Anxiety Disorders

Ch. 18. Week 2

Anxiety

“emotion that can range from relatively mild feelings of
uneasiness to immobilizing terror. . . an adaptive response to threatening or harmful stimuli”
o Hyperarousal
o Increased autonomic responses (HR, BP, respiration)
o FIGHT, FLIGHT, OR FREEZE

Anxiety Disorder

When the protective fear response is prolonged and
inappropriate to the actual threat level of the environment, compromising the individual’s ability to function

Anxiety Disorders are the most common

psychiatric disorders with a prevalence rate of 15%
o Generalized anxiety disorder
o Separation anxiety
o Selective mutism
o Phobia
o Social anxiety
o Panic disorder
o Agoraphobia
• People are most likely to seek help for anxiety from their primary care providers
• OTPs work with people with anxiety or anxiety disorders in all practice settings

Generalized Anxiety Disorder (GAD)

Excessive fear or anxiety about several everyday life circumstances
o Anxiety and worrisome thoughts substantially interfere with daily activities
o Pervasive, without precipitant, longer duration, accompanied by physical symptoms (restlessness, nausea, feeling on edge)

Separation Anxiety

Excessive fear or anxiety about separation from home
or primary attachment figures
o More common in children but related to more severe panic symptoms and greater impairment when diagnosed in adults
o Worrying about the well-being of attachment figures
o Associated behaviors include reluctance to be alone or away from home and clinging to parents or other attachment figures

Selective Mutism

Consistent failure to speak in social situations despite ypically having normal language development

Phobia

Fear or anxiety about a specific object or situation
o Persists over time and out of proportion to the risk presented
o May exhibit avoidant behaviors

Agoraphobia

Fear or anxiety in at least two of the following situations
1. Using public transportation
2. Being in open spaces
3. Being in enclosed spaces
4. Standing in line or in a crowd
5. Being outside of the home alone
o Associated with thoughts of something terrible happening with no opportunity for escape or to access help
o People may be unable to leave house for treatment

Social Anxiety

Intense fear of anxiety of social situations

Provoked by meeting new people, eating/drinking in front of others, or giving a speech

May be limited to performance social anxiety disorder

Panic Disorder

Recurrent, unexpected panic attacks

Panic disorder is also associated with anxiety or fear about having a panic attack that may result in maladaptive behaviors (e.g. avoiding or restricting daily activities related to triggers)

Gender Difference

Women are 50% more likely to develop an anxiety disorder than men

Gender specific risk factors

• Socioeconomic disadvantage

• Gender based violence

• Responsibility for the care of others

Women - more likely to have comorbid depression, eating disorder, 2nd anxiety disorder

Men- more likely to have comorbid oppositional defiant disorder, conduct disorder, substance use

Environmental Factors

ACEs

Disorder specific factors

Parenting style

Experiences of marginalization or injustice

Impact on Occupational Performance

Physical - high rate of comorbid physical illness

Cognitive - anxiety can impact cognitive functioning

Psychosocial - limited social participation/disruption in education + careers/difficulty maintaining social relationships

Medication

SSRI - first line treatment of anxiety

Benzodiazepines - NOT first line and used as short term treatment of acute symptoms

OT Intervention Approaches

1. Nature Based Approaches

2. Building Routines and Time Use

3. Sensory Approaches

4. Exercise and Wellness