PHOBIA/ ANXIETY

ANXIETY, PHOBIA & RELATED DISORDERS

ANXIETY

  • Definition: Internal, emotional response to a real or perceived threat.
  • Characteristics:
    • Normal reaction to real dangers or threats to personal or physical health.
    • Normal anxiety subsides when the threat is no longer present.
    • Stress levels are often assessed by societal norms.

DEFENSE MECHANISMS

  • Description: Psychological strategies to cope with anxiety and manage conflict.
  • Features:
    • Subconscious processes.
    • Can be both adaptive (helpful) or maladaptive (harmful).

TYPES OF DEFENSE MECHANISMS

  • Common mechanisms include:
    • Altruism
    • Sublimation
    • Suppression
    • Repression
    • Displacement
    • Reaction formation
    • Conversion
    • Undoing
    • Acting out
    • Regression
    • Dissociation
    • Rationalization
    • Passive aggression
    • Devaluation
    • Idealization
    • Splitting
    • Projection
    • Denial
    • Humor

ASSESSMENT OF ANXIETY

  • Evaluation Criteria:
    • Intensity, frequency, and duration of symptoms.
    • Impact on social or occupational functioning.
    • Persistent symptoms that cause significant distress.

LEVELS OF ANXIETY

  1. Mild Anxiety:

    • Enhances problem-solving; information is grasped more effectively.
    • Motivating but causes selective inattention.

  2. Moderate Anxiety:

    • Decreased optimal problem-solving.
    • Physical symptoms begin (e.g., heart racing).

  3. Severe Anxiety:

    • Limited field of vision, concentrated on immediate concerns.
    • Somatic symptoms intensify; learning difficulties arise.

  4. Panic Anxiety:

    • Out of touch with reality; irrational behavior.
    • Possible hallucinations or paranoia.

INTERVENTIONS FOR ANXIETY

  • Mild/Moderate Anxiety Interventions:

    • Identify and verbalize anxious feelings.
    • Use active listening techniques.
    • Determine triggers for anxiety; offer physical activity or distraction.

  • Severe & Panic Anxiety Interventions:

    • Stay calm; anxiety is contagious.
    • Limit stimuli and use firm, simple communication.
    • Implement safety boundaries and listen for themes.
    • Encourage exercise, but seclusion is a last resort.

GENERALIZED ANXIETY DISORDER (GAD)

  • More prevalent in women; often linked to comorbid medical conditions.
  • Genetic and environmental factors play significant roles.
  • Constant worry lasting for 6+ months includes 3 from: restlessness, fatigue, irritability, sleep disturbances.

PANIC DISORDER

  • Characterized by panic attacks lasting typically 5-30 minutes.
  • Symptoms include terror, physical discomfort, but not linked to specific triggers or situations.
  • DSM-5 panic attack criteria include palpitations, trembling, sensations of choking, fear of losing control, and feeling detached from reality.

PHOBIAS

  • Specific fear causing avoidance behavior; diagnosis needed only when the fear markedly affects functioning.
  • Types of Phobias:
    • Specific phobia
    • Agoraphobia: fear of being in situations where escape might be difficult.
    • Social anxiety disorder: fear of social interactions due to fear of being judged.

TREATMENT FOR ANXIETY/PHOBIA

  • Cognitive Behavioral Therapy (CBT):
    • Change negative thinking patterns and learned responses.
    • Techniques include systematic desensitization and flooding.
    • Relaxation techniques and mindfulness meditations are also effective.

OBSESSIVE-COMPULSIVE DISORDER (OCD)

  • Develops typically in late teens/early 20s.
  • Involves obsessions (intrusive thoughts) and compulsions (repetitive behaviors).
  • Treatment includes SSRIs, exposure and response prevention therapy.

BODY DYSMORPHIC DISORDER & HOARDING

  • Body Dysmorphic Disorder involves preoccupation with perceived physical flaws, leading to compulsive behaviors.
  • Hoarding Disorder characterized by difficulty parting with possessions, causing distress.

TRICHOTILLOMANIA

  • Impulse to pull out one’s hair to relieve anxiety; may lead to significant distress or shame.

PHARMACOLOGY

  • Medications include:
    • SSRIs: First-line for many anxiety disorders.
    • SNRIs: Effective for generalized anxiety.
    • Buspirone: Targets social anxiety and GAD.
    • Benzodiazepines: Short-term management of acute anxiety.

COMPLEMENTARY & ALTERNATIVE MEDICINE

  • Include treatments like Kava Kava, Valerian root, and progressive muscle relaxation.

NURSING PROCESS AND INTERVENTIONS

  • Focus on structured interventions, teaching self-care, and promoting relaxation techniques.
  • Anticipate collaboration in planning to enhance patient outcomes, especially during crises.