Anxiety disorder

• Fear vs Anxiety?
• Adaptive?
• Stress and anxiety
• Trait anxiety: This is a habitual tendency to be
anxious in general (a trait)
• State anxiety: This is the anxiety felt at the
present, cross-sectional moment (state)
NMHS, 2015-16
ICD 10 DSM V

• Phobic anxiety disorder • Separation Anxiety disorder

– Agoraphoobia • Selective mutism
– Social phobia
• Specific Phobia
– Specific phobia
• Social Anxiety Disorder
• Other anxiety disorder
• Panic Disorder
– Panic disorder
– Generalized Anxiety Disorder • Agoraphobia
• Obsessive- compulsive • GAD
disorder
 Agoraphobia
• Panic: acute intense attack of anxiety
accompanied by feelings of impending doom
• 6 months
• rigidly avoid situations in which it would be
difficult to obtain help
• prefer to be accompanied by a friend or a
family member and closed-in vehicles
• Marked and consistently manifested fear in or
avoidance of at least two of the following
situations:
(1) crowds;
(2) public places;
(3) travelling alone;
(4) travelling away from home.
• at least two symptoms present together, on at
least one occasion, from the list below, one of
which must have been
• from items (1) to (4)
• Autonomic arousal symptoms
(1) Palpitations or pounding heart, or accelerated
heart rate.
(2) Sweating.
(3) Trembling or shaking.
(4) Dry mouth (not due to medication or
dehydration).
• Symptoms concerning chest and abdomen
(5) Difficulty breathing.
(6) Feeling of choking.
(7) Chest pain or discomfort.
(8) Nausea or abdominal distress (e.g. churning in stomach).
Symptoms concerning brain and mind
(9) Feeling dizzy, unsteady, faint or light-headed.
(10) Feelings that objects are unreal (derealization), or that
one's self is distant or "not really here"
(depersonalization).
(11) Fear of losing control, going crazy, or passing out.
(12) Fear of dying.
• General symptoms
(13) Hot flushes or cold chills.
(14) Numbness or tingling sensations.
• Significant emotional distress due to the
avoidance or the anxiety symptoms, and a
• recognition that these are excessive or
unreasonable.
• Symptoms are restricted to or predominate in
the feared situations or when thinking about
them.
 Panic Disorder
• 1month
• Recurrent panic attacks, that are not
consistently associated with a specific
situation or object,
• and often occurring spontaneously (i.e. the
episodes are unpredictable)
 A panic attack
(a) it is a discrete episode of intense fear or
discomfort;
(b) it starts abruptly;
(c) it reaches a crescendo within a few minutes
and lasts at least some minutes;
(d) at least four symptoms must be present from
the list below, one of which must be from
items (1) to (4):
• Autonomic arousal symptoms
(1) Palpitations or pounding heart, or accelerated
heart rate.
(2) Sweating.
(3) Trembling or shaking.
(4) Dry mouth (not due to medication or
dehydration).
Symptoms concerning chest and abdomen
(5) Difficulty breathing.
(6) Feeling of choking.
7. Chest pain or discomfort.
8. Nausea or abdominaldistress
• Symptoms concerning brain and mind
(9) Feeling dizzy, unsteady, faint or light-headed.
(10) Feelings that objects are
unreal (derealization), or that one's self is distant or
"not really here" (depersonalization).
(11) Fear of losing control, going
crazy, or passing out.
(12) Fear of dying.
Other
(13) Hot flushes or cold chills.
(14) Numbness or tingling sensations
 Social Phobia
• phobia refers to an excessive fear of a specific
object, circumstance, or situation
• social phobia is a strong, persisting fear of
situations in which embarrassment can occur
• A specific phobia is a strong, persisting fear of an
object or situation
• diagnosis of both specific and social phobias
requires the development of intense anxiety,
even to the point of panic, when exposed to the
feared object or situation.
• lifetime prevalence 3%
• The peak age of onset for social phobia is in
the teens, although onset is common as young
as 5 years of age and as old as 35.
• Comorbidity - history of other anxiety
disorders, mood disorders, substance-related
disorders, and bulimia nervosa.
 Criteria
• A. Either marked fear / avoidance of of being
the focus of attention, or fear of behaving in a
way that will be embarrassing or humiliating
• These fears are manifested in social situations
-eating or speaking in public
- encountering known individualsin public
- entering or enduring small group
situations, such as parties, meetings and
classrooms
• At least two symptoms of anxiety in the feared
situation at some time since the onset of the
disorder, as
• defined in criterion B for (Agoraphobia)
– Autonomic arousal symptoms
– Symptoms concerning chest and abdomen
– General symptoms
(5) Difficulty breathing.
(6) Feeling of choking.
(7) Chest pain or discomfort.
(8) Nausea or abdominal distress (e.g. churning in stomach).
Symptoms concerning brain and mind
(9) Feeling dizzy, unsteady, faint or light-headed.
(10) Feelings that objects are unreal (derealization), or that
one's self is distant or "not really here"
(depersonalization).
(11) Fear of losing control, going crazy, or passing out.
(12) Fear of dying.
• General symptoms
(13) Hot flushes or cold chills.
(14) Numbness or tingling sensations.
• Significant emotional distress due to the
avoidance or the anxiety symptoms, and a
• recognition that these are excessive or
unreasonable.
• Symptoms are restricted to or predominate in
the feared situations or when thinking about
them.
• addition one of the following symptoms:
• (1) Blushing.
• (2) Fear of vomiting.
• (3) Urgency or fear of micturition or defecation.
• C. Significant emotional distress due to the
symptoms or to the avoidance.
• D. Recognition that the symptoms or the
avoidance are excessive or unreasonable.
• E. Symptoms are restricted to or predominate in
the feared situation or when thinking about it.
 Specific (isolated) phobias
• A. Either (1) or (2):
• (1) marked fear of a specific object or situation
not included in agoraphobia (F40.0) or social
phobia (F40.1);
• (2) marked avoidance of such objects or
situations
• Among the most common objects or situations
are animals, birds, insects, heights, thunder,
flying, small enclosed
• spaces, sight of blood or injury, injections,
dentists and hospitals.
• Symptoms of anxiety in the feared situation at
some time since the onset of the disorder, as
defined in
• criterion B for F40.0 (Agoraphobia).
• C. Significant emotional distress due to the
symptoms or the avoidance, and a recognition
that these are
• excessive or unreasonable.
• D. Symptoms are restricted to the feared
situation, or when thinking about it.
• If desired, the specific phobias may be
subdivided as follows:
• - animal type (e.g. insects, dogs)
• - nature-forces type (e.g. storms, water)
• - blood, injection and injury type
• - situational type (e.g. elevators, tunnels)
• - other type