Anxiety Disorders

Psychopathology: Anxiety and Stressor-Related Problems

Overview of Anxiety Disorders

  • Anxiety Disorders: Characterized by excessive feelings of apprehension, uncertainty, and fear.

  • Types of Anxiety Disorders:

    • Specific Phobias

    • Social Anxiety Disorder

    • Panic Disorder & Agoraphobia

    • Generalized Anxiety Disorder (GAD)

    • Obsessive-Compulsive Disorder (OCD)

    • Trauma & Stress-Related Disorders

Nature of Anxiety, Fear, and Panic

  • Anxiety: An excessive or aroused state characterized by emotions that can disrupt normal daily living.

    • Out of proportion to the threat posed.

    • Constant state of distress.

    • Symptoms include:

    • Inability to relax

    • Muscle tension

    • Rapid adrenaline response to events

  • Fear: A normal emotional response to perceived threats.

    • Can lead to panic attacks under certain conditions.

  • Panic: Involves sudden, overwhelming fear, often linked to physical symptoms.

    • Symptoms include shortness of breath, chest pain, and feelings of impending doom.

Symptoms of Anxiety Disorders

  • Physical Symptoms:

    • Heart palpitations

    • Shortness of breath

    • Trembling

    • Dizziness

  • Psychological Symptoms:

    • Persistent worries and fears (e.g., fear of dying, specific objects/situations).

    • Other characteristics:

    • Mixed anxiety and depressive disorder

    • Inner tension

    • Irritability

  • Examples of Specific Phobias:

    • Fear of snakes

    • Fear of heights

    • Fear of public speaking

    • Fear of public toilets

Common Characteristics of Anxiety Disorders

  • Physiological symptoms of panic.

  • Cognitive biases (selective attention to negative information).

  • Often related to dysfunctional beliefs.

  • Frequently connected to early life experiences (e.g., childhood abuse).

  • Comorbidity: High likelihood of co-existing mental disorders.

Biological Contributions to Anxiety Disorders

  • Physiological Vulnerability:

    • Polygenic influences impacting anxiety.

    • Role of neurotransmitters:

    • Corticotropin-Releasing Factor (CRF): Involved in stress response.

    • Serotonergic and Noradrenergic Systems: Linked to stress response and physiological effects in anxiety.

    • Dysregulated HPA (Hypothalamic-Pituitary-Adrenal) axis, leading to abnormal cortisol levels.

  • Neurotransmitters:

    • GABA: Calming neurotransmitter.

    • Adrenaline & Noradrenaline: Fight or flight response.

    • Dopamine, Serotonin, and Endorphins: Influence mood and anxiety levels.

The HPA Axis in Stress Response

  • Exposure to a threat activates the Hypothalamus, leading to the release of:

    • CRH: Triggers the pituitary gland to release ACTH.

    • ACTH: Signals adrenal glands to release cortisol and adrenaline.

    • Feedback Loop: The hypothalamus adjusts CRH release based on cortisol levels.

Integrated Model of Anxiety Disorders

  • Triple Vulnerability Model:

    • Biological vulnerability: Genetic factors inherited that predispose to anxiety.

    • Psychological vulnerability: Learned beliefs/perceptions from life experiences.

    • Specific psychological vulnerability: Unique fears or anxious apprehensions tied to specific events.

Specific Phobias

  • Definition: An excessive, unreasonable, persistent fear triggered by a specific object or situation.

  • Characteristics:

    • Immediate fear response to the phobic stimulus.

    • Avoidance behaviors leading to significant distress.

    • Symptoms persist for 6 or more months and cause significant impairment in functioning.

  • Prevalence:

    • Social Phobia: 3.2%

    • Blood-Injury-Injection Phobia: 3.5%

    • Height Phobia: 4.7%

Aetiology of Specific Phobias

  • Psychoanalytic Accounts: Early childhood experiences can influence phobias.

  • Classical Conditioning: Learning through associations.

  • Biological Factors: Evolutionary predispositions for fear of dangerous stimuli.

  • Cognitive Factors: Misinterpretation of bodily sensations.

Treatment of Phobias

  • Exposure Therapies:

    • Systematic Desensitization: Gradual exposure to the phobic stimulus.

    • Flooding: Immediate full exposure.

    • Cognitive Therapy: Techniques to restructure fear-related thoughts.

Social Anxiety Disorder

  • Definition: Persistent fear of situations where one may be scrutinized or judged.

  • Symptoms:

    • Fear of embarrassment.

    • Avoidance of social interactions.

  • Prevalence: 4-13% in Western societies; higher in females.

  • Aetiology: Factors include genetic predispositions and family dynamics.

Panic Disorder & Agoraphobia

  • Symptoms: Characterized by recurrent panic attacks.

    • Symptoms include heart palpitations, dizziness, feelings of losing control, depersonalization.

  • Criteria: Must have recurrent unexpected panic attacks followed by persistent fear of further attacks.

  • Agoraphobia Criteria: Fear of situations where escape might be difficult if panic-like symptoms were to occur.

  • Prevalence: 1.5% to 3% for panic disorder; 0.4% to 3% for agoraphobia.

Generalized Anxiety Disorder (GAD)

  • Symptoms: Persistent excessive worry about various aspects of life.

  • Prevalence: Lifetime prevalence rate of around 5%, more common in women.

  • Aetiology: Combination of biological factors and cognitive biases.

  • Treatment: Includes CBT, medication, and other strategies for effective management.

Obsessive-Compulsive Disorder (OCD)

  • Symptoms:

    • Obsessions: Intrusive thoughts that provoke anxiety.

    • Compulsions: Repetitive behaviors performed to alleviate the anxiety caused by obsessions.

  • Prevalence: Lifetime prevalence rate around 2.5%; often starts in early adolescence.

  • Aetiology: Influenced by biological, psychological, and cognitive factors.

  • Treatment: Exposure and Response Prevention (ERP), CBT, and medications (SSRIs).

Trauma & Stress-Related Disorders

  • Post-Traumatic Stress Disorder (PTSD): Symptoms include intrusive memories, avoidance of reminders, negative alterations in cognition, and increased arousal.

  • Diagnosis: Must have experienced an extreme trauma; presence of symptoms for more than one month.

  • Aetiology: Involves a combination of biological vulnerabilities, coping strategies, and conditioning theories.

  • Treatment: Exposure therapies, cognitive restructuring, and psychological debriefing.

Treatment Overview

  • Pharmacotherapy for Anxiety Disorders:

    • Targeted drug classes include SSRIs, SNRIs, and benzodiazepines.

    • Commonly prescribed medications include:

    • SSRIs: E.g. Fluoxetine (Prozac), Sertraline (Zoloft)

    • Benzodiazepines: E.g. Alprazolam (Xanax), Diazepam (Valium)

  • Psychotherapy: Tailored approaches such as CBT, exposure therapy, and relaxation techniques.

Conclusion

  • Understanding anxiety and stressor-related disorders is critical for effective treatment and management.

  • Recognizing symptoms and various aetiological factors can lead to better patient outcomes and enhanced psychological health.