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Complexity of Anxiety Disorders

  • Anxiety, fear, and panic are interconnected.

  • Definitions:

    • Anxiety: Negative affect, somatic symptoms of tension, future-oriented.

    • Fear: Immediate alarm reaction to a clear threat, strong escapist tendencies.

    • Panic Attack: Inappropriate fear response; can be expected or unexpected.

Relationship between Anxiety, Fear, and Panic

  • Anxiety can lead to panic when it escalates.

Characteristics of Anxiety

  • Anxiety vs. Fear:

    • Fear: Response to immediate, known threats.

    • Anxiety: Response to vague sense of threat.

  • Physiological effects are similar (e.g., increased respiration, perspiration).

Adaptive Nature of Anxiety/Fear Response

  • Can be protective in situations requiring fight or flight.

  • However, excessive or mismanaged responses can result in anxiety disorders.

Cultural Perspectives on Anxiety

  • Expression and interpretation of anxiety varies across cultures:

    • Nervios (Latino): Symptoms with somatic features.

    • Ataque de Nervios (Latino): Behavioral panic symptoms.

    • Shenjing Shuairuo (Chinese): Mixed symptoms.

Causes of Anxiety

Biological Contributions

  • Anxiety linked to specific brain circuits, neurotransmitters (e.g., CRF system).

  • Behaviors are influenced by biological factors related to the fight-or-flight response.

Psychological Contributions

  • Roots in childhood experiences; feeling out of control, overprotective parenting.

  • Key traits: anxiety sensitivity and learned behaviors.

Social Contributions

  • Stressful life events influence anxiety (social, interpersonal, physical).

  • Genetic factors also contribute.

Integrated Model of Anxiety

  • Triple Vulnerability Theory:

    • Generalized biological vulnerability

    • Generalized psychological vulnerability

    • Specific psychological vulnerability

Comorbidity in Anxiety Disorders

  • Comorbidity refers to occurrence of multiple disorders.

  • Major depression and anxiety disorders are frequently comorbid.

  • Anxiety disorders can occur alongside physical conditions and lead to poorer quality of life.

Suicide Risk in Anxiety Disorders

  • Panic disorder patients have a notable suicide attempt rate (20%).

  • Suicidal ideation is common among those suffering from anxiety.

Generalized Anxiety Disorder (GAD)

Clinical Features

  • Uncontrollable, chronic worrying about everyday events.

  • Symptoms must last for at least six months and disturb daily functioning.

Prevalence and Demographics

  • Approximately 3% of Canadians affected, with higher rates in women vs. men.

  • Often develops in early life; treatment is less sought after.

Causes of GAD

Genetic and Sociocultural Influence

  • Heritable components contribute; higher rates in monozygotic twins.

  • GAD can develop in stressful socio-economic environments.

Cognitive Perspective

  • Maladaptive thought patterns contribute significantly:

    • Assumptions about needing approval and predicting disasters.

    • Overemphasis on danger can perpetuate anxiety.

  • New cognitive theories (metacognitive, intolerance of uncertainty) explain GAD mechanisms.

Biological Factors

  • Abnormalities in neurotransmitters like norepinephrine implicated in GAD.

Treatment of GAD

Pharmacological Options

  • Common treatments include benzodiazepines and antidepressants.

Psychological Treatment

  • Cognitive-behavioral therapy (CBT) is effective. It focuses on:

    • Identifying and restructuring negative thought patterns.

    • Behavioral techniques like relaxation training and exposure are emphasized.

Panic Disorder and Agoraphobia

Overview

  • Panic Disorder characterized by unexpected panic attacks.

  • Agoraphobia involves fear/avoidance of situations where escape is difficult.

Clinical Features of Panic Disorder

  • Symptoms include sensations of dying, losing control, or suffocation.

  • Attacks often misunderstood as life-threatening.

Development and Statistics

  • Can develop alongside or independently of agoraphobia.

  • Common onset is between ages 25 and 29; women are affected at higher rates.

Causes of Panic Disorder

Biological Perspective

  • Involves norepinephrine irregularities and genetic risks; environmental factors also contribute.

Cognitive Perspective

  • Misinterpretations of bodily sensations lead to panic. Highly sensitive individuals are more prone.

Treatment of Panic Disorder

  • Combination of medication (SSRIs, benzodiazepines) and cognitive-behavioral therapy is recommended.

  • Focus on reducing fear and avoidance behaviors through gradual exposure.