ANXIETY DISORDERS
PRESENTER : MS VILIMAINA TAKAYAWA
MENTAL HEALTH NURSING KNOWLEDGE & PRACTICE COORDINATOR & FACILITATOR
SANGAM COLLEGE OF NURSING
FIJI.
Learning objectives
At the end of the session the student is
be able to:
1.Determine Anxiety and Anxiety Disorders
2.Characterize the various types of anxiety
disorders
3.Analyze the classification and assessment
criteria for anxiety disorders under DSM V.
Cont’d
4. Discuss the signs and symptoms and
comorbidities of the identified anxiety disorders.
5. Identify relevant coping mechanisms, and
management for anxiety disorders.
6. Collate a client and family education/teaching
strategies for anxiety disorders.
What is Anxiety?
is a feeling of unease, such as worry or dread, that can be
mild or severe.
• Everyone has feelings of anxiety at some point in their
life.
• It might cause you to sweat, feel restless and tense, and
have a rapid heartbeat. It can be a normal reaction to
stress.
• For example, you might feel anxious when faced with a
difficult problem at work, before taking a test, or before
making an important decision or you may feel worried
and anxious about sitting an exam, or having a medical
test or job interview
What is the difference between Anxiety
and fear
•Fear is an emotional immediate
reaction to a specific, real danger.
•Anxiety is an excessive and unfocused
fear that may be triggered by a variety
of stimuli. Anxiety caused by stress
may persist long after the trigger is
removed or arise with no trigger at
all.
Anxiety vs Fear
Anxiety
Fear
•Apprehension about
a future threat
•Sympathetic nervous
system
•increases
preparedness
•Response to an
immediate threat
•triggers “fight or
flight ”
•May save life
They both involve physiological arousal and they
both can be adaptive
What is Anxiety Disorder
Occasional anxiety is OK!
BUT, when there is constant and overwhelming
anxiety and fear, then it becomes a disorder.
The excessive anxiety can make you avoid work,
school, family get-togethers, and other social
situations that might trigger or worsen your
symptoms.
Types of Anxiety Disorders
1. Generalized anxiety disorders (GAD)
2. Panic disorder .
3. Social anxiety disorder(aka –social phobia)
4. Specific phobias.
5. Agoraphobia.
6. Separation anxiety.
7. Selective mutism.
8. Medication-induced anxiety disorder.
Signs and Symptoms
•Panic, fear, and uneasiness, Feelings of doom, or
danger
•Sleep problems
•Cold, sweaty, numb, or tingling hands or feet
•Shortness of breath, Breathing faster and more
quickly than normal (hyperventilation)
•Heart palpitations, Dry mouth, Nausea, Tense
muscles, Dizziness
•Thinking about a problem over and over again and
unable to stop (rumination), Inability to concentrate
•Intensely or obsessively avoiding feared objects or
places
Under dSM 5’S rUle
1. Preoccupation with the idea that one has or will get a serious
illness.
2. Lack of somatic or mild somatic symptoms, such as diaphoresis
or slight tachycardia.
3. If there is a verifiable medical condition present, e.g., a benign
cyst, or the patient is in a high –risk category for developing a
medical condition, e.g., heart disease, but there are no current
indicators of heart disease- the patient’s anxiety or concern is out
of proportion to the reality.
4. The patient is hyper-vigilant about their health, and is prone to
feeling distressed about their health, changes in their health, or
ambiguous symptoms.
Cont’d
5. The
patient will frequently monitor themselves for sign
of illness, e.g. checking their B/P or TPR several times a
day.
6. The patient will avoid medical care or evaluation due to
anxiety about what they imagine will be found.
7. This anxiety and preoccupation will have persisted at
least 6 months, although the source of anxiety may shifte.g., fear of diabetes will be superseded by fear of cancer.
8. The anxiety and preoccupation with illness is not better
accounted for by another mental disorder, including
somatic symptom disorder, panic disorder, GAD, OCD, or a
psychotic episode with somatic delusions.
Anxiety Disorders under DSM V
1. Specific phobias
2. Social anxiety disorder
3. Panic disorder
4. Agoraphobia
5. Generalized anxiety
disorder
•Most common
psychiatric
disorders
•28% report anxiety
symptoms
•Most common are
phobias
Need to know!
The clinician can add specifiers to the diagnosis:
• Care-seeking type: The patient will frequently seek medical care, presenting with health
concerns and complaints, and undergoing diagnostic procedures.
• Care-avoidant type: The patients will have anxiety about presenting themselves for diagnosis
and avoid medical care (American Psychiatric Association, 2013).
Other components of the clinical presentation of IAD can include:
• Frequent, dramatic statements regarding one’s health.
• Self-pity.
• Exaggeration of the impact of actual disorders.
• Dramatic response and preoccupation with minor injuries.
• Claiming to have unverifiable disorders, or a disorder persisting for an implausible length of
time.
• Lack of response to reassurance from medical providers.
Phobias
Refers to a group of anxiety symptoms
brought on by certain objects or situations
•Fear out of proportion to actual threat
•Awareness that fear is excessive
•Must be severe enough to cause distress or
interfere with job or social life
•Avoidance
Specific Phobia
Formerly called a simple phobia, is a lasting and unreasonable fear
caused by the presence or thought of a specific object or situation
that usually poses little or no actual danger.
• Common examples: fear of flying, snakes, heights, etc.
• Fear out of proportion to actual threat
• Awareness that fear is excessive
• Most specific phobias cluster around a few feared objects and
situations
• High comorbidity of specific phobias
Social Anxiety Disorder
•Called Social Phobia in DSM-IV-TR
• Causes more life disruption than other phobias
•More extensive than shyness
• Persistent, intense fear and avoidance of social situations
• Fear of negative evaluation or scrutiny
• Exposure to trigger leads to anxiety about being humiliated or
embarrassed socially
• Onset often adolescence
• 33% also diagnosed with Avoidant Personality Disorder
• Overlap in genetic vulnerability for both disorders
Panic Disorder
Frequent, sudden, intense episode of
apprehension, terror, feelings of impending
doom, unrelated to specific situations
•Intense urge to flee
•Symptoms reach peak intensity within
10 minutes
Agoraphobia
A fear of being in situations where escape
might be difficult or that help wouldn't be
available if things go wrong.
•E.g., crowds, stores, malls, churches, trains,
bridges, tunnels, etc.
•Causes significant impairment
•In DSM-IV-TR, was a subtype of Panic Disorder
•Al least half of agoraphobics do not suffer panic
attacks
Generalized Anxiety disorder(gad)
A chronic, excessive, uncontrollable worry
•Lasts at least 3 months and Interferes with daily life
•Often cannot decide on a solution or course of
action
•Other symptoms:
•Restlessness, poor concentration, tiring easily,
muscle tension
•Common worries:
•Relationships, health, finances, daily hassles
•Often begins in adolescence or earlier
Comorbidities of anxiety D/O
80% of those with anxiety disorder meet criteria for another
anxiety disorder in the list.
• Subthreshold symptoms (do not meet full DSM) very
common
• Causes of comorbidity
• Symptoms used to diagnose the various anxiety
disorders overlap:
• Social anxiety and agoraphobia might both involve a fear
of crowds
• Etiological factors may increase risk for more than one
anxiety disorder
75% of those with anxiety disorder meet criteria for another
psychological disorder
Cont’d
Disorders commonly comorbid with anxiety:
•60% with anxiety also have depression
•Substance abuse
•Personality disorders
•Medical disorders, e.g. coronary heart
disease
Factors that May Increase the Risk for More
than One Anxiety Disorder
•Behavioral conditioning
•Genetic vulnerability
•Increased activity in the fear circuit of
the brain
•Decreased functioning of GABA and
serotonin; increased norepinephrine
activity
Gender and
Sociocultural Factors
Women are twice as likely as men to have anxiety
disorder
Possible explanations
• Women may be more likely to report symptoms
• Men more likely to be encouraged to face fears
• Women more likely to experience childhood
sexual abuse
• Women show more biological stress reactivity
Etiology of anxiety disorders
The causes of anxiety disorders aren't fully
understood.
Below are some possible anxiety triggers:
Past or childhood experience
Your current life situation
Physical and mental health problems
Past childhood experience
Drugs and medications
Risk Factors
1.
Genetic • Twin studies suggest
heritability
• About 20-40% for phobias,
GAD, and PTSD
• About 50% for panic
disorder
• Relative with phobia increases
risk for other anxiety disorders
in addition to phobia - anxiety
sensitivity
2. Neurobiological
Fear circuit overactivity
Amygdala
Medial prefrontal cortex deficits
3. Neurotransmitters
Poor functioning of serotonin and GABA
Higher levels of norepinephrine
4. Behavioral inhibition
Tendency to be agitated, distressed, and cry in unfamiliar or novel
settings
Predicts anxiety in childhood and social anxiety in
adolescence
Cont’d
 Neuroticism
• React with negative affect
• Linked to anxiety and depression
• Higher levels linked to double the likelihood of developing
anxiety disorders
 Cognitive
• Sustained negative beliefs about future
• Bad things will happen
• Engage in safety behaviors
• Belief that one lacks control over environment
• More vulnerable to developing anxiety disorder
• Childhood trauma or punitive parenting may foster beliefs
• Serious life events can threaten sense of control
Treatment of the Anxiety Disorders
• Psychological treatments emphasize exposure.
Face the situation or object that triggers anxiety
• Systematic desensitization
Relaxation plus imaginal exposure
• Cognitive behavioral therapy approaches
Increase belief in ability to cope with the anxiety trigger
Challenge expectations about negative outcomes
Social skill training
Role playing
Cont’d
• Panic control therapy
Use of coping strategies to control symptoms
• Relaxation
• Deep breathing
• Tactile sensation
• Medications
Anti depressants
Antianxiety: drugs that reduce anxiety
• Fluoxetine
Benzodiazepines
• Valium
• Xanax
The end!
Thank you for
listening
REFERNCE PAGE
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Louis. (pp184-203)
3. Townsend, M.C., (2015). Psychiatric Mental Health Nursing-Concepts of Care in Evidence-Based
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(pp17-23
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Elsevier, Mosby, London.
(pp316-338)
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