Anxiety Disorders

Anxiety Disorders

Generalized Anxiety Disorder

• 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.

Biological Perspective

• 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).

Psychological Perspectives

• 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.

Behavioral Perspective

• 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.

Panic Disorder

• 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.

Agoraphobia

• 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.

Specific Phobia

• 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.

Treatment Overview

• 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.