Anxiety Disorders
What is Anxiety?
Anxiety is a negative mood state characterized by bodily symptoms of physical tension and apprehension about the future.
It can manifest as:
A subjective sense of unease.
Behavioral responses like looking worried or fidgeting.
Physiological responses such as elevated heart rate and muscle tension, originating in the brain.
Moderate amounts of anxiety can be beneficial, enhancing performance (as per Yerkes & Dodson, 1908).
Anxiety serves as a normal, automatic response intended to signal threat or danger and aid survival.
How does anxiety differ from Fear and Worry?
Anxiety: Future-oriented, long-acting response to a diffuse (unclear) threat.
Worry: A state of mental distress or agitation due to concern about an impending or anticipated event, threat, or danger.
Fear: Present-oriented, short-lived response to a clearly identifiable and specific threat.
Study Pointers:
Understand the core components of anxiety: physical tension and future-oriented apprehension.
Distinguish between anxiety, fear, and worry based on their time orientation and the nature of the perceived threat.
Recognize that anxiety, in moderation, is adaptive.
When Does Anxiety Become a Disorder?
Anxiety may be considered a disorder based on its:
Intensity: How strong or severe the anxiety feels (ranging from mild to severe).
Duration: How long an anxiety episode lasts (minutes to hours).
Frequency: How often anxiety occurs (e.g., daily, weekly, monthly).
Study Pointer:
Remember these three dimensions (intensity, duration, frequency) as key factors in differentiating normal anxiety from a clinical disorder.
Types of Anxiety Disorders
Separation Anxiety Disorder
Selective Mutism
Specific Phobia
Social Anxiety Disorder (Social Phobia)
Panic Disorder
Panic Attack Specifier
Agoraphobia
Generalized Anxiety Disorder (GAD)
Substance/Medication-Induced Anxiety Disorder
Anxiety Disorder Due to Another Medical Condition
Other Specified Anxiety Disorder
Detailed Breakdown of Anxiety Disorders
1. Separation Anxiety Disorder
Marked by: Excessive fear or anxiety concerning separation from home or attachment figures. It involves unrealistic and persistent worry about harm to attachment figures or events leading to separation.
Prevalence: Normal up to age 6. Affects approximately 4% of American children, 1.6% of adolescents, and 0.9% to 1.9% of adults.
Diagnostic Criteria (DSM-5 F93.0):
Developmentally inappropriate and excessive fear/anxiety about separation from attachment figures, with at least three specific symptoms (e.g., recurrent distress at separation, worry about losing figures, reluctance to go out/be alone, nightmares about separation, physical symptoms upon separation).
Persistent for at least 4 weeks in children/adolescents, typically 6 months or more in adults.
Causes clinically significant distress or impairment.
Not better explained by another disorder.
Associated Features: Social withdrawal, apathy, sadness, difficulty concentrating; fears (animals, dark, etc.); homesickness; school refusal (in children); anger/aggression when forced to separate; perceptual experiences in children (seeing people, feeling watched); demanding/intrusive behavior in children; dependent/overprotective behavior in adults; excessive checking on attachment figures by adults.
Differential Diagnosis: Distinguish from GAD (focus on separation vs. general worry), Panic Disorder (separation trigger vs. unexpected attacks), Agoraphobia (fear of being away from figures vs. fear of trapped situations), Conduct Disorder (school avoidance preference vs. separation fear), Social Anxiety Disorder (school refusal due to judgment fear vs. separation fear), PTSD (separation fear post-trauma vs. persistent fear), Illness Anxiety Disorder (worry about own health vs. attachment figure's health), Prolonged Grief Disorder (distress over deceased vs. future separation fears), Depressive/Bipolar Disorders (reluctance to leave home due to low motivation vs. separation fear), ODD (situational defiance vs. persistent opposition), Psychotic Disorders (situational perceptual disturbances vs. hallucinations), Dependent Personality Disorder (indiscriminate reliance vs. specific attachment figures), Borderline Personality Disorder (fear of abandonment with identity/impulsivity issues).
Comorbidity:
Children:
GAD
Specific Phobia.
Adults:
Specific Phobia
PTSD, Panic Disorder
GAD
Social Anxiety Disorder
Agoraphobia
OCD
Prolonged Grief Disorder
Depressive/Bipolar Disorders
Cluster C Personality Disorders
Causal Factors:
Genetic predisposition
Heightened sensitivity to aversive stimuli
Overprotective/anxious or indifferent/rejecting parenting
Family stress
Traumatic experiences (illness, loss, major life changes)
Cultural factors (emphasis on obedience, exposure to violence).
Possible Treatments:
CBT (anxiety management, assertiveness training)
Parent training and support (gradual exposure to separation)
Anti-anxiety medication/antidepressants (for adults, combined with psychological interventions)
Cool Kids program (manualized treatment for children 7-17).
Study Pointers for Separation Anxiety Disorder:
Focus on the "developmentally inappropriate" aspect and the specific focus on attachment figures.
Understand how it manifests differently in children vs. adults.
Pay attention to the detailed differential diagnosis section to distinguish it from many other conditions.
2. Selective Mutism
Marked by: Consistent failure to speak in specific social situations where there is an expectation for speaking (e.g., at school), despite speaking in other situations. Often associated with high social anxiety.
Prevalence: More likely in young children; a rare disorder (0.03%-1%).
Associated Features: Excessive shyness, fear of social embarrassment, social withdrawal, clinging, compulsive traits, negativism, temper tantrums, mild oppositional behavior; generally normal language skills, though some may have an associated communication disorder.
Comorbidity: Strongly linked to anxiety disorders, especially social anxiety disorder. Also possible: oppositional behavior, communication disorders.
Differential Diagnosis:
Distinguish from the normal "silent period" in children learning a new language.
Communication Disorders (e.g., language disorder, stuttering) cause speech disturbances in all settings, not just selective ones.
Neurodevelopmental/Psychiatric Disorders (e.g., Autism, Schizophrenia) impair social communication but differ in that selective mutism requires the ability to speak in some social settings.
Social Anxiety Disorder: Often co-occurs, and both can be diagnosed.
Causal Factors: Inhibited/shy/anxious temperament; overprotective/controlling parenting, family stress, lack of social exposure; family history of anxiety disorders; underlying speech/language difficulties; cultural adaptation stress (in bilingual/immigrant children).
Possible Treatments: CBT (using reinforcement for speech, graded exposure); psychoeducation for caregivers.
Study Pointers for Selective Mutism:
The core feature is the selectivity of not speaking.
Its strong link with social anxiety is important.
Consider how cultural and linguistic factors might play a role in assessment.
3. Specific Phobia
Marked by: Clinically significant fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Exposure typically provokes immediate fear or anxiety, and the object/situation is actively avoided or endured with intense fear. The fear is out of proportion to the actual danger.
Prevalence: Cross-national lifetime prevalence: Females 7.4%, Males 5.5%. 12-month prevalence: Females 9.8% & 7.7% (two figures provided), Males 4.9% & 3.3% (two figures provided, source: 2017 World Mental Health Survey).
Specifiers: Individuals often have multiple specific phobias (average 3); about 75% fear more than one stimulus. Each phobia requires a separate diagnosis with its own code based on the phobic stimulus type.
Associated Features: Increased physiological arousal upon anticipation/encounter; sympathetic nervous system activation in situational, natural environment, and animal phobias.
Blood-injection-injury phobia: Often triggers a vasovagal response (initial spike in heart rate/blood pressure, followed by a drop, leading to fainting/near-fainting).
Explanation: The "vasovagal response" is a specific physiological reaction distinct from the typical fight-or-flight response seen in other phobias.
Brain activity abnormalities in the amygdala, anterior cingulate cortex, thalamus, and insula are linked.
Differential Diagnosis:
Agoraphobia: If only one agoraphobic situation is feared, it's specific phobia, situational type; if two or more, it's agoraphobia. Fear in agoraphobia is about difficulty escaping/getting help, while specific phobia fear is about direct harm.
Social Anxiety Disorder: Fear of negative evaluation vs. fear of the object/situation itself.
Separation Anxiety Disorder: Fear related to separation from caregiver.
Panic Disorder: If panic attacks only occur with the phobic stimulus, it's specific phobia; if unexpected attacks occur elsewhere, it's panic disorder.
OCD: Fear stemming from obsessions (e.g., contamination fears related to blood).
PTSD: If phobia follows a traumatic event, PTSD is considered first.
Eating Disorders: Avoidance related only to food/eating.
Schizophrenia Spectrum: Fear due to delusional thinking.
Comorbidity: Often the first disorder to develop due to early onset. Increased risk for other anxiety disorders, depressive/bipolar disorders, substance-related disorders, somatic symptom disorders, and dependent personality disorder.
Causal Factors:
Traumatic Conditioning Experiences: Direct (e.g., trapped in an elevator), vicarious (observing others' fear), or informational transmission (hearing about danger).
False Alarms and Anxiety Sensitivity: Panic attacks in specific situations can lead to phobia.
Evolutionary Preparedness: Inherited tendency to fear historically threatening situations (e.g., predators). Strong genetic basis for some types like blood-injection-injury.
Genetic and Familial Influence: Phobias run in families (approx. 30% of first-degree relatives).
Social and Cultural Factors: Societal norms (e.g., discouraging fear expression in men) and gender roles influence reporting.
Possible Treatments: CBT, anti-anxiety medication or antidepressants (if disabling); Behavioral Treatments:
Systematic Desensitization: Controlled exposure to phobic stimuli.
Applied Tension Technique (for blood-injection type): Tensing muscles to prevent fainting.
Modeling: Observational learning to lessen anxiety.
Flooding: Intensive exposure until fear is extinguished.
Study Pointers for Specific Phobia:
Note the different types/specifiers.
The vasovagal response in blood-injection-injury phobia is a unique and important feature.
Understand the various pathways to acquiring phobias (conditioning, observation, information).
4. Social Anxiety Disorder (Social Phobia)
Marked by: Intense fear or anxiety of social situations where the individual may be scrutinized by others. Individuals fear being judged or doing something embarrassing.
Types: Can center on performance situations (e.g., public speaking) or non-performance situations (e.g., eating in public).
Prevalence: 12-month (world) = 0.5%-2%; 12-month (US) = 7%.
Associated Features: Inadequate assertiveness or excessive submissiveness; rigid body posture; inadequate eye contact; speaking softly; shyness and withdrawal; limited self-disclosure; preference for jobs with minimal social interaction; prolonged living at home; delayed marriage/family (men); women avoiding working outside the home; self-medication with substances; exacerbation of medical symptoms in older adults (e.g., tremor); blushing is a hallmark physical response.
Culture-Related Diagnostic Issues:
Taijin Kyofusho (Japan & Korea): Fulfills criteria for social anxiety disorder but is characterized by the fear that the individual makes other people uncomfortable.
Explanation: This is a key cultural variation where the focus of fear is on offending or discomforting others rather than personal embarrassment.
Differential Diagnosis:
Shyness: Common trait, not pathological unless significantly impairing.
Agoraphobia: Fear of social situations due to difficulty escaping, not scrutiny; calm when alone.
Panic Disorder: Panic attacks triggered by social situations, not random.
GAD: Social worries focus on relationships, not fear of negative evaluation.
Separation Anxiety Disorder: Social avoidance due to fear of separation.
Specific Phobias: Fear is situation-specific (e.g., fainting), not generalized social fear.
Selective Mutism: Failure to speak due to fear of negative evaluation, but no fear in non-speaking social settings.
MDD: Negative self-evaluation from feeling unworthy, not fear of social behavior judgment.
Body Dysmorphic Disorder: Social fear driven by perceived physical flaws.
Delusional Disorder: Delusions of rejection/offense, lacks insight into excessive fears.
Autism Spectrum Disorder: Social deficits from impaired communication, whereas SAD individuals have skills but anxiety.
Personality Disorders (especially Avoidant): Broader avoidance, more impairment, deep-rooted self-worth issues.
Comorbidity: Other anxiety disorders (often preceding SAD, except specific phobia and separation anxiety); Major Depressive Disorder (from chronic social isolation); Substance Use Disorders (self-medication); Body Dysmorphic Disorder; Avoidant Personality Disorder (generalized SAD often overlaps); High-Functioning Autism Spectrum Disorder (children); Selective Mutism (children).
Causal Factors:
Evolutionary: Biologically prepared to fear angry/critical/rejecting people; socially anxious individuals recognize angry faces faster.
Genetic/Temperamental: Inherited vulnerability to anxiety or social inhibition; shyness in infancy increases risk.
Psychological Vulnerabilities: Belief that stressful events are uncontrollable; fear of social evaluation learned from socially fearful parents.
Learned/Conditioned Responses: Panic attacks in social situations become conditioned; traumatic social experiences (e.g., bullying – 92% of adults with SAD report severe childhood bullying).
Social/Environmental: Parents with social anxiety may pass on fear of judgment; environments with harsh evaluation.
Possible Treatments: CBT (cognitive restructuring, graduated exposure therapy); group therapy (practice social skills); self-help (affirmations, video feedback); antidepressant medications (MAOIs, SSRIs); mindfulness-based interventions.
Study Pointers for Social Anxiety Disorder:
Distinguish between performance-only and generalized social anxiety.
Taijin kyofusho is an important example of cultural influence.
The high rate of bullying reported by individuals with SAD is a significant finding.
5. Panic Disorder
Marked by: Recurrent unexpected panic attacks accompanied by persistent worry about having another attack or maladaptive behavioral changes related to the attacks. Individuals may think they're dying or losing control during an attack.
Prevalence: 12-month (US & several EU countries) = 2%-3%; 0.1%-0.8% (Asian, African, Latin American countries). Gradual increase during adolescence, peaks in adulthood, declines in older individuals (>64 years).
The Panic Cycle: A threat perception leads to panic, physical symptoms develop, worsening anxiety, which increases the likelihood of a repeat attack.
Panic Attacks (Specifier): Sudden episodes of intense fear or discomfort lasting minutes to hours, triggering uncomfortable physical sensations. Can be a specifier for any anxiety disorder, other mental disorders, and some medical conditions.
DSM-5 Criteria for Panic Attack: An abrupt surge of intense fear or discomfort reaching a peak within minutes, with four or more of 13 physical and cognitive symptoms (e.g., palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, chills/heat, paresthesias, derealization/depersonalization, fear of losing control, fear of dying).
Associated Features: Persistent worry about attacks and consequences; fear of catastrophic outcomes from mild physical symptoms; intolerance of medication side effects; concerns about handling daily tasks; excessive substance use to control attacks; extreme behaviors to prevent panic (e.g., food restrictions).
Culture-Related Diagnostic Issues:
Trúng gió ("hit by the wind") (Vietnamese): Panic attack related to wind exposure.
Ataque de nervios ("attack of nerves") (Latin Americans): Involves trembling, uncontrollable screaming/crying, aggression/suicidal behavior, depersonalization/derealization.
Khyâl ("soul loss") (Cambodians): Quick onset of heart palpitations, blurry vision, shortness of breath.
Differential Diagnosis:
If only limited-symptom unexpected attacks, consider Other Specified or Unspecified Anxiety Disorder.
Not diagnosed if attacks are due to a medical condition (e.g., hyperthyroidism, cardiac conditions). Onset after age 45 or atypical symptoms (vertigo, loss of consciousness) are clues for medical cause.
Not diagnosed if attacks are due to substance intoxication or withdrawal (e.g., stimulants, alcohol withdrawal).
Not diagnosed as panic disorder if attacks are only triggered by situations specific to other anxiety disorders (e.g., social situations in SAD, phobic objects in Specific Phobia). If unexpected attacks also occur, both diagnoses may apply.
Comorbidity: High rate (80% have a lifetime comorbid mental disorder). Common: other anxiety disorders (especially agoraphobia), major depressive disorder, bipolar disorders, mild alcohol use disorder, illness anxiety disorder. Depression precedes panic disorder in 1/3 of cases; coexists or follows in 2/3. Substance use for self-medication. Medical comorbidities: dizziness, cardiac arrhythmias, hyperthyroidism, asthma, COPD, IBS.
Causal Factors:
Biological: Moderate heritability; dysregulation of neurotransmitters (norepinephrine, serotonin, GABA, cholecystokinin) in locus coeruleus and limbic system; "stress response center" (locus coeruleus), "fear network" (amygdala), hippocampus involvement; biochemical abnormalities (panic provocation procedures).
Psychological:
Cognitive Theory/ Interoceptive Awareness: Tendency to catastrophically interpret bodily sensations.
Explanation: "Interoceptive awareness" is the perception of internal bodily sensations. In panic disorder, this awareness is heightened and often misinterpreted.
Comprehensive Learning Theory: Association of internal (interoceptive) and external (exteroceptive) cues with panic attacks through conditioning.
Explanation: "Exteroceptive cues" are external environmental stimuli.
Anxiety Sensitivity: Trait-like belief that certain bodily symptoms have harmful consequences (e.g., "When I notice my heart beating rapidly, I worry I might have a heart attack.").
Perceived Control: Lack of control can increase panic; a sense of control reduces it.
Cognitive Bias: Attention drawn to threatening information.
Possible Treatments: CBT (Panic Control Treatment - PCT: education, breathing control, logical reanalysis of thoughts, interoceptive exposure); systematic desensitization; support groups; anxiolytics (e.g., alprazolam, clonazepam); antidepressants (tricyclics, SSRIs, SNRIs).
Study Pointers for Panic Disorder:
The "unexpected" nature of some panic attacks is key for diagnosis.
Understand the Panic Cycle and the cognitive model (catastrophic misinterpretation of bodily sensations).
Be familiar with culture-bound expressions of panic.
"Interoceptive awareness" and "anxiety sensitivity" are important psychological constructs.
6. Agoraphobia
Marked by: Fear and avoidance of being alone or in public places from which escape might be difficult or help not available if panic-like symptoms or other incapacitating/embarrassing symptoms were to occur. Often described as a fear of open spaces, but it's more complex. Can develop after a panic attack due to worry about a repeat experience.
Commonly Feared Situations: Public transport, being in enclosed spaces (e.g., theaters, stores), standing in line or being in a crowd, being outside of the home alone.
Prevalence: Approx. 1.7% of adults and adolescents annually. 12-month = 0.4% in persons >65 years.
Associated Features: In severe cases, individuals may become completely homebound and dependent on others. Demoralization and depressive symptoms are common. Alcohol and sedative abuse for self-medication.
Differential Diagnosis:
Specific Phobia (Situational Type): If fear is limited to only one agoraphobic situation. Agoraphobia requires fear of two or more situations.
Separation Anxiety Disorder: Fear about detachment from significant others/home, not panic-like symptoms in feared situations.
Social Anxiety Disorder: Fear of negative evaluation, not fear of being unable to escape or panic.
Panic Disorder: If panic disorder is present, agoraphobia is diagnosed if avoidance extends to two or more agoraphobic situations.
Acute Stress Disorder & PTSD: Avoidance related to trauma reminders only.
Major Depressive Disorder: Avoidance due to apathy/low energy, not fear of panic/incapacitation.
Medical Conditions: If avoidance is due to realistic concerns from a medical condition (e.g., fainting from transient ischemic attacks), it's not agoraphobia unless the fear is excessive.
Comorbidity: High (about 90% have at least one other mental disorder). Common: other anxiety disorders (specific phobias, panic disorder, social anxiety, separation anxiety), depressive disorders (MDD), PTSD, alcohol use disorder.
Onset: Other anxiety disorders often precede agoraphobia; depressive and substance use disorders usually develop after.
Causal Factors:
Biological: Generalized biological vulnerability (neurobiologically overreactive to stress); emergency alarm reaction (prone to unexpected panic attacks); genetic predisposition to panic disorder.
Psychological: Learned alarms (internal/external cues conditioned for panic); cognitive vulnerability (catastrophic interpretation of bodily sensations); psychodynamic factors (early object loss, separation anxiety leading to dependence); generalized psychological vulnerability (anxiety over future panic).
Social/Environmental: Stressful life events triggering initial panic; cultural influences; childhood experiences (learning bodily sensations are dangerous).
Interaction: Triple Vulnerability Model (biological, psychological, social factors). Cognitive cycle of panic (misinterpretation of sensations leading to a vicious cycle).
Possible Treatments: Intensive psychotherapy (e.g., CBT with exposure); self-help groups; exposure using visual materials, teaching panic management (breathing); lifestyle management (exercise, diet); antidepressants.
Study Pointers for Agoraphobia:
The core is fear of situations where escape might be difficult if panic-like or other incapacitating symptoms occur.
The requirement of fearing two or more situations is key for diagnosis.
Often linked with panic disorder but can occur independently.
7. Generalized Anxiety Disorder (GAD)
Marked by: A pattern of frequent, persistent, excessive anxiety and worry about a wide range of issues and situations, which is out of proportion to the actual impact of the event or circumstance.
Symptoms: "Threat" reactions like heart palpitations, trembling, sweating, irritability, restlessness, headaches; insomnia; difficulty concentrating, making decisions, or dealing with uncertainty.
Prevalence: Women are 60% more likely to develop GAD than men.
Associated Features: Muscle tension-related symptoms (trembling, twitching, shakiness, muscle aches); somatic symptoms (sweating, nausea, diarrhea); exaggerated startle response; autonomic hyperarousal symptoms (less prominent than in Panic Disorder, e.g., accelerated heart rate, shortness of breath, dizziness); stress-related conditions (IBS, headaches).
Differential Diagnosis:
Anxiety Disorder Due to Another Medical Condition: Anxiety caused by a physiological effect of a medical condition (e.g., hyperthyroidism).
Substance/Medication-Induced Anxiety Disorder: Anxiety caused by a substance (e.g., caffeine).
Social Anxiety Disorder: Anxiety specific to social situations/evaluation.
Separation Anxiety Disorder: Anxiety focused only on separation from attachment figures.
Panic Disorder: Panic attacks in GAD are triggered by worry; panic disorder involves unexpected attacks.
Illness Anxiety / Somatic Symptom Disorder: GAD involves multiple worries; illness anxiety focuses solely on health.
OCD: GAD worries are about future problems; OCD involves intrusive thoughts/urges/images.
PTSD: Anxiety linked to trauma.
Adjustment Disorder with Anxiety: Anxiety in response to a specific stressor, time-limited.
Depressive, Bipolar, Psychotic Disorders: GAD diagnosed separately if anxiety/worry is severe enough.
Comorbidity: High comorbidity with other anxiety disorders and unipolar depressive disorders. Shared underlying factors: negative affectivity (neuroticism), emotional lability, shared temperamental/genetic/environmental risks. Less common: substance use disorders, conduct disorders, psychotic disorders, neurodevelopmental/neurocognitive disorders.
Causal Factors:
Psychological: Psychoanalytic (unconscious conflict between ego and id); perceptions of uncontrollability and unpredictability; sense of mastery (history of control affects reactions); cognitive bias (attentional and interpretive bias toward threat).
Biological: Genetics; neurotransmitter abnormalities (functional deficiency in GABA); Corticotropin-Releasing Hormone (CRH) role via bed nucleus of the stria terminalis (BNST an area for mediating generalized anxiety); smaller left hippocampal region (similar to depression).
Possible Treatments: CBT (identify triggers, negative thoughts, avoidance); behavioral therapy (identify new goals); group therapy (assertiveness, self-esteem); medications (e.g., benzodiazepines like diazepam, buspirone).
Study Pointers for GAD:
The "generalized" and "excessive" nature of the worry across multiple domains is key.
The role of GABA deficiency is often highlighted.
Contrast the worry in GAD with the specific fears in phobias or the obsessions in OCD.
8. Substance/Medication-Induced Anxiety Disorder
Marked by: Nervousness, restlessness, worry, obsessions, or panic caused by taking a drug or stopping a drug.
Causative Agents: Alcohol and illegal drugs (e.g., cocaine, LSD); nonprescription medicines (e.g., decongestants); caffeine; prescription medicines (e.g., stimulants, steroids, asthma medications, Parkinson's medications, thyroid medications).
Mechanism: Imbalance of brain chemicals affecting thoughts, emotions, and actions.
Study Pointer:
Always consider the potential role of substances when assessing anxiety symptoms.
9. Anxiety Disorder Due to Another Medical Condition
Marked by: Anxiety symptoms that are a direct physiological consequence of an identifiable medical condition.
Examples of Medical Conditions: Endocrine conditions (e.g., hyperthyroidism), cardiovascular conditions, respiratory diseases, neurological conditions, metabolic conditions.
Study Pointer:
Thorough medical evaluation is crucial to rule out underlying medical causes of anxiety.
Case Analysis Example (from PPT)
Scenario: Mike, a 20-year-old college student, feels depressed and stressed about school, fearing he'll flunk out. He isolates in his dorm, plays video games, rarely attends class, and avoids professors. He's always been shy with a small group of friends. His stress amplified in college. When meeting new people, he worries about their judgment (thinking he's "dumb," "boring," or a "loser"), loses concentration, stutters, sweats, and feels uneasy. He replays interactions, focusing on "stupid" things he said. He has a history of discomfort with authority figures, difficulty raising his hand or approaching teachers. He isolates more, turns down invitations, ignores calls, and skips class due to concerns about others' views.
Diagnosis Given: Social Anxiety Disorder.
Study Pointer for Case Analysis:
Practice applying diagnostic criteria to case vignettes. Identify key symptoms and rule out other possibilities. In Mike's case, the fear of negative evaluation in social and performance situations, leading to avoidance and significant impairment, points to Social Anxiety Disorder.
Overall Study Advice for Anxiety Disorders:
DSM Criteria: Familiarize yourself with the core diagnostic criteria for each disorder.
Differential Diagnosis: This is crucial. Understand what makes each disorder distinct from others that share similar symptoms.
Causal Models: Appreciate the interplay of biological, psychological, and social/environmental factors.
Treatment Approaches: Know the main treatment modalities for each disorder, especially CBT and relevant medications.
Cultural Considerations: Be aware of how anxiety can manifest and be interpreted differently across cultures.
Terminology: Understand specific terms like "vasovagal response," "interoceptive/exteroceptive," "anxiety sensitivity," and culture-related terms like taijin kyofusho.