KAREN GAIL GARCIA ABINSAY

IV- BSOT

ANXIET
Y

German, ANGST

Feeling of apprehension
caused by anticipation of
danger, which may be
internal or external.

Accompanied by somatic
signs=hyperactive ANS.

SYNONYMS: dread,
nervousness, worry,

ANXIETY VS. FEAR

ANXIETY
RESPONSE TO UNKNOWN
THREAT
VAGUE
INTERNAL: intrapersonal
(self relationship;
between impulses & the
persons conscience.)

FEAR
RESPONSE TO KNOWN
THREAT
DEFINITE
EXTERNAL: interpersonal
(social relationship;
between pressures of
outside world & the
persons ego)

EPIDEMIOLOGY
Most

common groups of psychiatric

disorders
USA: 30 million
Prevalence: F (30.5% ) >M (19.2%)
1 out of 4 (at least 1 anxiety
disorder)

SYMPTOMS
Anxiety is an emotion often
accompanied by
various physical symptoms, including:
Twitching or trembling
Muscle tension
Headaches
Sweating
Dry mouth
Difficulty swallowing
Abdominal pain (may be

the only
symptom of stress especially in

& MORE SYMPTOMS

Sometimes other symptoms accompany
anxiety:
Dizziness
Rapid or irregular heart rate
Rapid breathing
Diarrhea or frequent need to urinate
Fatigue
Irritability, including loss of your
temper
Sleeping difficulties and nightmares
Decreased concentration
Sexual problems

COMMON CAUSE

There is no one cause for anxiety disorders.

Several factors can play a role
Genetics
Brain biochemistry
Overactive "fight or flight" response

Can be caused by too much stress

Life circumstances
Personality
People who have low self-esteem and poor coping skills may be more
prone

Certain drugs, both recreational and medicinal,

can lead to symptoms of anxiety due to either
side effects or withdrawal from the drug.
In very rare cases, a tumor of the adrenal gland
may be the cause of anxiety.

TYPES
Panic Disorder
Agoraphobia
Specific Phobia
Social Phobia
Obsessive-compulsive disorder
(OCD)
6. Posttraumatic Stress Disorder
(PTSD)
7. Gen. Anxiety disorder/
Overanxiousness
1.
2.
3.
4.
5.

1. PANIC DISORDER
Acute

intense attack of anxiety

accompanied by feelings of
approaching doom.
Peak @ 10 minutes
3 types of attacks: unexpected,
situational, situationally predisposed
(prone)

Panic Disorder
1. Unexpected - the attack "comes out of the
blue" without warning and for no apparent
reason.
2. Situational - situations in which an individual
always has an attack, for example, upon
entering a tunnel.
3. Situationally Predisposed - situations in
which an individual is likely to have a Panic
Attack, but does not always have one. An
example of this would be an individual who
sometimes has attacks while driving.

Panic Disorder
Attacks

characterized by 4 + of the ff:

Palpitations
Sweating
Trembling/shaking
SOB
Feeling of choking
Chest pain/discomfort
Nausea/abdominal distress
Dizziness, lightheaded, faint
Derealization/depersonalization
Fear of losing control or going crazy
Fear of dying
Numbness/tingling
Chills or hot flashes
Concern of future attacks and consequences
Significant change in behavior related to attacks
Presence of agoraphobia

DIAGNOSTIC CRITERIA
With

or without agoraphobia:

1. (Both A and B)
A. Recurrent unexpected panic attacks
B. Attacks ff. by at least 1 month of persistent
concern or worry about having attacks or
significant change in behavior.
2. Not due to effects of substance
3. r/o other anxiety disorders

2. AGORAPHOBIA (w/
Diagnostic Criteria)
A

(1) fear of being in [open] places or situations from which

escape might be difficult, embarrassing, or in which help may
be unavailable in the event of having a panic attack.

(2)r/o

other anxiety disorders

(3)

Often results in avoidance of the feared places or

situations:
Crowds
Stores
Bridges
Tunnels
Traveling on bus, train, airplane
Theaters
Standing in a line
Small enclosed rooms

3. SPECIFIC PHOBIA

Irrational fear of an object.

Types: Animal; natural environment; bloodinjection-injury type; situational; other.
Examples:
Acrophobia
Agoraphobia
Ailurophobia
Claustrophobia
Cynophobia
Erythrophobia
Hydrophobia
Mysophobia
Panphobia

DIAGNOSTIC CRITERIA
1.
2.
3.

4.
5.

Marked by excessive, unreasonable

fear.
Exposure to the phobic stimulus
provokes panic attack.
Phobic situation is avoided or
endured with intense anxiety or
distress.
Avoidance or distress interferes with
normal routine.
18 y/0 under-> duration is at least 6

4. SOCIAL PHOBIA
Irrational

fear of public
situations.
Examples:
Fear of public speaking
Fear of performing
Fear of eating in public

DIAGNOSTIC CRITERIA
Marked by unreasonable fear of 1 or more social or
performance situation in which person is exposed to
unfamiliar people or to possible scrutiny by others.
2. Individual fears that he/she will humiliate self.
3. Exposure to feared social situation provokes anxiety.
4. Situation is avoided or endured with intense anxiety or
distress.
5. Avoidance or distress interferes with normal routine.
6. 18 y/0 under-> duration is at least 6 months
7. Not due to effects of substance
8. If a general medical condition or another mental disorder
is present, the fear in Criterion 1 is unrelated to it.
**Consider additional diagnosis of AVOIDANT PERSONALITY
DISORDER if fear is GENERALIZED.
1.

5. OBSESSIVE-COMPULSIVE
DISORDER (OCD)
Recurrent

intrusive ideas,
impulses, thoughts (obsessions),
or patterns of behavior
(compulsions) that are ego-alien
and produce anxiety if resisted.
Obsession: irresistible thought/feeling
Compulsion: need to act on impulse

OCD
Cleaning. Repeatedly washing their hands,

showering, or constantly cleaning their home;

Checking. Individuals may check several or
even hundreds of times to make sure that stoves
are turned off and doors are locked;
Repeating. Some repeat a name, phrase or
action over and over;
Slowness. Some individuals may take an
excessively slow and methodical approach to
daily activities, they may spend hours organizing
and arranging objects;
Hoarding. Hoarders are unable to throw away
useless items, such as old newspapers, junk
mail, even broken appliances

DIAGNOSTIC CRITERIA
1. Either compulsion
A. Obsession

or obsession.

recurrent and persistent thoughts, impulses, or images experienced

not simply excessive worries about real life problems
Attempts to ignore/suppress thoughts
Recognized that thoughts are product of own mind

B. Compulsion
Repetitive behavior/mental act performed in response to obsession
Aimed at reducing anxiety or preventing some dreaded event
2. Recognition of obsessions and compulsions as

3.
4.
5.

unreasonable.
Caused mark distress, time-consuming, and
significantly interferes with normal routine.
Not restricted to other disorders.
Not due to substance use.

6. POSTTRAUMATIC STRESS
DISORDER (PTSD)

Anxiety produced by extraordinary major life

stress.

Symptoms of PTSD are:

Reexperiencing the event, which can take the form of
intrusive thoughts and recollections, or recurrent
dreams;
Avoidance behavior in which the sufferer avoids
activities, situations, people,and/or conversations which
he/she associates with the trauma;
A general numbness and loss of interest in surroundings;
Hypersensitivity, including: inability to sleep, anxious
feelings, overactive startle response, hypervigilance,
irritability and outbursts of anger.

DIAGNOSTIC CRITERIA
Exposure to traumatic event in which

1.

2.

3.
4.
5.
6.

Actual or threatened death or injury was experienced or

witnessed
Response involved intense fear or helplessness

Re-experiencing event through: recurrent

recollections, recurrent dreams, acting or feeling as if
even were recurring, distress at exposure to similar
events/cues.
Persistent avoidance of stimuli associated with
trauma.
Persistent Sx of hyper-arousal.
Duration of Sx is more than 1 month.
Causes impairment is social and occupational fxn:
Rape-common in women

7. GEN. ANXIETY DISORDER/

OVERANXIOUSNESS
Characterized

by chronic,
generalized anxiety for at least 6
months.
Includes overanxious disorder of
childhood.

DIAGNOSTIC CRITERIA
1.
2.
3.

Excessive anxiety or worry for at least 6 months.

Difficulty controlling the worry.
At least 3 of the ff. are present:
Restlessness
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance

4.
5.
6.

Not confined to other axis 1 disorders.

Causes impairment in Fxning.
r/o substance

DIFFERENTIAL
DIAGNOSIS
Anxiety,

as a symptom, can be associated with

many psychiatric disorders in addition to the
anxiety disorder themselves.
A MSE is necessary to determine the presence of
mood symptoms or psychotic symptoms that
may suggest another psychiatric diagnosis.
For a clinician to conclude that a px has an
anxiety caused by a general medical condition,
the px should clearly have anxiety as the
predominant symptom and should have a
specific causative nonpsychiatric medical
disorder.

DIFFERENTIAL
DIAGNOSIS
To

ascertain the degree to which a general

medical condition is causative for the anxiety,
the clinican should know whether the medical
condition and the anxiety symptoms have been
related closely in literature, the age of onset
(primary anxiety disorders usually have their
onset before age 35), and the pxs family history
of both anxiety disorders and relevant general
medical conditions.
A diagnosis of adjustment disorder with anxiety
must also be considered in the differential
diagnosis.

OTHER DISORDERS
Anxiety

disorder due to GENERAL

MEDICAL CONDITIONS (GMC)
Substance induced anxiety disorder
Anxiety disorders not otherwise
specified
Mixed Anxiety-depressive Disorder

FACTS

Generalized Anxiety Disorder

Women are twice as likely to be afflicted than

men.
Very likely to exist along with other disorders.

Obsessive Compulsive Disorder

It is equally common among men and women.
One third of afflicted adults had their first

symptoms in childhood.

Panic Disorder
Women are twice as likely to be afflicted than

men.
Occurs with major depression in very high

FACTS

Posttraumatic Stress Disorder

Women are more likely to be afflicted than

men.
Rape is the most likely trigger of PTSD, 65% of
men and 45.9% of women who are raped will
develop the disorder.
Childhood sexual abuse is a strong predictor of
lifetime likelihood for developing PTSD.

Social Anxiety Disorder

It is equally common among men and women.

Specific Phobia affects

Women are twice as likely to be afflicted as

Social Effects of Anxiety

Depression

Not as involved with family and friends the way

you used to be
Lowered quality of relationships
Low energy
Lack of motivation to do the things you once
looked forward to doing

Unable to convey the person that you are

Fear and avoidance of situations where
previous attacks occurred

TREATMENT
Medications

(Drug Therapy):
Behavioral Therapy
Cognitive Behavioral Therapy
Psychodynamic Psychotherapy

ALTERNATIVE
TREATMENTS
Acupuncture
Aromatherapy
Breathing Exercises
Exercise
Meditation
Nutrition and Diet Therapy
Vitamins
Self Love

MEDICATIONS
Buspirone: shown to be effective but
usually takes 3-4 weeks, particularly
useful in elderly patients
Benzodiazepines: include Xanax and
Valium, act rapidly and successfully but
can be addictive and loses effectiveness
over time
Side Effects: dizziness, headaches,
nausea, impaired memory

Behavioral and Cognitive

Therapy

Teaches patient to react differently to situations

and bodily sensations that trigger anxiety
Teaches patient to understand how thinking
patterns that contribute to symptoms
Patients learn that by changing how they
perceive feelings of anxiety, the less likely they
are to have them
Examples: Hyperventilating, writing down list of
top fears and doing one of them once a week,
spinning in a chair until dizzy; after awhile
patients learned to cope with the negative
feelings associated with them and replace them
with positive ones

Psychodynamic
Psychotherapy
Psychodynamic therapy is a general name for
therapeutic approaches which try to get the patient to
bring to the surface their true feelings, so that they
can experience them and understand them.
Psychodynamic Psychotherapy uses the basic
assumption that everyone has feelings held in the
subconscious which are too painful to be faced. We
then come up with defenses (such as denial) to
protect us knowing about these painful feelings.
Psychodynamic psychotherapy assumes that these
defenses have gone wrong and are causing more
harm than good, making you seek help. It tries to
subdue them, with the intention that once you are
aware of what is really going on in your mind the
feelings will not be as painful.
Takes an extremely long time and is labor intensive

Acupuncture
Caused by the imbalance of chi
coming about by keeping
emotions in for too long
Emotion effects the chi to move
in an abnormal way: when
fearful it goes to the floor,
when angry the neck and
shoulders tighten
Redirects the chi into a
balanced flow, releases tension
in the muscles, increases flow
of blood, lymph, and nerve
impulses to affected areas
Takes 10-12 weekly sessions

Aromatherapy
Calming Effect: vanilla,
orange blossom, rose,
chamomile, and lavender
Reducing Stress: Lavender,
sandalwood, and nutmeg
Uplifting Oils: Bergamot,
geranium, juniper, and
lavender
Essential Oil Combination:
3 parts lavender, 2 parts
bergamot, and 1 part
sandalwood

Exercise

Benefits: symbolic meaning of the activity, the

distraction from worries, mastery of a sport,
effects on self image, biochemical and
physiological changes associated with
exercise, symbolic meaning of the sport
Helps by expelling negative emotions and
adrenaline out of your body in order to enter a
more relaxed, calm state to deal with issues
and conflicts

Meditation
Cultivates calmness to create a sense of control over life
Practice: Sit quietly in a position comfortable to you and
take a few deep breaths to relax your muscles, next
choose a calming phrase (such as om or that with
great significance to you), silently repeat the word or
phrase for 20 minutes

Nutrition and Diet

Therapy
Foods to Eat: whole grains, bananas,
asparagus, garlic, brown rice, green and
leafy veggies, soy products, yogurt
Foods to Avoid: coffee, alcohol, sugar,
strong spices, highly acidic foods, foods
with white flour
Keep a diary of the foods you eat and your
anxiety attacks; after awhile you may be
able to see a correlation
East small, frequent meals

Vitamins
B-Vitamins stabilize the bodys lactate
levels which cause anxiety attacks (B-6, B1, B-3)
Calcium (a natural tranquilizer) and
magnesium relax the nervous system;
taken in combination before bed improves
sleep
Vitamin C taken in large doses also has a
tranquilizing effect
Potassium helps with proper functioning of
adrenal glands
Zinc has a calming effect on the nervous
system

Self Love
The most important
holistic treatment of all
Laugh: be able to laugh at
yourself and with others;
increases endorphin levels
and decreases stress
hormones
Let go of frustrations
Do not judge self harshly:
dont expect more from
yourself than you do
others
Accept your faults

RESOURCES:
Kaplan

and Sadock. Synopsis of

Psychiatry. 10 ed. USA: Lippincott
Williams & Wilkins, 2007.

Bruce,

Timothy J. "Anxiety disorder."

World Book Student. World Book,
2013. Web. 11 Sept. 2013