Adventist Medical Center College

San Miguel, Iligan City

School of Nursing

ANXIETY DISORDERS

PANIC ANXIETY
- Is composed of discrete episodes of panic attacks that is 15 to 30 minutes of rapid,
intense, escalating anxiety that a person experiences great emotional fear as well as
physiologic discomfort (videbeck, 2014)
- An overwhelming fear that occurs out of the blue without warning and for no reason.
Etiology:
- Genetically transmitted
- Environmental factors
- Brain and biological factors: Increase in serotonin; abnormalities in the brain’s
benzodiazepine receptors
Signs and Symptoms:
- Palpitation, increased heart rate, or chest pain
- Suffocation or feeling of choking, or shortness of breath
- Paresthesia, numbness or tingling
- Abdominal distress or nausea
- Tremors, trembling
- Chills or hot flushes, sweating, dizziness, light-headedness
- Fear of dying, going crazy or losing control
- Depersonalization
- Derealization
- Agoraphobia

Nursing Interventions:
1. Provide a safe environment and ensure client’s privacy during a panic attack. 

2. Remain with the client during a panic attack. 

3. Help client to focus on deep breathing. 

4. Talk to client in a calm, reassuring voice. 

EVALYN M. LECCIONES,RN ‘18

5. Teach client to use relaxation techniques. 


6. Help client to use cognitive restructuring techniques. 

7. Engage client to explore how to decrease stressors and anxiety-provoking situations.
Medical Management:
1. Selective serotonin reuptake inhibitors (SSRI’s)
2. Antidepressants - imipramine
3. Benzodiazepene – clonazepam, alprazolam
Psychotherapy:

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 - Cognitive Behavior Therapy

PHOBIA
- Is an illogical, intense, and persistent fear of a specific object or a social situation that
causes extreme distress and interferes with normal functioning.
Etiology:
- individual factors, environment, family environment, genetic
Types of phobias
1. Agoraphobia - fear of open spaces, public places
2. Social phobia / social anxiety disorder – which is anxiety provoked by certain social or
performance’s situation
3. Specific phobia – irrational fear of an object or a situation.
5 categories:
a. animal phobia – fear of animal or insects, often develops in childhood and can
continue through adulthood.
Examples: Arachnophobia – fear of spiders
Ophidiophobia – fear of snakes
Mysophobia – the fear of germs
b. natural environmental phobia – fear of storms, heights, water, or other phenomena
example: Acrophobia – fear of heights
Astraphobia – the fear of thunder/lightning
c. blood-injection phobia – fear of seeing of one’s or other’s blood, traumatic injury, or
an invasive medical procedure such as an injection.
Example: Trypanophobia – fear of needles
Thanaphobia – fear of death
Homophobia – fear of blood
d. situational phobia – fear of being in a specific in a specific situation such as on a
bridge or in a tunnel, elevator, small room, hospital, or airplane
example: Claustrophobia – the fear of small spaces
Aerophobia – the fear of flying
Glossophobia – the fear of public speaking
Monophobia – fear of being alone
e. other types of specific phobia – cued by other stimuli than the above, such as of
choking, vomiting, or contracting an illness EVALYN M. LECCIONES,RN ‘18
example: Emetophobia – fear of vomiting
Other examples: Atychiphobia – fear of failure
Philophobia – fear of love
Hippopotomonstrosesquippedaliophobia – the fear of long words
Nursing Management:
1. Application of Behavior Therapy
a. Systematic desensitization – uses relaxation techniques and carefully planned
exposure to the feared object or situation gradually.
b. Flooding – a rapid desensitization - the client is exposed to the feared object or
situation without much preparation
2. Do not force the client to get in contact with the feared object
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 3. Express client’s feelings and thoughts
4. Videotape with review and feedback and role playing
5. Do not reason out or humiliate client
6. Protect patient from acting out impulses that may harmful to him or others.

Medical Treatment:
- Imipramine, alprazolam, clonazepam, phenelzine

GENERALIZED ANXIETY DISORDER

- Also known as free floating anxiety, is characterized by persistent anxiety that hounds the
person everyday and cannot be controlled.

Signs and symptoms:

- Restless
- Muscle tension
- Difficulty thinking
- Irritable
- Sleep alteration
- Fatigue
- Uneasiness
Nursing Interventions:
1. Psychosocial
- Support therapy – to provide patient assurance and comfort
- Cognitive-Behavioral Therapy(CBT) – relaxation techniques
2. Provide calm and quiet environment
3. Encourage patient to describe and discuss their feelings with you.
4. Educate client on signs and symptoms and enhance problem solving skills
5. Refer to support groups
Medical Management:
1. Buspirone (Buspar) – drug of choice
2. Selective Serotonin Reuptake inhibitors (SSRI’s) or SNRI

OBSESSIVE-COMPULSIVE DISORDER

Obsessions – recurrent, persistent, intrusive and unwanted thoughts, images, or impulses that EVALYN M. LECCIONES,RN ‘18
cause marked anxiety and interfere with interpersonal, social, or occupational function.

Compulsions – are ritualistic or repetitive behaviors or mental acts that a person carries out
continuously in an attempt to neutralize anxiety.

Common compulsions:
o Checking rituals (repeatedly making sure the door is locked or the coffee pot is
turned off ) 


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 o Counting rituals (each step taken, ceiling tiles, concrete blocks, desks in a
classroom) 

o Washing and scrubbing until the skin is raw 

o Praying or chanting 

o Touching, rubbing, or tapping (feeling the 
 texture of each material in a clothing
store; 
 touching people, doors, walls, or oneself ) 

o Hoarding items (for fear of throwing away 
 something important) 

o Ordering (arranging and rearranging items 
 on a desk, shelf, or furniture into a
perfect order; vacuuming the rug pile in one direction) 

o Rigid performance (getting dressed in an unvarying pattern) 

o Aggressive urges (for instance, to throw one’s child against a wall) 


DSM-5 DIAGNOSTIC CRITERIA: Obsessive-Compulsive Disorder 300.3 (F42)

A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at
some time during the disturbance, as intrusive and unwanted, and that in most
individuals cause marked anxiety or distress.
2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to
neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g.,
praying, counting, repeating words silently) that the individual feels driven to perform
in response to an obsession or according to rules that must be applied rigidly.
2.The behaviors or mental acts are aimed at preventing or reducing anxiety or EVALYN M. LECCIONES,RN ‘18
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.
Note: Young children may not be able to articulate the aims of these behaviors or
mental acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour
per day) or cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.

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 C. The obsessive-compulsive symptoms are not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a medication) or another medical
condition.
D. The disturbance is not better explained by the symptoms of another mental
disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation
with appearance, as in body dysmorphic disorder; difficulty discarding or parting with
possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling
disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in
stereotypic movement disorder; ritualized eating behavior, as in eating disorders;
preoccupation with substances or gambling, as in substance-related and addictive
disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual
urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-
control, and conduct disorders; guilty ruminations, as in major depressive disorder;
thought insertion or delusional preoccupations, as in schizophrenia spectrum and
other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum
disorder).
Specify if:
With good or fair insight: The individual recognizes that obsessive-compulsive
disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are
probably true.
With absent insight/delusional beliefs: The individual is completely convinced that
obsessive-compulsive disorder beliefs are true.
Specify if:
Tic-related: The individual has a current or past history of a tic disorder.
Reprint permission pending from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright 2013).
American Psychiatric Association.

RELATED DISORDER:

 Dermatillomania or skin picking – is self-soothing behavior that is characterized by EVALYN M. LECCIONES,RN ‘18
repeated picking at one's own skin which results in skin lesions and causes
significant disruption in one's life.
 Trichotillomania or repetitive hair pulling – compulsive hair pulling from scalp, eyebrows,
or other parts of the body; leaves patchy bald spots which the person tries to conceal
 Onychophagia or nail biting – is a self-soothing behavior; it is sometimes described as a
parafunctional activity, the common use of the mouth for an activity other than
speaking, eating, or drinking. For example, fingers and hands can look unattractive as a
result of damage finger nails that look shredded and torn.

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 Kleptomania or compulsive stealing – reward-seeking behavior; stolen item is not the
reward, it is the thrill of stealing and not getting caught. steal unnecessary items for no
reason.
 Oniomania or compulsive buying – reward seeking behavior possessions are acquired
compulsively without regard for cost or need for the item
 Body dysmorphic disorder – is a preoccupation with imagined or slight defect in physical
appearance that causes significant distress for the individual and interferes with functioning
in daily life.
 Hoarding disorder – is a persistent difficulty discarding or parting with possessions because
of a perceived need to save them; experiences stress at the thought of getting rid of an item
 Body identity integrity disorder – also known as amputee identity disorder and
apotemnophilia or “amputation love”.
Example: The nurse is assessing a client who wants an amputation of his healthy left arm.
The client feels that the left arm "does not belong" to the body and it feels unnatural

Nursing diagnoses can include the following:

 Anxiety 

 Ineffective Coping 

 Fatigue 

 Situational Low Self Esteem 

 Impaired Skin Integrity (if scrubbing or 
 washing rituals) 


Nursing Interventions (OCD)

1. Offer encouragement, support, and compassion
2. Be clear with the client that you believe he or she can change
3. Encourage the client to talk about feelings, obsessions, and rituals in detail.
4. Gradually decrease time for the client to carry out ritualistic behaviors
5. Assist client to use exposure and response prevention behavioral techniques
6. Encourage client to use techniques to manage and tolerate anxiety responses.
7. Assist client to complete daily routine and activities within agreed-on time limits.
8. Encourage the client to develop and follow a written schedule with specified times and
activities.
EVALYN M. LECCIONES,RN ‘18
Client Family Education (OCD)
For clients:
- Teach about OCD
- Review the importance of talking openly obsessions, compulsions, and anxiety
- Emphasize medication compliance as an important part of treatment
- Discuss necessary behavioral techniques of managing anxiety and decreasing prominence
of obsessions.
- Tolerating anxiety is uncomfortable, but not harmful to health or well-being.
For Families:
- Avoid giving advice such as “Just think of something else.”
- Avoid trying to fix the problem – that never works.

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 - Be patient with their discomfort
- Monitor your own anxiety level and take a break from the situation if you need to.

Medical Management:
1. SSRIs: Luvox- fluvoxamine. Zoloft- sertraline.
2. SNRIs: Effexor- venlafaxine.

EVALYN M. LECCIONES,RN ‘18