In-Depth Notes on Anxiety Disorders

Panic Disorder and Panic Attacks

  • Panic Attack: A discrete period of intense fear or terror with a sudden onset, typically peaking within minutes.
    • Symptoms:
    • Cardiac reactions: palpitations, increased heart rate.
    • Physical sensations: sweating, trembling, shortness of breath, choking feelings, chest pain, abdominal distress (nausea), faintness, chills.
    • Cognitive symptoms: derealization, depersonalization, fear of losing control or going crazy, fear of dying.
  • Types of Panic Attacks:
    • Unexpected (uncued): Occurs out of the blue with no identifiable trigger.
    • Expected (cued): Triggered by identifiable situations or objects (e.g., heights, dogs).
  • Diagnosis of Panic Disorder: Requires recurrent unexpected panic attacks and persistent concern about having more attacks or behavioral changes due to the attacks over a month period.

Agoraphobia

  • Defined as anxiety about being in situations where escape might be difficult or help unavailable in the event of panic-like symptoms.
  • To be diagnosed, individuals usually fear at least two of the following:
    • Using public transportation
    • Being in open spaces
    • Being in enclosed spaces
    • Standing in line or being in a crowd
    • Being outside of the home alone
  • Differentiation from other phobias: Agoraphobia is more pervasive and generalized compared to specific phobias which usually involve fear of specific objects or situations.

Epidemiology of Panic Disorders

  • Panic disorder is common, especially in adolescents, but rarely diagnosed in community samples.
  • Panic attacks considered equally prevalent in males and females, but panic disorder more commonly diagnosed in girls.
  • Onset frequently occurs during adolescence.

Etiology of Anxiety Disorders

  • Multifactorial: Genetic predisposition, temperament, and psychosocial influences.
  • Genetic Factors: Moderate heritability associated with anxiety disorders.
  • Environmental Factors: Childhood rearing practices, exposure to parental anxiety can contribute to the development.

Assessment and Intervention

  • Assessment: Sensitive to cultural diversity; often involves interviews, self-report measures, and observational assessments.
  • Psychological Interventions:
    • Cognitive Behavioral Therapy (CBT) is most common; involves behaviors and cognitive restructuring.
    • Exposure therapy to anxiety-provoking situations is integral for treatment success.
  • Pharmacological Treatment: SSRIs like fluoxetine are commonly used but not always FDA approved for children; careful monitoring for side effects.
  • Prevention: Programs address potential symptoms early and promote healthy coping strategies for anxiety.