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Anxiety & Anxiety Disorders

November 18, 2013

Normal Anxiety
Everyone experiences anxiety. It is characterized most commonly as a diffuse, unpleasant, vague sense of apprehension, often accompanied by
autonomic symptoms such as headache, perspiration, palpitations, tightness in the chest, mild stomach discomfort, and restlessness, indicated
by an inability to sit or stand still for long. The particular constellation of symptoms present during anxiety tends to vary among persons.
Fear versus Anxiety
Anxiety is an alerting signal; it warns of impending danger and enables a person to take measures to deal with a threat. Fear is a similar alerting
signal, but should be differentiated from anxiety. Fear is a response to a known, external, definite, or nonconflictual threat; anxiety is a
response to a threat that is unknown, internal, vague, or conflictual.

Classification of Anxiety Disorders

Panic disorder
Recurrent unexpected panic attacks characterized by four or more of the following:
Trembling or shaking
Shortness of breath
Feeling of choking (also known as air hunger)
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, lightheaded, or faint
Derealization or depersonalization
Fear of losing control or going crazy
Fear of dying
Numbness or tingling
Chills or hot flashes
Persistent concern of future attacks
Worry about the meaning of or consequences of the attacks (e.g., heart attack or stroke)
Significant change in behavior related to the attacks (e.g., avoiding places at which panic attacks have occurred)
Presence of agoraphobia

Fear of being in 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

Patients with agoraphobia rigidly avoid situations in which it would be difficult to obtain help. They prefer to be accompanied by a friend or a
family member in busy streets, crowded stores, closed-in spaces (e.g., tunnels, bridges, and elevators), and closed-in vehicles (e.g., subways,
buses, and airplanes). Patients may insist that they be accompanied every time they leave the house.

Often results in avoidance of the feared places or situations, for example:

Traveling on a bus, train, or airplane
Standing in a line
Small enclosed rooms

Social phobia
Marked and persistent fear of one or more social or performance situations in which the person is concerned about negative evaluation or
scrutiny by others, for example:
Public speaking
Writing, eating, or drinking in public
Initiating or maintaining conversations
Fears humiliation or embarrassment, perhaps by manifesting anxiety symptoms (e.g., blushing or sweating)
Feared social or performance situations are avoided or endured with intense anxiety or distress

Specific phobia
Marked and persistent fear that is excessive, unreasonable, cued by the presence or anticipation of a specific object or situation, for example:
Enclosed spaces

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Anxiety & Anxiety Disorders
November 18, 2013

Heights Blood
Storms Provokes an immediate anxiety response
Animals (e.g., snakes or spiders) Recognition that the fear is excessive or unreasonable
Receiving an injection Avoidance, anticipatory anxiety, or distress is significantly impairing

Obsessive-compulsive disorder
Has obsessions or compulsions
Obsessions are defined as recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate, for
Repeated doubts
Sexual images
Compulsions are defined as repetitive behaviors or mental acts whose goal is to prevent or to reduce anxiety or distress, for example:
Hand washing
Repeating words
Recognition that the fear is excessive or unreasonable
Obsessions cause marked distress, are time-consuming (more than 1 hour per day), or cause significant impairment in social, occupational or
other daily functioning

Posttraumatic Stress Disorder and Acute Stress Disorder

ASD is an anxiety disorder that arises in response to a terrifying traumatic event. Common symptoms are: numbing; detachment; de-
realization; depersonalization or dissociative amnesia; continued re-experiencing of the traumatic event by such way as thoughts, dreams or
nightmaresThe person has been exposed to a traumatic event, and flashbacks; and avoidance of anything that reminds them of the event.
Symptoms last for a minimum of 2 days, and a maximum of 4 weeks, and occur within 4 weeks of the event.

Posttraumatic stress disorder (PTSD) is a condition marked by the development of symptoms after exposure to traumatic life events. The
person reacts to this experience with fear and helplessness, persistently relives the event, and tries to avoid being reminded of it.
To make the diagnosis, the symptoms must last for more than a month after the event and must significantly affect important areas of life,
such as family and work.

Generalized anxiety disorder or overanxious disorder

Anxiety can be conceptualized as a normal and adaptive response to threat that prepares the organism for flight or fight. Persons who seem to
be anxious about almost everything, however, are likely to be classified as having generalized anxiety disorder.

Excessive anxiety and worry about a number of events or activities (future oriented), occurring more days than not for at least 6 months
Worry is difficult to control
Worry is associated with at least three of the following symptoms:
Restlessness or feeling keyed up or on edge
Easily fatigued
Difficulty concentrating
Muscle tension
Sleep disturbance
Anxiety and worry cause significant distress and impairment in social, occupational, or other daily functioning

Other Anxiety Disorders

Anxiety Disorder due to a General Medical Condition
Many medical disorders are associated with anxiety. Symptoms can include panic attacks, generalized anxiety, obsessions and
compulsions, and other signs of distress. In all cases, the signs and symptoms will be due to the direct physiological effects of the
medical condition.
Anxiety Disorder not Otherwise Specified
Some patients have symptoms of anxiety disorders that do not meet the criteria for any specific DSM-IV-TR anxiety disorder.

Kaplan & Sadocks Synopsis of Psychiatry 10th edition

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