Anxiety

Anxiety, Obsessive-Compulsive, and Related Disorders

Introduction

  • Copyright Notice: This material is the copyrighted property of Assessment Technologies Institute, L.L.C. and is provided under license for nursing programs utilizing ATI Engage resources.

Learning Objectives

  • Describe the impact of anxiety and obsessive-compulsive and related disorders on a client’s overall health.
  • Explore epidemiological and etiological risk factors contributing to clients experiencing anxiety and obsessive-compulsive related disorders.
  • Differentiate the clinical presentation of clients experiencing anxiety and obsessive-compulsive related disorders.
  • Explore the role of the nurse in caring for clients experiencing these disorders.
  • Apply the nursing process using clinical judgment functions while providing care to clients with these disorders.

Overview of Anxiety

  • Normal Response: Anxiety is a normal response to stress and is a common human experience, characterized by feelings of worry, fear, or nervousness when threatened.

  • Temporary vs. Persistent Anxiety:

    • Temporary anxiety can be motivational.
    • Persistent or excessive anxiety can interfere with daily functioning (APA, 2021).

  • Prevalence:

    • Anxiety disorders are the most commonly diagnosed psychiatric disorders in the U.S.
    • Approximately 30% of adults report experiencing an anxiety disorder at some point in their lives (NAMI, 2017).

Physiological Expression of Anxiety

  • Anxiety serves an adaptive function by protecting individuals from danger.
  • Symptoms of anxiety become problematic when they:
    • Occur at inappropriate times or situations.
    • Increase in frequency.
    • Increase in intensity affecting the ability to function.
    • Prolong in duration.

The Anxiety Cycle

  • Components:
    • Stress: Triggering thoughts such as "What will happen next?" or "Only bad will come of this."
    • Fear is followed by:
    • Anxiety
    • Worry
    • Physiological symptoms:
      • Dizziness
      • Elevated heart rate
      • Gastrointestinal distress
      • Fast, shallow breathing
      • Dry throat
      • Beginning to sweat
    • Behavioral Responses:
    • Fight: Anger, frustration, aggression.
    • Flight: Avoidance, alcohol use.
    • Freeze: Inability to respond.
    • Fawn: Trying to please to avoid anxiety.

Levels of Anxiety

  • Mild Anxiety: Restlessness, trouble sleeping, feeling overwhelmed, acting out.
  • Severe Anxiety: Panic, experiencing terror, exhaustion, and withdrawal from stimuli.

Obsessive-Compulsive Disorder (OCD)

  • Nature of OCD:
    • Precipitated by anxiety, can occur in children and adults.
    • Involves obsessions (recurrent, intrusive thoughts) and compulsions (ritualistic behaviors performed to alleviate anxiety).
    • Time-consuming behaviors interfere with daily tasks.

Examples of Obsessions

  • Fear of harm (to oneself or others), safety concerns, worries about germs, offending a deity, forgetting important things, and the need for orderliness.

Examples of Compulsions

  • Checking door locks repeatedly, a ritualistic order for handwashing, repeating words or phrases, hair pulling, counting objects or actions, and repeating actions a certain number of times.

Epidemiological and Etiological Risk Factors

  • Anxiety-Related Disorders: Most common mental illness in adults in the U.S. (Anxiety & Depression Association of America, 2022a).
    • Genetic link: Family history increases risk; more than 25% of youths aged 13-18 are affected.
    • Gender Differences: Individuals assigned female at birth are twice as likely to develop anxiety disorders.

Comorbidities

  • Anxiety is transdiagnostic and seen alongside various disorders:
    • Panic disorders, PTSD, depressive disorders, substance use, somatic and sleep disorders, eating disorders (APA, 2013).
    • Includes chronic illnesses such as pulmonary conditions, myocardial infarction, cancer, IBS, mood disorders, tic disorders, ADHD, etc.

Risk Factors for Anxiety Disorder and OCD

  • Contributors:
    • Brain chemistry, social influences, lifestyle factors, family background, and genetic predisposition.

Adverse Childhood Experiences (ACEs)

  • Factors increasing the risk for anxiety include:
    • Lack of close relationships with caregivers, few friends, inconsistent discipline.
  • Protective factors (Positive Childhood Experiences, PCEs):
    • Safe and stable relationships, positive peer networks, and parental engagement.

Distinguishing Anxiety from OCD

  • Clinical Manifestations:
    • Recognition of varying signs and symptoms that characterize anxiety versus OCD conditions.

Anxiety Disorders Characteristics

  • Symptoms include:
    • Apprehension, restlessness, irritability, anticipatory anxiety, avoidance of triggers.
  • Physiological Signs:
    • Increased heart, respiratory rates, sweating, fatigue, concentration difficulties, GI disturbances, sleep disruptions.

Specific Anxiety Disorders (1 of 2)

  • Separation Anxiety: Inappropriate excessive fear of separation from attachments.
  • Selective Mutism: Failure to speak in known social situations affecting communication.
  • Phobias: Extreme fear and anxiety towards specific objects or situations (e.g., animals, heights).

Specific Anxiety Disorders (2 of 2)

  • Social Anxiety: Fear of self-presentation in social situations leading to hyperarousal.
  • Panic Disorder: Occurrence of unexpected panic attacks defined as abrupt surges of intense fear.
  • Agoraphobia: Anxiety linked to specific locations or travel situations.

Obsessive-Compulsive Disorders

  • Characterized by uncontrollable obsessive thoughts and compulsive behaviors (e.g., excessive cleaning, checking).

Specific Obsessive-Compulsive Disorders

  • Body Dysmorphic Disorder: Preoccupation with perceived appearance flaws.
  • Hoarding Disorder: Difficulty discarding possessions leading to clutter.
  • Trichotillomania: Hair pulling, often triggered by anxiety, providing relief.
  • Excoriation Disorder: Skin picking resulting in lesions, often focuses on previously affected areas.

Diagnostic Criteria

DSM-5 GAD

  • Main Features:
    • Excessive anxiety and worry over multiple events for at least six months.
    • Difficulty controlling the worry with associated symptoms: restlessness, fatigue, irritability, sleep disturbances.

DSM-5 OCD

  • Main Features:
    • Presence of obsessions and/or compulsions causing distress or impairment with symptoms lasting over an hour per day.

Treatment Approaches

Nonpharmacologic Treatment

  • Psychotherapy: Various approaches including CBT and exposure therapy.
  • Support Groups: Focusing on shared goals for anxiety management.
  • Lifestyle Management: Nutritional strategies, exercise, and avoidance of stimulants.

Pharmacologic Treatment

  • Medications: Use of anxiolytics (benzodiazepines), SSRIs, and SNRIs such as alprazolam, paroxetine, and venlafaxine.

Nursing Role and Client-Centered Care

  • Principles of Care: Trauma-informed, therapeutic relationships, and understanding the client’s perspective of illness.

Prevention Strategies

  • Focus: Managing anxiety rather than prevention, promoting a fulfilling life.

Teaching and Learning Strategies

  • Education on disorder specifics, management strategies, and when to seek help.

Support Strategies for Nurses

  • Engaging in active listening, using therapeutic communication, modeling behaviors, and providing anticipatory guidance.

Nursing Process Assessment

Recognizing Cues

  • Assessment Techniques: Identifying manifestations, aggravating factors, and physiological causes.

Screening Tools

  • GAD-7, HAM-A, SCARED, and others used to identify anxiety disorders.

Analysis and Planning

  • Emphasis on safety, prioritization of client-specific issues, and developing a solution-focused care plan.

Implementation and Evaluation

  • Actions: Communication, milieu control, medication management, and evaluation of care outcomes based on defined goals.

Practice Questions

  • Example scenarios and questions to enhance understanding of nursing interventions in cases of anxiety and OCD.