Anxiety Disorders

Definition: Excessive and uncontrollable anxiety and worry about everyday life without a specific reason.
Duration: Anxiety lasts for an extended period, significantly impacting daily life.
Symptoms:
- Mental and physical exhaustion.
- Diagnostic Criteria (A-E):
  - A: Excessive anxiety and worry.
  - B: Difficulty controlling the worry.
  - C: Associated with three or more symptoms present for more days than not over the past six months:
    - Restlessness or feeling keyed up.
    - Easily fatigued.
    - Difficulty concentrating or mind going blank.
    - Irritability.
    - Muscle tension.
    - Sleep disturbances.
  - D: Disturbance is not attributed to the physiological effects of substances or other medical conditions.
  - E: Anxiety causes clinically significant distress or impairment in important areas of functioning.

Genetic and Neurobiological Factors:
- The most common genetic predisposition is neuroticism, with modest heritability (15-20% variance attributed to genetic factors for GAD).
Neurotransmitters and Brain Structure:
- GABA: Inhibitory neurotransmitter affecting anxiety regulation.
- Amygdala: Regulates emotional response and is involved in fear processing.
- Imbalances in serotonin (mood regulation) and norepinephrine (stress response) are linked to GAD.
- Dysfunction in brain circuits modulating emotional response (particularly concerning the amygdala).

Psychodynamic Perspective:
- Generalized anxiety results from unconscious conflicts and inadequate coping mechanisms.
- Individuals with GAD may have histories of trauma or overcontrolling parenting that promote anxiety.
Cognitive Perspective:
- Schema Theory (Beck):
  - People with GAD develop negative schemas that perceive the world as dangerous.
  - Components:
    - Systematic Bias: Interpretations are often danger-related.
    - Individuals hold negative automatic thoughts concerning their safety and situations.
- Intolerance of Uncertainty Model:
  - Individuals struggle with uncertainty and demonstrate cognitive avoidance to manage anxiety.

Cognitive Avoidance Theory of Worry (Borkovec et al.):
- Worry serves to avoid unpleasant imagery.
- Reinforcement of worry prevents emotional processing, maintaining anxiety.
- Fear extinction is lessened due to avoidance behaviors.

Definition: Characterized by recurrent, unexpected panic attacks followed by concern about future attacks.
Diagnostic Criteria (A-D):
- A: Must have recurrent unexpected panic attacks (defined by at least 4 physical and cognitive symptoms).
- B: Must experience anticipatory anxiety regarding future panic attacks.
- C: Symptoms cannot be attributed to substances or other medical conditions.
- D: The disturbance is not better accounted for by another mental disorder.

Definition: Fear of situations where escape might be difficult in the event of a panic attack.
Symptoms: Occurs in settings like public transport, open or enclosed spaces, crowds, or lacking companionship.

Definition: Marked and persistent fear of a specific object or situation.
Diagnostic Criteria (A-G):
- A: Marked fear or anxiety about a specific object/situation.
- B: Immediate fear in response to the phobia.
- C: Actively avoided or endured under duress.
- D: Fear is disproportionate to actual danger.
- E: Persistent for 6 months or more.

Different approaches apply to anxiety disorders, recognizing the complexity in symptoms, biological influences, and psychological processes. Treatment might include cognitive-behavioral therapy, medication for neurotransmitter regulation, and psychodynamic insights to address deeper conflicts.