Nursing 3001: Anxiety and Anxiety Disorders

Overview for Week 3

• Understanding anxiety as a normal human emotion/reaction.

• Common signs and symptoms of anxiety.

• Levels of anxiety and the use of defence mechanisms.

• The rising rates of anxiety disorders.

• Comorbidities & etiology.

• Etiology theories.

• Brief overview of common anxiety disorders.

Feelings of Anxiety

• Anxiety is a basic human emotion, not a disease.

• Common feelings include apprehension, uneasiness, uncertainty, or dread due to real or perceived threats.

• Physical signs can also accompany anxiety.

• Distinction between fear and anxiety:

  • Fear refers to a specific threat.

  • Anxiety is the emotional response following cognitive appraisal of a threat.

Common Anxiety Signs and Symptoms

• Nervousness, restlessness, or tension.

• Sense of impending danger or panic.

• Increased heart rate and rapid breathing (hyperventilation).

• Sweating and trembling.

• Feelings of weakness or fatigue.

• Trouble concentrating.

• Sleep disturbances.

• Gastrointestinal issues.

• Difficulty controlling worry and avoiding anxiety triggers.

Levels of Anxiety

1. Mild Anxiety

   • Increased alertness; perceptual field broadened; motivates learning and creativity.

2. Moderate Anxiety

   • Focus on immediate concerns; limited perceptual field; grasp less information.

3. Severe Anxiety

   • Significant reduction in perceptual field; focus on one detail intensely.

4. Panic

   • Extreme feelings of dread; inability to communicate or function effectively.

Defence Mechanisms (Freud)

• Automatic coping styles to protect against anxiety and maintain self-image.

• Can be healthy or unhealthy.

• Examples include:

  1. Compensation: Making up for shortcomings.

  2. Conversion: Turning anxiety into physical symptoms without a medical cause.

  3. Rationalization: Logical justification of illogical behaviors.

  4. Denial.

  5. Projection.

  6. Identification.

  7. Regression.

  8. Repression.

  9. And others (see Table 12.2).

Anxiety Disorders

• Occasional anxiety is normal, but anxiety disorders manifest as:

  • Intense, excessive, and persistent worry and fear about everyday situations.

  • Fear and distress that disrupt daily functioning.

  • Repeated panic attacks that peak within minutes.

• Most common psychiatric disorders, more common in females.

• Symptoms often develop in childhood, adolescence, or early adulthood.

Prevalence of Anxiety Disorders in Canada

• Generalized Anxiety Disorder (GAD): 2.6% in 2012; 5.2% in 2022.

• Social Phobia Disorder: 3.0% in 2012; 7.1% in 2022.

Anxiety and Comorbidities

• Anxiety disorders often co-occur with major depression and substance use disorders.

• Increased morbidity and mortality associated with high comorbidity rates.

• Chronic anxiety may heighten cardiovascular risks.

Etiology of Anxiety Disorders

1. Genetic Links: Family clustering of disorders; importance of multigenerational history.

2. Biological Links: Influences from infections, neuropeptides (e.g., CCK, CRF), neurotransmitters (e.g., GABA, norepinephrine, serotonin).

3. Panicogenic Substances: Provocate anxiety reactions.

4. Non-psychiatric Causes: Include medical conditions like hypotension and asthma.

5. Brain Networks:

   • Prefrontal cortex vs. amygdala dynamics influence fear response.

   • Limbic system involvement, particularly the hippocampus.

Etiology Theories of Anxiety Disorders

Psychoanalytic Theory

• Anxiety arises from unresolved conflicts in the unconscious related to desires or traumas.

• Three anxiety types:

  1. Realistic anxiety: external threats.

  2. Neurotic anxiety: internal conflicts.

  3. Moral anxiety: guilt for transgressing ethics.

Cognitive Theories

• Anxiety emerges from distorted thought patterns and beliefs.

• Cognitive distortions worsen anxiety by misinterpreting threats.

• Cognitive Behavioral Therapy (CBT) is effective for treatment.

Existentialism & Anxiety

• Stemming from reflections on existence leading to feelings of insecurity and dread.

• Features include anxiety about fate, meaninglessness, and moral standards.

Learning Theory

• Anxiety can be learned through trauma and conditioning (classical and operant).

• Past experiences influence future anxieties.

Types of Anxiety Disorders

1. Panic disorder

2. Agoraphobia

3. Specific phobias

4. Social anxiety disorder

5. Generalized anxiety disorder

6. Somatic symptom disorders

7. Obsessive-compulsive disorder

8. Trauma and stressor-related disorders

9. Dissociative disorders

Panic Disorder

• Characterized by recurrent and unexpected panic attacks.

• Panic attacks involve rapid heartbeat, sweating, trembling, and feelings of impending doom.

• Factors influencing panic disorder: genetic predisposition, stress, brain function variances.

Agoraphobia

• Fear of situations where escape might be difficult, often linked with panic attacks.

• Commonly avoided scenarios include public transport, open spaces, and crowds.

Phobias & Specific Phobias

• Persistent, irrational fears leading to avoidance behavior.

• Common in women, specific phobias can last a lifetime without treatment.

Social Anxiety Disorder

• Marked by significant anxiety in social situations due to fear of judgment.

• Severe stress affects life aspects—relationships, work, and daily activities.

Generalized Anxiety Disorder (GAD)

• Characterized by ongoing, excessive anxiety interfering with daily activities.

• Symptoms may overlap with panic and OCD disorders.

GAD Symptoms

• Persistent and excessive worrying, difficulty handling uncertainty, and fear of making decisions.

Risk Factors for GAD

• Higher risk in women; genetic factors; history of trauma; chronic health conditions.

Somatic Symptom Disorders

• Physical symptoms with no identifiable medical cause; rooted in psychological distress.

Conversion Disorder/Functional Neurologic Disorder

• Symptoms affecting movement/senses without underlying neurological causes; not intentionally produced.

Post-Traumatic Stress Disorder (PTSD)

• Caused by exposure to traumatic events; symptoms include flashbacks, severe anxiety, and avoidance behavior.