of separation (as in separation anxiety disorder). **Note:** Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual's presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.